Comprehensive health services for developmentally disabled Navajo children

A retrospective study of 60 Navajo children with developmental disabilities was conducted to evaluate the quality and comprehensiveness of health services provided. Descriptive analysis by a multidisciplinary panel included medical record reviews, family interviews, and site visits to local health, educational, and family support services. Findings included timely and appropriate management of "medical" problems but a general neglect of "developmental" issues, such as hearing, speech/language, cognitive, and behavioral functioning, and attention to family understanding and adjustment toward caring for a handicapped child. Primary prevention and screening efforts were judged generally adequate, although not utilized by the majority of mothers of disabled children. Diagnostic assessments, family counseling, and referrals for treatment were incomplete, fragmented, and poorly coordinated. These problems resulted in potentially harmful delays in making referrals to available treatment programs. The majority of families interviewed tended to focus on the "medical" problems, had a poor understanding of the "developmental" components, and rarely participated actively in treatment.