Improving Developmental Screening among Community Partners Amy Belisle, MD Bob Holmberg, MD Nan Simpson, MSW Sue Mackey Andrews Maine Quality Counts January 30, 2015

Dr. Amy Belisle Dr. Bob Holmberg Nan Simpson

WELCOMING REMARKS, INTRODUCTIONS AND REVIEW OF EXPECTATIONS

DSCI Initial Training 2015 2

•

Welcome, Introductions, Agenda Review

Welcome and Introductions

~AGENDA~

Review of Developmental Screening Community Initiative expectations and the benefits of being a partner  Why is developmental screening so important?

Understanding the Consent Process and Information Sharing Goal Setting and Measuring Progress Electronic Information Sharing through ASQ On-Line Creating a Community EcoMap to Improve Communication Q&A, Closing Comments, and Next Steps DSCI Initial Training 2015 3

CME Disclosure

Today’s speakers have no conflicts of interest with commercial products in this presentation.

We will talk about some commercial products, ASQ online, ASQ-3, and the PEDS. We have no financial interest in these products.

4

DSCI is advised by the Maine Child Health Improvement Partnership (ME CHIP) and the SAIEL Team Mission

To optimize the health of Maine children by initiating and supporting

measurement-based

efforts to enhance child health care by fostering public/private partnership.

Vision

All practices providing health care to children will have the skills, support, and opportunities for collaborative learning needed to deliver high quality health care.

5

Bangor Community’s Circle of Strength

Assess Surveillance Screening Assess

S

Screening Assess

Swarm Theory and Leading Innovation

Innovation Networks

”

Collective Impact

• • • •

IS NOT : EVERYONE DOES SOMETHING AND TOGETHER WE ACHIEVE COLLECTIVE IMPACT IT IS:

A systemic approach relationships between organizations and the progress toward shared objectives.* to social impact that focuses on the

Collective Impact Initiatives are l

ong-term commitments by a group of important actors from different sectors to a common agenda for solving a specific social problem.* Collective Impact = Quality Improvement + Collaborative Innovation + Collaborative Learning

(Summit program book) *Source: Kania J, Kramer M. Collective Impact. Stanford Social Innovation Review. Winter 2011 http://www.ssireview.org/articles/entry/collective_impact Accessed march 2014

DSCI Initial Training 2015 8 14

Swarm Theory: Don’t be a star, be a galaxy!

Star Galaxy

Peter Gloor, “Swarm Creativity: Competive Advantage through Collaborative Innovation

Networks” DSCI Initial Training 2015 9

Rays of strength in your community..

To Get Us Started….

DSCI Initial Training 2015 10

DSCI Mission and Vision

Mission: The Developmental Screening Community Initiative will provide support to a multi-disciplinary community team in testing and implementing best practices for coordination to improve developmental screening efforts at critical ages for children ages birth to three. Vision: The Developmental Screening Community Initiative will result in better health outcomes and school readiness, through early identification, for Maine children ages birth to three.

DSCI Initial Training 2015 11

What have I got myself into???

Support the mission, vision and goals of the DSCI, and commit to improving developmental screening efforts for children ages birth to three.

And…children will be identified earlier for services

Ensure the involvement from across disciplines and an identified parent or family partner or an established parent advisory group that would be willing to provide input, guidance and feedback on the project.

And…you will be assured of appropriate, local referral sources

Develop a community work plan focused on strategies to achieve enhanced cross-disciplinary coordination, including a timeline of implementation check-in points to evaluate progress (testing).

And…you will learn valuable lessons on what is working and discontinue what is not

12 DSCI Initial Training 2015

What have I got myself into???

Identify a local team leader to work with the DSI Project Manager to coordinate community meetings as well as responsible to report on progress of work plan activities.

And…the team will get the support needed to be successful

Identify a fiscal agent to receive and report on funding on behalf of the community team.

And…the efforts for ensured success will be compensated

Commit to a minimum of two half-day trainings, monthly one hour meetings in person and bi-weekly check-in calls with the DSI Project Manager as well as three “All Practice, All Call” webinars

And…progress, successes and challenges will be shared and assistance will be provided

DSCI Initial Training 2015 13

What have I got myself into???

Learning about quality improvement methodologies, including the use of Plan-Do-Study-Act (PDSA) cycles to test components of the work plan.

And…get quick results on what efforts to sustain and what efforts to change or modify

Monthly data tracking and collection within

QI Team Space

from the different community organizations that will be submitted to the DSI Project Manager.

