The I-CCAN program relieves stress for families at the Montreal Children’s Hospital

November 20 is Pediatrician Day, and we’re celebrating the fantastic work happening in the I-CCAN program at the Montreal Children’s Hospital, led by pediatrician Dr. Sara Long-Gagné.

Pediatricians are known for their unwavering commitment to their young patients, who deal with health situations beyond their youthful years. One program at the Montreal Children’s Hospital is completely transforming the anxieties faced by families navigating an intricate medical system.

Pioneered by pediatrician, Dr. Sara Long-Gagné, the Intermediate-Complexity Coordination and Navigation (I-CCAN) program is lightening the load of youth who are followed by at least three ambulatory services at the Montreal Children’s Hospital (MCH) on a long-term basis.

“The model employed at I-CCAN is inspired by my experience working with the Complex Care Service,” Dr. Long-Gagné explains. “I felt inspired to create a program that offers the same comprehensive and coordinated support we see in Complex Care, but to patients with intermediate medical complexity who aren’t followed in that service because they don’t fit the criteria. Patients admitted to I-CCAN have chronic medical conditions that are managed by multiple specialists across different healthcare settings. It’s easy to get lost and feel overwhelmed trying to navigate our fragmented health system.  These families merit extra support and compassionate assistance.”

How does I-CCAN help?

I-CCAN brings together 12 pediatricians who work in different areas at the Montreal Children’s Hospital, along with a multidisciplinary team comprised of an administrative agent, care coordinators, a nurse practitioner and nurse clinicians. The program currently services 450 patients and families, and receives new referrals each week.

Scheduling multiple appointments and tests can be very stressful and labour intensive for parents and caregivers. One way I-CCAN helps is by taking on the role of a ‘super-scheduler’ who assists families in planning hospital visits according to their child’s needs.

“The I-CCAN team will partner with families and/or healthcare providers to facilitate the scheduling of appointments. Rather than driving back and forth several times for different appointments, we try to coordinate everything into one visit, whenever possible. Some families used to travel long distances, miss work and school frequently, to see different specialists on different days, but with our help, the process is now streamlined,” shares Dr. Long-Gagné.

I-CCAN also tries to increase healthcare efficiency. For example, if an ultrasound needs to be performed in the morning prior to seeing the specialist, the I-CCAN team will make sure it gets done. Another example is streamlined blood work; I-CCAN may coordinate with many specialists to make sure the child isn’t subject to numerous needles and the family doesn’t have to travel unnecessarily.

I-CCAN also offers health supervision clinics with their nurses and/or pediatricians. The I-CCAN team reviews the child’s health from head-to-toe, provides medical expertise, promotes preventive measures, and helps families access eligible supports. They also try to build bridges with the community so care is provided closer to home. They make sure that everyone is on the same page. The idea is for every person, no matter their role in the child’s life, to have the same goal in mind and to keep each other informed.

“This superstar-level of communication is all thanks to teamwork. I-CCAN works hard to encourage interdisciplinary communication and collaboration at the Montreal Children’s Hospital and beyond,” states Dr. Long-Gagné proudly. “Pediatricians in I-CCAN are extremely lucky to be surrounded by such a devoted multidisciplinary team, who cares deeply about the children and their families.”

Vision for the future

Dr. Long-Gagné has a vision in her heart for I-CCAN’s future: she aspires to use the same health navigation strategies within I-CCAN to address the needs of young adult patients moving into adult care.

“I’m passionate about working more closely with patients and families, and bridging the gap between pediatric and adult care. We need to ensure a smooth transition for patients who are close to turning 18. Collaborating and continuing to create partnerships with adult services would be pivotal, and very fruitful.”

The I-CCAN service is currently funded until 2029 through the generosity of the Montreal Children’s Hospital Foundation and Opération Enfant Soleil. I-CCAN has made exceptional strides since it won an honourable mention at the 2022 Prix d’excellence from the ministère de la santé et des services sociaux, and it is expected to expand to serve 1,000 families within the next few years.  

For more information, we invite you to visit the I-CCAN page.