Valley News – Vermont shuts down mobile clinic for kids

WHITE RIVER JUNCTION — A state-run mobile clinic that assessed children for developmental disabilities such as autism is closing, and the Vermont Department of Health is now directing families whose children need such assessments to the University of Vermont Medical Center in Burlington.

While some Upper Valley families can get these assessments – which can take two hours – at the Dartmouth-Hitchcock Medical Center in Lebanon, the two university medical centers wait up to a year.

Meanwhile, families and those trying to support them while they wait for a diagnosis must deal with children’s challenging behaviors without fully understanding what might be causing them.

“I don’t have much to say other than how desperate we are for the care of our neurodiverse pediatric patients,” said Dr. Rebecca Yukica, owner of Upper Valley Pediatrics, which has offices in East Thetford. and Bradford, Vermont, about the clinic closing. , which the state director of maternal and child health announced in a March 21 letter to community partners. “There is a huge need. It is a very difficult area. »

The Child Development Clinic of Children with Special Health Needs and the Vermont Department of Health has operated for over 60 years, providing assessments for children with neurodevelopmental delays through a network of regional community clinics, working with local and statewide service providers. . In addition to autism, the clinic assessed children for cerebral palsy, intellectual disability, genetic disorders, learning disabilities and ADHD. At its peak, the clinic was evaluating up to 400 children a year, said Ilisa Stalberg, director of maternal and child health at the Vermont Department of Health. More recently, in the midst of the pandemic, the clinic had stopped doing assessments.

The clinic was once staffed with a state-contracted pediatrician who traveled throughout Vermont providing ephemeral services, Stalberg said. Now that the state-contracted pediatrician has retired and UVM Medical Center has recruited a pediatrician who specializes in child development and behavior, the state is looking to this Burlington-based model.

“It’s been a long time coming,” Stalberg said.

She acknowledged that the change “will leave a void for families” in the number of spaces available and the convenience of their location for those who live far from Burlington with varying access to transportation. She said the state is working to determine if there is a way to offer mid-level assessment to children with less complex issues through community providers.

News of the clinic’s closure has left some in the Upper Valley concerned that the change will reduce access to already scarce resources for families. It comes at a time when parent-child centers such as The Family Place in Norwich are struggling to meet a high demand for support from families, as many have been in isolation for two years. Some continue to be isolated as COVID-19 vaccines for children under 5 are not yet available and child care spaces remain hard to come by.

Kelly French, a nurse who oversees The Family Place’s Integrated Children’s Services early intervention program, said the announcement of the clinic’s closure comes as the early intervention programs – which serve children aged 0-3 years – across the state are seeing high case loads, which have increased referrals for developmental assessments.

“I don’t remember when we had a quiet period,” French said.

While French and other early intervention can help families without a formal diagnosis, they can seek one when their efforts aren’t helping a child progress, she said.

Julia Dickenson, program assistant for children’s integrated services at The Family Place, said the diagnoses children receive through assessments can “open many doors for them”, such as enabling insurance coverage for therapy.

Dickenson, who said the announcement of the clinic’s closure came as a surprise, said six months or a year is a long time in a young child’s life.

“Making it even more difficult for families is just disheartening,” she said of the public clinic closing.

Dr. Christina DiNicola, a pediatrician at Gifford Medical Center in Randolph, echoed Yukica of Upper Valley Pediatrics in a desire for more support for families. In an interview on Friday, DiNicola said a mother, who brought a child in that morning, said, “I’m at my wit’s end.”

Seeing parents struggling in his practice is a daily occurrence, DiNicola said. She said parents sometimes deal with a difficult child, have limited parenting skills, or a combination of the two.

DiNicola said she’s worried the closure of the Child Development Clinic will further delay appointments for families. She said she had already seen children sitting on waiting lists at UVM for a year.

The wait time at DHMC is slightly less; ranging from six months to a year, she said. There are also private centers that can help, but not all take Medicaid, she said.

About the closure of the public clinic, she said: “I am really sad; disappointed.”

Some community members said they couldn’t see the one-year wait that others described.

“Our experience has been that we’ve been able to bring families in for supportive assessments with a fairly quick turnaround, often less than a month,” said Laura Perez, executive director of the White River-based special needs support center. Junction. child development services at Dartmouth Children’s Hospital.

Dr. Nina Sand-Loud, DHMC’s only developmental and behavioral pediatrician, said the twin states aren’t alone in facing a shortage of specialists in her field. It’s a national shortage that predates the pandemic.

Sand-Loud and the nurse practitioner who works with her try to prioritize younger children – sometimes getting them in within three months – because children over the age of 5 can access support through their schools and because early interventions can make the most difference, she says.

The demand and complexity of issues faced by some children has increased amid the pandemic, Sand-Loud said.

The pandemic and associated isolation have affected children’s social and emotional skills, in some cases contributing to disruptive behaviors and anxiety. Some of the effects of isolation can mimic developmental conditions and make diagnoses more difficult, Sand-Loud said.

“That’s why it takes so long,” she said of the assessments. It’s “not something you can get in a 15 minute visit”.

Despite the delays some families may face in accessing assessments, Sand-Loud said she hopes they won’t feel discouraged from seeking help from community providers such as The Family Place and their pediatrician. family.

“Community service is good service,” Sand-Loud said. “I don’t want people to be like, ‘Well, I’m not going to bother.’ ”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.