Personal viewpoint: eclecticism in health services for developmental disorders.

The term 'eclectic', as applied to health care for children with developmental disorders, portrays an individualized, adaptive service response to local constraints and pressures. While this may appear appropriate for the local setting, the end result is a broad diversity of health care approaches. This paper discusses three separate processes that interact at a local level, increasing the likelihood of an eclectic local model of health care for this population of children. The first process draws from the direct clinical work. Variable training, knowledge and skills among health care providers, in combination with differing beliefs around the nature of the problems and their management leads to health care which directly reflects the attributes of the local clinicians. A separate, second process fuelling variability 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 health services for children with disabilities, with the financial incentives (budgets compared to fee-for-service) driving a divergence of practice. This paper concludes that the external political, administrative and financial frameworks within which health care is constructed will continue to promote clinical eclecticism to a degree that would probably be considered unacceptable in other areas of child health care. The solution can only arise from within the clinical work itself, with greater clarity of understanding around the nature of the disorders, the outcomes for which health care takes responsibility, and an increasing focus on an evidence based set of approaches towards achieving these.