The Developmental Intervention Clinic UTH-PCOE Lusaka, Zambia REPSSI PSS Forum 2 September 2015, Victoria Falls, Zimbabwe A. Kabwe-Grollnek, & S. Shanungu

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The Developmental Intervention Clinic

UTH-PCOE Lusaka, ZambiaMultidisciplinary Assessment & Intervention Strategies & Case Report REPSSI PSS Forum 2 September 2015, Victoria Falls, Zimbabwe

A. Kabwe-Grollnek, & S. Shanungu

OutlineCase Report: how health and socio economic factors affect the well being of young children with special needs.

The psycho social needs of young children with special needs and their families are varied and mulitple

How a multidisciplinary model supports the well being of young children and their families

MARYBackground6y F. Referred for challenges in communication & learningLives with:Biological mother & 1 younger sisterFather left the family soon after birth of second childMother HIV positive on HAART. Unemployed & family has no regular incomePregnancy, delivery & perinatal periodReferred uneventfulNo PMTCT strategiesMARYDevelopmental milestones: Delayed in all domainsPast medical history: 2mo- child severely & chronically ill13mo- admitted for severe malnutrition & recurrent febrile episodes.Diagnosed with HIV & started on HAART3yr-onset of seizuresFollow up care & treatmentDefaulted several times: on 2nd line ARTDid not report for medical attention until 6 years of age

Delayed Milestones:?- social smile1y- sat unsupported3y- stood & and walked4y- first words

3y- onset of seizuresLeft partial complex seizures lasting a few minutesOccurring several times a monthNot reported for medical attention (including ART Clinic) until the age of 6y

4Factors Affecting Marys DevelopmentHIV infection in prenatal period & infancyRecognised cause of developmental delay and neurological disorders in infected children (HIV encephalopathy)Untreated epilepsy (uncontrolled seizures)Further neurological damage with significant behavioural and cognitive co-morbiditiesSevere malnutrition & chronic illnessCo factors in developmental delay & cognitive impairmentPsychosocial FactorsParental absenceMaternal healthSupportSocioeconomic insecurityPoor stimulation & emotional deprivation

Physically and medically safe5Challenges Faced by Young Children with Special Needs & Their FamiliesAcceptanceSupportCostsTime commitment24/7 consistent careFrequent hospital visitsDifficulty maintaining employmentImpact on parental relationship

Well being of other siblings

Limited rehabilitation services

Challenges with school enrolment

Data is out of 828 children aged 0 to 7Number in household: is out of 7126Addressing the Psychosocial Needs of FamiliesPsychosocial needs of adults have a direct impact on childrenConcurrent interventions need to be provided through parent or family focused interventionPrograms should:Focus on strengthening families as responsive and protective spaces for children

Action for rights of children-resource pack. Foundation Module 7 Psychosocial Support, 2009. situtation, dynamics and needs of each member are accounted for-consider culture and norms-enable conencting an adult to a childs life7Determinants of Wellbeing in Early Childhood DevelopmentHealth & socio economic factors affect development

Toxic environments = poor development

Importance of quality caregiver-child interactions

Siddiqui,A., Irwin,L., Hertzman C. (2007) 1. Children raised in impoverished, neglectful, abusive and or un-stimulating environments are at risk for poor health, malnutrition, stunting and developmental delay.

2. The level and quality of interaction child - primary caregivers significant role in child development(Vegas & Santibez, 2010).

8The Developmental Intervention ClinicProvide support to:Individual childs neurodevelopmental needsMedicalRehabilitativeCaregivers psychosocial needsFormal counsellingInformal counselingThe Developmental Intervention ClinicEarly identification & intervention of children with neurological complications & other special needs

Target age group: 0 7yrsDevelopmental delay/disability, HIV, Epilepsy, SCD

Parent focusedParents are key players in interventionSupports parent-child relationshipQuality interactionsPromote play & interaction with child10Multidisciplinary Support11Common Neurological Conditions2013 data12Challenges of Families at the D.I.C.Not in school 79%Meeting basic needs 31%Married 80%Single 13%5+ dependents 61%

Data is out of 828 children aged 0 to 7Number in household: is out of 712Meeting basic needs: feeding the family & transportation challenges13Marys Assessment & InterventionMothers Main ConcernsCommunicationsingle words onlyBehaviour:Hyperactive & limited attentionUnaware of dangerFollows strangers (asks for money or food)Has left home on several occasions-missing for a few days at a time

Assessment FindingsNeurological evaluationDisinhibitionHyperactivityShort attention spanInability to complete age appropriate simple tasksStunted: (height/age 2DS/3DS below the median)Diagnosis: RVD in HAARTDevelopmental delayBehavioural disorder (ADHD features, disinhibition)Speech & cognitive impairmentSymptomatic epilepsy

Speech & Language AssessmentExpressive language limited to 10 20 single wordsArticulation challengesReceptizve language: below average for ageUnable to follow 2-step directions

Further testing:EEG & Brain CT/MRITx with VPA started with good control of seizures

15Assessment FindingsCognitive AssessmentPoor performance in abstract reasoning, cube design & analogical reasoningUniversal Non-Verbal Intelligence Test (UNIT) full scale intelligence score: 463 standard deviations below mean

Further testing:EEG & Brain CT/MRITx with VPA started with good control of seizures

16Assessment FindingsDiagnosisCommunication, behavioural, cognitive Disorder

The ImpactHeavy consequences in:Educational opportunitiesSocial integrationHigh risk of child abuseHigh risk of drug resistance (poor compliance)

Further testing:EEG & Brain CT/MRITx with VPA started with good control of seizures

17Marys Intervention Counselling with MotherImportance of adherence to medicationPrepare for disclosure of childs statusNutritional counselling Parent training:Strategies to reduce dangerous behaviourStrategies to enhance communication and social skillsDeveloped in collaboration with parentAssist in educational support Address medical concerns (HIV, epilepsy, malnutrition)18ConclusionMultidisciplinary & targeted interventions can greatly improve psychosocial well being and neurodevelopmental outcomes

Neurological disorders are a common presentation in paediatric HIV 20% of presenting symptomsIncreased risk of Epilepsy in HIVEarly HAART can reverse CNS manifestations, reduce risk & severity of HIV encephalopathy & prevent epilepsy

19The Developmental Intervention ClinicAlice Kabwe GrollnekClinic

Sandra ShanunguPsychosocial counsellor/>Location:Paediatric Centre of Excellence University Teaching Hospital, Lusaka Zambia1 Nationalist Road, Lusaka Zambia

Tel: +260211 257 535/6Mobile: +26097 4595 361