Dr Mike Whitfield -Re: Proposed closure of the office of the Provincial Advisor of the Infant Development Programme

University of British Columbia
Department of Pediatrics
Neonatal Follow-Up Programme
British Columbia Children's Hospital
4480, Oak Street,
Vancouver, BC, V6H 3V4
Canada
Tel: 604-875-2854; Fax: 604-875-2483


Honorable Mary Polack, Minister Children and Family Development Minister.MCF@gov.bc.ca

Lesley Du Toit, Deputy Minister, Children and Family Development MCF. DeputyMinisterOffice@gov.bc.ca

Premier Gordon Campbell premier@gov.bc.ca

Date: 5 October 2009

Dear Ministers,

Re: Proposed closure of the office of the Provincial Advisor of the Infant Development Programme

I am staggered and disappointed by the recent proposal to close the office of the Provincial Advisor to the Infant Development Programme. I can only assume that this decision has been made without a clear understanding of what the Office of the Provincial Advisor does, and what good value for money and dividend in quality of family care and leadership of the programme this small operation provides. I am very aware of the need to make difficult decisions in times of fiscal stringency. In my opinion, the detriment to the functioning of the Infant Development Programme will far outweigh the small cost saving this course of action would save.

I was for more than 20 years the director of the Neonatal Follow-Up Programme in BC – a programme which provides sequential neurodevelopmental assessments of the developmentally highest risk infants in the Province as a result of perinatal adversity. In this role I have become intimately aware of the patchwork of community services available to parents who have a special needs infant or child, and the challenges faced by parents in finding the most appropriate support for their child as he/she grows and develops.

The importance of early developmental and social intervention in developmentally high risk children is well recognised now, including the long term cost savings and competence dividend this type of service provides for the child, the community and in the long run, the state. The Infant Development Programme is a highly valued, well established specific component of early developmental intervention for infants at risk available throughout the Province during the first 3 years of life – both from my own professional perspective, and from the perspective of the families using the service.

The strength of the IDP is the exceptional quality and commitment of its workers. With the rapid changes in the understanding of brain development in recent years, patterns of developmental intervention have changed over the 30 years or so that the IDP has been in operation, and patterns of practice have needed to be continuously updated, revised and refined based on evolving evidence from academic study and evaluation.

Though there are advantages to the IDP “contracts” being held locally in the regions and informed by the specific needs of those regions, the regional representatives have valued and benefitted from clear leadership from the Office of the Provincial Advisor who is the Provincial Expert in the provision of this service. The Office of the Provincial Advisor has provided:
1. Overall co-ordination of the programme to foster integration across the province and promotion of uniformity of services provided to families province wide.
2. Practice guidelines incorporating new material to keep infant development programme workers’ practice up to date and evolving appropriate for current standards across the province
3. Educational opportunities for IDP workers, and for the regional advisors. Amongst these, the “Early Years” conferences the run by the Office of the Provincial Advisor and administered by UBC Continuing Education have been particularly successful, and have provided a focus not only for learning, but for networking between IDP workers across the Province and nationally. BC is an acknowledged leader in this area of educational offering as a result of the efforts, energy and commitment of the Provincial Advisor.
4. The Office of the Provincial Advisor has been the only collector and analyser of uniform data relating to IDP practice across the Province at the request of the Ministry.
5. The Office of the Provincial Advisor has been an active force for proactive evaluation of how the programme is doing across the province, what could be done better, and what is working well. To this end, the Provincial Advisor spearheaded a successful database development project which has been trialled in several IDP sites, which could provide much needed data about waiting lists and different needs in different communities around the province.
6. The Provincial Advisor has been a consistent strong advocate for the developmental needs of children at developmental risk in the Province. Indeed, without her tireless efforts the IDP we know and value would not exist.

(And I am sure there are many other functions which I cannot at this moment articulate ; I am currently on holiday in New Zealand).

Thus the Infant Development Programme is made up of many units scattered across the province. They have benefitted greatly, individually and collectively, from the vision and leadership of the Provincial Advisor. If the Office of the Provincial Advisor ceases to exist the following consequences on of the service as we know it can be anticipated:

1. Fragmentation of IDP services across the Province – from a collaborative whole with a clear vision and mission, to an unco-ordinated “cottage industry” type service where each area does what it thinks best and there is no longer any uniformity, and a potiential deterioration of service to categories of clients.
2. Lack of leadership and uniformity in education of IDP workers – the workforce will over time become out of date in practice and attitudes and knowledge, further exaggerating regional differences in practice, and the quality of service provided to the clients.
3. There will be no effective way of enforcing standards and expectations – this risks devolution to the lowest common denominator and mediocrity.
4. There will be no way of idenitfying areas where there is over-resourcing or under-resourcing for the needs of the population.
5. No longer with a clear provincial advocate and voice for the needs for developmental services for developmentally at risk children, elements of regional IDP services, or the regional programmes themselves could be at risk of budgetary “cherry picking” during times of financial stringency. Though from a fiscal management point of view this might seem to offer actually some advantage, this development would fly in the face of the commitment of our society to care for our children – particuarly the disadvantaged members. The weakened IDP described in 1 – 4 would be a more vulnerable target for budget cutbacks than the co-ordinated professional largely homogeneous programme with a clear vision and identity that is currently operating under the watchful eye of the Provincial Advisor.

In order to be seen to be getting better value for money in these times of financial stringency, I would suggest that the Office of the Provincial Advisor of the IDP should be strengthened, with implementation of the previously mentioned database system across the province and expectations made for generation of accurate statistics that could better inform the optimal functioning of this scarce resource.

I believe that the Infant Development Programme as a whole provides very good value for money, and the expertise, energy, dedication and determintation of the Provincial Advisor is a key ingredient to ensuring that this is in fact the case, and has been for the past 30 years.





Yours sincerely


Michael F. Whitfield, M.D., F.R.C.P.C., F.R.C.P.E.,
Professor, Department of Paediatrics, University of British Columbia,
Neonatologist, Neonatal Follow-Up Programme, BCCH.
Tel: 604-875-2135; Fax: 604-875-3106
Email: mwhitfield@cw.bc.ca