Personal viewpoint - Eclecticism in health services for developmental disorders

The term 'eclectic', as applied to health care for children with developmen tal disorders, portrays an individualized, adaptive service response to loc al constraints and pressures. While this may appear appropriate for the loc al setting, the end result is a broad diversity of health care approaches. This paper discusses three separate processes that interact at a local leve l, increasing the likelihood of an eclectic local model of health care for this population of children. The first process draws from the direct clinic al work. Variable training, knowledge and skills among health care provider s, in combination with differing beliefs around the nature of the problems and their management leads to health care which directly reflects the attri butes of the local clinicians. A separate, second process fuelling variabil ity is the differing models of departmental responsibility across Australia - which Government departments fund which aspect of care for children with disabilities. The final process relates to funding streams for health care . State public health, federal Medicare and private insurance all support h ealth services for children with disabilities, with the financial incentive s (budgets compared to fee-for-service) driving a divergence of practice. T his paper concludes that the external political, administrative and financi al frameworks within which health care is constructed will continue to prom ote clinical eclecticism to a degree that would probably be considered unac ceptable in other areas of child health care. The solution can only arise f rom within the clinical work itself, with greater clarity of understanding around the nature of the disorders, the outcomes for which health care take s responsibility, and an increasing focus on an evidence based set of appro aches towards achieving these.