Children with special health care needs

Perspective of the Primary Care PaediatricianSpain : the Andalusian model of Early Intervention

Angel Carrasco PCP Madrid

Andalusia • One of the largest regions in Spain

• The most populated region : 8.4 millions inhabitants (1in 5 Spaniards)

• One of the poorest region in Spain: 25% (to 40%) unemployment rate, 35% of the population is at risk of poverty

• 20% population are <18y, (1,7 million), 1 in 4 Spanish children <18 y live in Andalusia

• National Health System (Beveridge model) SAS, Junta de Andalucia, 40 y of regional socialist government.

• 1150 PCP for the children < 14 y in 400 health centres

Why Andalusia ?

• Specific regional Law for Early Intervention (April 2017)

• Central KEY Role of the Primary Care Paediatrician

Question 1 Describe the organisation of care for children with

developmental disabilities (special

needs)

• EARLY INTERVENTION for children 0 to 6 y ( and their families) with Developmental Disabilities or Risk factors for them

• PRIMARY CARE PAEDIATRICIAN is the only health professional that can refer children to Early Intervention Units. Other specialist (like Paed Neurol, Neonatol,…) have to refer the child to his/her PCP. Teachers from the school can refer the child to his/her PCP.

• PCP can make a recommendation for the children to receive EI at EI centres.

• EARLY INTERVENTION UNITS: one or two in each of the 8 provinces, with one paediatrician experienced in DPM paediatrics, and one clinical psychologist. History & PE, Psychometric tests, and complementary exams or referral -ALWAYS INFORMING THE PCP.

• EIU has to be at less than 30 minutes from the child home, they work at several assessment centres in each province.

• EIU determines the need for EI at the EARLY INTERVENTIONCENTRES that have to include psychologists, speech pathologists, physiotherapists and social workers, that work with the children and families.

• Maximum waiting time from PCP to EIC less than 30 days. No waiting time now. EIC should be nearby child home.

Question 2 :What is the education

System for these children?

• There are EI educational Teams available (at least one for each province) and Orientation Teams available for schools (3 to 6 y) & ns (0 to 3 y). These teams work with the children at the schools.Special teachers & speech pathologists available for school children.

• Schools & KG can refer children to the PCP

• From 3 to 6 y, children can be treated at school in the classroom (type A), for some time out of the classroom (typeB), in an special classroom with other children with similar problems (type C), and only rarely in an special school (type D). Integration is the objective.

Question 3 : What social and financial support do these families

get ?

• EI is free for the families at EI centres and schools.

• EI centres are mostly private (foundations, parents associations, private) but affiliated to NHS, subject to requisites and quality control by NHS. NHS pays for the treatment at EI centres.

• Public grants for Special Education

• DEPENDENCE LAW for the worst cases, assures tax benefits and a fixed public economic support rent for families

• Grants from private Foundations

Question 4 : Cooperation between

health care, education and social care system ?

• EI centres have to elaborate reports for each children for schools and meet with them to discuss the reports, before the school year and periodically ( at least twice during the school year) to ascertain the needs and evolution of children.

• EI Units have to inform the PCP of the decision to refer to EI centre.

• School and KG teachers can refer children to PCP.

• Schools and KG and PCP can ask for Social Worker evaluation of the families. There are social workers in the EI centres.

• Acknowledgements : Spanish Team (Concha, Carmen & Maria), Guadalupe del Castillo, PCP Malaga