Transcript Slide 1
Health Care Transition
HRTW Patti Hackett, MEd
Co-Director & Founder Natick, MA
Brown Bag Lunch Training Series:
Transition Tips & Tools to prepare for health care transition
June 3, 2009
Mallory Cyr, BFA
Youth Coordinator Health Care Policy Sabattus, ME 1
Patti & Mal
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Ideas Speak too fast – tell me
Have a question, ask it Patti
• Promise: Agree
Ah ha!
Squirm
Disagree Patti
WIIFM
60 min – Making Changes to Make a Difference
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Section 01: KNOWLEDGE, SKILLS, & ABILITIES
Essential skills to help families promote youth involvement in health care decision making, reporting and health/wellness management. •
Section 02: YOUTH INVOLVEMENT
Avoiding making children and youth invisible by doing all the work. What does NO really say to child/youth and about their parents?
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Section 03: PERSONAL ACTION
How to model this approach with the families you assist & tools to help 3
INTERACTIVE DISCUSSION
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Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
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Key points
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Strategies to DO
WIIFM
Growing Up Ready to try new things!
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Growing Up: Completing college
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Growing Up and are Adults Health & Wellness …. + Humor
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Imagine the Possibilities….
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Knowledge
what needs to be learned
Skills
teach it, practice it, master it
Abilities
Automatic response, solution orientated Strengthen Circle of Support 10
60 min – Making Changes to Make a Difference Section 01: KNOWLEDGE, SKILLS, & ABILITIES
• Essential skills to help families promote youth involvement in health care decision making, reporting and health/wellness management. • Launching Adults not raising children- importance of children/youth having a role in the family and their health issues.
HRTW TOOL: Changing Roles
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Health & Transitions: YOU & Your Child
• HANDOUT: Changing Roles •
Fears & Anxiety
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1 new step at a time strategies Carry & Present Health Insurance Card YOU YOUR CHILD YOUR STUDENT 1 2 3 4 5
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Health & Transitions: YOU & Your Child
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Fears & Anxiety Youth knows & shares cultural practices that impact health treatments/services YOU YOUR CHILD YOUR DOCTOR & OFFICE STAFF 1
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1 step at a time strategies 2 3 4 5
Health & Transitions: YOU & Your Child
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Fears & Anxiety Youth carries portable medical summary YOU YOUR CHILD YOUR DOCTOR & OFFICE STAFF 1 2 3 4 5
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1 step at a time strategies
Health & Transitions: YOU & Your Child
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Fears & Anxiety Youth Calls and Makes Appts YOU YOUR CHILD YOUR DOCTOR & OFFICE STAFF 1 2 3 4 5
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1 step at a time strategies
Health & Transitions: YOU & Your Child
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Fears & Anxiety Youth Co-signs Medical Treatment YOU YOUR CHILD YOUR DOCTOR & OFFICE STAFF 1 2 3 4 5
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1 step at a time strategies
Skills
• Carry and present insurance card • • Know wellness baseline, Dx, Meds Make own Doctor appts • • Call in Rx refills Learning Choice • Decision making (assent to consent) • Prepare for Doc visit: 5 Qs • • Present Co-pay Assess: Insurance, SSI, VR • Gather disability documentation
Before 10 X X X Before 18 X X X X X X X X X X
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You can’t do it as well as I can
What are we saying
NO
to?
I don’t want you to get hurt.
The opportunity to TRY To fail, learn and to try again
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INTERACTIVE DISCUSSION
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Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
•
Key points
- start the conversation - remember WHO is the system for?
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Strategies to DO
WIIFM
60 min – Making Changes to Make a Difference
•
Section 02: YOUTH INVOLVEMENT
Avoiding making children and youth invisible by doing all the work. What does NO really say to child/youth and about their parents?
• • • • •
HRTW TOOLS:
HRTW Tool: Portable medical summary HRTW Tips: 15 min or less Doctor Visit Template & Sample - RX tracking Concise reporting- documentation of supports needed Sample - checklist for travel, medical/support needs 21
FAMILIES: Prepare for Changing Roles
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Self-Differentiation is a progressive, internal
interplay between autonomy (separation) and connection (togetherness) while progressing toward developing and known goals.
SOURCE: http://rodesmith.com/2006/03/25/bowen-differentiation/ 22
Simple Acts …..BIG Returns TOOL: Promote Individual
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Families
- protective
Role in the family
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Children / Youth
- being visible - community aware
*** be in charge of something - Grocery Store - Nightly Charge Wheelchair - Get Family Mail /sorting - Medications – pill box - 3 indicators on Rx bottle
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Knowledge Skills Abilities
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Handout:
Portable Medical Summary Carry in your wallet Good Days -
Cheat Sheet:
Use as a reference tool
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Accurate medical history Correct contact #s Document disability Health Crisis
- Expedite EMS transport & ER/ED care - Paper talks when you can not 25
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Preparing for the 15 minute or less, Doctor Visit: YES it can be done with practice!
