Enhancing Care Partnership Support March 27, 2014 1 – 2 pm Central

1. Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Seriesbrought to you by the National Center for Medical Home Implementation Enhancing Care Partnership Support March 27, 2014 1 – 2 pm Central

2. Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Seriesbrought to you by the National Center for Medical Home Implementation

3. Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Seriesbrought to you by the National Center for Medical Home Implementation Faculty: R.J. Gillespie, MD, MHPE The Children’s Clinic Portland, OR

4. Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Seriesbrought to you by the National Center for Medical Home Implementation Faculty: Cortnee Whitlock The Children’s Clinic Portland, OR

5. Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Seriesbrought to you by the National Center for Medical Home Implementation Faculty: Jill Rinehart, MD, FAAP Hagan, Rinehart, & Connolly Pediatrics, Burlington, VT

6. Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Seriesbrought to you by the National Center for Medical Home Implementation Faculty: Kristy Trask, BSN, RN Hagan, Rinehart, & Connolly Pediatrics, Burlington, VT

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

8. Webinar Objectives • Define the term “care partnership support” and explain its effectiveness as part of an approach to providing family- and patient-centered care. • Describe strategies for implementing successful care partnership support within a pediatric practice. • Provide examples of how care partnership support can be exemplified in pediatric practices.

9. Pediatric Medical Home • Team-based approach • Families are essential team members • Care partnership support is a strategy which helps to ensure families are essential team members within the medical home

10. Defining Care Partnership Support • A meaningful collaboration between families and the pediatric care team to ensure effective and quality care for the patient. • Addresses: • Family and patient access to quality care • Effective communication

11. Benefits of Enhanced Care Partnership Support • Health care plan is specific to each family’s individual circumstances • Empowers families and caregivers • Increased patient follow through, understanding, and compliance

12. Benefits of Enhanced Care Partnership Support • Increases access to • support services • specialty care • educational resources • Improved health outcomes • Meets the challenges faced by vulnerable populations

13. Implementation of Care Partnership Support • Create and articulate a policy of care partnership support • Market/communicate your policy • Encourage patient and family involvement in the health care plan

14. Best Practice R.J. Gillespie, MD, MHPE Cortnee Whitlock The Children’s Clinic Portland, OR

15. The Children’s Clinic, OR Parent Provider Partnership Partnership is a collaborative relationship between two or more parties based on trust, equality, and mutual understanding for the achievement of a specified goal. World Health Organization, 2009

16. The Children’s Clinic, OR The Value of Partnership • In the beginning, parents often feel very lost • Establishing a trusting relationship with the medical specialists and team members decreases a large percentage of parental stress regarding care • Access to support and continuing education • All in it together

17. The Children’s Clinic, OR Parent Partner Impact: • Vital team member • Coordinated team care that is centralized around the child • Provider, parent, and child team development • Role in improving and making a difference in the health care system

18. The Children’s Clinic, OR Maxims of Patient-Centered Care: “The needs of the patient come first Nothing about me without me Every patient is the only patient.” From: D. Berwick. What ‘Patient-Centered’ Should Mean: Confessions of an Extremist. Health Affairs, 28, no.4 (2009): w555-565.

19. Environmental Context The Children’s Clinic, OR Policy Macro-system Health Plan Delivery System Micro-system Clinic Hospital Patient-Provider Encounter Provider Patient From: D. Berwick. What ‘Patient-Centered’ Should Mean: Confessions of an Extremist. Health Affairs, 28, no.4 (2009): w555-565.

20. The Children’s Clinic, OR Steps for Adding Parents To Your Team: • Embracing the idea of a parent partner • Discussing characteristics, traits, and qualities • Successfully selecting a parent partner • Inviting and compensating a parent partner • Replacing a parent partner (when necessary)

21. The Children’s Clinic, OR What We Hoped To Get: • Genuine interest in improving care for families • Our state’s medical home standards include patient and family involvement • We thought we had a good idea of what parents wanted/ needed, but felt it would be important to ask • Goes beyond “clearing ideas” with a parent partner and involves meaningfully listening to their perspective and experience • We have specific questions about access, shared care plans, and other medical home principles

