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

‹#›

SIM$Collaborative$Learning$Session May$18,$2018

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 1

‹#›

Objectives*for*Session

• 1. Understanding0the0relationship0between0

health0and0healthcare0and0the0impact0of0 social0determinants0of0health0on0both

• 2. Describe0the0opportunities0and0challenges0

inherent0within0a0pediatric0setting0with0 respect0to0SDoH

• 3. Identify0strategies0to0implement0SDoH in0your0

practice

‹#›

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

3

‹#›

Factors+contributing+to+health+v+ spending

4

‹#›

Social*Determinants*of*Health

5

‹#›

Pathways+from+SDoH to+Health

6

‹#›

Screening(as(the(Vehicle(to(IBH

*All#screeners#provide#insight#into#social#determinants#

• f#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.

• utcomes.

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* conducts* Provider*and* staff*training*

• n*Beh

health*and* development IBHP* participates* in*well*child* checks* alongside* provider*for* prevention* and* anticipatory* guidance Real*time* family* consultations* to*provide* education* regarding* development,* parenting,*etc Overseeing* screening* process*and* tracking*of* screening*and* referrals Healthy*Steps* for*Young* Children Baby*and*Me* Group

‹#›

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 Educate0med0staff000000000000000 around0screening,0000 interventions0and0 referral0processes Provider0consults0 related0to0 development,0 psychosocial0or0 mental/behavioral0 health0issues0during0 their0med0visit Overseeing0 screening0process0 and0tracking0of0 screening0and0 referrals

2018,'Property'of'CCHAP.Org.'Do'not'replicate,'edit'or'distribute'without'permission.'

‹#›

Screening++++++++++++IBHP++Examples

Mom+has+ positive+ EPDS+at+1+ month+ WCC

IBHP+reviews+ case+with+care+ team+and+sees+ family++that+ day

IBHP+and+ Providers+ coordinate+plan+ for+follow+up+or+ community+ referrals

IBHP+sees+ family+at+next+ visit++

Improved+infant+ development+and+ health+outcomes

12+year+old+ has+a+ positive+ PHQG9+at+a+ sick+visit

IBHP+reviews+case+ with+care+team+ and+sees+family+ that+day Care+Team+ coordinate+plan+for+ follow+up+or+ community+referrals IBHP+conducts+coG located+visit+occurs+ within+2+weeks Improved+behavioral+ health+and+adherence+ to+medical+guidance.+ Reduce+suicide+risk.

Positive+ Psychosocial+ Screen

IBHP+reviews+ screen+with+family Care+Team+ coordinates+referrals+ and+follow+up+plan IBHP sees+family+at+ their+next+visit+OR+

• ffers+coGlocated+BH+

visit Improved+caregiver+ and/or+child+ behavioral+health+and+ adherence+to+medical+ guidance.+

2018,+Property+of+CCHAP.Org.+Do+not+replicate,+edit+or+distribute+without+permission.+

‹#›

MA#Gives# Screener#

• Introduces/by/normalizing/

“We/ask/all/families/these/ questions”

• In/their/native/language
• Checks#in#to#prompt#

completing#screener#

• Leaves/screener/in/room/

for/the/provider

Provider# Reviews# Screener# and# Responds

• During#the#medical#visit#

with#the#family

• Explores/if/they/are/open/

to/resource/support

• Critical#items#require#

response#from#SW/CLIMB# OR#consultation

• Resource/team/meets/with/

family/during/the/visit/

Documentation

• 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,# choose#“Positive#Screen,# Follow#up#needed”#even# if#they#see#the#family# during#the#visit

• MA/Nurse/enter/the/

screener/into/the/ Flowsheet

FN CHW 1P8

SW

10P13

CLIMB14a,/b

Call/Family/Navigators/or Community/Health/Liaisons

!#Call#Social#Work## before#family#leaves !#Call#CLIMB##before# family#leaves

*Medical/Resource/List//is/in/your/Pod 2017/Burnett/&Talmi;/Do/not/distribute,/edit,/or/replicate/without/ permission

Questions?/ Ask/CLIMB/ for/ Support!

‹#›

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*