Population Health Approach For Pediatric Healthcare: Establishing the Inland Empire Autism Assessment Center of Excellence (AACE) Family Voices Annual Health Summit March 14, 2016 Peter Currie, Ph.D. Copyright 2016

Medi-Cal Expansion - Source: Covered Ca

Effect on IEHP Membership ,000 Members ,000,000 Members ,125,000 Members

Mental Health in CA 4  4 million adults in California suffer from mental health illness  Serious Mental Illness in Adults  Serious Emotional Disturbance in Children Source: CHCF Total Adult Population = 29.6 million Total Child Population = 9.2 million

We are painfully aware… That healthcare finances have been wired so that we don’t have enough staff or time to meet the needs of Children and families with the resources we have today. So We Look for Better Ways to Leverage What We Have. Dale Jarvis, 2016

Why focus on Autism Assessment? CDC estimates as many as 1 in 68 children have ASD. Legislation mandates behavioral treatments driving demand for treatments that are not well understood or coordinated. CMS Guidance 7/07/2014 extends mandate to Medicaid Plans resulting in the Transition in responsibility for Behavioral Therapies from Regional Centers to Managed Care Plans The cost of ABA treatments may vary from $40,000 to $140,000 per child per year - without credible assessment and diagnosis treatment authorization is often based on cost rather than clinical criteria.

The Problem Late Diagnosis = Late Intervention = Diminished Quality of Life & Higher Life-Long Care Cost 7 Yrs old 5 Yrs old 4 Yrs old 2 Yrs old Age diagnosis can be reliable & valid Nationalaverage ofdiagnosisof ASD Average ageof ASDdiagnosis inthe InlandEmpire Average ageof ASDdiagnosis ofLatinoChildren in the InlandEmpire

Scarce Resources Quality of Life For Parents, For Children Kids with Autism Deserve The Right Diagnosis and Timely Treatment Scarce Resources Fragmented System

Collaborative “Child Centered” Model IEHPDBH Co Mental Health Primary Pediatricians LLUHC SB Dept of Education UCRMolina First 5 San Bernardino Riverside Dept of Education IRC First 5 Riverside

Inland Empire (IE) ASD Collaborative Vision: “Every child in the Inland Empire will have access to a collaborative, organized, integrated and Trans- Disciplinary Assessment/treatment resource for Autism.” Mission: “To meet the autism community’s needs through shared responsibility for a comprehensive and Trans- Disciplinary assessment, Treatment Recommendations, Referrals and Resources in order to maximize the quality of life for children in the Inland Empire with Autism and their families.”

AACE: Creating “Child Centered” Comprehensive Assessments Early Intervention leads to a higher quality of life & functioning Interagency collaboration improves referrals and aligns providers and educators Comprehensive Assessment eliminates wasted time & duplicative assessments “One Stop Shop” reduces parent’s burden of having to advocate and coordinate across multiple agencies

AACE Assessment Team Launched 1/2015 – Moving to New Facility

AACE Utilization Rates * Video courtesy of Youtube.com Averaging 40 patients a month  50% of evaluations are diagnosed with ASD Growing Wait List – currently 88

IEHP ASD Referrals 2015 ACCESS To Autism Services Totals Previously Reported thru (9/15/14-9/30/15 October Monthly Totals (10/1-10/31/15) November Monthly Totals (11/1-11/30/15) December Monthly Totals (12/1-12/31/15) Cumulative Totals thru 12/31/15 Total number of calls/inquiries received regarding BHT services: Total number of members referred for a comprehensive diagnostic evaluation: Total number of members who have completed a comprehensive diagnostic evaluation: Total number of members referred for assessment: Total number of members who have completed an assessment: Total number of members receiving BHT services:

Outcome Oriented Objectives Reduce the average age for ASD diagnosis & access to early intervention from 5 to 4 years and from 7 to 5 years of age for Latino children by 2016  Autism Society is measuring this year – likely to not meet goal but show progress in 2016 Improve the quality of life for ASD children and families measured by a pre and post AACE Assessment Survey  Satisfaction Survey to be implemented when AACE Opens in new location in April

Comprehensive Diagnostic Evaluation Follows the “Gold Standard” of Autism Evaluation (Filipek, Accardo, Ashwal, Baranek, Cook, Dawson, et al, 2000) : Parent Interview regarding current concerns and behavioral history related to autism Autism Diagnostic Observation Schedule (ADOS-II) Medical & neurological evaluation – Screening for common related conditions such as sleep and GI problems – Includes audiology, lead levels and EEG (when regression is noted) Speech, language, communication evaluation including pragmatics Cognitive and adaptive behavior evaluations Sensorimotor and occupational therapy evaluation Other Neuropsychological, behavioral, and academic evaluations (as appropriate)

AACE Trans-Disciplinary Team TEAMING MODEL Pediatric Neuropsychologist Developmental Behavioral Pediatrician Occupational Therapist Speech Language Therapist Genetics testing: MRI, EEG, EKG, Sleep- study are also available if deemed appropriate.

Transdisciplinary Clinical Assessment Team 18 Pediatric Neurologist, Developmental Behavioral Pediatrician, Geneticist, Neuropsychologist, Neuro-developmental Psychologist, Speech/Language Therapist, Occupational Therapist, Educational Psychologist, Pediatric Mental Health Clinician, Assessment/Evaluation Coordinators, Medical Assistant

AACE Goals  Be recognized by medical treatment providers, school districts, behavioral health and social service programs as a trusted and credible assessment provider  Provide families and providers with useful, appropriate and actionable treatment recommendations, referrals and resources  Be financially self-sustaining 2 years after start-up  Create a model that can be replicated in other communities.

Lessons Learned Watch the horizon, start when you see the first sign of opportunity and be in position when the wave peaks. Selecting the right balance of agency partner organizations required thoughtful selection and periodic reconsideration. Multi-agency collaboration takes time, persistence & lots of communication. Enlist consumers (Inland Empire Autism Society) early because doctors don’t know everything these children need. Involving the payer - IEHP (Medi Cal Plan) and the key start-up funding source (First 5) in the Collaborative from the start resulted in a seamless transition from planning to funding.