1. Implementing an Innovative Model of Care to Reduce Wait Times and Add Value to the Family and Clinicians Experience Tracy Conley BC Autism Assessment Network PHSA

2. BCAAN Provincial network that provides diagnostic assessments for children and youth (0 to 19) who have been referred for a suspected ASD Most children living in the lower mainland, have their assessments take place at Sunny Hill Health Centre for Children, which is part of BC Children's Hospital

3. Multidisciplinary All children under 6 received an autism assessment, a language assessment, and a psychology assessment as part of their clinical diagnostic assessment package Very time consuming and costly Current research shows that early intervention before the age of 4 1/2 provides the best outcomes for children diagnosed with Autism Spectrum Disorders (ASD)

4. Problem - Wait Times Average wait time of 8 weeks from 1 st appointment to diagnosis. Children and families were often coming back for up to 4 appointments Children would start their assessments and then wait up to 8-10 weeks for a psychology assessment

5. Psychology Psychology assessments look at cognitive functioning of a child – intellectual deficits Psychology resources have chronically been a long wait due to limited numbers of psychologists in the public sector in BC Recruitment and retention issues Not often is an Intellectual Disability (ID) diagnosed in a child under the age of 4 How can we use the scarce and specialized psychology resources where they are best serving these kids?

6. Data Reviewed charts of all children under 36 months who had an assessment in the last year to determine how many had a diagnosis for Intellectual Disability (ID) What we found: ID Diagnosis AgeTotal assessed Total number with +ve ID Dx Percent of total Ages 0-36 months711014%

7. One Year Pilot A team of experienced clinicians and leadership where brought together for a one day Kaizan (workshop) where the philosophy and tools of Lean were used to develop a novel way of providing Autism assessments Arena Assessment model Developmental Pediatrician and a Speech Language Pathologist assessed the child simultaneously during one 3 hour appointment

8. The Arena Assessment Pilot A PDSA (Plan Do Study Act) cycle was used to pilot the new model of care with a small team for a year and the data was analyzed at 3, 6, and 12 months Every family that was involved in the pilot was told in advance that they would be part of a new model of care and asked to complete a post assessment evaluation form The team was comprised of one Developmental Pediatrician, 2 Speech Language Pathologists and one Psychologist on stand by (if an ID was suspected) Limited scope – no ESL, no Tier 4 (complex cases)

9. First 3 Months Challenges: ‒The Speech Language Pathologists had to learn a new assessment tool ‒The logistics of 2 clinicians working simultaneously ‒A vigorous pace of work ‒Concern about psychologist colleagues ‒Self doubt - what if we miss something?

10. 4 - 6 Months Getting into a good rhythm Building arena assessment teams – added another Developmental Pediatrician and Speech Language Pathologist Family satisfaction – 100% Clinician satisfaction – improved – 2 of the clinicians presented the new model of care to Sunny Hill staff – Excited about giving families a diagnosis so quickly

11. One Year of Data n 1st Appointment to Diagnosis (weeks) Date of Referall to Diagnosis (weeks) AverageRangeAverageRange June 2012 – May 2013 229 80-28 3813-82 June 2013 – May 20143120-63118-43 n Average # of visits Range # of visits June 2012 – May 2013 2293 1-5 June 2013 – May 20143121 to 3

12. Outcomes Between June 2013 and May 2014 BCAAN assessed 31 children in the pilot project Majority of families were provided a diagnosis within 0-2 weeks (some families received the diagnosis the same day as the assessment) Families were 100% satisfied with the process Discussed progress at a Performance Wall where staff met once a week Formally reviewed the data at 3, 6, 12 months The median wait time from date of referral to diagnosis had gone from 38 weeks to 31 weeks

13. Results 31 psychology assessments spots were redirected to service older children who need more than a developmental assessment Decreased the wait times for young children and older children Avoided doing unnecessary assessments on young children Less number of visits More satisfaction for families Reduced cost of assessments for children under 36 months High clinician satisfaction with results

14. Challenges Getting buy-in from the clinicians to try a new model of care Lots of concern that the clinicians would not be able to get the information they needed from the family and the child in a 3 hour session The Speech Language Pathologists had to learn a new assessment tool Concern that they were ‘taking away work’ from their psychology colleagues

15. Next Steps In June 2014 we increased the age of eligibility for this assessment model from 36 to 42 months Included ESL and doing some Tier 4 assessments using this format (2 clinicians doing multiple assessments) Now have 4 Developmental Pediatricians and 4 Speech Language Pathologists doing the arena assessments

16. Lessons Learned Gather data and share it along the way as this shows the team the progress they are making and increases during the initial phase and the planning of phase 2. Pilot, pilot, pilot. Use the PDSA cycle to trial new initiatives before full implementation Ensure you have a small, competent team involved in the development from the beginning Change is difficult and the learning of new processes can be challenging but can be managed with ongoing support and communication