Outreach to Physicians to Increase Early Identification and Referrals to Early Intervention

1. Outreach to Physicians to Increase Early Identification and Referrals to Early Intervention Linda Tuchman-Ginsberg, PhD Director of theEarly Childhood Professional Development Program Waisman Center Elizabeth Wahl, MSW APSW Birth to 3 Professional Development Specialist Waisman Center

2. Session Objectives • Establish a framework for collaborative outreach to physicians for child find • Developmental screening • Referrals to early intervention • Provide a rational and examples of cross systems collaboration • Overview the components of a collaborative physician outreach program in Wisconsin

3. Aim of Our Work • Provide outreach and assistance to physicians • Pediatricians • Family Physicians • Increase the use of developmental screening tools during well child visits for purposes of: • Assuring families when their child’s development is on track • Early identification and referral to early intervention and other programs

4. Driving Forces • TRACE Center research and materials • Academic Detailing • Universal Referral Form • OSEP/AAP Early Intervention Brochure • American Academy of Pediatrics • Policy statement on Developmental Screening and Surveillance (2006)

5. Driving Forces • Title V/CYSHCN, Early Intervention and UCEDD Collaboration • Wisconsin Early Childhood Collaborating Partners • Assoc. Education of Young Children • IDEA, Part C & B Child Find • Early/Head Start • Home Visiting

6. Partnering with the University of WI –Waisman Center (UCEDD), Birth-3 Program (Part C), and Title V Regional Centers for CYSHCN • Promote developmental screening as part of the Medical Home • Increased outreach capacity to primary care providers (PCP) • Create database to track outreach and follow up

7. Partnering- UCEDD, Part C and Title V • Optimized resources through shared training and staff • Webcast series • http://www.waisman.wisc.edu/connections/webcast.php

8. Partnering- UCEDD, Part C and Title V • Promoted referral and collaboration at the local level between Part C and Title V • On site PCP training/TA with local Birth-3 and Regional Centers • Standard referral form

9. Title V Children/Youth with Special Health Care Needs Program • All state Title V Programs promote developmental screening as 1 of 6 • National Performance Outcomes • • Parent leadership • • Medical Home • • Health insurance coverage • • Screening and identification • • Coordinated services • • Transition to adult life

10. Next Steps • Prepared physicians to implement in their own practice and train other practices in local communities • Physicians, Birth to 3, & Regional Centers chose date to train local community, invited physicians, nurses, MAs, front desk staff • Champion physicians filled out baseline survey (importance of screening, number and methods of referral) 10 If citation needed, place here- Arial 10 or smaller

11. Encourage you to all learn more about what your state Title V Maternal and Child Health Program is doing to meet its early screening and Medical Home outcomes and look for opportunities to partner. • Sharon Fleischfresser, MD • CYSHCN Medical Director

12. Practice-Based Developmental Screening Initiative Train physicians to use validated screening tools and make appropriate community referrals (AAP recommendations) Prepare physicians to implement screening in their own practice & train other practices Collaboration among physicians, Birth to 3 programs, and Regional Centers for CYSHCN If citation needed, place here- Arial 10 or smaller

13. Train the Trainers Event • Project lead recruited 13 physicians from across WI, referred to as “Champion Physicians” • Held kickoff event with physicians, Birth to 3, and Regional Centers • Participants received: - copy of training - research articles supporting screening - ASQ toolkit 13

14. Elements of the Training • Rational for developmental screening & supporting research • Surveillance vs. Screening • Overview of various screening tools • Case study & demonstration of ASQ including scoring 14 If citation needed, place here- Arial 10 or smaller

15. Elements of the Training • Algorithm for Concerning & Reassuring results and next steps for referrals • Delivering screening results to families • Workflow & billing • Early Intervention partners (Birth to 3 & Regional Centers for CYSHCN) Who we are, What we do, & How to refer – Universal referral form 15 If citation needed, place here- Arial 10 or smaller

16. Supporting and Spreading the Training Statewide • Conducted over 15 trainings statewide - usually over lunch or evening • Stipends were offered to trainers • Project staff member attended all trainings for continuity and consistency of message & provided feedback to state level leads • Participants received CME credit as incentive to participate 16 If citation needed, place here- Arial 10 or smaller

17. Supporting and Spreading the Training Statewide • Mid-way through the project, state leads held conference call for champion physicians, Birth to 3, and Regional Centers to discuss implementation of screening tool and provide technical assistance for training and outreach in local communities 17 If citation needed, place here- Arial 10 or smaller

18. Project Completion and Follow-Up • Project began with 13 champion physicians and reached nearly 200 professionals in total • Upon conclusion of trainings sent 3 separate on-line surveys to: 1. Champion Physicians 2. Birth to 3 & Regional Center trainers 3. Training Participants, M.D.s & staff 18 If citation needed, place here- Arial 10 or smaller

19. What We Learned from the Surveys… • 100% of the champion physicians implemented screening (which was the hope) • 71% of the training participants who responded reported they are implementing or planning to implement the ASQ • 86% of the training participants who responded reported that their knowledge of Birth to 3 & Regional Centers increased as a result of the training • 83% of the training participants who responded reported that their experience showed benefit to using a validated screening tool to ID children with developmental delays 19 If citation needed, place here- Arial 10 or smaller

20. Other Valuable Lessons • Physicians reported that oftentimes parents appreciate screening tool and opportunity to discuss child’s development • Physicians valued having training at practice & valued face-to-face contact with Birth to 3 & Regional Center Staff • Birth to 3 reported receiving appropriate referrals as a result of practices implementing developmental screening 20 If citation needed, place here- Arial 10 or smaller

21. The Work Continues • Requests for trainings are still coming in • Practices are hearing about training via word of mouth • Physicians are helping one another with implementation and workflow • Birth to 3 and Regional Centers are building strong relationships with local physicians 21 If citation needed, place here- Arial 10 or smaller

22. The Work Continues • Screening passports for families • Condition specific screening (e.g. autism) • Child care linkages • Big Dream… • Better data collection across systems • Screening to referral 22 If citation needed, place here- Arial 10 or smaller

23. Resources • Wisconsin Early Childhood Collaborating Partners: Early Identification of Developmental Concerns website • www.collaboratingpartners.com/EarlyID/index.htm • American Academy of Pediatrics • www.medicalhomeinfo.org/screening/cdc_rev1.html 23 If citation needed, place here- Arial 10 or smaller

24. Contact Information Linda Tuchman-Ginsberg, PhD tuchman@waisman.wisc.edu 608-263-6467 Elizabeth Wahl, MSW APSW martinkus@waisman.wisc.edu 608-265-9423 Sharon Fleischfresser, MD sharon.fleischfresser@dhs.wisconsin.gov 608-266-3674 24

25. Questions & Discussions 25