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Funding an Interdisciplinary FASD Diagnostic Clinic. 15 Years of Experience. FAS Diagnostic & Prevention Network of Clinics (FAS DPN) University of Washington Seattle WA Susan Astley PhD, Director Professor of Epidemiology / Pediatrics.

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funding an interdisciplinary fasd diagnostic clinic 15 years of experience

Funding an Interdisciplinary FASD Diagnostic Clinic.15 Years of Experience

FAS Diagnostic & Prevention Network of Clinics (FAS DPN)

University of Washington

Seattle WA

Susan Astley PhD,

Director

Professor of Epidemiology / Pediatrics

washington state fas diagnostic prevention network of clinics 1
Washington State FAS Diagnostic & Prevention Network of Clinics1
  • The FAS DPN includes:
  • The Core Clinic in Seattle (University of Washington)
  • 4 Network Clinics around the state.
washington fas dpn clinic model 2
Washington FAS DPN Clinic Model 2
  • Seattle Core Clinic
    • Open 15 years (60 patients / year).
  • 4 Statewide Network Clinics
    • Open 13 years (10-20 patients / year in each clinic).
  • 2 patients / day (1 in the morning, 1 in the afternoon).
  • Interdisciplinary team using 4-Digit Code.
  • Diagnosis completed in one 4.5-hour visit.
  • Patients 3
    • All ages (newborn to adult, most school age).
    • See only those with confirmed prenatal alcohol exposure.
    • 75-85% in foster/adopt care.
interdisciplinary diagnostic team 2
Interdisciplinary Diagnostic Team 2

8-member Team

  • Pediatrician
  • 2 Psychologists
  • Occupational Therapist
  • Speech Language Pathologist
  • Social Worker
  • Family Advocate
  • Clinic Coordinator
4 5 hour fasd diagnostic evaluation 2
4.5-hour FASD Diagnostic Evaluation2

Prior to the clinic appointment, all medical, school, psychological, and placement records obtained by clinic coordinator.

actual cost of diagnostic evaluation
Actual Cost of Diagnostic Evaluation
  • $3,253 per patient
    • Cost breakdown:
      • $2,140: Salary / benefits for entire team
      • $1,113: Facility fee (indirect costs)

The cost (salary, benefits, and facility fees) for the 8-member diagnostic team to conduct a 4.5-hour evaluation:

(at the University of Washington, Seattle Clinic)

cost recovery
Cost Recovery
  • Typically only 25-30% of cost is covered by insurance / Medicaid6.
    • Cost recovery will vary by institution.
  • Not all clinical team members can bill for service.
    • (e.g., clinic coordinator, family advocate).
  • Those who can bill are not fully reimbursed.
    • (e.g., our MD recovers only 46% of their fee).
two models for funding wa fasd clinics
Two models for funding WA FASD clinics
  • Core clinic funded by ‘training dollars’.
    • (85 %) Federal Medicaid administrative match funds.
    • (15 %) State funds earmarked for training (not medical care).
  • Network clinics funded by ‘medical dollars’.
    • (30 %) Bill Medicaid and medical insurance.
    • (70 %) State funds supplement what cannot be covered through billing. ($2,000 per diagnosis). Alaska has similar model6

Both models established by State Legislature (Senate Bill 5688)7.

other funding sources in kind service
Other funding sources, in-kind service
  • In an academic setting:
    • Interns: Psychology, OT, SLP interns receive supervision hours in exchange for ‘free’ service in clinic.
  • In a community setting:
    • Cost-Sharing: School ‘donates’ psychologist, OT, SLP to serve on diagnostic team (1day / month). Gain valuable training / expertise that benefits school.
    • Local Funds: (e.g., United Way).
a novel way to fund a clinic training dollars
A novel way to fund a clinic: Training dollars

The Seattle Clinic hosts 10 community professional trainees every clinic.

Parent interview room

with 1-way observation window for trainees

Clinic staffing room

with extra seats for trainees

trainees include
Trainees Include:
  • medical professionals
  • medical / nursing students
  • clinicians (psychologists, SLP, OTs, etc)
  • school personnel (psychologist, special ed teachers)
  • social workers, case workers, CASA
  • foster / adoption personnel
  • juvenile justice personnel
  • child / family therapists
  • other

1,000’s have been trained to date.

training includes
Training Includes:
  • 30 minute lecture by clinical team member on what is FASD.
  • Full day observation of interdisciplinary team conducting 2 FASD diagnostic evaluations.
    • Case presentation.
    • Family interview, child testing.
    • Derivation of diagnosis and intervention plan.
    • Sharing diagnosis and intervention plan with family.
benefits of funding a clinic through training
Benefits of funding a clinic through training
  • Training funds support the diagnostic team to conduct a FASD diagnostic evaluation while 10 community professionals join us each day to learn what their role is in the community to identify, refer, and provide intervention / support services to these patients and their families.
  • Benefits:
  • The funds support 2 activities simultaneously (diagnostic evaluations and training).
  • The training generates community FASD awareness and education.
  • Community professionals learn who to refer to us for diagnosis.
  • Community professionals learn how to provide intervention to the patients we refer to them.
weblinks to publications cited in slides
Weblinks to publications cited in slides.
  • FAS DPN websitewww.fasdpn.org
  • Description of FAS DPN clinic.http://depts.washington.edu/fasdpn/pdfs/child.pdf
  • FAS DPN Patient Profilehttp://depts.washington.edu/fasdpn/pdfs/WAfasdpn042005-astley.pdf
  • FASD 4-Digit Code Diagnostic Toolshttp://depts.washington.edu/fasdpn/htmls/diagnostic-tools.htm
  • FASD Medical Summary Templatehttp://depts.washington.edu/fasdpn/htmls/diagnostic-forms.htm
  • Alaska FASD Provider Agreement.http://notes4.state.ak.us/pn/pubnotic.nsf/0/883e1c094938c3dc89257040000e3ac8/$FILE/AMENDED+AMENDED_FASD+Dx+Team_Provider+Agreement+_8-2+.pdf
  • FAS DPN Senate Bill 5688.http://depts.washington.edu/fasdwa/PDFs/senatebill5688.pdf

Questions: Contact Susan Astley, Ph.D. astley@u.washington.edu