Page 213 - Hospital Authority Convention 2018

Service Enhancement Presentations

F6.6 Enhancing Partnership with Patients and Community 10:45 Room 421

Outcomes of Six-year Follow-up of a Cohort of Infants of Substance Abusing Mothers Showed that the New
Community Paediatric Service Model Achieved All the Objectives of Comprehensive Child Development Service
1
1
Shiu YK , Shek CC , Sin NC 2
2
1 Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hospital Authority Head Office, Hong Kong HOSPITAL AUTHORITY CONVENTION 2018
Introduction
Infants of substance abusing (SA) mothers were well known to have poor compliance to vaccination and health follow-
up. According to the “Inverse Care Law”, patients who default healthcare follow-up are of the highest risk that indeed
need the most intensive and comprehensive service. Comprehensive Child Development Service (CCDS) was piloted in
Princess Margaret Hospital (PMH) in 2005 using the strategy of community-based, child-centred, family-focused, integrated,
multidisciplinary service, to serve infants born by mothers with high risk factors. Infants of SA mothers are one of the targeted
groups with the highest risk.

Objectives
(1) Early identification of pregnant women with substance abuse habit and provide early intervention and support; (2) improve
engagement in follow-up; (3) modify high risk behaviour of mothers and empower them for proper parenting; and with the
ultimate objective of (4) improve the developmental outcome of infants of SA mothers.
Methodology
PMH CCDS applied the strategy of: (1) early identification of high-risk families in antenatal clinic; (2) community-based:
outreaching paediatric clinic in Maternal and Child Health Centre (MCHC); (3) early engagement and counseling for the
families by CCDS midwife, paediatrician and social worker; (4) integrated, multidisciplinary team: collaboration between
Department of Obstetrics, Paediatrics, Psychiatry, MCHC, Family Social Worker and NGOs for substance abuse treatment.
Efficacy of CCDS was indicated by: (1) attendance rate of CCDS follow-up; (2) nutrition and vaccination rate; (3) neuro-
developmental outcome of the children; and (4) detoxification rate of the mothers.

Results
(1) Attendance rate of infants of SA mothers in PMH CCDS clinic in 2013/14 is 69.4%, compared with 46.8% before CCDS was
established. (2) Cohort of infants of SA mothers born between 2011-2014 and follow-up at PMH CCDS was evaluated: total
no. of infants is 193; vaccination rate is 100%; failure-to-thrive is 1%; borderline or delay in development is 17% (vs pre-CCDS
is 25%, and cohort in 2006-2009 was 20%)(according to definition, 15% of general childhood population have borderline or
delay in development). Attention Deficit Hyperactivity Disorder is 1%; Autism Spectrum Disorder is 1%. (3) 77% of the mother
successfully detoxified.

Conclusions
According to the outcome of the cohort follow-up at PMH CCDS, the community paediatric service model has achieved all
the objectives set out during the establishment of CCDS, and led to close-to-normal developmental outcome of very high risk
infants. Tuesday, 8 May 2018

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