Communities Coordinating for Healthy Development

1. Communities Coordinating for Healthy Development Training for Clinics

2. Coordinating Communities for Healthy Development The goal of the CCHD project is to create and institutionalize a feedback communication loop between clinical providers and early intervention and preschool special education providers to benefit children with developmental delays or socio/emotional or behavioral health concerns.

3. Training Topics • Before you begin • Goals & Tools • How to start • Model for implementing change • Guiding the team through the process • Completing and Spreading the Work • Modifications

4. Before you Begin Clinics participating in a CCHD project will need to be: • Using an Electronic Medical Record system • Regularly screening children for developmental delays or socio/emotional or behavioral concerns

5. Goals & Tools

6. Helpful Terminology • Early Intervention/Preschool Special EducationFor the purposes of this Toolkit, we will be using the term “early intervention/preschool special education” to refer to these programs that together serve children from birth – five years old. This includes: • Infant/toddler early intervention services for children birth to three, under Part C, and • Preschool Special Education services for children three to kindergarten, under Part B619. • Part C and Part B619 are parts of the federal Individuals with Disabilities Education Act (IDEA), the legislation that mandates these programs. • Clinic StaffThe term “clinic staff” refers to doctors, nurses, care coordinators, administrators, and others who work at the child’s primary care facility (most likely a clinic). • Help Me Grow • Minnesota’s name for the early Intervention system that includes child find, public awareness, outreach, and service delivery.

7. How to Start Identify team members to recruit Reach out through established relationships Share materials Begin meeting

8. Helpful Terminology Cont. Evaluation -- Under Part C (0-3 years) • Procedures used by qualified personnel to determine a child’s initial and continuing eligibility under this part consistent with the definition of infant or toddler with a disability. • Initial evaluation refers to the child’s evaluation to determine his or her initial eligibility under this part.Assessment-- Under Part C (0-3 years) • Ongoing procedures used by qualified personnel to identify the child’s unique strengths and needs and the early intervention services appropriate to meet those needs throughout the period of the child’s eligibility and includes the assessment of the child…and the family-directed assessment of the child’s family. • Initial assessment refers to the assessment of the child and the family-directed assessment conducted prior to the first IFSP meeting. Evaluation and Assessment-- Under Part B619The definition for evaluation is very similar to the definition under Part C, however, assessment in Part B619 refers to an ongoing process as opposed to a specific part of the evaluation process. Service PlanPlan created by early intervention/preschool special education team to provide appropriate services to student. The Individualized Family Service Plan (IFSP) is used for children 0-3 and the Individualized Education Program (IEP) is for children over 3.

9. Identifying Team Members • Early Intervention or Preschool Special Education Providers • Most likely in local school district • Where do your patients go to school? • Local public health or agencies doing childhood screening • Parents • Other agencies involved in referral process • Who are you currently sending referrals to? • Other providers of early childhood services such as Head Start, ECFE • Clinicians providing medical services to your patients – OT, PT, Mental Health

10. After you’ve identified potential team members… Contact them, talk about the goals of the project, see if they’re interested in meeting to discuss it or have ideas of other people who should be included. Be open to varying length of commitment – this project may lead to long term connections, but at the same time some team members may only be able to be involved as long as it takes to implement the feedback cycle. Share materials and resources. Invite them to a launch meeting.

11. Suggestions for Launch Meeting • Introductions and roles in current referral and service system in the community • Discussion of goals for CCHD team and CCHD process • Review of materials to learn (other trainings or toolkit) • Set up next steps (start meeting regularly, using change model, etc.)

12. Model for Improvement The team can work together to create a system for implementing the CCHD changes, or you can use the Model For Improvement. The model leads the team through testing out small changes toward big goals, in a Plan-Do-Study-Act process. More information on the Model is found in the CCHD toolkit.

13. Guiding the Team through the Process • Meet regularly • Identify a way to know when your team has completed the project • At the beginning, learn how the current system works, to identify where to approach changes • Work through modifying the tools to be useful to all the team members • Ask the early intervention/ preschool special education providers to start sending responses • Track the responses through clinic EMR • Report back to team on progress • Address issues and barriers • Add team members when needed or available

14. Creating a Workflow as a Team Creating a work flow diagram may help your CCHD team examine all the aspects of the referral feedback loop and be able to identify areas where changes are needed. Here are examples of a few work flows that CCHD teams created in the past.

