Overseas Training on Child Assessment Service in USA 2004
Experience sharing
by
Ms Kitty LI, Senior Nursing Officer, Child Assessment Service
I had received overseas training in the United State of America (USA) for a month from 20 September to 20 October 2004. As I was new to the Child Assessment Service (CAS), it would be beneficial to me to have more exposure and acquire knowledge on assessment and intervention for children with developmental delay.
I had clinical attachment at some famous children hospitals in USA where I learnt a lot. Among them were the Child Development Center of Children's Hospital of Philadelphia; the Clinical Center for Development and Learning of the University of North Carolina, as well as the Child Development Unit of the Children's Hospital of the University of Colorado Health Sciences Center.
In USA, the nurse practitioners work independently. They would first interview the family and child, and do the physical and neurological examinations for all new cases. Nurse practitioners also participated in doing the Autism Diagnostic Observation Schedule (ADOS) - an assessment for Autism which was usually performed only by Clinical Psychologist. Health education and promotion are carried out naturally and routinely during the usual medical consultation when parents are introduced to various publications and resources such as relevant web pages with information on child's condition. Parents are advised to read up the materials before returning for the next follow up. This prepares the parents for making decision on treatment suggested. Through empowerment, parents can further understand their children's needs and became positively involved in promoting their children's optimal development.
There are very good services for families who cannot afford the treatment and training. The Wraparound Services in Philadelphia for children less than 21 year of age diagnosed with emotional and/or behavioral disorders are one particular service for the poor. The Wraparound Services are individualized behavioral health care services provided anywhere the child is - at home, at school or in other community settings. The behavioral therapist goes to the child's home or school to provide training and thus the families need not to worry about the transportation and time taken for traveling.
The Lindens at Bancroft NeuroHealth Center is an intensive neurobehavioral stabilization program in USA, which won national recognition for their unique clinical model: a combination of neuropsychology and behavioral analysis. It is designed to help people with brain injuries, autism and other disabilities to overcome severe behavioral problems. It is run in a natural homelike setting preparing individuals for transition back to family and community. This program allows a less expensive but more effective alternative to psychiatric hospitals, in a less restrictive environment.
I observed a Functional Behavioral Analysis for an autistic child and the one-on-one structured therapy as well as planned daily living activities for other children. Based on the results of evaluation after behavioral analysis, a personalized treatment plan is developed for the child. These therapy sessions and activities are carefully monitored to measure the child's progress on a daily basis. This has given me an idea of the principle of functional behavioral analysis and helped me to better understand its application.
The most exciting experience was in North Carolina when I was attached to All Kinds of Minds, a private and non-profit making developmental assessment center where I had the opportunity to sit-in and observe Dr Mel Levine, a famous Developmental Pediatrician who is a specialist in the assessment of neurodevelopment functions for children with learning difficulties. He was able to arouse the awareness of education professionals in looking at the child with poor academic results from different angles and successfully motivated them to think positively of children with learning difficulties. Ways on how to adjust and train these children in order to maximize their potentials were also taught.
The assessment here are different from those at school and other clinics in that they describe the child's skills, rather than give scores or grades. There is a learning specialist working with the clinical team members to determine individual child's neurodevelopmental profile. The learning specialist will assess the child's academic skills such as reviewing the homework, interpreting teacher and parent questionnaires and testing skills. After all assessments and team conference, demystification will be carried out by one of the team members to parents and child. Demystification is a process that helps the children to understand their neurodevelopmental strength and weakness and is part of management by profile, a process developed by Dr Mel Levine for managing the education of children with difficulties in learning. Recommendations are given and the report will be sent to the parents within 4 to 6 weeks. The parents will take the report back to school for services. Staff will follow up by phone to assess the effectiveness of the plan formulated. Although it is expensive to have assessment done here, yet everyday a lot of Americans from all parts of the country flew to this Center just to have their children assessed here by the specialists. The waiting list for new case is very long and waiting time is very often more than a year.
The practice of recruiting a learning specialist in the team is something new to us in Hong Kong. According to their model, the involvement of professionals from the education field in the assessment team is essential and significant towards a successful and effective learning plan for individual child.
At the Child Development Unit of Children's Hospital in Denver, I have observed some very interesting clinics. The clinic for the Pediatric Oral Feeding Program is designed as a diagnostic clinic and is served by a multi-disciplinary team. The team identifies medical, developmental, or psychological conditions related to the feeding problems. The goal is to provide guidance, support and information to children, families and doctors in order to promote healthy eating patterns, growth and nutrition. After observing the child and family's eating habits, the team together with the family and their primary care provider will collaboratively work out a treatment program for implementation.
The Kid Street is a day care centre for children with physical, developmental and behavioral disabilities. The occupational therapist, physiotherapist and speech therapist jointly provide service daily to children in the day care centre. There are a lot of volunteers on duty. Music therapy, which is loved by all children, is held once weekly. It is very effective in decreasing the incidence of temper tantrums of those kids.
Finally, I took the Denver II Master Instructor training in Denver. The training program consisted of a one-day lecture, a half-day clinical practice in a childcare centre and a written examination. Certificate will be issued only after a videotape of the screening test for a child performed by the trainee has been critiqued and passed by the trainer. This training program helps me to understand and learn about the standardization and accurate performance of the screening test as well as the interpretation of the test result.
The overseas training in USA widens my horizon of child assessment service in other parts of the world. The clinical attachment at various centers enables me to have an insight into the assessments and different approaches to management of children with developmental, learning and behavioral problems. Nurses in USA with their high qualification work independently as equal counterpart with doctors and other professionals. They contribute enormously and effectively in the assessment service for children. I learnt from their skill and clinical expertise in the management of children with developmental, learning and behavioral problems. This overseas experience has fulfilled my aim of training and is relevant to my work in supporting the multidisciplinary team of CAS in assessment and intervention work for clients through the nursing team.
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