13 Improving Developmental Paediatric Care for Equity-Deserving Patients: Using a quality improvement approach to develop a care pathway between a Complex Developmental Conditions diagnostic clinic and Social Paediatrics initiative

Abstract Background It is well known that Indigenous patients face structural racism within the Canadian healthcare system. The Excluded report from the British Columbia Representative for Child and Youth found that Fetal Alcohol Spectrum Disorder (FASD) is viewed as an “Indigenous problem” throughout Canadian healthcare settings. Recommendation 7 from this report urges review of referral pathways for FASD diagnosis, addressing systemic bias and enhancing family support. The Complex Development and Behavioural Conditions (CDBC) Program diagnoses complex developmental concerns, including FASD, and receives referrals from the RICHER (Responsive, Intersectoral, Child and Community Health, Education, and Research) social paediatrics initiative, serving equity-deserving communities, including Indigenous families, in Vancouver's Downtown Eastside. Objectives In response to report recommendations, this project aims to ensure families feel understood and well-supported during developmental assessments. Specifically, our objective is to ensure that, within 1 year of implementing program changes, >95% of families referred from the RICHER initiative will feel their needs are understood and that they are supported while their child undergoes a complex developmental assessment through the CDBC program. Design/Methods Interviews with 8 RICHER and CDBC clinicians identified key improvement themes. 5 Indigenous families with assessment experience completed online surveys addressing these themes, revealing need for longitudinal support during the assessment process. A Social Support Form was created based on feedback, aiming to collect information about children and families’ circle of support at the point of referral to support inclusion in the patient journey. The form was attached to 5 RICHER-to-CDBC referrals to initiate a PDSA cycle, utilizing pre- and post-test feedback from families and clinicians to implement program improvements. Outcome measures include percentage of families feeling supported and that their needs are understood. Process measures include percentage of families offered support by the Indigenous Health Team, offering of transportation support, and number of patient complaints. Balancing measures include no-show rates, extra care provider time spent, and appointment booking time delays. Results Initial findings of this initiative show that physician and clinician stakeholders have expansive ideas for improvement of the care experience of families referred to CDBC (Table 1). Further, exploring family assessment experiences finds actionable areas for program improvement (Table 2). A RICHER-CDBC Social Support Form was created in response to feedback from stakeholders and families, and will expand the referral package to include important information regarding family supports. We predict PDSA cycles for implementation of this referral addendum will result in families feeling more supported and will inform assessment recommendations. Conclusion This project highlights that community and tertiary care programs must work together to improve care for equity-deserving families, and that family voices must be forefront in the improvement of paediatric provincial healthcare programming. We predict implementation of our Social Support Form will allow for improved support of families with attention to community, family, school, and cultural connections, and consideration of transportation and healthcare needs throughout the CDBC assessment process and informed recommendations resulting from assessment.

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