15. Family arrives for visit and either gives check in staff the completed questionnaire or completes one in the lobby Nurse or other clinic staff score the questionnaire and give results to the child’s practitioner Practitioner determines if a referral is needed, notifies the family and asks clinic staff to make the referral Referral is made to Help Me Grow (state referral system) Prior to office visit, clinic administrative staff send screening questionnaire to family Sample Internal Referral FeedbackWorkflow for Screening at Clinic Help Me Grow funnels referral to appropriate school district for early intervention or preschool special education evaluation Early intervention or preschool special education program staff send referral report form back to clinic via fax Family consent to report back to clinic is obtained Practitioner reviews report, highlights any issues, and gives it to care coordinator Care coordinator reviews report to identify any follow up needs to act on and gives it to support staff Administrative staff receive report by fax, give to practitioner Support staff files in medical record Clinics will vary in which staff will perform which of these functions. As part of the CCHD project, it will be important to identify these staff and engage them in the improvement process.

16. Child visits clinic, completes a screening tool with a score that triggers a referral District receives referral, assigns to staff for evaluation Evaluators contact family and set up meeting Family refuses evaluation or is unable to be contacted, referral is closed HMG determines appropriate district, sends them the referral Clinic sends referral to the Help Me Grow state online system Early Intervention/ Preschool Special Education Referral Report Workflow District sends this information back to the clinic Family accepts, service plan is created, student begins to receive services Student is determined to be ineligible for services, is given alternative resources, possibly signed up for Follow Along Program Clinic sends referral directly to early intervention office at school district Family refuses services, referral is closed Student comes in for evaluation, consent to send results back to clinic is requested. Student is determined to be eligible for services District Workflow Referral Report Opportunity

17. Early Childhood Screening • Screens children for concerns • Screening forms are sent to the clinic, along with consent forms Clinic/Community Workflow for Early Intervention and Preschool Special Education Referrals • Developmental Screening Coordinator (DSC) (part of clinic staff) • Enters reports and consent forms into medical records • Sends electronic update messages to providers • Responds to information requests from community partners (when consent is provided) Follow Along Program Tracks children with potential concerns Sends both a monthly list of enrollees and abnormal screening reports to clinic • School District Early Intervention or Preschool Special Education Staff • Receives referrals from DSC and conducts evaluations with children • When an evaluation is completed, and the child is a clinic patient who has consented to share information, sends a report back to the DSC • Clinic: Primary Care Provider • Reviews reports received from DSC • Conducts screenings with patients • Sends recommendations to DSC to follow up or call family

18. Completing and Spreading the Work • Complete when you’ve met your team goals. • Celebrate! • Tell others about your work, to encourage spreading the CCHD project to other communities, clinics, and families.

19. Modifications • Health Care Homes/ Medical Home Model: completing the CCHD project can help your clinic prepare for HCH certification in MN. Contact information for HCH is found on the CCHD website. • MOC 4 Project: The first round of CCHD projects applied for and received MOC 4 certification from the Academy of Physicians. Data run charts used in that process are available in the toolkit.

20. Technical Assistance Available The CCHD website has sample referral communication forms, examples of work flow diagrams, and links to many resources to support the project. You can also email CCHD.Info@state.mn.us . www.dhs.state.mn.us/cchd

21. Resources • Developmental Screening Overview: http://www.health.state.mn.us/divs/fh/mch/devscrn/ • Developmental Screening Tools: http://www.health.state.mn.us/divs/fh/mch/devscrn/instruments.html • Online Developmental Screening Training Module: http://www.health.state.mn.us/divs/fh/mch/webcourse/devscrn/index.cfm • Institute for Healthcare Improvement’s Model for Improvement: http://www.ihi.org/knowledge/Pages/HowtoImprove/default.aspx • Information for Parents and overview of MN’s online referral system: • www.mnparentsknow.org . Follow the button in the top right hand corner to Help Me Grown, the online referral page. • Online trainings for practitioners, with CME Credits: www.edopc.net, go to training page and look for “Coordinating Care Between Early Intervention and the Primary Care Practices” • Helpful Toolboxes for Clinicians www.nashp.org

22. Communities Coordinating for Healthy Development Funded by a grant from The Commonwealth Fund and supported by the National Academy for State Health Policy Created in cooperation with the Minnesota Department of Education and the Minnesota Department of Health. www.dhs.state.mn.us/cchd