 1. The changing epidemiology of pediatric practice.  2. The emergence of new technology.  3. The impact of racial and ethnic disparities.  4. The greater prevalence of women in pediatric practice  5. Changes in health care financing.  6. International models.

 Better disease prevention  Improved care of kids with chronic disease  Increased survival of VLBW babies  Results: 75% of health care dollars goes to kids with chronic and disabling conditions  CSHN are 12.8% of kids <18  Almost 60% of parents of CSHCN do not feel partnership with providers of care

The child is a 5 year old born full term to a woman with bipolar disorder and p.t.s.d. Normal L&D. 4 mos of age: surgery for a vascular ring ended badly. Chylothorax, chest tube, seizures, acidosis, ventilator. Child currently has a developmental level of a two year old, is in special education, has required a g-tube, orthopedic procedures for contractures and dislocated hips. Currently in the Model Waiver Program.

 Parent/Guardian  Pediatrician  School Staff  Funding Agency  Attorney/ GAL

 Different Definitions  Different Styles  Different Perceptions of Self/Others  Everybody thinks they’re the most important

Goals Objectives Methods Metrics of Success …..Progress …..End Point(s)

 The use of lay health workers, compared to usual healthcare services:  - probably leads to an increase in the number of women who start to breastfeed their child; who breastfeed their child at all; and who  feed their child with breastmilk only;  - probably leads to an increase in the number of children who have their immunization schedule up to date;  - may lead to slightly fewer children who suffer from fever, diarrhoea and pneumonia;  - may lead to fewer deaths among children under five;  - may increase the number of parents who seek help for their sick child.

 Role Separation  Overestimation and Disappointment  Realistic Appraisal  Accommodation  Integration

 Structure of Stages:  1. Information Exchange  2. Role Clarification  3. Goal Clarification  4. Negotiation  5. Decision Making

 Role Sep: Traditional Boundaries  Disappointment: Inapp. Expectations  Realism: Open to accepting info from each team member  Accommodation: Info shared compliments that from other team members  Integration: Recognition of expertise and special knowledge

 Role separation: Maintain traditional roles  Disappointment: Role Ambiguity  Realism: Recog of potential contribution; less boundaries  Accommodation: Permeability of boundaries  Integration: recog of expertise and spec. capabilities

 Goal setting remains separate----   Systemic view of Goals Negotiation Anxiety, competitiveness----  Non-threatening, open comm

 Role Separation: Power of position  Disappointment: Overestimate of ability to make decisions  Realism: More open to mutually-agreed upon decisions  Accommodation: Increasing agreement on decisions of intervention  Integration: Sharing of moral responsibility

 Increasing numbers of children with special needs demand a collaborative approach  Community Partners need to understand the new model of the, “office without walls.”  The new model requires an appreciation of the models for collaboration