And…receive a report of trends over time to share with stakeholders

Identifying, testing and implementing potentially new practices, processes and/or procedures related to developmental screening.

And…you will ensure that screening takes place without duplication

Participation in the evaluation of the initiative including sharing lessons learned, challenges and plans for sustainability; at least one member will share this information at the May 20, 2015 DSI Stakeholder meeting.

And…you will be recognized as a State leader for change

DSCI Initial Training 2015 14

Dr. Amy Belisle Dr. Bob Holmberg Nan Simpson

WHY IS DEVELOPMENTAL SCREENING SO IMPORTANT?

DSCI Initial Training 2015 15

• • •

Leading Change: Why We Need to Reimagine Well Care for Children

What interventions during well care are going to improve the health of kids the most and make sure that kids are ready for school?

How can we incorporate patients, families, consumers and community partners into well care redesign?

How do we create a Medical Neighborhood for Kids?

DSCI Initial Training 2015 16

•

Why is Developmental Screening in Children Ages 0-3 years Important?

Pop Quiz:

• What % of kids are affected by developmental delays and conditions?

• According to information published on March 2014**, 1 out of how many kids have Autism Spectrum Disorder (ASD)?

A. 1 out of 250 B. 1 out of 150 C. 1 out of 88 D. 1 out of 68 ** MMWR, Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 3/27/14*** DSCI Initial Training 2015 17

Are we all speaking the same language?

Developing common terminology across the early childhood education and medical sectors DSCI Initial Training 2015 18

M aine’s Early Childhood Birth to Three Developmental Screening, I dentification and Assessment Terminology Chart DEVELOPM ENTAL SURVEI LLANCE

Determining strengths and identifying children who may be at risk for developmental delays in one or more domain* through a gathering of history, observation, parental concerns, and documentation of changes over time Routinely performed on a periodic basis utilizing observation, parent input, and documentation of changes over time (e.g., AAP Bright Futures, SWYC)

DEVELOPM ENTAL SCREENI NG

Administration of brief, standardized tool aiding the identification of children at-risk of a developmental disorder in one or more domain* Conducted on a periodicity schedule using a standardized tool such as,

ASQ-3, PEDS,

and

MCHAT-R

DEVELOPM ENTAL EVALUATI ON (Diagnostic)

Identifies/diagnoses the existence of a delay or disability, identifies the child’s strengths and needs in one or more area of development* and determines the scope, intensity and duration of a therapeutic service(s) should a delay be identified Conducted on an inter-periodic basis utilizing a standardized or norm-referenced instrument (e.g., BDIST, CDI, HELP, PPVT-IV, GFTA-2, ASQ-SE)

DEVELOPM ENTAL ASSESSM ENT (Ongoing)

Collects, synthesizes, and interprets information about children from several forms of evidence of the child’s learning, growth, and development on an ongoing basis over a period of time. The assessment process identifies a child’s unique strengths and needs in developmental domains* and the child’s unique approach to learning and development. Methods can be both formal and informal, including standardized testing, observations, and parent input. An ongoing process that is conducted initially and periodically to determine a baseline of skills and as an ongoing process to measure child growth and development (e.g., Teaching Strategies GOLD, AEPS, High Scope COR) Conducted by medical practices during well-child visits, Public /Community Health Nursing, and early childhood teachers with informed, active parental input and participation Ideally conducted for all children 0-3 in multiple settings in partnership with parents and basis according to the AAP Periodicity schedule minimally Newborn, 3-5 days, 1, 2, 4, 6, 12, 15 and 24 months, 3 years Performed/facilitated by medical practices, CDS/Part C, Public/Community Health Head Start and early childhood teachers with informed, active parental input and participation Conducted for all children 0-3 minimally according to the AAP Periodicity Schedule or on an inter-periodic basis when concerns are expressed by a parent/caregiver or by surveillance. For EHS-complete within 45 days of enrollment Developmental: 9, 18, 24 or 30 months; Autism: 18 and 24 months Performed by CDS/Part C, pediatric developmental specialists, child psychologists, SLP, OT, PT and social workers with informed, active parental input and participation Conducted for children 0-3 who have been referred as a result of screening and/or parental or medical practice concerns. For CDS/Part C, must be completed within 45 calendar days of referral Initially and at least every 3 years or more frequently as determined by clinical judgment Performed by CDS/Part C, Early Head Start, medical sub-specialists, SLP, OT, PT, social workers with informed, active parental input and participation. Contributes to individualized curriculum planning and parental support services. If eligible for CDS, information is used to develop the individualized Family Services Plan that defines and guides early intervention services across the developmental domains* Conducted in early childhood education settings including Early Head Start as part of curriculum and individualized planning as well as for children who may have been identified as having developmental concerns and are eligible for CDS. Frequency varies by program and purpose Initial and ongoing

* Domains:

cognitive, communication, adaptive, social-emotional, physical Developmental Systems Integration (DSI) Project Rev 9/3/2014 [email protected]

When Should Screening Happen and What Tools Can You Use?

