Abstract
BACKGROUND
COPE is a collaboration between health and education in a large urban centre. The program enables vulnerable children with undiagnosed developmental, behavioural, mental health and/or medical problems which impact their learning and socialization, to be seen by a paediatrician or child psychiatrist at their school, with first hand input from the school and family.
OBJECTIVES
To introduce and describe COPE to paediatricians in Canada.
To review 16 years of the program by identifying gender characteristics of the population served, major diagnoses resulting from the consultaitons, describe the referral process, and to present an evaluation of the program obtained through surveying the schools and families for their perception of efficacy, usefulness and confidentiality of the process.
DESIGN/METHODS
This is a review of 3105 children and adolescents served through COPE from 2001–2017. Data has been collected for 16 years and has been analyzed to calculate gender ratios, percentage of consults that required follow up appointments, and percentage of files reactivated for ongoing or new difficulties. ICD 10 codes were collated for the children who had specific diagnoses and were analyzed to determine category of medical, behavioural, developmental and mental health issues being addressed. Likert scale (1–4) surveys sent to school personel and parents were analyzed.
RESULTS
The program initially saw only elementary children, but has expanded to include all ages. 80 % of students were male, 20 % female, and 0.45% transgendered. There was an average of 2.3 contacts per child. 39% were initial consultations, 61% reviews/follow-ups. 21% of files were reactivated to address new or ongoing concerns.
The most common ICD10 code was Hyperkinetic disorders =71%. Anxiety disorders =13%, Developmental disorders of scholastic skills =12 %, conduct disorders-(the majority are ODD)=10%, specific developmental disorders of speech and language =9%, pervasive developmental disorders =7%, problems related to upbringing, negative life events and family circumstances =7%, and reactions to severe stress and adjustment disorders =5%, (1265 /3104 had ICD10 diagnoses) Many children had multiple diagnoses.
ICD coding for all medical and psychiatric diagnoses, and problems related to the family and social circumstances was not done consistently in the early years of the program. The profile of the students served in the past 5 years is fairly constant, and the social complexity of each individual case is increasing.
Family and school satisfaction surveys were tracked for 7 years. They consistently report being very satisfied with scores falling between 3.2 and 3.9 on a four point Likert scale.
CONCLUSION
COPE is a highly successful diagnosis and intervention model, impacting a large number of children identified as priorities by their schools.