Before the Appointment PROBLEM GET THE DATE AND TIME THAT WORKS FOR YOU
Know your schedule before making an appointment. Check for conflicts with school events, community activities, family functions and work schedules.
GATHER THE PAPERWORK
• • • Have there been tests done since the last visit? - Bring copies with you. - Change in insurance, call in info before the appt. Make copies of the insurance card. - Every family member has and carries his/her own insurance card. (yes, children/youth too!) Update your portable medical summary.
KNOW THE HOURS AND POLICIES
Yes, sometimes it is a matter of timing. Avoid calling the Doctor’s Office on Mondays and Fridays. Know who to call, or where to go when there is an urgent issue or an emergency. In the hospital, learn when shift change occurs and do not go to the nurses’ station 30 min before or after the shift begins (they need prep time).
GIVE A CONCISE MEDICAL REPORT
Practice what you want to say before the day of the appointment. Use the 5 Qs and Multi-System Medical History Tools to help you identify what you consider to be a priority. It may require another office visit. This is partly due to time limits for office appointments and may also be due to what your insurance will pay for in one visit.
Day of the Appointment 1 2 3
1. BE ON TIME. Call ahead to see if the Doc is running late.
2. DRESS COMFORTABLE: clothes that are easy to take off 3. BRING: insurance card, medical reports, questions to ask (write them down), money or a check for the co-pay and your calendar schedule to book next appointment.
What You Can Do Now!
• How does your body feel on a good day?
• What is your typical body temperature, respiration count, elimination habits plus skin quality?
• Recognize signs, symptoms of when you are getting sick and take action (have a plan!).
2. Create 1 page Portable Medical Summary
• Reference tool to provide accurate medical history • Emergency Info and contact numbers • Carry in your wallet, share with love ones & trusted others
3. Teach Skills EARLY!
• HOW TO LIVE HEALTHY & WELL with chronic health issues and disability.
Survive & Thrive!
• INCREASE CHILD/YOUTH INVOLVEMENT Ask 5 questions at each visit, co-sign treatment plans (assent). Call for appointments and Rx refills.
• GIVE CONCISE MEDICAL REPORT Give brief overviews about health status and needs. Know the emergency plan when health changes.
4. Getting Ready to Move On
• PREPARE FOR THE DIFFERENCE Understand the difference in the way health care services are provided by pediatricians and by adult health care providers. • ASK OTHERS care.
– Ask health allies and other families for names of physicians who have the skills and expertise needed, and who may match styles in co-managing health • INTERVIEW - Encourage youth to check out new physician, the practice and hospital before the official transfer. • HEALTH INSURANCE PLAN. Before age 18-check the plan. Many states have extended coverage for adult disabled dependent child.
The Ultimate Outcome: Transition to Adulthood !
www.hrtw.org
We provide information and connections to health and transition expertise nationwide – from those in the know, doing the work and living it!
This website focuses on understanding systems, access to quality health care, and increasing the involvement of youth. It also includes provider preparation plus tools and resources needed to make more informed choices!
Health Records
- Keep copies: test results, health visits receipts.
- Request copies: hospital discharge summaries.
- File: medical records - Share file with the Doctor when needed.
Health Surrogate
- Yearly talk with your family or trusted friends about what health care treatments you want and do not want.
- Legally identify WHO you want to speak on your behalf when you are unable to.
NAME: AGE: DOB: XX-XX-XXXX HEIGHT: WEIGHT: HOME PH: CELL: ADD EMAIL: ADDRESS:
Insert/affix picture
Name(s) of Custodial Parent: ___ N/A Guardian: ___ Y ___ N Limited Guardian: ___ Y ___ N Who filled in this form? Check all that apply. ___ Patient/Consumer ___ Parent ___Other family member ___Guardian ___Other, specify
ADL Area - Skill Level
Description and Medical Supports and Needs
ADD Medicaid Regulation Bed Mobility: FIRST NAME
level of functioning
___Independent ___Needs assistance ___Able to direct others ___Unable to perform How person moves to and from lying position, turns side to side, and positions body while in bed; Sufficient mobility to move into or out of a bed, chair, or wheelchair, or to move from place to place, whether by walking, using a wheelchair or by other means. 5 – 10 minutes
FORM: Tracking Poly Pharm Patient:
ADD NAME
ALLERGIES: list DOB:
??/??/??
Reason Rx # Drug
health issue Add # Add name
Dose
Add dose
30 day Copay 90 day Copay Last Next Left Rx renewal
Add amount Add amount Add date Add date Add date Add date ADD PH
PHARMACY ONLINE: ADD NAME LOCAL: ADD NAME
ADD PH
URL USER NAME: PASSWORD: ADD ADDRESS
Reason
Depressi on #08267025 4717 Effexor XR 75mg Bipolar
Rx # Drug Dose
AM 3x1 #1998367 01157 Lithium 300 mg AM 1x1 PM 2x1
90 day copay
$30.00
30 day copay
-----
Last Next
09/2 3/08 ???
