220 likes | 347 Views
Community Collaboration for Child Health. The 6 Trends in WCC: considerations for change. 1. The changing epidemiology of pediatric practice. 2. The emergence of new technology. 3. The impact of racial and ethnic disparities. 4. The greater prevalence of women in pediatric practice
E N D
The 6 Trends in WCC: considerations for change • 1. The changing epidemiology of pediatric practice. • 2. The emergence of new technology. • 3. The impact of racial and ethnic disparities. • 4. The greater prevalence of women in pediatric practice • 5. Changes in health care financing. • 6. International models.
Changing Epidemiology • Better disease prevention • Improved care of kids with chronic disease • Increased survival of VLBW babies • Results: 75% of health care dollars goes to kids with chronic and disabling conditions • CSHN are 12.8% of kids <18 • Almost 60% of parents of CSHCN do not feel partnership with providers of care
The Patient The child is a 5 year old born full term to a woman with bipolar disorder and p.t.s.d. Normal L&D. 4 mos of age: surgery for a vascular ring ended badly. Chylothorax, chest tube, seizures, acidosis, ventilator. Child currently has a developmental level of a two year old, is in special education, has required a g-tube, orthopedic procedures for contractures and dislocated hips. Currently in the Model Waiver Program.
Who is Involved in the Child’s Care? The Community Team… • Parent/Guardian • Pediatrician • School Staff • Funding Agency • Attorney/ GAL
This sounds easy, but… • Different Definitions • Different Styles • Different Perceptions of Self/Others • Everybody thinks they’re the most important
How/Who…define the problem Goals Objectives Methods Metrics of Success …..Progress …..End Point(s)
Using Community Partners • The use of lay health workers, compared to usual healthcare services: • - probably leads to an increase in the number of women who start to breastfeed their child; who breastfeed their child at all; and who • feed their child with breastmilk only; • - probably leads to an increase in the number of children who have their immunization schedule up to date; • - may lead to slightly fewer children who suffer from fever, diarrhoea and pneumonia; • - may lead to fewer deaths among children under five; • - may increase the number of parents who seek help for their sick child.
The Stages of Collaboration • Role Separation • Overestimation and Disappointment • Realistic Appraisal • Accommodation • Integration
A Model for Collaboration… • Structure of Stages: • 1. Information Exchange • 2. Role Clarification • 3. Goal Clarification • 4. Negotiation • 5. Decision Making
Information Exchange • Role Sep: Traditional Boundaries • Disappointment: Inapp. Expectations • Realism: Open to accepting info from each team member • Accommodation: Info shared compliments that from other team members • Integration: Recognition of expertise and special knowledge
Role Clarification • Role separation: Maintain traditional roles • Disappointment: Role Ambiguity • Realism: Recog of potential contribution; less boundaries • Accommodation: Permeability of boundaries • Integration: recog of expertise and spec. capabilities
Goal Clarification • Goal setting remains separate---- • Systemic view of Goals Negotiation Anxiety, competitiveness---- Non-threatening, open comm
Decision Making • Role Separation: Power of position • Disappointment: Overestimate of ability to make decisions • Realism: More open to mutually-agreed upon decisions • Accommodation: Increasing agreement on decisions of intervention • Integration: Sharing of moral responsibility
In summary… • Increasing numbers of children with special needs demand a collaborative approach • Community Partners need to understand the new model of the, “office without walls.” • The new model requires an appreciation of the models for collaboration