22. The Children’s Clinic, OR Embracing the Idea: • Discuss the concept in depth • Include all stakeholders on current team • Be sure to include key thought leaders and decision makers at your practice • It is best not to debate the concept AFTER bringing a parent into the mix • Start this journey committed to the concept • There may be barriers experienced and refinements needed- committing to work through this experience is key to achieving success and realizing the value

23. The Children’s Clinic, OR Discussing Traits and Qualities: • Determine what collection of characteristics meets your needs • Key traits include: • Has the time to commit (access to childcare, etc.) • Confident, able to speak up in group settings • Fits in with group dynamic -- humor! • Experience with local resources and multiple specialists

24. The Children’s Clinic, OR Discussing Traits and Qualities (Continued): • Parents of children and youth with special health care needs have an extremely valuable perspective when it comes to medical homes for children • Multiple parent partners with different experiences provide for an even richer parent perspective

25. The Children’s Clinic, OR What We Got: • A parent who is dedicated to the improvement of her own medical home, in the interest of her children • A perspective that cannot be achieved any other way • Important insights: • What aspects of the care we provide are going well • Where we needed to improve (some of which we didn’t know)

26. The Children’s Clinic What’s Next? • Having a parent on a quality improvement (QI) team is one of many ways that parent perspectives can be heard • We have also conducted parent surveys (CAHPS CG PCMH) which gave vital information about our practice • Designed QI project based on the findings • Re-fielding the survey in summer/fall 2014 • Now in the planning phases for a parent advisory group • Broader parent perspective • Less time commitment for parents (quarterly instead of 1-2 meetings a month)

27. Best Practice Jill Rinehart, MD, FAAP Kristy Trask, BSN, RN Hagan, Rinehart, and Connolly Pediatrics, PLLC Burlington, VT

28. Hagan, Rinehart, and Connolly Pediatrics, VT • Effective Care Coordination • Care Planning • Care Plans • Care Conferences

29. Hagan, Rinehart, and Connolly Pediatrics, VT 5 Key Elements of Highly Effective Care Coordination Antonelli, McAllister, Popp. Making Care Coordination a Critical Component of the Pediatric Health System: A Multidisciplinary Framework. The Commonwealth Fund, May 2009

30. Hagan, Rinehart, and Connolly Pediatrics, VT A Framework for Highly Performing Pediatric Care Coordination Antonelli, McAllister, Popp. Making Care Coordination a Critical Component of the Pediatric Health System: A Multidisciplinary Framework. The Commonwealth Fund, May 2009.

31. Hagan, Rinehart, and Connolly Pediatrics, VT Partnership Care Planning Model

32. Hagan, Rinehart, and Connolly Pediatrics, VT ECOMAP Medical Specialists Financial Supports Medical Home Primary Care Provider Care Coordinator Community and State Services Family School Informal Supports Childcare

33. Hagan, Rinehart, and Connolly Pediatrics, VT Dr. Hastings- Peds-Ophthalmology Dr. Benjamin- physiatrist Dr. Bauer- Peds Neurosurgeon at Dartmouth Community Alliance Church in Hinesburg Hagan, Rinehart and Connolly Pediatricians Medical Store Dr. Filiano- Neurologist at Dartmouth Children's Ministry Dr. D'Amico- Gastroenterologist CSHN Social Worker Dr. Tranmer- Neurosurgeon 3 Squares Vermont Outings- Sugar House, Echo, Lowes, town activities, swimming etc. Biomedic Appliances Shelburne Community School Keen Medical Champlain College- Healthcare Technology PCA Apria VG Section 8 Housing CSHN Registered Dietitian Debbie- Para-professional CG 5 yo SSA 4 yo 7 yo Child Only Reach Up Grant Swimming at YMCA SSI PSE School Physical Therapist (service dogs in training) S.&J., MGM friends Wheels for Johnny-Fundraiser for handicap accessible vehicle Shelburne Nursery School Occupational Therapist Petsmart Shelburne Community School Therapy Dogs of Vermont Rue Kendrick- classroom teacher Howard Center Medical Family State/Education/Community Special Educator Speech Language Pathologist Deborah Keel- Flexible Family Funding Delana- BRIDGE Garrison, Victoria . Interview by Marley Donaldson. Personal interview. 26 Mar. 2013.

