Mary Wyrwich & Pat EganHealth Management and Informatics, University of Missouri, Columbia, MO

MODELS OF INTERDISCIPLINARY PRACTICE FOR CHILDREN WITH ASD: CLINICAL STRENGTHS AND CHALLENGES

Literature Review

Methods

Purpose Sample Clinic Flow

Discussion

The main purpose of this study was to understand the process of interdisciplinary clinical practice through a review of the research literature on children with special health care needs and observation of an existing clinic for school-age children with ASD. The aim was to clarify the strengths and challenges of this clinical approach to service delivery for those with ASD.

We conducted a systematic review of literature on comprehensive coordinated care for Children with Special Health Care Needs to examine the results of studies on the benefits of multidisciplinary coordinated care among this population. The studies show that there are significant results for reduction in utilization and costs, as well as improvement in family satisfaction, quality of life, health/functional status, and the services provided. Results of this literature review, combined with observations of the existing CAT clinic, were used to identify strengths and challenges of this approach and to make recommendations for next steps in improving interdisciplinary clinics.

An extensive systematic literature search was conducted to assess the current research on the efficacy of comprehensive coordinated care for children with special health care needs. After conducting the literature review, the Clinical Assessment Team (CAT) clinic at the MU Thompson Center was selected for use as an existing real life example. We observed the clinic and conducted informal interviews with all providers involved. A work flow diagram was created to visualize the process and resources used in providing the CAT interdisciplinary clinic.

Costs Utilization Satisfaction Quality of Life Health/Fucntional Status Services Provided

Cost per hour of each

discipline

Rate of referral visits

kept

Access to and satisfactionwith health

care and related services

Time family spent

travelingComplexity of

Patient

Activities involved in providing

interdisciplinary care

Cost per hour of personnel

Resources used

Satisfaction with costs

Time family spent

coordinating services

Child functioning

Number of disciplines involved

in child‘s care

Out-of-pocket patient/family

costs Missed work Type of Clinic

Health Insurance Coverage

Missed school Time with patient of

each discipline

The strengths of interdisciplinary practice for children with ASD are improved coordination of care and access to early intervention services. The challenges of this approach to care are providing adequate financial support to all involved providers and coordinating all providers. To address these challenges and improve access to quality care, interdisciplinary teams should consider routine collection and review of key process and outcome data. Suggested measures are below.

Sample Measures

DisciplineMonths

PriorWeek Prior

Clinic Day

Weeks Post Clinic Total Hours

Psychologist 0.25 1 5 3 9.25Psychiatrist 0 1 5 1 7SPL 0 0.25 5 1 6.25OT 0 1 5 1 7Administrative 3 0 0 0 3Total 3.25 3.25 20 6 32.5

CAT Clinic Total Hour Estimates