supporting complex health care needs of individuals with idd · who is pchc? •philadelphia...
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Supporting Complex Health Care Needs of Individuals with IDDMelissa A. DiSipio, MSA, FAAIDD
Philadelphia Coordinated Health Care (PCHC)
Southeastern PA Health Care Quality Unit (HCQU)
Objectives
• Define ways to promote healthy lifestyles for individuals with IDD.
• Document medical information and status by the use of new resources and forms such as Dysphagia, Dementia and Dental Checklists.
• Construct and implement a Health Promotion Activity Plan and a Behavioral Health Promotion Activity Plan for individuals with IDD.
Who is PCHC?
• Philadelphia Coordinated Health Care (PCHC) is committed to providing indirect health care support for more than 3500 people living in residential settings in the Intellectual Disabilities (ID) community.
• Our mission is to enhance access to community physical and mental health care through education, public health outreach, advocacy and empowerment as well as to improve health care outcomes for individuals with an Intellectual Disability (ID).
• 1989
• Grant
• Pennhurst
• Embreeville
• Expansion to SE Region
• Model for statewide HCQUs
How did we begin?
What is a HCQU?
Who do we serve?
• 5 counties (Bucks, Chester, Delaware, Montgomery, Philadelphia)
• Over 100 provider agencies
• Approx. 3,500 people in community residential programs
• Approx. 16,000 people registered in SE Region
National Community of Practicewww.supportstofamilies.org
www.lifecoursetools.com
Health DisparitiesAging/Dementia
Behavioral Health
Dental - #1
Diabetes
Dysphagia
Transition stages:
Pediatric to Adult
Adult to Geriatric
Lack of Health Prevention
Health Promotion
Internships
• Multiple Fields:
• Medical School (in. Psychiatric)
• Dental School
• Nursing school
• Social Work
• Public Health
Build it and they will come!
Field of Dreams, (1989)
Men’s Health
Women’s Health
Exercise
Individual I-pad Trainings
Community Health = Public Health
Connect!
• Toss the pebble!
• Make the phone call!
• Send the e-mail!
• Set up a meeting!
Communicate a joint need!
• Alzheimer’s Association
• American Cancer Society
• Diabetes Education
• Community Hospital Outreach
• Hospice Care
Eating, Drinking & Swallowing Checklist
• The Eating, Drinking & Swallowing Checklist is an observational document.
• Anyone can fill out this document
• Should be filled out annually OR at the sight of problems; such as, loss of weight or eating difficulties.
• This document should be shared with the agency nurse and taken to the physicians office during an appointment.
• PCHC nurses will be available to answer questions and/or concerns you may have with filling out this form
Number One
Unmet Health
Care Need
Dental Summit 2007
“Resource Coalition for the Future of PA
Dental Services”“Dental Care now represents the number one health
care issue among people with neurodevelopment disorders.”
Dr. Steven Perlman
Most People Do Not Need Anesthesia, IV Sedation
or ‘Special Care’
A study by Elwyn in 2006 funded by the PADDC found that 70-75% of
people with developmental disabilities can be seen without
extra supports.
Achieva Dental Form The Achieva Dental Form was funded by the
Pennsylvania Developmental Disabilities Council (PADDC), FISA Foundation and
undertaken by representatives from ACHIEVA: The Pennsylvania Office of Medical Assistance
Programs, the Office of Developmental Programs, Department of Public Welfare, as well as the Pennsylvania Northeastern and
Southeastern Health Care Quality Units (HCQU’S).
“Levels of Care” = There is a dentist for everyone.
Although all dentist registered with Medical Assistance (MA) and all MA MCO’s are aware of this form, it has not been officially promoted. If the team feels they can benefit from the use of this form they are welcome to use it.
Send the pre-visit form to the dentist before the visit OR bring it with you.
www.achieva.info OR www.pchc.org
DEMENTIA & ID
THE DOUBLE
WHAMMY
Dementia Screening Tool (DST)
There is no accurate test to rule out dementia for people with I/DD.
Created as a non clinical assessment tool to be used by family members, direct support
professionals and anyone with a supporting role in the life of someone with an intellectual
disability.
Use with accompanying instruction sheet and follow up test sheet.
Initial baseline
Direct observation/communication with the person
First of its kind for individuals with intellectual and developmental disabilities.
Piloted and used at PCHC
Recognized by a National Task Group
Currently being revised to be distributed around the country.