• • Developmental Surveillance: at every well-child care visit

Bright Futures Survey of the Well-Being of Young Children (SWYC)

• • Developmental Screening: at 9, 18 , 24 or 30 month visit

Ages and Stages Questionnaire-3 (ASQ-3) Parent’s Evaluation of Developmental Status (PEDS)

• • Autism Screening: at 18 and 24 months

Modified Checklist for Autism in Toddlers (M-CHAT-R)

MCHAT is validated from 16-30 months Children's Health Insurance Program Reauthorization Act (CHIPRA)/Maine Health Homes metric is a documented developmental screening by ages 1, 2, and 3 years. DSCI Initial Training 2015 20

DSCI Initial Training 2015 21

Practices are Implementing Developmental Screening: MaineCare billing has increased since 2011

DSCI Initial Training 2015 22

Why use a Screening Tool?

• • • In Maine, up to 28% of children with disabilities are not identified before they enter school (2013) • • Surveillance detects less than 30% of children with developmental disability Inconsistent …..not very effective engaging parents early around concerns, strengths Value of evidence based tools vs provider surveillance/ observation • • • • Why?

Failure to use validated screening tools Inadequate training Lack of resources and adequate reimbursement Lack of time in the office to observe carefully DSCI Initial Training 2015 23

Why Not Watchful Waiting?

• • • • Personal stories: Early language concerns Loss of parent confidence/satisfaction in provider “My other doctor just wasn’t listening to my concerns” Value of “ I think everything OK but I hear your persistent concerns, let’s get a second opinion with CDS to be sure we’re not missing anything!” DSCI Initial Training 2015 24

Why is this important for families?

• • • • • • Need to understand what development should look like: CDC- “Learn the Signs, Act Early” and U.S. DHHS and Education: “Birth to 5: Watch Me Thrive!” Hope to find answers and improve quality of life for children and families for children with developmental delays Connect with early intervention developmental services Need a more standard approach to evaluate with screening tools- we see the kids for a few minutes in the office, parents are with the kids all the time and can provide critical information Families may need help with care coordination Families may need help with finding treatment services DSCI Initial Training 2015 25

• • • • • • •

When Results Are Concerning: Explain the follow-up process and timeframe

Complete a hearing and vision test Help family schedule Child Development Services (CDS) evaluation they have a 45 day window to complete an evaluation. Send to CDS even if you think they might not qualify for services- enters them into Child Find system Consider medical evaluations- refer to developmental pediatrician and/or pediatric neurology/genetics based on history- include results of ASQ/PEDS/MCHAT Evaluate for psycho-social stress at home (ACES) Track referrals and follow-up with family: Involve office referral specialist and Nurse/MA care coordinator Provide family with community resource list Help family connect to case management resources (April webinar) DSCI Initial Training 2015 26

Role of Other Sectors in Developmental Screening: Primary Care Needs to Coordinate

Maine Families Home Visiting

 Conduct developmental screening using

ASQ-3

following the ASQ-3 periodicity schedule starting at 2 months  Conduct social-emotional screening at least once between ages of 6 and 12 months using

ASQ-SE

Early Head Start

 Conduct developmental screening using

ASQ-3

within 45 days of enrollment and then follow the periodicity with the

ASQ-3

 Conduct social-emotional screening using

ASQ-SE

Public and Community Health Nursing

 Will begin using the

ASQ-3

following the AAP periodicity schedule in 2014

Child Development Services (CDS)

 Uses a variety of tools but mainly the ASQ and Battelle 27 DSCI Initial Training 2015

DSI Goals

• • • •

The goal of the initiative is to improve developmental screening across the early childhood system for children ages 0-3 and their families by generating:

Acceptance of a set of standardized developmental screening tools used by child health and early care and education providers: Decided in Nov 2013 to use Ages and Stages Questionnaire (ASQ-3) and Parents Evaluation of Developmental Status (PEDS) across sectors Protocols for training requirements and administration of developmental screening tools that promote reliable and valid results; Mechanisms for sharing and communicating results efficiently and securely among child health and early care and education providers; and Cross-departmental policies in support of the coordinated system, including Health Home (HH) and Patient Centered Medical Home (PCMH) initiatives.

