Pediatric Regional Integrated Services Model

Purpose The purpose of the Pediatric Regional Integrated Service Model (PRISM) is to provide streamlined coordinated screening, assessment, planning, service provision and follow-up to children and their families to achieve optimal functioning in their environment.

Philosophy We believe: Health outcomes are improved for children and families when they are supported early in life In family-centered service All families are diverse and unique and have capacity to participate in processes that support reciprocal communication with professionals and agencies involved Opportunities to increase knowledge are enhanced through collaborative models that utilize the expertise of all involved

Child & Family Services * Family Supports for Children with Disabilities * Family Enhancement Workers Complex Needs Committee Early Learning and Child Care *Preschool opportunities Mental Health Parental Supports * Parent Link Centres * Home Visitation Programs Public Health Services * Early Intervention Program * Public Health Nursing * Genetics * Nutrition Services * Oral Health Rehab Services * OT *PT *SLP * RT * Audiology School Divisions SHIP Cross-sectoral sharing of information Joint Assessment Collaborative service planning and provision Improved outcomes for child and family Screening (ASQ) Referral Centralized Intake Case Review Assessment Referral to Secondary Level Assessment (Neurodevelopment / FASD) Service Planning Family Service Plan (FSP) Individual Program Plan (IPP) Reporting Service Provision Follow up / Evaluation Partnerships and Services Regional PRISM Process Results for Family and Child

Screening / Consultation Education / Health / Children’s Services / Physicians / Other Agencies No further service required Inquiry / Request Regional Central Intake/ Integrated Case Coordination Unclear needs Single Service Need Situational Review – Ad hoc Local Service Coordinator Identified Collaborative Assessment Family Service Planning and Delivery Follow-Up/Transition Discharge Regional Secondary Pediatric Assessment & Recommendations (i.e. FASD/Neuro) Tertiary Consultation (i.e. Glenrose Hospital) Access to East Central Complex Needs Review Team PRISM Pediatric Regional Integrated Services Model Service Model Existing efforts exhausted * At any time the participating agencies / services may vary based on the needs of the child and family (This model is imbedded within a Population Health approach)

Has Concerns ASQ given to parent by screen facilitator Parent completes ASQ with assistance as needed Parent returns completed ASQ to screen facilitator who dispersed/provided it No Concerns Screen Facilitator sends family a form letter and Activity Sheet. Screen facilitator forwards ASQ score sheets to Central Intake for statistical collection Screen facilitator talks to family re: referral to professional Agreement No agreement No further family involvement – screen facilitator forwards screening scores to Central Intake for Statistical Collection. Screen Facilitator sends family a form letter inviting them to revisit or call for questions or concerns; included with the form letter is the age appropriate Activity Sheet. Screen facilitator sends screening scores / other additional information as available to Central Intake Screen facilitator scores ASQ Alternate Screening Tool completed by Education staff SCREENING INTAKE FLOWCHART

Goal 1: PRISM will support collaborative, community-based team development and integration of services that support children and families Develop a framework Increase cross-sector collaboration –Advisory Committee –Local interdisciplinary, cross- sector teams –Infrastructure of support for teams Increase knowledge and skills –Comprehensive learning plan Implement Central Intake –Referrals & ASQ results

East Central – 9 counties/municipal districts

Goal 1: PRISM will support collaborative, community-based team development and integration of services that support children and families Develop processes that actively incorporate families’ participation –Information sharing –Consents –Participation in IPP/FSP –Family Capacity Building –System level participation

Goal 2: To enhance children’s/families’ access to developmental screening, assessment, services, and integrated case management Increase the # of access points for developmental screening Increase the # of opportunities for screening children aged 6 to 60 months Increase the # of access points for collaborative team assessment & service Increase family participation in service planning

Goal 2: To enhance children’s/families’ access to developmental screening, assessment, services, and integrated case management Increase the # of children & families that have access to: –Regional Case Coordinator –Local Service Coordinator Improve timely service delivery –Population –Targeted Community –Individual Increase access to Program Unit Funding

Goal 3: To maximize the capacity of parents to maximize their child’s ability to function Increase parental knowledge of –General child development –Community supports Increase parental confidence for –Handling of child’s needs –Advocating on behalf of the child –Engaging in system change

Goal 3: To maximize the capacity of parents to maximize their child’s ability to function To improve child functioning in their natural support environment To improve health-related quality of life for –Children and –Parents

Ultimate Outcome: Children living an Optimal, Quality Life