Montreal health centre mobilizes to 'act early' for children with special needs

Students arrive at school as Quebec students get back to school in Montreal on Tuesday, January 18, 2022. THE CANADIAN PRESS/Paul Chiasson

"Acting early" for children is the leitmotiv of the Minister responsible for Social Services, Lionel Carmant, but it is also a program that is transforming practices in the health network.

The CIUSSS du Centre-Sud-de-l'Île-de-Montréal has become the first institution to deploy the new local diagnostic pathway for children with special needs.

After taking the time to set up its new service corridor over the past year, and then testing its formula as part of a pilot project last summer, the CIUSSS officially adopted this pathway in September.

It is aimed specifically at children with suspected neurodevelopmental problems.

All the other CISSSs and CIUSSSs in Quebec will have to follow suit by developing a similar service offering in their territories. It is a requirement of the Health and Social Services Minister and is part of the Agir tôt programme, which is particularly dear to Minister Carmant's heart.

"That's why I went into politics in the first place," said the man who practised as a neuropediatrician before being elected MNA for Taillon.

Even before he became a member of the national assembly, Carmant was campaigning for intervention with children before focusing on their diagnosis.

In the network, "people didn't think it was possible," he said.

"The network saw it as too big a paradigm shift, but we did it one piece at a time," he explained. "The government first ensured that additional resources were added to the network. Then, we developed the online assessment platform for reporting cases of children with special needs. Now we're working on establishing diagnostic trajectories.

"CIUSSS Centre-Sud is one of our leaders. They're the first to do it so effectively, and I congratulate them on that."

ONE TEAM PER CHILD

To sum up the concept, a professional identifies what he or she perceives as a possible developmental disorder in a child aged zero to seven. This could be a nurse at a vaccination appointment, an educator or a family doctor, for example. This professional then registers the child on the Agir tôt platform.

In the past, such a file would have been sent to a tertiary centre specializing in pediatrics, such as the CHU Sainte-Justine, the Montreal Children's Hospital or the Laval or Sherbrooke university centres.

The child and his or her family would have had to wait several months, even a year or two, before seeing a series of specialists, then obtaining a diagnosis before finally receiving services in their region. It was often very late or too late.

In order to reduce delays, improve efficiency and, above all, serve children better, the request must be handled by the local establishment. Interventions are then rapidly deployed to meet the immediate needs of the young user. The child will be seen by the specialist who meets the main need identified.

The professional will become the child's key worker and will be supported by a multidisciplinary team. Each team of three to six professionals is modulated according to the child's needs. If the problem persists and a proper diagnosis is deemed necessary, this same multidisciplinary team will take charge.

"That's what's new. We have dedicated professionals to diagnostic assessments," said Annick Rajotte, coordinator of early childhood programs and outreach services at the CIUSSS du Centre-Sud-de-l'Île-de-Montréal.

"In concrete terms, we have mobilized speech therapists, occupational therapists, social workers, pediatricians and neuropsychologists," said Rajotte. "They work as a team to provide the child and his or her family with the support they need to meet their particular needs. Thanks to this new model, we believe we can complete the entire trajectory in less than three months."

Efficiency is increased by only assessing the child once, by keeping the same professionals and by sharing observations between professionals. The program prioritizes cases according to clinical criteria and not just according to the order in which they are reported. In particular, the aim is to take action at the right time if a child is preparing to enter a CPE or nursery school.

BENEFITS

For pediatrician Dr. Julien Roy-Lavallée, the new procedure is already yielding benefits, since his colleagues' observations provide a "360-degree picture" of his young patients.

He added that keeping the diagnosis stage within the local team also facilitates the continuity of the treatment.

Of course, subspecialized centres will always have a role to play. In fact, coordination agreements have been signed to integrate the CHU Sainte-Justine team into the CIUSSS du Centre-Sud-de-l'Île-de-Montréal pathway, should the need arise.

The tertiary centres will eventually be able to focus mainly on more complex or more severe cases, which should lighten their burden.

The ultimate goal is to ensure that every child requiring specialized services can be identified in time and taken care of so that they are ready to learn when they start school.

It is important, therefore, to be patient before assessing the impact, but Carmant is confident that the educational success of the next generation of students will be greatly improved.

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This report by The Canadian Press was first published in French on Nov. 29, 2023.