1. Building a Community of Caring The WATCH Project Using Technology to Promote Communication and Collaboration within the Early Intervention System Juliellen Simpson-Vos, M.Ed, Joshua J. Alexander, MD The University of North Carolina at Chapel Hill School of Medicine

2. Who Are We? n Joshua Alexander, MD Director of Pediatric Rehabilitation and TelAbility Program Director UNC School of Medicine n Juliellen Simpson-Vos, M.Ed TelAbility/WATCH Project Director

3. Where did we come from? n Our TelAbility Center is located in Chapel Hill, NC.

4. What are we going to talk about? n History of our telemedicine programs n Services and Outcomes of the WATCH Project n Successes, Challenges, Lessons Learned n Definition and Elements of a Successful Community of Practice n Questions and Resources

5. What is TelAbility? What is TelAbility? An Internet-Based Telehealth Program For Young Children with Disabilities http://www.telability/org

6. Goal #1 Connect people in different locations to increase access to specialized healthcare services for families and decrease professional isolation

7. Goal #2 Serve as a resource for parents and professionals seeking credible and reliable information on topics related to children with disabilities

8. Population Served n Birth – 5 years old n Cerebral Palsy n Spina Bifida n Down Syndrome n Brain Injury n Feeding Difficulties n Developmental Disabilities n Special Needs

9. 1998

10. End-user Locations

11. WATCH Wake Area Telehealth Collaborative Helping Children with special needs

12. Building a Community of Practice “ A group of people who share a concern, set of problems, or passion about a topic and who deepen their knowledge and expertise in this area by interaction on an ongoing basis.”

13. Who does WATCH Serve? n There are over 1000 children ages birth-3, who meet the eligibility criteria, to currently receive early intervention services through the Raleigh CDSA. n There are over 1100 children ages three through five, who meet the eligibility criteria, to currently receive intervention services through Wake County Preschool Services.

14. Inclusive Child Care Centers n Learning Together n Lucy Daniels Center n Project Enlightenment n Tammy Lynn Center n White Plains Children’s Center

15. Service Programs n Community Partnerships for Children n Learning Together n Pediatric Therapy Associates n Carolina Pediatric Dysphagia n Project Enlightenment n Lucy Daniels Center n Developmental Therapy Associates

16. State Agencies n The Raleigh Children’s Developmental Services Agency (ages birth-3) n Wake County Preschool Services (ages 3-5)

17. WATCH Current Programming Website Content /Expertise Directory Listserv Newsletters Videoconferencing

19. Other Website Features n Expertise Directory n Handouts n Links n Calendar n Books n Articles n Videos n More!

20. n 2005 = 60 n 2008 = 310 Expertise Directory

21. WATCH@listserv.unc.edu n 2005= 29 n 2008= (253)

22. Electronic Newsletter Subscribers= 395 n Website Updates n Event Listings n Center Descriptions n Article Reviews n Tips and Topics n Project Updates

23. Videoconferencing Videoclinics Videoconsults Professional Development Sessions Point to point meetings (administrative, family visits, etc.)

24. Videoconferences By Type December 2005-February 2008

25. Videoclinics and consults n 44 videoclinics and consults have been held Involving 358 families, therapists, and medical personnel Satisfaction level average =4.81 out of 5.0 Comfort level average = 4.96 out of 5.0

26. Professional Development Sessions n 26 Professional Development Session have been held via videoconference Involving 943 therapists, EISC, parents, teachers, EI providers Satisfaction level average =4.1 out of 5.0 Comfort level average = 4.3 out of 5.0

27. Professional Development Data Continued… n Sessions were held free of charge to participants n Infant Toddler Certification credit was offered for all sessions n Sessions are based on WATCH Member needs, interests and suggestions n Session cover all EI domains (PT, OTR/L, SLP. Medical, Mental Health, Developmental, Education)

28. Networking Data n 13 Networking sessions have been held via videoconference 100 people participated Satisfaction level average= 4.16 out of 5.0 Comfort level average= 4.5 out of 5.0

29. Administrative Videoconferences n 11 Administrative meetings have been held between WATCH Sites and Wake County Agencies Involving 113 participants Satisfaction level average = 3.8 out of 5.0 Comfort level average= 4.45 out of 5.0

30. WATCH Recap Since December of 2005… n 80 videoconference session have occurred n Involving over 1358 people n The average satisfaction rating for video conference sessions is 4.4 (out of 5) n The average comfort level for video conference sessions is 4.6 (out of 5)

31. Travel Savings n April 2007-February 2008 518 participants have participated in videoconferences Miles saved by offering sessions via videoconference = 31,603 Travel costs saved = $15,959 in gas (31,603 x.505) Doesn’t include time out of the office, food, etc.