DSCI Initial Training 2015 28

“Bridging Health Care and Early Education System Transformations to Achieve Kindergarten Readiness in Oregon” From CLASP: “First Steps for Early Success: State Strategies to Support Developmental Screenings in Early Childhood Settings” FROM Six by 15 Campaign…EARLY

CHILDHOOD At least six states increase by 15 percent the proportion of children ages 0-3 who receive recommended developmental screening. At least six states commit to improving cross system information exchange that supports access to services for children identified by screening .

“BIRTH TO 5: WATCH ME THRIVE A COMPENDIUM OF SCREENING MEASURES FOR YOUNG CHILDREN” “Improving Developmental Screening Documentation and

Referral Completion” (9/2014)

Sue Mackey-Andrews

UNDERSTANDING THE CONSENT PROCESS & SHARING INFORMATION AMONG COMMUNITY GROUPS

DSCI Initial Training 2015 30

Today’s Work Assignment

• • • • • The FERPA/HIPAA Connection Regulatory requirements – Summary listing – The 3 C’s What we have learned through the DSI – Key learning points – Brief review of the matrix on consent language from across DSI/SAIEL disciplines Review of most recent universal consent form Where to now?

DSCI Initial Training 2015 31

The FERPA/HIPAA Connection

Early Head Start Child Development Services Maine Families Primary Care Medical Home (PCMH) Public Health Nursing

HIPAA/ FERPA

DSCI Initial Training 2015 Allied Health Providers (PT, OT, SPL, Mental Health, Nursing services, etc.) 32

• • • • • • • • •

Common HIPAA/FERPA Regulatory Requirements

Fully informed parent/individual Protected information Situations when information is not protected and must/can be shared (research, child well being) Opt out Right to review record, obtain copies Opportunity for change/amendment to record including hearing option External access listing (beyond parent, entity) Destruction of information Complaint procedures and process including timelines DSCI Initial Training 2015 33

DSCI Initial Training 2015 34

DSCI Initial Training 2015 35

Actualizing these Protections

• • • The 3 C’s: Content Comprehension Compliance DSCI Initial Training 2015 36

Content

• • • • • • Parent must be fully informed, understand and agree to the nature of the consent: Clear straightforward language – 6 th -8 th grade reading level maximum Readability – font size, color “Native” language of the child, family Includes all regulatory requirements All blanks on each consent are filled in or marked “N/A” prior to parent signature Parent choice is evidenced in “menu” of options – – – Who Specifically what is to be shared and how shared For how long (situational vs. one year) DSCI Initial Training 2015 37

• • • • •

Comprehension

Informed Written Consent implies: Family/individual fully understands the intent, wording and outcome of the consent form – Explained in detail to them – Opportunity to ask questions Family/individual understands/comprehends and agrees to the each/all of the provisions set forth Family/individual understands what they can do if they don’t agree with what is being asked (Power to say “no”) Family/individual understands they can make changes, retract consent at any time (forward application) Family/individual understands what to do if they feel something wrong has happened with respect to their confidentiality protections (grievance procedure) DSCI Initial Training 2015 38

Compliance

• • • • • Each individual consent is reviewed with the family to explain the five W’s (who, what, when, why, how) A copy of each release is in the child’s record The family has a copy of each release that they sign Releases typically accompany the first transmission of information so that recipient also has a copy for their files All blanks on each consent are filled in or marked “N/A” DSCI Initial Training 2015 39

Previous Work Completed: Reviewed DSI/SAIEL Partner Releases, Consents

• • • Pluses Flexibility and willingness of partners to consider change Identified “what is” within and across disciplines/programs Pilot/implementation sites will offer new opportunities for testing solutions • • • Minuses Reported historical difficulties with AG’s office related to consents, etc.

Multiple and different forms within programs and across disciplines/programs Inconsistent content and statements across programs DSCI Initial Training 2015 40

“Setting the Table” for Next Steps

• • • • Why is the confidentiality of family/child information important the families you serve? Why is the confidentiality of family/child information important to your program? What did you learn today?

What questions do you have?

DSCI Initial Training 2015 41

Nan Simpson Deb Gilbert

MEASURING OUR PROGRESS: DSI METRICS

DSCI Initial Training 2015 42

Developmental Systems Integration Metrics

Objective 1: Children will receive general developmental screening by ages 1, 2, and 3.

Measure 1.1. Number of children screened for general development through the use of an evidence-based screening tool by ages 1, 2, and 3.

