Communities Coordinating for Healthy Development: Minnesota’s ABCD III Initiative National Academy for State Health Policy Annual Conference October 5, 2011 Castellano

Project Overview Purpose of the project – To improve linkages between primary care providers, medical specialists, and other child and family service providers in the community to support the healthy development of Minnesota’s children ages birth to 3 years – Build upon previous initiatives (ABCD II and ABCD Screening Academy) – Focus is on referral, care coordination and building a system within the community 2 Castellano

Project Structure 4 pilot community teams including: a clinic and early intervention, plus public health, Head Start, and others Clinic has a designated care coordinator Clinic conduct universal developmental and mental health screening Early Intervention program willing to work with clinic staff to improve referrals 3 Castellano

CCHD Participating Communities 4 Castellano

Team Project Participation Attend annual in-person learning collaboratives Participate in monthly technical assistance phone calls and/or webinars Hold regular, local team meetings (monthly) Use Model for Improvement PDSA cycles for QI Participate in project evaluation activities (monthly data submission, annual surveys) 5 Castellano

Technical Assistance to Teams Attend team meetings Assist with quality improvement process Help teams figure out how to collect the evaluation data at their site Provide sample forms and materials from other sites or states Assist in setting up and using the Access database for tracking Topical webinars over the lunch hour Annual learning collaboratives 6 Castellano

Technical Assistance Webinars October Screening and Referral November Help Me Grow and Care Coordination February 2011 – Implementing screening tools and a referral system (Park Nicollet Clinic System) March 2011 – Data gathering and tracking for HMG (Wilder Research) April 2011 – Coding and Billing May 2011 – ABCD III Baseline Data Upcoming – Help Me Grow/IEIC restructure and how to engage and involve parent partners 7 Castellano

Community Based Activities Community teams meeting regularly Clinic consent forms in use Teams using referral/feedback forms between HMG and clinic Written protocols for clinic flow and clinic/early intervention communication Clinics using Access database or other tracking system to support care coordination 8 Castellano

Health Care Home Helps Parallel activities to HCH requirements and measures: – Access data base meets all HCH referral tracking requirements – Care coordinator role similarly defined – Expectations regarding follow-up – A clinic improvement team in place w/parents Most participating clinics viewed ABCD III as step toward preparing for Health Care Home certification 9 Castellano

Systems Based Activities Joint Human Services and Education Dept. trainings to enhance billing for early intervention services Continued work on consent forms w/Dept. of Ed Enhancing early intervention statewide on-line referral to give providers local contact info for follow-up Refining data base MOC4 application Developing standardized referral and feedback forms 10 Castellano

St. Luke’s Clinic Referral Process 11 Castellano

St. Luke’s Clinic Referral Process 12 Castellano

St. Luke’s Clinic Referral Process 13 Castellano

Evaluation & Measurement Frequency: baseline and each subsequent year of the grant for most measures Five surveys: – Parent – Provider – Help Me Grow/Early Intervention staff – Clinic administrators – Care Coordinators Clinic tracking data, monthly reports 14 Castellano

Provider Referrals 15 Castellano

Parent Survey Majority of parents said they completed a questionnaire of child’s development (63%) and mental health (56%) some time in the last year Less than ½ of those whose provider noted a concern were referred to HMG Parents reported referrals most often to specialists (18%), followed by community services (10%), Early Intervention (7%) 16 Castellano

Parent Survey Providers discussed next steps with ½ of those receiving mental health screening and 62% receiving developmental screening 12% of families indicated they were receiving care coordination from their clinic 7% said that they need someone to coordinate their child’s care 17 Castellano

Early Intervention Referrals since January, Castellano

What We’ve Learned Office flow very individualized, everyone has to invent their own wheel, would be hard to role out en masse Written protocol an important step State agency restructure of EI changed local contacts Clinics in the midst of other projects (EMR) struggled Helps for clinic and EI staff to meet each other Some EI programs discouraging “too many” referrals – 2 way communication helps build trust on both sides Previous clinic experience with QI important, or teach it to them 19 Castellano

Contacts Glenace Edwall: Susan Castellano: Meredith Martinez: Ruth Danielzuk: Catherine Wright: Castellano