32. WATCH Benefits for Providers n Responsive to community’s needs and interests n Increases professional development and education opportunities n Increases collaboration with other locations and professionals n Reduces professional isolation n Improves communication and care coordination efforts n Reduces travel time and costs

33. WATCH Benefits for Parents n Improves communication and care coordination efforts n Reduces feelings of isolation from their child or the professionals caring for their child n Reduces travel time and costs n Allows for long term care coordination n No extra charge to use the technology

34. Challenges n Lack of technical knowledge and support at sites n Sustainable funds to cover costs of high speed internet connection n NC won’t reimburse therapists for care offered via videoconference. n Small monitors of the Tandberg 1500 n Buy in/consistent participation from all sites (turnover, time constraints, etc.) n Establishing a public network/technical support issues Modems provided by local services providers are often incompatible with unit software upgrades

35. Lessons Learned n Technical Support Need for a consistent, knowledgeable, easily accessible IT support person. First attempts to establish a public network system was unreliable. Purchase and installation of a border controller has helped to stabilize the network.

36. Lessons Learned cont. n Programmatic Support Fully funded Project director position is necessary to coordinate communication and activities within the project and be point person for IT problems. Needs assessments of each site and frequent communication with each site is vital to success. The collaborative should consist of sites with specific expertise to help meet the collective needs of the members. Professional development opportunities great opportunities for sites to network, share expertise, and gain knowledge Reimbursement of therapists through grant funding increases the likelihood of participation in videoclinics and consults..

37. Quote from WATCH Service Agency Director : n “…Some days things can be very difficult with the day to day demands of patient care and administration of a practice but your educational options, along with your organization communication skills are a very positive exciting thing for a provider. It is so much easier to participate in these sessions because: 1.They are on practical topics of interest 2.They are on a Friday, not in the middle of a patient care day. 3.They are well organized and the handouts are sent by you ahead of the presentations 4. You take care of the registration and curriculum outlines and the speaker organization 5. The scope of the presentations are well organized for the time segments allowed 6. They are free, and obviously very appreciated. “

38. WATCH is only as successful and useful as the collaborative members make it!

39. Elements of a Successful Community of Practice n Champion for the Cause n Collaborative Coordinator n Technical Support n Member buy-in

40. How to Make Useful to CPD n What is your need? n How would a telemedicine collaborative help to meet those needs? n Who would you look to be a part of your collaborative? (agencies, services) n What services could your agency offer the collaborative? n Who might be your champions? n What do you see as the initial challenges?

41. n “Instead of all competing or working as separate entities, WATCH allows for us all to come together for the greater good of the child and family.”

42. Future Goals

44. Using the Tandberg 1500: The System n Camera n Monitor (on/off switch) n Base with built in microphone (on/off switch n Two power cables n Remote control (see handout)

45. To begin… n When the system is not in use it is in stand by mode. The screens are black. n Wake up the system by picking up or pressing any key on the remote control. n When “ON” you will see the Welcome Screen which presents the main menu and camera image.

46. Making a Call n Use the menu to control the system. n You will primarily use the Make a Call option. n You can enter the number in manually or select the book icon to get a number from your phone book. n Select Place Video Call. n This system has multipoint capabilities which means you can call up to 3 other locations at once. n Choose Add Video Call and more dial fields will appear.

47. Answering a Call n You can receive calls anytime, even in Standby mode. n Your unit is currently in auto answer mode so it will automatically connect/answer to an incoming call. n To answer a call: 1. Press OK or the green key on remote control 2. Press the red key to reject the call

48. To End a Call 1. Press End Call from the Main menu or red key on the remote control. 2. Press the red key on the remote control again or OK to confirm that you want to end the call. To End a Multipoint Call 1. Press the red key on the remote control. 2. A list of participants appears allowing you to end each call separately. Select a participant and press OK or the red key. 3. Press End All Calls if you want to end the whole conference. Let’s give it a try…

49. Phone Book n The phone book stores up to 200 contacts. n Includes last number dialed. n All WATCH sites are listed in the phone book.

50. Etiquette Guide

52. Mute Button Tips n Use during multipoint conferences n Use when your location is not talking n Use when shuffling papers, sneezing or coughing, or when making other distracting noises n Use during side conversations

53. Resources TelAbility website http://www.telability.org The Children’s Partnership Brief: The Role of Telemedicine http://home.graffiti.net/tcpaccessible/ telemedicine.html American Telemedicine Association website http://www.atmeda.org Information Exchange http://tie.telemed.org/default.asp Cultivating Communities of Practice (Hardcover) by Etienne Wenger (Author), Richard McDermott (Author), William M. Snyder (Author)Etienne WengerRichard McDermottWilliam M. Snyder

54. Questions for us? Joshua Alexander Joshua_alexander@med.unc.edu Juliellen Simpson-Vos jsimpvos@med.unc.edu (919) 843.0427 http://www.telability/org