Children with complex conditions get faster access to therapy
Thanks to recent provincial investment, kids and families at Hamilton Health Sciences’ McMaster Children’s Hospital’s (MCH) medically complex care program will now have faster access to support for complex conditions. This investment – the largest in the hospital’s history – has supported the growth of services, spaces and staff to care for more families in need across 24 pediatric programs and services at MCH.
For the outpatient medically complex care program, the investment means MCH could hire a dedicated occupational therapist (OT) to support more patients who would otherwise be on the waiting list.
Complex Care Program now provides feeding support
MCH’s complex care program provides holistic care to more than 180 medically fragile children and youth who require close monitoring as well as coordination with caregivers and community partners. These patients often have multiple serious, complex health needs.
Children with complex care needs are not defined by specific syndromes, rather, by the level of their needs, such as whether they are dependent on technology or machines like a ventilator, have life-threatening or chronic conditions, or if they require care from multiple health care teams. The program consists of both a complex care unit for children needing to stay in the hospital for care, and an outpatient clinic for day appointments.
“With this new role, families don’t have to be referred to another program to have their child’s feeding and swallowing needs addressed.”
Mary Van Impe is now the OT in the outpatient complex care clinic, and she also supports MCH’s surgical clinic. Part of her role includes supporting children with feeding and swallowing challenges. These patients may need a tracheostomy procedure or BPAP machine to support breathing, or a g-tube for feeding. Or, children may be able to eat food using their mouth, but require support to do so safely.
Before Van Impe joined the team in September 2023, children in the complex care clinic would access occupational therapy from MCH’s feeding and swallowing clinic, which sits in a different department at the hospital. This meant that a referral to another program was required.
“There are a lot of kids who fall under complex care who also have feeding and swallowing concerns, but they don’t need support of the whole team in MCH’s feeding and swallowing clinic, just the OT,” says Van Impe. “With this new role, families don’t have to be referred to another program to have their child’s feeding and swallowing needs addressed.”
Loads of benefits from dedicated resource
As an OT on the same team as the complex care providers, everything is more streamlined. Van Impe can stay informed about a patient’s medical concerns and can help provide a seamless transition from inpatient to outpatient.
“I have a greater understanding of the whole picture and next steps,” she says. “Before a patient goes home from a long stay, I can go to the inpatient unit to meet the patient and family and have a conversation with the inpatient OT, so the care when they leave hospital is seamless.”
The majority of Van Impe’s role is assessment.
“I complete developmental assessments through observation, play and parent reports to evaluate functional abilities, developmental milestones, motor skills and activities of daily living. This helps to identify areas of strength and areas that may benefit from interventions,” she says.
“Having this role enhances the team’s ability to address a wider range of developmental and functional needs of the children we see, ultimately improving their quality of life.”
Van Impe performs feeding assessments to look at a child’s oral motor and swallowing skills and sometimes follows up with a more in-depth test in the hospital to visualize what happens in a patient’s mouth and throat when they swallow to avoid choking.
“These tools help me to assess swallowing safety in order to provide recommendations and feeding interventions,” she says.
She also completes home safety and equipment assessments, collaborates with other members of the complex care team including the dietician, respiratory therapist, and nurses, as well as OTs in hospital and in the community to ensure coordinated care and holistic support for the child and their family.
She empowers families to be actively involved in their child’s care, and shares information about community supports, equipment, adaptive strategies, oral feeding progression and ways to support their child’s development and independence outside of clinic; and she advocates for children to ensure access to appropriate services, resources and equipment in the community.
Reducing waiting lists and getting families the care they need
The addition of a dedicated OT to the complex care clinic means patients no longer have to be referred to other teams to access specific OT services. Instead, those needs can be addressed from within one team, reducing wait times and improving the team’s ability to provide comprehensive care.
“Having this role enhances the team’s ability to address a wider range of developmental and functional needs of the children we see,” says Van Impe, “ultimately improving their quality of life.”
