Dbp and CBT – a Professionally Rewarding "Blend" - the Impact of Professional Collaboration on a Vulnerable Underserved Group : Children with Disabilities, Including Those with Autism Spectrum Disorders, Mental Health Challenges, and Their Caregivers

Background: Mental health services are critical and frequently unaddressed, especially within the paediatric population. The World Health Organization identified both developmental disabilities and mental health disorders as significant contributors to the global health burden, especially in middle to low-income and developing countries, of which Trinidad and Tobago occupies the latter category. In the absence of locally-derived statistics, and based on international statistics from developed countries, about 20-30% of children and teenagers experience social and emotional problems that are concerning to their caregivers, with some of these being severe and clinically significant. This quantum is greater in children and adolescents with disabilities, whether simple or complex, especially if they have co-morbid chronic medical conditions. Many children and teens with “dual” mental health and somatic diagnoses, experience symptoms that are unrecognized, undiagnosed, under-diagnosed, or misdiagnosed . As a consequence, these issues remain untreated. There is no known national epidemiologic mechanism for data collection related to these issues, thus making it difficult to include these population niches within national health policy frameworks. This vulnerable population represents a major gap in our national public health system, with fragmented and/or unavailable services being the norm. Caregivers of children and adolescents with complex chronic medical issues, autism spectrum disorders, neurodevelopmental and/or behavioral issues experience higher levels of negative psychosocial stressors and have greater levels of maladaptive coping mechanisms than parents of healthy, typically developing children and teenagers. Children and adolescents with autism, are known to experience higher rates of anxiety, learning disabilities, sensory challenges and dietary atypia, which often go unrecognized.

Objectives:  To develop, audit and systematically improve a collaborative and integrated model of service delivery between a volunteer mental health clinician (Cognitive Behavioural Psychotherapist) and a physician (Developmental Behavioural Paediatrician). To provide Specialist Paediatric care, Sub-specialty Developmental Behavioral consultation/support, Paediatric Psychopharmacotherapy (medication management), and Psychotherapeutic support for both child and caregiver as well as care coordination are offered by this, despite an overwhelming, persistent lack of time; and professional and material resources.

Methods:  Case selection occurs from the socioeconomically, ethnically and geographically diverse clientele of a public health sector, sub-specialty paediatric ambulatory service. Clinical evaluation, case-conferencing and existing clinical evidence informs management plans, to the limit of material and human resources. Where necessary, cross-referrals are made to other disciplines e.g. Psychiatry, Occupational Therapy and to other governmental agencies, e.g. Ministry of Education.

Results:  This professional synergy, despite its occurrence in a resource-poor environment, includes improvements in the insight of the child/teen and/or their caregiver(s) to their own challenges, self-monitoring (where applicable), coordinated medical, pharmacologic and mental health management; as well as application of well-known evidence-based strategies to enhance positive behaviours, to augment coping skills; personal and family resilience in chronic conditions.

Conclusions:  Multidisciplinary, integrated models of care, have proven synergistic and more efficacious in the management of comorbid developmental disabilities, medical and psychiatric problems. There is potential to expand this type of service, to include other related disciplines to provide more effective service to this vulnerable niche of our paediatric population nationwide.