Objective 2: Children receiving developmental screening by ages 1, 2, and 3 will have their screening results shared with their medical home and other relevant service providers.

Measure 2.1: Number of children whose developmental screening results were shared with their medical home.

Measure 2.2: Number of children whose developmental screening results were shared with another service provider (Early Head Start, CDS, Maine Families, Public Health Nursing, other).

DSCI Initial Training 2015 43

Developmental Systems Integration Metrics

Objective 3: Children whose screening indicates a referral to Child Development Services, community-based services or a medical specialty service is conducted.

Measure 3.1: Number of children with a developmental screening that indicated a referral.

Objective 4: Children who are receiving a specialized service are indicated. Measure 4.1.: Number of children referred who are receiving services (CDS, Community-Based Service, Medical Specialty).

Measure 4.2.: Number of children who are NOT receiving services DSCI Initial Training 2015 44

Metric Review

…More about what pre-work told us …From the metrics…what data would be important to your community?

…From the metrics…what data could be a challenge to track and collect?

…Are there metrics missing that would be important to capture?

DSCI Initial Training 2015 45

QI Team Space

What is QI Team Space?

An on-line system where monthly data collection will be captured Password protected for your program to enter their data Developed to help with chart review process for medical practices but aggregate data can be captured tool use to share information, track progress, and give useful feedback on how you are doing

Stay tuned for a demonstration of QI Team Space….

DSCI Initial Training 2015 46

• • • •

Data Collection

Aggregate or chart review possibilities-we are hoping to have all groups enter monthly data into QI TeamSpace- additional training will be forthcoming Role of ASQ on-line and data collection Baseline data Monthly data collection expectations DSCI Initial Training 2015 47

Dr. Amy Belisle Nan Simpson

GOAL SETTING IN THE QUALITY IMPROVEMENT PROCESS

DSCI Initial Training 2015 48

How have we learned that we can accelerate change and increase improvements?

Aim Statement

DSCI Initial Training 2015 49

What are we trying to accomplish?

• Aim Statement: – – What?

For whom?

– By when?

– How much?

DSCI Initial Training 2015 50

Purpose of Setting Aims

Having an exciting destination is like setting a needle in your compass. From then on, the compass knows only one point-its ideal. And it will faithfully guide you there through the darkest nights and fiercest storms." Daniel Boone 51 DSCI Initial Training 2015 51

What are we trying to accomplish?

The AIM is Not just a vague desire to do better A commitment to achieve measured improvement – In a specific

system

– With a definite

timeline

– And numeric

goals

“Soon is not a time, some is not a number, hope is not a plan.”

-Donald Berwick, MD, Former CEO, Institute for Healthcare Improvement

52 DSCI Initial Training 2015 52

Cascading Aims

• Each part of the system will have their own individual aims (aims for the organization) but all should be aligned with the global aim.

DSCI Initial Training 2015 53

DSCI High Level Aim & Goals

Developmental Screening Community Initiative Aim Statement: Between January 2015 to September 2015, improve the developmental screening process to ensure that 75% of children ages 0-3 are screened, without duplication, and if the screening indicates, are referred and then receive appropriate services . • • • •

Goals

75 % of children will have a documented developmental screening using a validated tool (ASQ or PEDS) at the 9 mo, 18, and the 24/30 months 75 % of developmental screening results are shared with the child’s medical home and other community organizations upon parental consent 75 % of children are referred to appropriate services as indicated by the developmental screening results 75 % of children referred to services are followed to determine if services are in place and if not, why not DSCI Initial Training 2015 54

• • • • • •

Start to think about Your Aim Statement

The (name of your team/practice): intends to accomplish (This is a general over arching statement describing what you intend to accomplish during the time you work on this process – it answers the first question of the Model for Improvement. The process is identified in the statement, any specific or segmented area is mentioned and words like improve, reduce, and increase are often utilized) by (time frame, i.e. month/year in which you intend to accomplish improvement) for (what group are you doing this for – who is the customer) because (the rational and reasons to work on this improvement project) Our goals include: (your measures – it answers the second question of the Model for Improvement. Here they are stated as numeric goals) DSCI Initial Training 2015 55

• • • • •

Example Aim & Goals

By August 31, 2015, our organization will improve our developmental screening rates for children at the 9, 18 or 24/30 by 75%.

By August 31, 2015, 75% of developmental screening results will be shared with community service providers/medical provider deemed appropriate by the family By August 31, 2015, 100% of children whose developmental screening results indicated a referrals will be referred to an appropriate service provider.

