Social$Determinants$of$Health$in$ Pediatric$Practices - PowerPoint PPT Presentation

1 Executing-the- Transformation Social$Determinants$of$Health$in$ Pediatric$Practices Sue$Williamson,$J.D.$– CCHAP Bridget$Burnett,$PsyD – CCHAP$and$ University*of*Colorado*School*of*Medicine,*Dept*of* Psychiatry* John$Laukkanen,$MAR,$MSW,$LCSW$– Horizon$Pediatrics SIM$Collaborative$Learning$Session May$18,$2018 ‹#›

Objectives*for*Session 1. Understanding0the0relationship0between0 health0and0healthcare0and0the0impact0of0 social0determinants0of0health0on0both 2. Describe0the0opportunities0and0challenges0 inherent0within0a0pediatric0setting0with0 respect0to0SDoH 3. Identify0strategies0to0implement0SDoH in0your0 practice ‹#›

3 National+Health+Expenditures+(NHE)+ (2016)+Source:++CMS • NHE+grew+4.3%+to+$3.3+trillion+in+2016,+or+$10,348+per+person,+and+accounted+for+17.9%+of+ Gross+Domestic+Product+(GDP). Medicare+spending+grew+3.6%+to+$672.1+billion+in+2016,+or+20+percent+of+total+NHE. • Medicaid+spending+grew+3.9%+to+$565.5+billion+in+2016,+or+17+percent+of+total+NHE. • Private+health+insurance+spending+grew+5.1%+to+$1,123.4+billion+in+2016,+or+34+percent+of+ • total+NHE. Out+of+pocket+spending+grew+3.9%+to+$352.5+billion+in+2016,+or+11+percent+of+total+NHE. • Hospital+expenditures+grew+4.7%+to+$1,082.5+billion+in+2016,+slower+than+the+5.7%+growth+ • in+2015. • Physician+and+clinical+services+expenditures+grew+5.4%+to+$664.9+billion+in+2016,+a+slower+ growth+than+the+5.9%+in+2015. Prescription+drug+spending+increased+1.3%+to+$328.6+billion+in+2016,+slower+than+the+8.9%+ • growth+in+2015. The+largest+shares+of+total+health+spending+were+sponsored+by+the+federal+government+ • (28.3+percent)+and+the+households+(28.1+percent). The+private+business+share+of+health+ spending+accounted+for+19.9+percent+of+total+health+care+spending,+state+and+local+ governments+accounted+for+16.9+percent,+and+other+private+revenues+accounted+for+6.7+ percent ‹#›

4 Factors+contributing+to+health+v+ spending ‹#›

5 Social*Determinants*of*Health ‹#›

6 Pathways+from+SDoH to+Health ‹#›

Screening(as(the(Vehicle(to(IBH * All#screeners#provide#insight#into#social#determinants# of#health *Workflows#that#provide#optimized#care#team#response# to#screens#can#help#providers: % understand.and.respond.to.their.patient.population % influence.risk.stratification % and.build.foundations.towards.measurable.health. outcomes. 2018,.Property.of.CCHAP.Org..Do.not.replicate,.edit.or.distribute.without.permission .. ‹#›

Examples)of)Screeners)in)Pediatric) Primary)Care)Settings • Pregnancy,Related,Depression • Developmental,Screens • PHQ;9,Teen,Depression • SBIRT • Psychosocial/ACEs,Screens 2018,,Property,of,CCHAP.Org.,Do,not,replicate,,edit,or,distribute,without,permission ., ‹#›

Pediatric)IBHP)Activities • Screening+and+Referral1Screenings+are+often+ the+vehicle+for+IBH+activities • Care+Coordination1can+be+related+to+screens+ (positive+and+negative) • Health+Prevention+and+Promotion • Case+Based+Consultation/Intervention – Includes+provider+consultations 2018,+Property+of+CCHAP.Org.+Do+not+replicate,+edit+or+distribute+without+permission .+ ‹#›

Health*Prevention*and*Promotion* Examples Well*Child*Checks IBHP* participates* Real*time* IBHP* in*well*child* family* Overseeing* Healthy*Steps* conducts* checks* consultations* screening* for*Young* Provider*and* alongside* to*provide* process*and* Children staff*training* provider*for* education* tracking*of* on*Beh Baby*and*Me* prevention* regarding* screening*and* health*and* Group and* development,* referrals development anticipatory* parenting,*etc guidance ‹#›

