Communities Coordinating for Healthy Development : Minnesota’s ABCD III Initiative

1. Communities Coordinating for Healthy Development: Minnesota’s ABCD III Initiative National Academy for State Health Policy Annual Conference October 5, 2011 Castellano

2. Project Overview • Purpose of the project • To improve linkages between primary care providers, medical specialists, and other child and family service providers in the community to support the healthy development of Minnesota’s children ages birth to 3 years • Build upon previous initiatives (ABCD II and ABCD Screening Academy) • Focus is on referral, care coordination and building a system within the community Castellano

3. Project Structure • 4 pilot community teams including: a clinic and early intervention, plus public health, Head Start, and others • Clinic has a designated care coordinator • Clinic conduct universal developmental and mental health screening • Early Intervention program willing to work with clinic staff to improve referrals Castellano

4. CCHD Participating Communities Castellano

5. Team Project Participation • Attend annual in-person learning collaboratives • Participate in monthly technical assistance phone calls and/or webinars • Hold regular, local team meetings (monthly) • Use Model for Improvement PDSA cycles for QI • Participate in project evaluation activities (monthly data submission, annual surveys) Castellano

6. Technical Assistance to Teams • Attend team meetings • Assist with quality improvement process • Help teams figure out how to collect the evaluation data at their site • Provide sample forms and materials from other sites or states • Assist in setting up and using the Access database for tracking • Topical webinars over the lunch hour • Annual learning collaboratives Castellano

7. Technical Assistance Webinars • October 2010 - Screening and Referral • November 2010 - Help Me Grow and Care Coordination • February 2011 – Implementing screening tools and a referral system (Park Nicollet Clinic System) • March 2011 – Data gathering and tracking for HMG (Wilder Research) • April 2011 – Coding and Billing • May 2011 – ABCD III Baseline Data • Upcoming – Help Me Grow/IEIC restructure and how to engage and involve parent partners Castellano

8. Community Based Activities • Community teams meeting regularly • Clinic consent forms in use • Teams using referral/feedback forms between HMG and clinic • Written protocols for clinic flow and clinic/early intervention communication • Clinics using Access database or other tracking system to support care coordination Castellano

9. Health Care Home Helps • Parallel activities to HCH requirements and measures: • Access data base meets all HCH referral tracking requirements • Care coordinator role similarly defined • Expectations regarding follow-up • A clinic improvement team in place w/parents • Most participating clinics viewed ABCD III as step toward preparing for Health Care Home certification Castellano

10. Systems Based Activities • Joint Human Services and Education Dept. trainings to enhance billing for early intervention services • Continued work on consent forms w/Dept. of Ed • Enhancing early intervention statewide on-line referral to give providers local contact info for follow-up • Refining data base • MOC4 application • Developing standardized referral and feedback forms Castellano

11. St. Luke’s Clinic Referral Process Castellano

12. St. Luke’s Clinic Referral Process Castellano

13. St. Luke’s Clinic Referral Process Castellano

14. Evaluation & Measurement • Frequency: baseline and each subsequent year of the grant for most measures • Five surveys: • Parent • Provider • Help Me Grow/Early Intervention staff • Clinic administrators • Care Coordinators • Clinic tracking data, monthly reports Castellano

15. Provider Referrals Castellano

16. Parent Survey • Majority of parents said they completed a questionnaire of child’s development (63%) and mental health (56%) some time in the last year • Less than ½ of those whose provider noted a concern were referred to HMG • Parents reported referrals most often to specialists (18%), followed by community services (10%), Early Intervention (7%) Castellano

17. Parent Survey • Providers discussed next steps with ½ of those receiving mental health screening and 62% receiving developmental screening • 12% of families indicated they were receiving care coordination from their clinic • 7% said that they need someone to coordinate their child’s care Castellano

18. Early Intervention Referrals since January, 2010 Castellano

19. What We’ve Learned • Office flow very individualized, everyone has to invent their own wheel, would be hard to role out en masse • Written protocol an important step • State agency restructure of EI changed local contacts • Clinics in the midst of other projects (EMR) struggled • Helps for clinic and EI staff to meet each other • Some EI programs discouraging “too many” referrals – 2 way communication helps build trust on both sides • Previous clinic experience with QI important, or teach it to them Castellano

20. Contacts • Glenace Edwall: 651.431.2326 glenace.edwall@state.mn.us • Susan Castellano: 651.431.2612 susan.castellano@state.mn.us • Meredith Martinez: 651.431.2623 meredith.martinez@state.mn.us • Ruth Danielzuk: 651.431.2061 ruth.danielzuk@state.mn.us • Catherine Wright: 651.431.2336 catherine.wright@state.mn.us Castellano