By August 31, 2015, 100% of children referred for services will be followed up to determine if services have been rendered and if not, why not. The goals should be directed by your baseline data. DSCI Initial Training 2015 56

How have we learned that we can accelerate change and increase improvements?

Percent Measure(s)

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425

weeks

DSCI Initial Training 2015 57

Family of Measures

 Outcome measures  Overall measure of success  Voice of customer or clinical outcome  Process measures  How work gets done  More sensitive to change  Come and go as work changes  Balancing  Is there any other part of the system that might be influenced by your changes?

• Patient Satisfaction • Finances • Staff Satisfaction  Qualitative Data  Patient feedback  Surveys  Focus groups DSCI Initial Training 2015 58

One example of data collected from First STEPS 2014 Practices’ Progress To-Date: Screening Completed, Chart Review Gen'l Developmental Screen Documented

Rate Target 75% 30 20 10 0 80 70 60 50 40 31,5 42,8 29,3 45 Baseline Apr-14 May-14 Jun-14 Jul-14 50,4 80 70 54,8 60 50 40 Aug-14 30 20 10 0

Autism Screen Documented

Rate Target 75% 50,6 65,9 73,1 70,5 73,7 Baseline Apr-14 May-14 Jun-14 Jul-14 Aug-14 75,8 DSCI Initial Training 2015 59

Three Types of Data

• • • Data for improvement Data for accountability/judgment Data for research • • We understand that the data may be imperfect BUT for purposes of improvement, it does not negate the value of it. It can still be used for learning EVEN if the learning is that the data is imperfect!

How much data do we need for improvement? Just enough! It is the condition of the experiments/test of change that matter most! (Source: Paul Batalden) DSCI Initial Training 2015 60

Nan Simpson

USING ELECTRONIC INFORMATION SHARING

DSCI Initial Training 2015 61

Using Electronic Records and Registries to Improve Care

• • • • • Shifting focus in healthcare to Population Based Care making sure every child gets the right care, at the right time, in the right place Registries- lists of children grouped by a category, like clinical condition or disease (asthma, developmental screening, immunizations) that allow us to look at help manage care and see variations in care Helpful to get information from “point of care” Want to avoid “duplicate entry of data” into registries because of increased workload on staff, errors, etc.

Data helps us understand what is happening at the practice and community level and we hope will ultimately help improve care DSCI Initial Training 2015 62

Does your office use registries?

• • • What kind of registry?

Has it been helpful for tracking and monitoring children?

How interconnected is your regisry? Are you getting information from other organizations in your registry?

DSCI Initial Training 2015 63

Testing ASQ On-line at the Community Level

ASQ Enterprise …

multi-site-unlimited number of programs on account …create and manage child and program records …select the right questionnaire every time with automated questionnaire selection …eliminate scoring errors and improve over- and under-referral rates …store results and follow-up decisions in child records …easily track when children need to be screened again …analyze results with child and program reports …quickly access activities parents can try at home to encourage child progress …generate aggregate reports that show trends across multiple screening programs …can download into Excel spreadsheets DSCI Initial Training 2015 64

ASQ Enterprise Demonstrations

A general overview of ASQ Enterprise: http://agesandstages.com/wp content/themes/ASQ/engine/swf/player.swf?url=http:/ /agesandstages.com/wp content/uploads/asq_overview_final.mp4

DSCI Initial Training 2015 65

ASQ Decisions

Number of screenings for budgeting-pre-pay for 500 screenings Who will be the account administrator?

…responsibilities-set up the system and permissions; main contact for Brookes Publishing; get invoices and reports from Brookes Publishing; run system reports (like number of screenings total) but no access to child reports …funding implications

Permission Levels:

…account administrator ..Program administrator-where a lot of permissions lie; where child information can be looked at …Reviewer-can see summary reports only (in aggregate)

Inter-agency MOU’s for sharing information Consent from families to share information electronically Quote for budgeting (see handout)

DSCI Initial Training 2015 66

Nan Simpson Sue Mackey Andrews Dr. Amy Belisle Dr. Bob Holmberg

CREATING A COMMUNITY ECOMAP: UNDERSTANDING THE WORKFLOW IN YOUR ORGANIZATION AND ACROSS THE COMMUNITY

DSCI Initial Training 2015 67

? Where do Maine children, 0-3, access General Developmental Screening?

How do we move this forward at the system level?

MAINE 0-3 DEVELOPMENT SCREENING FLOW CHART NOTE: How does data sharing/communication flow (loop, 2 way, 1 way, etc.) Where do Maine Children ages 0-3 access Developmental Screening Programs and Services?