34. Hagan, Rinehart, and Connolly Pediatrics, VT Tools: Care Conferences • Introductions • Set Agenda • Set Roles • Review Youth & Family Strengths • Discussion • Minutes • Update Care Plan with “Goals” • Create Next Steps • Set Next Conference Date • Share Care Plan

35. Hagan, Rinehart, and Connolly Pediatrics, VT Care Study 1: Matt • 13 year old boy with autism, non-verbal, self injury, polydipsia • Parents struggling with bolting, overall safety • Middle school unable to educate or keep safe • Medical issues of skin infections, enuresis, sleep dysfunction • Family has gone above and beyond capacity of most families to deal with this at home

36. Hagan, Rinehart, and Connolly Pediatrics, VT Care Planning 1:

37. Hagan, Rinehart, and Connolly Pediatrics, VT Care Study 2: Mary • 4 year old with tuberous sclerosis • self-injurious behaviors • tantrums • sleep dysfunction • heading toward inpatient psychiatry hospitalization • Despite having a VT developmental services waiver, respite care and a team of multidisciplinary medical experts at Massachusetts General Hospital

38. Hagan, Rinehart, and Connolly Pediatrics, VT Care Study 2: Mary (Cont) • Intractable seizures seemed the least of her concerns in comparison to behaviors • Strengths: • strong parent involvement and expertise • loving respite family • Mary engaging • verbal with cognitive strength (can anticipate seizures)

39. Hagan, Rinehart, and Connolly Pediatrics, VT Care Planning 2:

40. Hagan, Rinehart, and Connolly Pediatrics, VT Principles for Successful Use of Shared Plan of Care • Active engagement in care • Clear, frequent, and timely communication • Patient and family assessment based on full understanding of needs • Strong family/professional relationship characterized by mutual trust and respect. • Family-centered care teams can access the information they need to make shared, informed decisions. McAllister, J., et al., Achieving a Shared Plan of Care for Children and Youth with Special Health Care Needs: 2014 (in press), Lucille Packard Foundation for Children's Healthcare

41. Hagan, Rinehart, and Connolly Pediatrics, VT Principles for Successful Use of Shared Plan of Care (Cont.) • Shared goals and negotiated actions; mutual understanding on behalf of all partners • Monitoring, feedback, adjustment • Anticipate, prepare and plan for all transitions • Common, shared document; used consistently by all providers • Care is well coordinated across all involved organizations/systems McAllister, J., et al., Achieving a Shared Plan of Care for Children and Youth with Special Health Care Needs: 2014 (in press), Lucille Packard Foundation for Children's Healthcare

42. Hagan, Rinehart, and Connolly Pediatrics, VT Why is a Family- Centered Medical Home Important to family? • Opportunity for the family to build a trusting and collaborative relationship with the pediatrician and office staff • Care coordination provides smooth facilitation among all members of the child’s care team including family, specialists, pharmacy staff, community and school services • Comprehensive source of complete patient medical history Victoria Garrison, “Innovations in Medical Home,” VFN annual conference, April 2013

43. Conclusions • Care partnership support helps to ensure family, caregiver, and patient involvement within the pediatric medical home. • Implementation of care partnership support results in improved health of the child and improves future care goals.

44. Resources • National Center for Medical Home Implementation (NCMHI): Care Partnership Support • NCMHI: Positioning the Family and Patient at the Center, Resources and Tools • Family Voices: Family Centered Care • National Initiative for Children’s Healthcare Quality: Powerful Partnerships • Region 4 Genetics Collaborative: Partnering With Your Doctor, the Medical Home Approach

45. NCMHI Educational Video Series • Don’t forget to view the National Center for Medical Home Implementation (NCMHI) Video Series. Topics Include: • Team Huddles • Care Partnership Support • Family Advisory Groups

46. Save the Date Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Series Starting and Supporting Family Advisory Groups April 24, 2014 11 am – Noon (Central) REGISTER NOW!

47. We’re Here to Help You! Have a question about medical home? Contact us! Medical_home@aap.org 800/433-9016 ext 7605 Subscribe to our Listserv!

48. Questions?

49. Save the Date Fostering Partnerships and Teamwork in the Pediatric Medical Home: A “HOW TO” Webinar Series Starting and Supporting Family Advisory Groups April 24, 2014 11 am – Noon (Central) REGISTER NOW!