1. VISION: Possibilities, Potentials and Progress Addressing unmet Regional Healthcare Access for Children

2. Need: SE TN was an Underserved Region for Developmental Behavioral Pediatrics 2007 National Survey of Children with Special Health Care Needs in TN revealed: Approx. 132,000 children [46.1%] age 4 months to 5 years were at moderate to high risk for developmental, behavioral or social deficit conditions CDC DATA on Child Prevalence: 9/1000 Autism Spectrum Disorder 12/1000 Intellectual Disability 3.1/1000 Cerebral Palsy

3. Children Need Early Identification and Treatment for Best Developmental Outcome LESSON: Development of a new subspecialty service line is challenging and incredibly rewarding for the patient, the provider, the community and the region. Nationally, about 17 percent of children under the age of 18 are affected by a developmental, behavioral, or learning disability. In 2007, data from TN and GA indicate up to 23% of children have special health care needs. For children in SE TN/North GA region, Developmental Behavioral Pediatric services were available in Nashville, Knoxville or Atlanta with local services by consulting MDs from these areas available on a limited basis. Wait times for DBP specialty evaluations were reported to exceed a year.

4. Building a Vision Community collaboration to deliver unmet regional healthcare needs for children with the opening of the Center for Developmental Behavioral Pediatrics Planning, fundraising, construction, staff recruitment to open was a 2 year endeavor Our CDBP is located at SCI in downtown Chattanooga, TN The CDBP is staffed by TCTCH clinical and administrative personnel.

5. Mission: To improve the health of children with or at risk for developmental behavioral pediatric conditions from birth to teens. Vision: To deliver healthcare access to multi-specialty services for comprehensive assessment, diagnosis and family centered treatment, optimizing potentials and long term developmental outcomes in infants and children. Delivery of quality healthcare requires a MISSION and a VISION CDBPCDBP

6. Recruitment of Qualified Staff National search for a Board Certified Developmental Pediatrician to provide Leadership and Clinical expertise for the CDBP Clinical Staff –DB Pediatrician –Psychologist –Advanced Nurse Practitioners –LPN Therapy Staff –Physical Therapist –Occupational Therapist –Speech Pathologist –Feeding Team Administrative Staff –Program Director –Admin Assistant –Financial/Insurance Admin –Receptionist

7. Regional Notification to Primary Care Physicians of New Service Center construction and furnishing completed early July 2009 CDBP doors opened for patients on July 22. Region referrals have steadily increased over the first 8 months from TN, GA, and NC Currently, new referrals are seen within 2-6 months Recruitment for a second DB Pediatrician to reduce wait time has begun

8. Progress: YTD First 8 months Total Patient Visits: Pediatric: 705 Therapy: 1304

9. Presenting Primary Diagnosis in Pediatric Patients Most Common: Diagnosis Code Description Dev Delay Disorder Disruptive Behaviors ADHD and Hyperkinesis Speech / Language Disorder Autism Spectrum Disorders Anxiety disorders Sleep Disorders Cognitive Impairment Family Counseling Premature Infants Chromosomal Abnormalities Less Common: Diagnosis Code Description Cerebral Palsy Spina Bifida / Encephalocele Developmental Coordination Disorders Neuromotor Disorders Oculomotor Apraxia Rare Disorders Post Perinatal HIE/Asphyxia Down Syndrome Bereavement Verbal –Motor Apraxia Hearing Impairment Vision Impairment

11. Impact on Improving Access to Care Adding an essential subspecialty service to a region has a direct impact on access to care for that service It also improves access to care to other subspecialty service needs for patients with referral needs identified during the patient’s appointment Referrals from CDBP [downstream effect] have included: Other Specialties –Neurology –Genetics –Endocrinology –Orthopedics –Ophthalmology –Cardiology –Pulmonology –Dermatology Lab/X-Ray/MRI/EEG/EKG Therapy: PT/OT/Speech/Feeding School State Early Intervention and Child Find

12. Conclusion It is easy to say, we can not provide that service here and send a family a great distance to find care for their child or to have a child wait an extensive period of time to see a specialist. It is hard on a child to make this journey and detrimental to their long term outcome to delay care. As physicians, we have the opportunity to make a change and to expand our impact in medicine. We must be able to see the bigger picture of needs for patients. To do this means we must at times step outside the comfort of our practice and recognize broader needs in the community or our field of practice. By engaging and restating problems as manageable possibilities, closed doors become unlocked to future potentials within our communities. The ripple effect of a single new subspecialty service line touches far beyond the individual field of endeavor. Downstream effects are felt in improved healthcare for the patient and increased utilization of resources within and outside of the medical facility. Relationships are enhanced across the community. And progress is seen with improved healthcare access.