PUBLIC HEALTH NURSING COMMUNITY HEALTH NURSING CHILD CARE CENTER-BASED - LICENSED EARLY HEAD START/ HEAD START MAINE FAMILIES/ Home Visiting CHILD CARE FAMILY CARE - LICENSED CHILD CARE FAMILY/FRIEND /NEIGHBOR (NON-LICENSED) CDS/PART C/0-3 includes Child Welfare CAPTA/PREP PRIMARY CARE PROVIDERS Patient Centered Medical Home/Health Homes (PCMH) NEONATAL INTENSIVE CARE UNITS (NICUs) DEVELOPMENTAL PEDIATRICIANS SPECIALTY PRACTITIONERS: PT, OT, SPL, SOCIAL WORK BEHAVIORAL HEALTH CARE PROGRAMS SUB-SPECIALITY PHYSICIANS COMMUNITY CARE TEAMS DSI/SAIEL Workgroup, 8/2013 Individual Child Hardcopy Record Individual Child Electronic Record DATA ENTRY How and What Developmental Screening Data is Exchanged/Viewed? MEDICAL HOME/ PRIMARY CARE PHYSICIAN CHILD CARE CENTER-BASED - LICENSED CHILD CARE FAMILY CARE - LICENSED CHILD CARE FAMILY/FRIEND /NEIGHBOR (NON-LICENSED) PUBLIC HEALTH NURSING COMMUNITY HEALTH NURSING EARLY HEAD START/ HEAD START MAINE FAMILIES/ Home Visiting CDS/PART C/0-3 includes Child Welfare CAPTA/PREP SPECIALTY PRACTITIONERS: PT, OT, SPL, SOCIAL WORK SUB-SPECIALITY PHYSICIANS COMMUNITY CARE TEAMS PRIMARY CARE PROVIDERS Patient Centered Medical Home/Health Homes (PCMH) DEVELOPMENTAL PEDIATRICIANS BEHAVIORAL HEALTH CARE PROGRAMS DSCI Initial Training 2015 68

How does your organization approach developmental screening?

What is required in terms of developmental screening by your organization?

What is your flow of work… ….Before Developmental Screening ….During Developmental Screening ….Sharing Information ….Referrals

….Follow-Up DSCI Initial Training 2015 69

How does your community approach developmental screening?

How do you currently interface with others regarding developmental screening?

How could/should you be interfacing with one another to optimize developmental screening efforts?

The EcoMap DSCI Initial Training 2015 70

Understanding the Framework of the Medical Home: Definition

• • • • • • •

The Medical Home is the model for 21st century primary care, with the goal of addressing and integrating high quality health promotion, acute care and chronic condition management in a planned, coordinated and family-centered manner … ~ National Center for Medical Home Implementation

Accessible Culturally Effective Continuous Comprehensive Coordinated Compassionate Family Centered National Center on Medical Home Implementation: http://www.medicalhomeinfo.org/how/care_delivery / 71

Creating a Medical Home Neighborhood Map to Assess Needs and See where Natural Supports are Available

DSCI Initial Training 2015 72

Beginning to develop a Shared Care-Planning Model in

•

Partnership with Families

Identify needs and strengths • Build essential partnerships • Create a Plan of Care • Implement the Plan of Care • What does the medical and community neighborhood look like for families in your area? (Lucille Packard Foundation for Children's Health Report by Jeanne McAllister "Achieving a Shared Plan of Care with Children and Youth" : http://lpfch-cshcn.org/wp-content/uploads/2014/04/Achieving-a-Shared-Plan-of Care-Implementation-Guide.pdf

; p. 3) DSCI Initial Training 2015 73

•

Building Partnerships

What are the key elements of successful partnerships? DSCI Initial Training 2015 74

• • • •

Key Elements of Partnerships

Working with children, youth, and families; not doing things to them or for them without their involvement Meeting families where they are at and finding out where they want to go Helping families realize they know more than they think they know (and often more then we think they know) Believing that families know their children best (Marinell Newton, LICSW, Jill Rhinehart, MD, Beth Ann Maier, MD, “Partnerships,” VCHIP Presentation, May 22, 2014) DSCI Initial Training 2015 75

• • • • •

Strengthening Families Framework

Ability to access services in times of need Social connections/source of support Knowledge of Child Development Resiliency Child’s Social and Emotional Competence (Brown, Strengthening Families Approach Center for Study of Social Policy, 2014; www.cssp.org/reform/strenthening-families) DSCI Initial Training 2015 76

•

How can we look at community resources for a family: Eco-Map

An eco-map is a graphic representation that shows all of the systems at play in an individual's life. Eco-maps are used in individual and family counseling within the social work and nursing profession. They are often a way of portraying Systems Theory in a simplistic way that both the social worker and the client can look at during the session.

