1. Sustainability & Spread: Continue, Change! Marian Earls, MD Amy Pirretti, MS

2. 2 Disclosures We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in our presentation.

3. 3 Systemic Challenges oIntegration of Family-Centered Principles: e.g. continuity, comprehensiveness, coordination, cultural sensitivity. oFacilitation of networking between community resources that have historically been in “silos.” oPaucity of mental health services, especially for 0 – 5 year olds.

4. 4 Systemic Challenges (cont.) oAdditional risks for children living in poverty or in foster care (continuity especially important). oLack of reimbursement for care coordination. oUninsured and underinsured. Many insurance/HMO plans have inadequate or deny coverage for services for CSHCN

5. 5 Challenges for the Primary Care Practice  Treating the “whole” child: in the context of the family, the school, the community.  Adopting an Office Systems approach  Operationalizing family feedback as part of the practice system  Considering family needs as well as office needs for scheduling and logistics  Enhanced processes for CSHCN: registries, scheduling tailored for longer visits, linkages to community resources, assistance with referrals

6. 6 Challenges for the Primary Care Practice o“Knowing the system” of public and private providers locally oNetworking with community partners effectively oMaintaining continuity and communication with specialists, child care, school, …(Wraparound) oAssuring child and family role in care planning for a child/adolescent who has a chronic/complex condition

7. 7 Challenges for Families  Knowing the important components of preventive care (screening, continuity, etc)  Knowing how to choose a medical home: what questions to ask  Feeling comfortable with communication and raising concerns and priorities.

8. 8 Sustaining Change Fundamental change in office systems  Practice – wide guideline  How do you get buy-in that these changes will be practice-wide?  All Pediatrics  Process is routine  Process is reliable, and does not depend on particular staff to be present to occur  Roles at each level are clear and understood

9. 9 Reliability  Level 1 – outcome goal, practice guideline, 80-90%  Level 2 – checklists and observation, redundancy, standardization of process, PSPS, 90-98 %  Level 3 – real time awareness of failures, daily monitoring, resilience, >98%

10. 10 Sustaining Change New kind of communication with community  Relationship with key partners  Networking to facilitate process beyond practice  Agreements on how to exchange information, e.g. standardized referral process/form  How did you help link families to community resources?  What barriers did you face?

11. 11 Establishing Relationships  Invite community resource representative's) to the practice for lunch & learn re processes for communication and referrals.  Have periodic meetings with partners who provide “wraparound” services for patients and families.  Have evening “mixer” for primary providers and community mental health providers to establish contacts.  Compile contact information and identify staff to be the liaison for the practice.

12. 12 Sustaining Change Participatory role for parents/family  Parent is partner in care  Parent helps drive change by asking for service  Parent gives feedback on referral sources and communication process  How do we get families more engaged?  Have you received any feedback from families about the changes in your practice?

13. 13 Bright Futures Champions  You are a Bright Futures Champion!  EQIPP to Continue Change  Involvement with Bright Futures at the State/National level  Where we are going next: Bright Futures and Chapter Quality Network

14. 14 Bright Futures 2011 & Beyond