Sustainability & Spread:Continue, Change!

Marian Earls, MD

Amy Pirretti, MS

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Disclosures

We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in our presentation.

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Systemic Challenges

o Integration of Family-Centered Principles: e.g. continuity, comprehensiveness, coordination, cultural sensitivity.

o Facilitation of networking between community resources that have historically been in “silos.”

o Paucity of mental health services, especially for 0 – 5 year olds.

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Systemic Challenges (cont.)

o Additional risks for children living in poverty or in foster care (continuity especially important).

o Lack of reimbursement for care coordination.

o Uninsured and underinsured. Many insurance/HMO plans have inadequate or deny coverage for services for CSHCN

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Challenges for the Primary Care Practice

Treating the “whole” child: in the context of the family, the school, the community.

Adopting an Office Systems approach Operationalizing family feedback as part of the

practice system Considering family needs as well as office needs

for scheduling and logistics Enhanced processes for CSHCN: registries,

scheduling tailored for longer visits, linkages to community resources, assistance with referrals

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Challenges for the Primary Care Practice

o “Knowing the system” of public and private providers locally

o Networking with community partners effectively

o Maintaining continuity and communication with specialists, child care, school, …(Wraparound)

o Assuring child and family role in care planning for a child/adolescent who has a chronic/complex condition

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Challenges for Families

Knowing the important components of preventive care (screening, continuity, etc)

Knowing how to choose a medical home: what questions to ask

Feeling comfortable with communication and raising concerns and priorities.

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Sustaining Change

Fundamental change in office systems Practice – wide guideline

How do you get buy-in that these changes will be practice-wide?

All Pediatrics

Process is routine Process is reliable, and does not depend on

particular staff to be present to occur Roles at each level are clear and understood

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Reliability

Level 1 – outcome goal, practice guideline, 80-90%

Level 2 – checklists and observation, redundancy, standardization of process, PSPS, 90-98 %

Level 3 – real time awareness of failures, daily monitoring, resilience, >98%

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Sustaining Change

New kind of communication with community

Relationship with key partners Networking to facilitate process beyond practice Agreements on how to exchange information, e.g.

standardized referral process/form How did you help link families to community

resources? What barriers did you face?

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Establishing Relationships

Invite community resource representative's) to the practice for lunch & learn re processes for communication and referrals.

Have periodic meetings with partners who provide “wraparound” services for patients and families.

Have evening “mixer” for primary providers and community mental health providers to establish contacts.

Compile contact information and identify staff to be the liaison for the practice.

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Sustaining Change

• Participatory role for parents/family Parent is partner in care

Parent helps drive change by asking for service

Parent gives feedback on referral sources and communication process

How do we get families more engaged? Have you received any feedback from families about

the changes in your practice?

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Bright Futures Champions

You are a Bright Futures Champion!EQIPP to Continue Change Involvement with Bright Futures at the

State/National levelWhere we are going next: Bright Futures

and Chapter Quality Network

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Bright Futures 2011 & Beyond