This is NOT a diagnostic tool and a physician will need to rule out other conditions!
Overview: http://aadmd.org/ntg
Practice Guidelines: http://aadmd.org/ntg/practiceguidelines
Early Detection Screen for Dementia (NTG-EDSD):
(includes versions in multiple languages and user manual)
http://aadmd.org/ntg/screening
The NTG Training Curriculum: http://aadmd.org/NTG/training
Usable by support staff and caregivers to note presence of key behaviors associated with dementia Picks up on health
status, ADLs, behavior and function, memory, self-reported problems
Available in several languages
‘NTG-Early Detection Screen for
Dementia’ (NTG-EDSD)
Pages ①②: Basic information Pages ③④: Information
about function and
indicators of problem
areas associated with
dementia
Page ⑤: Coincident
conditions
Page ⑥ Medications
& Comments
www.aadmd.org/ntg/screening
“If we have these conversations, the person will die…If we do not have these conversations, the person will still die.”
Ellen Cameron, Lower Cape Fear Hospice
End of Life Work Group Southeast Pennsylvania
www.pchc.org
Lifespan of people with disabilities
• In 2004, 641,000 people with developmental disabilities were over 60.
• In 2030, 1,242,800 will be over 60
0
10
20
30
40
50
60
70
80
1930's 1970's 1990's
MR/DD life expectancy trend
Down Syndrome life expectancy trend
Combined life expectancy trend
Role of Caregivers & DSPs
Health Promotion Activity Plan (HPAP)
• There are over 130 different HPAP’s
Examples Include:
Asthma
Diabetes
Seizure Disorder
• Each plan is personalized.
• A definition of certain conditions, signs and symptoms
• A plan of action to be made to address one’s illness
• These forms are not intended to replace medical advice.
• Instructions given by a physician regarding the diagnosis should be included in the plan.
Dual Diagnosis = ID + MH
• Developmental Disabilities Council Grant
• Bridging the Gap videos
• Mental Health Challenges Training for individuals
• DDX Curriculum (in-person and on-line)
• WRAP
• CPS (Certified Peer Specialist)
• MHFA (Mental Health First Aid)
• BHID-CTT
• Capacity Building Institute
Peer to Peer Support
Understanding Mental Health Challenges
Behavioral Health Promotion Activity Plans (BHPAPs)
• Supports dually diagnosed (MH & ID)
• Provides clear definitions of common mental illnesses
• Assists in treatment planning
• Helps to identify and track the symptoms of a given psychiatric disorder
• Lists possible behaviorally observable symptoms
• Provides support strategies and examples of psychotropic meds
• REMEMBER: Psychiatric diagnoses should only be made by qualified medical and/or mental health professionals!
Behavioral Health Team Review Form
• A 3 part form designed in order to have a written record/communication between team members, residential, family, behavioral specialist and psychiatrist.
• Used when a person has a mental health diagnosis and being treated with psychotropic medications.
• When filled out correctly, it will improve the quality of care for the individual being supported.
• Provides the psychiatrist with CRITICALinformation about the person in a fraction of the time.
• Use of the form can enhance team communication.
Behavioral Health Team Review Form
Top 10 List: Mistakes people make when using the form
1) Not having diagnosis, target symptoms and medication match.
2) Form incomplete/sections left blank
3) Challenging behavior is listed as a target symptom
4) Target symptoms not clear or specific
5) Target symptoms listed on part 1 do not match those listed on part 2
6) Not filling in a full 5 Axis DSM-IV diagnosis
7) No data collection regarding target symptoms
8) Medication list incomplete
9) Not having a medication reduction plan
10) Dates and signatures missing
Behavioral Health Team Review Form
• All 3 parts should be filled out by the appropriate person with each person reviewing first what was previously written.
• Current Health Status Section is VITALto rule out medical
• This form is very extensive; therefore, additional training on how to properly complete this form can be found on the PCHC website.
In certain counties in the SE Region, Pennhurst class members are mandated to complete the Team
Review Form. The completed form is sent to the Behavioral Health Department after every
psychiatric visit or at lease after every 90 days
Quality Health Care = Quality of Life
Melissa A. DiSipio, MSA, FAAIDDDirector
Philadelphia Coordinated Health Care (PCHC)Southeastern PA Health Care Quality Unit (HCQU)
www.pchc.org