concerned about development : ohio’s initiative to improve care and outcomes for children with...
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Concerned About Development:Ohio’s Initiative to Improve Care and Outcomes for Children with Delayed Development, Autism, and Social-Emotional Concerns
A collaborative program effort among the Ohio chapter of the American Academy of Pediatrics, Akron Children’s Hospital, the Center for Health Care Quality
at Cincinnati Children’s Hospital, the Kent State Family and Child Learning Center and
The Ohio Department of Health and the Ohio Department of Job and Family Services
Concerned About Development Initiative
Raise awareness about importance of screening Marketing campaign Website
Train clinicians (learning collaboratives)
Develop diagnostic partnerships in local communities
Strengthen referral linkages
AUTISM DIAGNOSIS EDUCATION
PILOT PROJECT
Engage families, child care providers, educators, health care professionals, and community leaders in finding ways to promote early identification of autism using standardized methods, while facilitating regional coordination of timely service linkages for families of children with developmental delays like autism.
Ohio Department of Health to Ohio chapter of the American Academy of Pediatrics
Medtapp Developmental Screening Implementation Project
Ohio Department of Job and Family ServicesUniversity of Cincinnati/Cincinnati Children’s Hospital Medical Center
Outcomes to date 85 Practices trained through CADLC
8-month collaboratives beginning with Web-based (2) or Face-to-Face (12) Learning Sessions from 9/08 to 3/09
CADLC has reached nearly 900 of Ohio’s 2,173 licensed general pediatricians, including 6 residency programs.
Twenty-eight community-based diagnostic partnerships formed to aid in enhanced evaluation. 140 attended Diagnostic Partnership Training 4/15/10-4/16/10 100 attended ADOS Training 4/22/10-4/23/10 Ongoing support for reliability and implementation planned through
December 2010
Collaboration with ODJFS Bureau of Child Care and ODH Healthy Child Care Ohio Focus group held 4/29/10 with Child Care Providers to identify needs re:
developmental screening
13,000 visitors to www.concernedaboutdevelopment.org Extensive media placement across Ohio
CADLC: Screening for autism and delayed development
# of Participating
Teams
# of Teams with >25% Medicaid Patients
ADSLC (Pilot)Sept/Oct 08-May 09
22 12
CADLC Wave 2009Sept/Oct 09-May 10
30 22
CADLC Wave 2010Feb/Mar 10-Oct 10
33 28
TOTAL 85 62 (73%)
OHIO MEDICAID 96110 Claims Data – (Quarterly)
Note: about a 6-7 month lag time in Medicaid claims data availability
AAP GuidelinesIntroduced for
DevelopmentalScreening
AAP GuidelinesIntroduced for
AutismScreening
ADEPPBegins
ADSLCBegins
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
2006 2007 2008 2009
9611
0 S
cree
enin
g R
ates
at
EP
SD
T V
isit
sfo
r C
hil
dre
n o
n M
edic
aid
24 mo
18 mo
9 mo
LCL
UCL
Per JFS claims data, at least an additional 8258 screenings done in children on Medicaid between January 2008 and present (underestimate)
Baseline01.06-12.07
Intervention rate01.08-09.09
# kids screened > baseline
9 m 8.6% 10.0% 1801
12 m 8.8% 9.2% 803
18 m 7.4% 11.5% 3134
24 m 7.2% 10.7% 2520
Referrals to Ohio Help-Me-GrowReferrals July 2006-
June 2007July 2007-June 2008
2009 2010
Hospitals 41077 39212
Families 14609 14618
Child Protective Services
5226 6306
Social Service Agencies
7157 6169
Help Me Grow
5513 5896
Physicians 2099 1932 ?????? ??????
Early Care and Education
538 499 Obtaining
this data
Total 81432 78850
Findings from the Pilot Diagnostic Partnerships
Diagnoses (N = 45) Number %
Autism 14 31%
“ASD” (PDD-NOS) 5 11%
Aspergers 1 2%
TOTAL ASD 20 44%
Language Delay/Disorder
13 28%
Language + Behavior 4 9%
Language + Motor 1 2%
Global Delay 5 11%
ADD 1 2%
No Clinical Dx 1 2%
Findings from the Pilot Diagnostic Partnerships
Diagnosis x Age (N=45)
Age ASD Other
< 12 months 0 1
13-24 months 4 3
25-36 months 5 3
Total < 36 months 9 7
37-48 months 3 10
49-60 months 6 5
> 60 months 2 3
Total > 36 months 11 18
Findings from the Pilot Diagnostic Partnerships
Group(All groups are parent report)
Age ofFirst
Concern
Age First Talked to Someone
Age at Diagnosi
s
Concern-Diagnosi
sLag Time
ADEPP Initial Focus Groups(N = 43 children)
28 54 28
ADEPP Dx Partners (ASD, N = 17)
22.6 29.1 42.9 20.3
Findings from the Pilot Diagnostic Partnerships
Diagnostic Group(All groups are parent report)
Concern-Diagnosis Lag
Time(in months)
IAN 2010 Ohio
(N = 301)
ADEPP Dx Partners(N= 17)
Autism 21.6 17.1PDD-NOS 27.4 24 Asperger 55.3 44
Partners and Funding
ADEPP receives $300,000 in funding through ODH through June 30th 2010.
Cincinnati Center For Health Care Quality receives MEDTAPP funding through June 2011
ADEPP has received nearly $60,000 in regional and federal grants for added support.
Lessons Learned
Content and process both matter. We’re dealing with comprehensive
systems change. It’s hard work, but it can be done. When it works, it works well. Community spirit is essential. Local People. Local Situations.
Local Solutions.
Next Steps
April 2010-June 2011: Enhanced public awareness campaign through social and on-line media. Print campaign if funded.
June 2010: Distribute Resident Orientation to Developmental Screening Module to all Ohio Pediatric and Family Medicine Programs
April-December 2010: Support 2010 Diagnostic Partnerships
April 2010: Identify needs of child care providers re: developmental screening
May 2010: Wrap up 2009 CADLC May-September 2010: Complete 2010 CADLC
Next Steps May 2010: Develop Online Developmental screening
module in collaboration with American Board of Pediatrics for ongoing training of clinicians
July 2010- March 2011 : CADLC Learning Session 7/27/10, Akron16 sites, 90 additional practitioners already signed
up (58 physicians, 2 NP’s, and 30 residents)Will now include all 8 pediatric residencies in Ohio
Fall 2010- June 2011: Determine interest in training by Family Medicine
Residencies and develop planDiagnostic Partnership training and support
25 additional counties
Potential Next Steps--a pilot using subset of engaged group of Ohio pediatric practices: Addressing Mental Health Concerns in Primary Care (Using AAP recommendations and toolkit)
Mental Health Practice Readiness Inventory
Mental Health Care Delivery Algorithms • Algorithm A—for promoting social-emotional health, eliciting and addressing concerns or symptoms, and triaging for problems that require further assessment or referral • Algorithm B—for assessing and managing social-emotional, mental health, or substance use problemsCommunity ResourcesHealth Care FinancingSupport for Children and FamiliesClinical Information Systems/Delivery System RedesignDecision Support for Clinicians