PReschool Pathways and services, need for communication, collaboration, coordination

1. Dr Teresa Carter Developmental Paediatrician McMaster Children’s Hospital PReschool Pathways and services, need for communication, collaboration, coordination

2. What can be done in Primary care Use case examples to illustrate collaboration with community services Objectives

3. ‘Many parts in an intricate arrangement’ influenced by: • Genetics • Prenatal environment • Specific health needs • Physical environment • Social environment/cultural environment • Learning environment • Emotional environment Complexity

4. Promote play Refer to Universal Services First approach in primary CARE

5. 18 month old boy 2-3 words, not imitating gestures 3-4 temper tantrums per day Fussy when they visit the mall Likes to watch the same DVDs and listen to the same books Mum is very stressed and cannot cope They feel as if their son rules the Case 1

6. 18 month old boy Walking since 14 month Unable to get up from sitting Did not mobilise prior to walking Picky eater since 15 months, losing weight Severe distress in grocery store very distressed visiting others homes Case 2

7. 18 month old girl No words, points and babbles Knows several body parts Easily follows a one step command Crawls, not taking weight on her feet Has a fine pincer grasp and holds a spoon Case 3

8. Team Assessment • Girl, 18 months • Severe delays • Hypotonic • FTT & major feeding challenges • Concerns about vision • ESL Case 4

9. Down Syndrome – Health supervision guidelines AAP 2001 Williams Syndrome AAP 2001 – growth charts Angelman – become overweight at adolescence There is no care pathway for ASD, yet! http://www.ncbi.nlm.nih.gov/sites/GeneTests/?db=GeneTests Care Pathways

10. Children with Complex needs should be linked to community based services as soon as possible We need to improve communication and collaboration between community services and primary care Conclusion