Case(based+consultation+Examples Well+or+Sick+Visits Caregiver+or+Provider+request+for+Behavioral+Health+ Consult+related+to+family+or+child+health+and+well+ being Suicide+assessment+of+child+or+caregiver+and+safety+ planning Brief+psychosocial+assessment,+triage+and+plan+for+ families+with+positive+social+emotional,+autism,+ substance+use,+PRD,+PHQ(9,+Psychosocial+screening Telehealth+Psychopharm consultations 2018,+Property+of+CCHAP.Org.+Do+not+replicate,+edit+or+distribute+without+permission .+ ‹#›

IBH'Provider'Consult'Activity'Examples Psychopharm Overseeing0 Educate0med0staff000000000000000 screening0process0 around0screening,0000 and0tracking0of0 interventions0and0 screening0and0 referral0processes referrals Provider0consults0 related0to0 development,0 psychosocial0or0 mental/behavioral0 health0issues0during0 their0med0visit ‹#› 2018,'Property'of'CCHAP.Org.'Do'not'replicate,'edit'or'distribute'without'permission .'

Screening++++++++++++IBHP++Examples Mom+has+ IBHP+and+ IBHP+reviews+ positive+ IBHP+sees+ Providers+ case+with+care+ Improved+infant+ coordinate+plan+ EPDS+at+1+ family+at+next+ team+and+sees+ development+and+ for+follow+up+or+ visit++ family++that+ health+outcomes month+ community+ day referrals WCC 12+year+old+ has+a+ Care+Team+ Improved+behavioral+ IBHP+reviews+case+ IBHP+conducts+coG coordinate+plan+for+ health+and+adherence+ with+care+team+ positive+ located+visit+occurs+ follow+up+or+ to+medical+guidance.+ and+sees+family+ within+2+weeks community+referrals Reduce+suicide+risk. that+day PHQG9+at+a+ sick+visit Improved+caregiver+ Positive+ IBHP sees+family+at+ Care+Team+ and/or+child+ their+next+visit+OR+ IBHP+reviews+ Psychosocial+ coordinates+referrals+ behavioral+health+and+ screen+with+family offers+coGlocated+BH+ and+follow+up+plan adherence+to+medical+ Screen visit guidance.+ ‹#› 2018,+Property+of+CCHAP.Org.+Do+not+replicate,+edit+or+distribute+without+permission .+

•Introduces/by/normalizing/ Questions?/ “We/ask/all/families/these/ Ask/CLIMB/ questions” •In/their/native/language for/ • Checks#in#to#prompt# Support ! MA#Gives# completing#screener# Screener# •Leaves/screener/in/room/ for/the/provider • During#the#medical#visit# with#the#family *Medical/Resource/List//is/in/your/Pod •Explores/if/they/are/open/ Provider# to/resource/support Reviews# • Critical#items#require# Call/Family/Navigators/or Screener# response#from#SW/CLIMB# Community/Health/Liaisons OR#consultation and# FN •Resource/team/meets/with/ Responds family/during/the/visit/ CHW 1P8 •Providers/document/ positive/or/negative/ screen/in/their/note./ • If#ANY#resource#from#FN,# CHW,#SW,#CLIMB#is# needed#for#the#family# based#on#the#screening,# !#Call#Social#Work## SW Documentation choose#“Positive#Screen,# before#family#leaves Follow#up#needed”#even# if#they#see#the#family# 10P13 during#the#visit •MA/Nurse/enter/the/ !#Call#CLIMB##before# CLIMB 14a,/b screener/into/the/ family#leaves Flowsheet ‹#› 2017/Burnett/&Talmi;/Do/not/distribute,/edit,/or/replicate/without/ permission

These(and(other(tools(available(via(Cchap.Org 2018,(Property(of(CCHAP.Org.(Do(not(replicate,(edit(or(distribute(without(permission .( ‹#›

Screening++++++++++++IBHP+Case++Examples+&+ Discussion EPDS PHQ=9 M=CHAT ‹#› 2018,+Property+of+CCHAP.Org.+Do+not+replicate,+edit+or+distribute+without+permission .+

Acknowledgements • Colorado*SIM*Office • The*Zoma Foundation • The*Piton*Foundation • Child*Health*Clinic,*Childrens Hospital*Colorado • Project*CLIMB*Team • BHIPP:0E5*Technical*Assistance*Team • University*of*Colorado*School*of*Medicine* Departments*of*Psychiatry*and*Pediatrics* ‹#›