----- $ 15.00 10/1 0/08 ???
Left Rx renew
01 12/12/ 08 -0 NEED Month ly ADD #2003796 01157 Vyvanse - 40 mg AM 1x1 Thyroid # ADD # ADD Levoxyl .125 mg Oppo days Levoxy l .137 mg Oppo days ----- $ 30.00 11/1 3/08 12/13 /08 ---- $ ADD ?11/ 14/0 8 ?12/1 4/08 ---- $ ADD ?11/ 14/0 8 ?? -0 NEED Month ly ??
???
??
??
END OF MONTH PILL COUNT Rx # Pill Count -- Surplus as of xx/xx/08 Effexor XR 75 mg 29
1995288-01157 082670254717 30 Suspect improper daily dosage 119 Surplus in two Rx bottles, last refill dated 9/23 @ 90 day supply/40 days remaining x 3=120
Lithium 300 mg 105
1998367-01157 1982471-01157 1985986-01157 90 Suspect improper daily dosage 01 14 Q>Rx refill date was 11/10/08-no evidence of refill, surplus in Rx bottle 10/10/08 Q>Rx states AM 1 x 1, PM 2 x 1, patient says he has been instructed to take 3 in AM, which is right?
Vyvanse 40 mg - 0-
2003796-1157 previous refill 10/22/08, recent refill 11/13/08 Suspect overuse of daily dosage, giving it away or selling it??
Why did he run out this month 11 days beforehand Why did Pharm refill 11 days beforehand?
Q>Any contradictions with taking No-Doze? Unable to monitor intake, but spent wrappers indicate daily ? use of multiple doses?
ESSENTIALS TRAVEL SUPPLY LIST - 30 DAYS Vendor/ Supply # Item PACK Notes/Comments
Pulmonetic – Notebook – Repairs and Working Info 01 01 Wheelchair battery charger Allegiance 21211 /Latex Free suction/urine cath) NPB-40 DME - Pulse Stat sensors ID G00854587 Flashlight thermometer stethoscope Electrical Surge Strips RX - all & herbs + butt cream 150 01 03 01 01 02 Roll in group of 10s extra batteries extra batteries BRING LIST AND #s
INTERACTIVE DISCUSSION
•
Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
•
Key points
- teach though tip sheets - checklists reduce forgetting
•
Strategies to DO
WIIFM
60 min – Making Changes to Make a Difference Section 03: PERSONAL ACTION
• How to model this approach with the families you assist & tools to help • • •
HRTW TOOLS:
Health & life Qs to Ask 8 Steps To Thriving Postcard -- in 1 week, 1 month, 3 months declaring what to do 36
Key Areas for Transition Planning – How does health affect/impact …… Employment and job training Post-secondary experiences/ education Independent/home living Community Life Leisure and Recreation Wellness Baseline
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HRTW 8 TIPS: Thriving Health & Wellness EASY: Things to Do by Next Tuesday
1.
2 3.
4.
Paying for health care:
Carry your Health Insurance Card in your wallet
Who to Call?
Put “ICE” contacts in your cell phone (in case of emergency)
Staying Well:
Make an appointment with your primary physician for your annual well visit. Review the Screening Guidelines to see what tests you may need to schedule this year.
Health & Wellness Baseline:
typical body temperature, respiration rate, nail color, elimination habits.
write down your
5.
6.
7.
TAKES TIME: Start by next month Health Information at your finger tips.
Create a one page portable medical summary. This is a record of your health issues, medications (prescriptions, over the counter and herbs), test results, contact information of providers, list of hospitalizations and other information that maybe asked during routine doctor visits and also during emergency care.
Your Health Insurance Plan: Check out the website for your health insurance plan. Read over the “benefit package.” Learn what services are covered, what is excluded. Find the forms you need to submit claims.
Find Mentors: Identify people who knows how to make the health care system work easier less stressful for such as” how to get bills paid and who can teach you how to prepare paperwork for insurance claims, program eligibility (SSI, VR).
HARD DECISIONS: Due by Thanksgiving
Best made during non-stressful times .
8. Advance Directives:
Who have you named to be your health care decision maker in the event you are unable to make decisions for yourself? – AND – what treatments do you want or do not want in the event you are in a serious health crisis?
Action Plan
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7 days - Step 1: In one week I will commit to do…… 30 days - Step 2: By next month I will commit to do……
I Did It!
90 days - Step 3: In three months I will commit to do……
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Knowledge Information Learning Skills Teach Practice Abilities Automatic Demonstrate
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INTERACTIVE DISCUSSION
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Which ideas struck you?
WIIFM
Jedi Master Yoda
DO or NOT DO, there is no “try”.
What are we saying NO to?
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Q & A
Patti Hackett
Mallory H. Cyr
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