To describe patterns of service utilization to health services, educational and disability supports for children aged 0 to 18 with Neurodevelopmental Disabilities (NDD) in British Columbia.
Multi Methods Study Design. Qualitative: Using a qualitative descriptive methodology, inductive thematic data analysis was conducted in 16 semi-structured interviews with service providers and decision-makers from childhood disability services across ministries in British Columbia to explore the perspectives of service providers and decision-makers about system barriers and facilitators for service utilization and identify solutions to address these. Quantitative: Retrospective longitudinal cohort study of children with NDD aged 0 to 18 using linked administrative data from British Columbia provincial health, educational and social services and support. Descriptive longitudinal analysis was used to describe which children are/are not accessing disability services and support, categorized by NDD type.
Two themes were identified for barriers and facilitators: along the navigation process and across ministries in the qualitative study. Subthemes include trust and collaboration, early engagement of families with system, diagnosis-based policy, limited service provider capacity, waitlist to get diagnosed, overloaded case manager, lack of intersectoral collaboration, administrative protocols limiting system flexibility and location-based differences. Two themes were identified for policy and program design recommendations: a “wider door” policy and a Holistic System that “works for everybody”. Subthemes include functional eligibility criteria and outcomes, life-course perspective, funding, intersectoral collaboration, system navigation, and training.
In the quantitative study, based on a functional definition of neurodevelopmental disability, more children are (1) using higher levels of funding in special education, (2) eligible to access medical and respite benefits, and (3) eligible to access developmental disability programs. The number of children accessing autism funding program does not vary.
The system barriers and facilitators interact within the system before, during and after the disability system establishes interaction with families and their children with support needs. It creates a complex setting to deliver services, hampering an equitable provision of disability services and support, where a functional approach for eligibility may provide equitable access to services. Findings provide a systemic and intersectoral overview of the interrelated challenges that arise while using and navigating the system applicable to many jurisdictions.
These results reveal critical recommendations for changes in disability policy and program implementation from a system perspective to improve and address the challenges in using and navigating disability services and support through more equitable childhood disability support policies and programs.
Service Utilization
Neurodevelopmental disability
