Physician involvement in support of ECI Requested Perspective from - PowerPoint PPT Presentation

Physician involvement in support of ECI Requested Perspective from the Pediatrician Member of the Advisory Committee The Texas Part C ICC ECI Advisory Committee April, 4, 2018

Commonality of Core Components IDEA – Part C AAP Medical Home • The Medical Home is not so much a • Provides a measureable place, but a measureable “process of “process of care” care” • Provide comprehensive, • Provides accessible, family-centered, coordinated, family-centered, continuous, comprehensive, multi-disciplinary system coordinated, and culturally effective • Relies on coordination with primary care. other agencies (public & • Developmental surveillance, private) for best services identification of developmental • “Child find” a core component delays/disorders, appropriate referral Face fiscal and staffing challenges Face fiscal and staffing challenges

The formal Clinical Report from the AAP to educate and encourage involvement of pediatricians in the important work of each State’s Part C Program and interaction with its ICC. Cost Effective, Coaching , Natural Learning Environments, Tools for Communication Between M.H. & Part C, Etc.

7 Key Principles for Providing Early Intervention Services in Natural Environments Infants and toddlers learn best through everyday experiences and interactions with familiar 1. people in familiar contexts; All families, with the necessary supports and resources , can enhance their children’s learning and 2. development; The primary role of a service provider in early intervention is to work with and support family 3. members and caregivers in children’s lives; The early intervention process, from initial contacts through transition, must be dynamic and 4. individualized to reflect the child’s and family members’ preferences, learning styles, and cultural beliefs; Individualized Family Service Plan outcomes must be functional and based on children’s and 5. Perhaps this families’ needs & family -identified priorities; includes The family’s priorities, needs, and interests are addressed most appropriately by a primary provider who 6. pediatrician receives team and community support ; Interventions with young children and family members must be based on explicit principles, validated 7. practices , best available research , and relevant laws and regulations.

File Search for: Pediatric Pediatrics Pediatrician Physician Medical Home “1 item identified”

File Search for: Pediatric Pediatrics Pediatrician Physician Medical Home “No items identified” SSIP Infrastructure Analysis and Improvement Strategies Tracker Systems Framework for Building High-Quality Early Intervention Programs

Part C state staff use and promote strategies that facilitate clear communication and collaboration, and build and maintain relationships between Part C stakeholders and partners. Systems in place for efficient dissemination and clear communication of action- oriented items and beneficial informational items to stakeholders; participation in regular inter and intra-agency workgroups, and relevant state and community-based committee; systems of standing meetings for internal and external communication.

So, are all of your local / regional pediatricians fully understanding and actively engaging ? Yes !!! No … ? Congratulations. What is going to make Can you Share? that change ? Part C State Staff use and promote strategies that facilitate clear communication and collaboration, and build and maintain relationships between Part C stakeholders and partners.

Ideas for Enhancing Involvement and Support of the Medical Community Knowledge of Local Program: Content / Purpose / Goals Knowledge of Process of Collaboration IN THE LOCAL COMMUNITY Knowledge of Cost Efficiency and Referrals in the Medical Home Knowledge of Family Satisfaction

Ideas for Enhancing Involvement and Support of the Medical Community What do you want Pediatricians to Do ? Identify Babies in Need & Refer to ECI ! And maybe stay involved in the process ???

C O L L Texas Part C Program Texas Pediatricians A Suggestions of Interest Suggestions of Interest B in Engaging in Partnering with and O Pediatricians at the Utilizing Services of ECI R Local / Regional / State for their patients & A Systems families T I O N

Behavioral Changes Among Beliefs and Pediatricians Expectations Social ↑ Intention or Norms Decision to Perform Self-Efficacy this Desired Emotions / Behavior Affect Self-concept Social Image Love, Jenson, Khan, et al. Child Adol Psych Clin N Am. 26:851. 2017

Environmental Knowledge & Facilitators / Skills Constraints ↑ Intention or Behavior Decision to Performance Perform Actualized the Desired Behavior Habits Salience of Automatic Behavior Processes

Behavioral Changes Among Beliefs and Pediatricians Expectations ↑ Intention or Social Norms Decision to Perform Self-Efficacy the Desired Emotions / Affect Behavior Self-concept ECI Assessment Social Image

Behavioral Changes Among Beliefs and Pediatricians Expectations ↑ Intention or Social Norms Decision to Perform Self-Efficacy the Desired Emotions / Affect Behavior Self-concept Social Image ECI Assessment

Beliefs and Expectations Doctor’s perceptions of Advantages and ↑ Intention or Disadvantages associated Decision to with referral & partnering. Perform A referral to ECI will result in the less frequent, less Desired “aggressive” therapy. Behavior A referral brings “value added” support; What are Broad Perceptions by Therapies are incorporated physicians across Texas? More importantly, what are the into functional child/family perceptions of your referral base? routines.

Social Norms People who are important to ↑ Intention or the Doctor embrace ECI. Decision to ----------------- Perform More likely to employ the the system of developmental surveillance if: outlined by Desired AAP (professional Behavior standards) and if a colleague Using the C-FIT Model – do we have says “Let’s do this” on- going local “champions” who (personally respected person have been identified and are in community). viewed as local leaders ?

Self-Efficacy ↑ Intention or Decision to The Doctor’s self -appraisal of Perform the ability to perform the the targeted behavior(s) Desired successfully. Behavior Direct hands-on experiences Are there mechanisms to invite the in making the components of local Doctor to observe / participate the process work for in an IFSP or other evaluation by him/herself. the Local Team? Can ECI discuss tools easily obtained for use in their practice?

Emotions / Affect The doctor’s emotional ↑Intention or reaction to the experience Decision to Perform of providing collaborative the Desired support with your local ECI Behavior Program. Are there parent-partners – with A strong (-) experience in children in the Doctor’s practice – willing to go with you to thank the attempting to take on the Doctor/ staff for referral & visit how role and perform the tasks much Doctor/staff has helped this may reduce the likelihood family and the child? of further activities.

Self-concept / Social Image The degree to which the ↑ Intention or targeted behavior is Decision to congruent with the Perform self/social image the Doctor the wishes to project. Desired The Doctor who prides Behavior herself in staying up-to-date Have the Local or State Part C in Evidence Based literature offices approached the Doctor perceives herself to be “a about clinical value of ECI and ways good doctor” --- delivering they might support MOC activities state-of-the-art care. by the Doctor?

Environmental Knowledge & Facilitators / Skills Constraints ↑ Intention or Behavior Decision to Performance Perform Actualized the Desired Behavior Habits Salience of Automatic Behavior Processes

Knowledge & Skills How does your message meet the knowledge base or present needs of the Pediatric Partner? Intention Behavior - “Cookie cutter” handouts? - Assessment : knowledge Performance base; skill sets; tools; Actualized expectations; motivation; etc? No assumptions / condescension Who is the “ECI practice champion” in your Pediatric Partner’s office? - Similar assessment…

Environmental Facilitators / Constraints What is flow & pace & demographics of the office ? What is the process for Intention Behavior surveillance in that setting? Performance Does the office have good Actualized information on coding and billing ? Including for consultations with your staff? ------------------------------------------------------------------------------------ Can you assure a standard of constancy and continuity in your local ECI program?

Salience of Behavior Is the activity perceived by your Pediatric partner to be “pertinent”, Behavior “important”, “relevant”, Intention “vital”, “essential”? Performance Speaks to prior interactions Actualized Is this activity a core component of the physician’s practice? Speaks to the quality of the practice.