1. Effective referrals for child development needs… How one non-profit is partnering with the medical community to improve the health of Oklahoma children.

2. Objectives Describe the structure and function of a community clinic partnership Framework- Collective Impact Function- Who are we Really Reaching? Describe the benefits of coordinated primary care screening coupled with systematic referrals Examples of Structures OU-Tulsa Pediatric Department Next Steps Developmental Clinic Morton Comprehensive Health Services Private Pediatric Practices Closing the Referral Loop Partnership Opportunities

3. What is Sprouts? Hint… it’s not the Grocery Store Sprouts Child Development Initiative offers developmental resources and information to engage young children in experiences that help them grow! Do this through: Online Developmental Screening Early Literacy Developmental Resources Intervention Outreach

4. Sprouts… Creating a continuum of service for child development Unique service in the community Tremendous case management experience Response to changing child care and healthcare needs Remaining lack of developmental specialist in Tulsa and surrounding areas Needed to put a more formalized structure around child development activities

5. …Through Collective Impact

6. Commitment of a group of actors from different sectors to a common agenda for solving a specific social problem, using a structured form of collaboration

7. Common Agenda Shared Communication Shared Measurements Cascading Collaboration Backbone Organization

8. Common Agenda Increase developmental screening rates for children under 60 months Promote Family Resiliency and Engagement Promote Early Literacy Increase access to child development services

9. Common Measurements ASQ-3 Battell Denver Developmental And more…. All validated tools with measures which are easily built into electronic medical records Sprouts utilizes only best-practices in child development

10. Mutually Reinforcing Activities: We Can’t All Do Everything, But Everyone Can Do Something! Clinical PreventiveNavigational Promotion of Provider/Patient Relationship Empowered Consent and Shared Decision Making Promote Existing Resources to Support Change Behaviors Increase Awareness of Personal Susceptibility Develop. Delays Promotion of Existing Services to Eliminate Barriers into Care Empowered Consent and Shared Decision Making Increase Information Seeking Behaviors for Health Concerns Increased Comprehension and Confidence of Healthcare Delivery System Creation of an Integrated Medical Neighborhood to Improve Access into Care

12. Shared Communication We must address our weaknesses in the process We are trying to partner better here… Emails (secure), faxes, tele-health Early phases of working out a relationship with Doc2Doc services MyHealth has been engaged in developed HIE connectivity

13. Backbone Organization Who is going to manage all of this work??? There is sooo much to do!!! We need: A convener of activities Administrative oversight Creative Minds Passion for Improvement

14. Functions of a Backbone Organization FunctionDescription Strategic Coherence Guide vision and strategic direction Analyze landscape, build common understanding, identify gaps Data Management Collect, house, analyze, report, and provide TA on data Manage development of shared measurement systems Facilitation Manage meetings and logistics, acting as a neutral convener Community Outreach Support meaningful cross-sector community engagement Help develop policy agenda and coordinate advocacy Funding Coordinate grant writing among partners, seek grants Possible: Re-grant, serve as fiscal agent Programs Possible: Pilot innovative programs Possible: Assist is scaling proven programs

15. Collective Impact in Infant Mortality Backbone Organization Family Health Coalition new 5-year Strategic Plan focuses on new direction of collaboration and partnerships Activities are focused on: Healthcare transformation Public/Private partnerships Leveraging shared resources Social marketing Development of child development continuum Collective application for funding opportunities around preventative health

16. We Are Sprouting Across Tulsa

17. Why do Child Development Resources need to partner with the Medical Community? Where are children best observed? Natural environment or Physicians Office Do you know all of the child development resources in the community? Do you have time to case manage and coordinate the care of children with developmental needs? Can you help the parents? We need to work better to understand the natural alignment of our work efforts… This again is an example of why collective impact works for us!

18. Sprouts Child Development Initiative A New Online Developmental Screening Link and Child Development Resource Website (formerly the LINK Project)

19. Transition The LINK Project Sprouts Child Development Initiative

20. LINK Project numbers 2006-2013 6788 children participated in screenings  Suspect developmental 32%  Suspect social-emotional 12%  Minnesota Developmental Inventory NWNL8.5%  Overall monitor or delay identified30-35% Age Groups 0-12 months 9% 12-24 months17% 24-36 months 23% 36-48 months25% 48-60 months19% Over 60 months 7%

21. Challenges 9,500 babies born each year 1,400 spend time in the NICU 500 diagnosed with chronic medical conditions 900 discharged back into the community

22. AAP Statement Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home 1 and an appropriate responsibility of all pediatric health care professionals. 1

25. And please tell us if we can do it better!

26. National Call to Action Healthy child development is multidimensional. 2. Health practitioners are the “first contact” with young children. 3. Exemplary strategies exist that address the multidimensionality of child health, starting with developmental screening. 4. Federal health provisions offer the opportunity to address children’s healthy development. 5. States and communities must be intentional and creative to take advantage of these federal provisions.

28. Examples from the field…

29. OU-Pediatric Clinic Working towards implementation of specialized pilot project focusing on emerging language development; Children will be screening during 30-36 month range for emerging language concerns; Social Work staff is already sending Sprouts team referrals for evaluation for suspected developmental delays; and Reporting channels are still underdevelopment.

30. Next Steps Child Development Business Associate Agreement in place; Next Steps provides triage form to Sprouts staff for review and initial contact with families for developmental services; Sprouts team works with families to conduct ASQ-3 or other required screenings; Reports/evaluations are provided back to Next Steps in secure fashion; and Sprouts provides information on referrals provided.

31. Morton Comprehensive Health Services Embedding services in clinics on specific days weekly/monthly to deliver developmental observations/assessments on patients; This model works for Morton due to FQHC billing and Medicaid billing requirements; Working with Social Work staff to have all families complete online developmental screening; and Going through credentialing process with Morton to assist in billing and increasing access to developmental services.

32. Private Pediatric Doctors Parent Guides Referral Cards Early Literacy Promotion Direct referrals Fax Online Email Expanding to Family Practice partnerships

33. Closing the Referral Loop When an ASQ-3 is completed… What happens next? Reports Evaluations Referrals Case Management Care Coordination Follow-up

34. Sprouts Child Development Initiative offers developmental resources and information to engage young children in experiences that help them grow! http://sproutsdevelopment.com/

35. ASQ LINKS Family Access URL https://www.asqonline.com/family/24016d Screening Management https://www.asqonline.com/screening_managemen t

36. Facebook Facebook https://www.facebook.com/pages/Sprouts-Child-Development-Initiative/188004068048028?ref=hlReferences http://www.nichq.org/pdf/2010_Presentations/A2%20Guevara_James%20ppt.pdf http://pediatrics.aappublications.org/content/118/1/405.full http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH/DuringEarnItPC MH/OtherPCMHResources/FAQsforPediatricPractices.aspx http://www.medscape.com/viewarticle/727970_print