Reference: http://en.wikipedia.org/wiki/Eco-map DSCI Initial Training 2015 77

What does an Eco-map look like in your community?

Look at Your Workflow:

DSCI Initial Training 2015 79

DSCI Initial Training 2015 80

Start with a Block Diagram

Patient checks Patient inconvenienced Screen completed Screen scored Results reviewed w/ Family • Screening given to patient by front clerical staff • Screen completed by parent in wait room • MA collects and includes w/ check out sheet person?

•Are there unnecessary waits?

•Communication breakdowns?

•Is this value added for the patient?

•Is this value added for the staff?

• Re-work Provider enters encounter, reviews and scores w/ pt • Provider scores form on enclosed scoring sheet using Step 3: For each step, ask: •Can it be eliminated?

laminate score instructions posted in room •Can it be done in a different order?

•Can it be done by someone else-more appropriate • Provider reviews screen w/ pt • Provider discusses interventions as needed and signs Screen • Provider puts quick text in EMR indicating screen complete • Provider documents assessment & clinical impression Extra work DSCI Initial Training 2015 Referrals made as necessary Patient checks out • Follow up visits and/or referrals made at point of care via EMR • Patient checks out with plan of care Diminished *Results shared with other early communication childhood sectors 81

82

Nan Simpson

Q&A, NEXT STEPS, CLOSING COMMENTS

DSCI Initial Training 2015 83

What questions do you have of us?

Questions??

DSCI Initial Training 2015 84

Insert time line for DSCI DSCI Initial Training 2015 85

Tri-Community Webinar Dates

January 8th, 2014, 12-1 pm Intro for practices to DSCI; QI Methodology: Understanding the model for improvement; creating aim statements, metrics for developmental screening and understanding baseline data for project; intro to QI Team Space: Nan Simpson, MSW, Sue Butts-Dion, Amy Belisle, MD, Sue Mackey Andrews February 12, 2015, 12-1 pm Making the Connection with the Medical Home and Child Development Services, Part B and C - Cindy Brown and Roy Fowler, CDS Site Report: Midcoast Area QI Methology: effectively designing and using PDSA cycles, Baseline Data review April 9, 2015, 12-1 pm Expanding the Medical Neighborhood with Maine Families Home Visiting and Early Head Start- Lee Sowles and Sarah Lavallee Site Report: KVCAP QI Methology: Flowcharting at the organization and expanding to community flowchart, data review June 11, 2015 Planned Coordinated Care in Patient and Family Centered Medical Home and Information Sharing within the Medical Neighborhood- Dr. Bob Holmberg and Sue Mackey Andrews Site Report: Bangor QI Methodology: Sustaining QI Work, data review

86

CME

• • • • • CME will be available for participants who attended the training today. We do not have separate nursing CEUs- but you can get a CME certificate.

A CME evaluation survey will be sent via email after the training. If you did not get the email link, please email Deb Gilbert at [email protected]

. We get 5-10 incorrect email addresses each month. Please complete the survey via Survey Monkey within 1 week.

A CME certificate will be emailed within 1 month of completion of the survey. Please contact Deb Gilbert if you have not received a CME certificate after doing the survey.

DSCI Initial Training 2015 87

Contact Information

• • • • • • Nan Simpson, MSW, DSI Project Manager, [email protected]

, 207-441-3722 Sue Mackey Andrews, Consultant to QC for Kids on DSI Project, [email protected]

, 207-564-8245 Bob Holmberg, MD, MPH, Consultant to QC for Kids on First STEPS, [email protected]

Amy Belisle, MD, Director of Child Health Quality Improvement, Maine Quality Counts, [email protected]/ 207-847-3582 Sue Butts-Dion, QC for Kids Quality Improvement Specialist, 207-283 1560, [email protected]

Deb Gilbert, QC for Kids Administrative Coordinator, O: 207.620.8526, ext. 1017, F: 207.620.8538, [email protected]

DSCI Initial Training 2015 88

DSI Funding Statement

Supported by the Maine DHHS through funding from the US CDC Preventive Health and Health Services Block Grant 3B01DP009026-13 and the US DHHS Health Resources and Services Administration Maternal and Child Health Bureau Grant 2D89MC23149-02-00.

DSCI Initial Training 2015 89

As you leave…..

Another Strength that Emerged for You

Another strength that emerged for you…

DSCI Initial Training 2015 90