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

• Provides a measureable

“process of care”

• Provide comprehensive,

coordinated, family-centered, multi-disciplinary system

• Relies on coordination with
• ther agencies (public &

private) for best services

• “Child find” a core component

Face fiscal and staffing challenges

IDEA – Part C AAP Medical Home

• The Medical Home is not so much a

place, but a measureable “process of care”

• Provides accessible, family-centered,

continuous, comprehensive, coordinated, and culturally effective primary care.

• Developmental surveillance,

identification of developmental delays/disorders, appropriate referral 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

1.

Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts;

2.

All families, with the necessary supports and resources, can enhance their children’s learning and development;

3.

The primary role of a service provider in early intervention is to work with and support family members and caregivers in children’s lives;

4.

The early intervention process, from initial contacts through transition, must be dynamic and

individualized to reflect the child’s and family members’ preferences, learning styles, and

cultural beliefs;

5.

Individualized Family Service Plan outcomes must be functional and based on children’s and families’ needs & family-identified priorities;

6.

The family’s priorities, needs, and interests are addressed most appropriately by a primary provider who

receives team and community support;

7.

Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.

Perhaps this includes pediatrician

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

SSIP Infrastructure Analysis and Improvement Strategies Tracker

Systems Framework for Building High-Quality Early Intervention Programs

File Search for: Pediatric Pediatrics Pediatrician Physician Medical Home “No items identified”

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-

• riented 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 !!! Congratulations. Can you Share? No … ? What is going to make 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 ???

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

↑ Intention or Decision to Perform this Desired Behavior

Beliefs and Expectations Social Norms Self-Efficacy Emotions / Affect Self-concept Social Image

Love, Jenson, Khan, et al. Child Adol Psych Clin N Am. 26:851. 2017

Behavioral Changes Among Pediatricians

Behavior Performance Actualized

Knowledge & Skills Environmental Facilitators / Constraints Salience of Behavior Habits Automatic Processes

↑ Intention or Decision to Perform the Desired Behavior

↑ Intention or Decision to Perform the Desired Behavior

Beliefs and Expectations

Social Norms

Self-Efficacy

Emotions / Affect

Self-concept Social Image Behavioral Changes Among Pediatricians ECI Assessment

↑ Intention or Decision to Perform the Desired Behavior

Beliefs and Expectations

Social Norms Self-Efficacy

Emotions / Affect Self-concept Social Image

Behavioral Changes Among Pediatricians ECI Assessment

↑ Intention or Decision to Perform the Desired Behavior

Doctor’s perceptions of Advantages and Disadvantages associated with referral & partnering. A referral to ECI will result in less frequent, less “aggressive” therapy. A referral brings “value added” support; Therapies are incorporated into functional child/family routines. Beliefs and Expectations

What are Broad Perceptions by physicians across Texas? More importantly, what are the perceptions of your referral base?

↑ Intention or Decision to Perform the Desired Behavior

Social Norms People who are important to the Doctor embrace ECI.

• More likely to employ the

system of developmental surveillance if: outlined by AAP (professional standards) and if a colleague says “Let’s do this” (personally respected person in community).

Using the C-FIT Model – do we have

• n-going local “champions” who

have been identified and are viewed as local leaders?

↑ Intention or Decision to Perform the Desired Behavior

The Doctor’s self-appraisal of the ability to perform the targeted behavior(s) successfully. Direct hands-on experiences in making the components of the process work for him/herself.

Are there mechanisms to invite the local Doctor to observe / participate in an IFSP or other evaluation by the Local Team? Can ECI discuss tools easily obtained for use in their practice?

Self-Efficacy

Emotions / Affect The doctor’s emotional reaction to the experience

• f providing collaborative

support with your local ECI Program. A strong (-) experience in attempting to take on the role and perform the tasks may reduce the likelihood

• f further activities.

Are there parent-partners – with children in the Doctor’s practice – willing to go with you to thank the Doctor/staff for referral & visit how much Doctor/staff has helped this family and the child?

↑Intention or Decision to Perform the Desired Behavior

Self-concept / Social Image The degree to which the targeted behavior is congruent with the self/social image the Doctor wishes to project. The Doctor who prides herself in staying up-to-date in Evidence Based literature perceives herself to be “a good doctor” --- delivering state-of-the-art care.

Have the Local or State Part C

• ffices approached the Doctor

about clinical value of ECI and ways they might support MOC activities by the Doctor?

↑ Intention or Decision to Perform the Desired Behavior

Behavior Performance Actualized

Knowledge & Skills Environmental Facilitators / Constraints Salience of Behavior Habits Automatic Processes

↑ Intention or Decision to Perform the Desired Behavior

Behavior Performance Actualized

Knowledge & Skills

Intention

How does your message meet the knowledge base or present needs of the Pediatric Partner?

• “Cookie cutter” handouts?
• Assessment: knowledge

base; skill sets; tools; expectations; motivation; etc?

No assumptions / condescension

Who is the “ECI practice champion” in your Pediatric Partner’s office?

• Similar assessment…

Behavior Performance Actualized Intention

What is flow & pace & demographics of the office ? What is the process for surveillance in that setting? Does the office have good 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?

Environmental Facilitators / Constraints

Behavior Performance Actualized

Salience of Behavior

Intention

Is the activity perceived by your Pediatric partner to be “pertinent”, “important”, “relevant”, “vital”, “essential”?

Speaks to prior interactions

Is this activity a core component of the physician’s practice?

Speaks to the quality of the practice.

Behavior Performance Actualized Intention

For Pediatric partners established in their practices, habits & processes are derived by self- imposed standards and time constraints. Are the actions that you are requesting honoring these? Are the changes disruptive or easily incorporated by physician?

• Systems within the office may be

easier to shift. Habits / Automatic Processes

Behavior Performance Actualized Knowledge & Skills Environmental Facilitators / Constraints Salience of Behavior Habits Automatic Processes ↑Intention or Decision to Perform the Desired Behavior Beliefs and Expectations Social Norms Self-Efficacy Emotions / Affect Self-concept Social Image

Ultimate Goal: A Steady Collaboration Sustained Over Time Reinforcing Physician Involvement

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

Self-Efficacy

Emotions / Affect Self-concept Social Image

Feedback and communication happens Families feel supported ; Infants make progress

Ultimate Goal: A Steady Collaboration Sustained Over Time Reinforcing Physician Involvement

Physician involvement in support of ECI

7 Questions for Consideration by the Part C State Office. Focus: how to Support & Sustain “Interventions” by the Regional Programs to better foster bi-directional collaboration and involvement

↑ Intention

• r Decision

to Perform the Desired Behavior

12 Questions for Consideration by the Part C State Office. Focus: Support Physicians’ abilities; Avoid Barriers to actual practice changes; Build system of support ($ and materials) for all Regional Programs

Behavioral Performance Actualized

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-

• riented 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.

?

Beyond Awareness