Funding an Interdisciplinary FASD Diagnostic Clinic. 15 Years of Experience

1. Funding an Interdisciplinary FASD Diagnostic Clinic.15 Years of Experience FAS Diagnostic & Prevention Network of Clinics (FAS DPN) University of Washington Seattle WA Susan Astley PhD, Director Professor of Epidemiology / Pediatrics

2. Washington State FAS Diagnostic & Prevention Network of Clinics1 • The FAS DPN includes: • The Core Clinic in Seattle (University of Washington) • 4 Network Clinics around the state.

3. Washington FAS DPN Clinic Model 2 • Seattle Core Clinic • Open 15 years (60 patients / year). • 4 Statewide Network Clinics • Open 13 years (10-20 patients / year in each clinic). • 2 patients / day (1 in the morning, 1 in the afternoon). • Interdisciplinary team using 4-Digit Code. • Diagnosis completed in one 4.5-hour visit. • Patients 3 • All ages (newborn to adult, most school age). • See only those with confirmed prenatal alcohol exposure. • 75-85% in foster/adopt care.

4. Diagnostic Method: FASD 4-Digit Code4 www.fasdpn.org

5. Interdisciplinary Diagnostic Team 2 8-member Team • Pediatrician • 2 Psychologists • Occupational Therapist • Speech Language Pathologist • Social Worker • Family Advocate • Clinic Coordinator

6. 4.5-hour FASD Diagnostic Evaluation2 Prior to the clinic appointment, all medical, school, psychological, and placement records obtained by clinic coordinator.

7. Actual Cost of Diagnostic Evaluation • $3,253 per patient • Cost breakdown: • $2,140: Salary / benefits for entire team • $1,113: Facility fee (indirect costs) The cost (salary, benefits, and facility fees) for the 8-member diagnostic team to conduct a 4.5-hour evaluation: (at the University of Washington, Seattle Clinic)

8. Cost Recovery • Typically only 25-30% of cost is covered by insurance / Medicaid6. • Cost recovery will vary by institution. • Not all clinical team members can bill for service. • (e.g., clinic coordinator, family advocate). • Those who can bill are not fully reimbursed. • (e.g., our MD recovers only 46% of their fee).

9. Two models for funding WA FASD clinics • Core clinic funded by ‘training dollars’. • (85 %) Federal Medicaid administrative match funds. • (15 %) State funds earmarked for training (not medical care). • Network clinics funded by ‘medical dollars’. • (30 %) Bill Medicaid and medical insurance. • (70 %) State funds supplement what cannot be covered through billing. ($2,000 per diagnosis). Alaska has similar model6 Both models established by State Legislature (Senate Bill 5688)7.

10. Other funding sources, in-kind service • In an academic setting: • Interns: Psychology, OT, SLP interns receive supervision hours in exchange for ‘free’ service in clinic. • In a community setting: • Cost-Sharing: School ‘donates’ psychologist, OT, SLP to serve on diagnostic team (1day / month). Gain valuable training / expertise that benefits school. • Local Funds: (e.g., United Way).

11. A novel way to fund a clinic: Training dollars The Seattle Clinic hosts 10 community professional trainees every clinic. Parent interview room with 1-way observation window for trainees Clinic staffing room with extra seats for trainees

12. Trainees Include: • medical professionals • medical / nursing students • clinicians (psychologists, SLP, OTs, etc) • school personnel (psychologist, special ed teachers) • social workers, case workers, CASA • foster / adoption personnel • juvenile justice personnel • child / family therapists • other 1,000’s have been trained to date.

13. Training Includes: • 30 minute lecture by clinical team member on what is FASD. • Full day observation of interdisciplinary team conducting 2 FASD diagnostic evaluations. • Case presentation. • Family interview, child testing. • Derivation of diagnosis and intervention plan. • Sharing diagnosis and intervention plan with family.

14. Benefits of funding a clinic through training • Training funds support the diagnostic team to conduct a FASD diagnostic evaluation while 10 community professionals join us each day to learn what their role is in the community to identify, refer, and provide intervention / support services to these patients and their families. • Benefits: • The funds support 2 activities simultaneously (diagnostic evaluations and training). • The training generates community FASD awareness and education. • Community professionals learn who to refer to us for diagnosis. • Community professionals learn how to provide intervention to the patients we refer to them.

15. Weblinks to publications cited in slides. • FAS DPN websitewww.fasdpn.org • Description of FAS DPN clinic.http://depts.washington.edu/fasdpn/pdfs/child.pdf • FAS DPN Patient Profilehttp://depts.washington.edu/fasdpn/pdfs/WAfasdpn042005-astley.pdf • FASD 4-Digit Code Diagnostic Toolshttp://depts.washington.edu/fasdpn/htmls/diagnostic-tools.htm • FASD Medical Summary Templatehttp://depts.washington.edu/fasdpn/htmls/diagnostic-forms.htm • Alaska FASD Provider Agreement.http://notes4.state.ak.us/pn/pubnotic.nsf/0/883e1c094938c3dc89257040000e3ac8/$FILE/AMENDED+AMENDED_FASD+Dx+Team_Provider+Agreement+_8-2+.pdf • FAS DPN Senate Bill 5688.http://depts.washington.edu/fasdwa/PDFs/senatebill5688.pdf Questions: Contact Susan Astley, Ph.D. astley@u.washington.edu