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For the Children of Illinois…

For the Children of Illinois…. And those MOST underserved! Steven A. Schulz, MD. Key Points. Underserved: children in rural downstate Illinois with developmental and behavioral disabilities constitute the most underserved population of children in our state.

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For the Children of Illinois…

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  1. For the Children of Illinois… And those MOST underserved! Steven A. Schulz, MD

  2. Key Points • Underserved: children in rural downstate Illinois with developmental and behavioral disabilities constitute the most underserved population of children in our state. • Primary care specialty: a physician trained to provide care for these children would be an enormous asset to Illinois. This training and care is within the context of primary care pediatrics.

  3. Key Point #1:Who’s more underserved? • Children who live in areas that are: • Rural OR • Children who have: • Developmental-Behavioral Disabilities

  4. How about children who are both? 1. Underserved because of lack of care for children with developmental behavioral disabilities & 2. Underserved because they live in a rural area with scarce resources

  5. Illinois Population Statistics • The State of Illinois • 12.85 Million People • 2006 Census • The Chicago Metropolitan population • 8.6 Million People • Includes Cook, DeKalb, DuPage, Grundy, Kane, Kendall, Lake, McHenry, & Will Counties per 2006 Census • Ratio: • 2 Chicago Area people per 1 Downstate person • 12.85M (total) - 8.6M (Chicago) = 4.25M (Downstate) • 8.6M divided by 4.25 = 2 to 1 ratio

  6. Illinois Child Population • 3.2 Million Illinois Children (0-18 yrs) • 2006 Census • ~1.07 Million Downstate Children • Extrapolation from data on previous slide (Ratio of Chicago Area to Downstate = 2:1)

  7. Illinois Child Population with Dev-Behavioral Disabilities • 18,467 children with Individualized Family Service Plans (0-3 yrs) • 2008 Early Intervention Illinois Annual Performance Report (IDHS) • 323,249 children received special education services (3-21 yrs) • 2006-07 Annual Illinois State Report on Special Education Performance (ISBE) • 341,716 Total IL Children (w/ Disabilities) • ~114,000 Downstate Children with delays/special education needs • Ratio of Chicago Area to Downstate = 2:1

  8. Illinois Dev-Behavioral Pediatricians (DBPs) • ~20 Chicago Metropolitan Area Developmental Behavioral Pediatricians • 2 Downstate Developmental Behavioral Pediatricians • Charles Morton, MD (Bloomington, Champaign, Urbana, Danville) • Andrew Morgan, MD (Peoria, but soon retiring)

  9. Who is most underserved? • 1 DBP per ~57,000 children with disabilities in Downstate Illinois • (114,000 kids divided by 2 DBPs) • (1:15,500 counting Chicago DBPs – 341,716 kids divided by 22 DBPs) • As compared to… • 1,700 children per general practice pediatrician in Illinois • National AAP Division of Health Policy Research 2008

  10. And that doesn’t even include… • Children not yet identified as having a developmental or behavioral problem • Children not formally evaluated for an IFSP or IEP • The average of 2,700 new referrals for IFSPs for children 0-3yrsper month • 2008 Early Intervention Illinois Annual Performance Report (IDHS) • When development and behavior are at their MOST FORMATIVE YEARS!!!

  11. Why does identification matter? • Of these 2,700 new referrals per month, they will all need to be evaluated: • To confirm a diagnosis • To ensure appropriate services • To ensure appropriate schooling/behavioral management • To ensure appropriate treatment • To ensure appropriate follow-up • To give them the best chance to succeed in life!

  12. What do these kids do now? • Wait 6+ months to see Dr. Morton or Dr. Morgan • Drive hours to Chicago, St. Louis, Iowa City, Indianapolis, Madison • Go without the services they need and deserve!

  13. Just to clarify… • Children with developmental-behavioral disabilities in downstate Illinois are >33 timesmore underserved than the general Illinois pediatric population!!!!!

  14. What does the IDPH scholarship say is underserved? • Section 590.410  Criteria for Designating Shortage Areas a)         Shortage areas may include the following: 1)        An urban or rural area which is a rational area for the delivery of health services; 2)       A population group (ex: children with developmental-behavioral disabilities living in downstate Illinois)

  15. What does the IDPH scholarship say is underserved? c)     Additional areas shall be designated using the following criteria: 2)  Rural service areas with a population-to-primary care physician ratio of at least 2400:1 How about 57,000 children : 1 Physician?!

  16. Key Point #2So, What is Developmental-Behavioral Pediatrics Anyway? • It is what makes the practice of general pediatrics unique as compared to general internal medicine. • It is what well child visits are all about. • It is a primary care pediatrics specialty.

  17. So, What is DBP Anyway?(Continued) • It provides specialized training in those areas where development and behavior differ from normal. • It is largely primary care & service coordination for a special, underserved population of children.

  18. Learning disorders (dyslexia, math or writing problems) ADHD Oppositional defiant disorder Conduct disorder, other behavior problems Tics, Tourette’s, other habit disorders Genetic Disorders (Down’s) Depression Anxiety Sleep, feeding, discipline, toilet-training problems Failure to Thrive Muscular dystrophies Cerebral Palsy Prematurity post-NICU graduation Spina Bifida Intellectual disability, Global developmental delay Hearing, Vision defects Delays in speech, motor, language, and thinking abilities Chronic illnesses/conditions Stressful family situations Who are adopted Autism spectrum disorders And more!! DBPs see children with…

  19. Not to mention… • The majority of general pediatric primary care is behaviorally and developmentally based, and not simply treating kids who get sick.

  20. What does the IDPH scholarship require? Section 590.240  Scholarship Repayment a)         Upon the Illinois licensure of the scholarship recipient to practice medicine, the recipient shall provide primary health care in a designated shortage area of Illinois. The term of this service shall be one year for each academic year he or she is a scholarship recipient. (Section 3.07 of the Act)

  21. What does the IDPH scholarship require? f)          The scholarship recipient's practice shall meet the following requirements: 1)     Be located in a designated shortage area(s); 2)   Be a full-time, office-based practice providing direct patient care; 3)    Be in one, or in a combination of the primary care specialties; and 4)    Be providing continuous service at the rate of 12 months for each academic year of medical school supported by the scholarship.

  22. What does the IDPH scholarship require? • Fellowships in a primary care field areallowable when approved by the Department.

  23. What I’m asking for… • To complete 3 years of fellowship training in developmental-behavioral pediatrics • To return to Illinois with this extra training and expertise, while at the same time still being able to provide general pediatric care as I will be board certified in BOTHGeneral PediatricsANDDevelopmental Behavioral Pediatrics • An opportunity for me to work in the two areas of pediatrics I truly love, while fulfilling my IDPH scholarship at the same time

  24. What this gives Illinois… • An investment of time that will pay off for Illinois in terms of: • Providing care for Illinois’ most underserved and vulnerable populations (both rural primary care and DBP) • Increasing the workforce of an extremely underserved primary care specialty • Keeping children’s care in Illinois and within reasonable driving distances • Keeping healthcare dollars in Illinois • Expertise that will extend to the public health arena as well (see next slide)

  25. Added Bonus #1 • I am currently working on a project involving Nurse Family Partnership, an evidence-based, cost-effective program that “may be the most effective program for vulnerable children and families ever created.“ • Illinois’ own President Obama plans to expand NFP • Projected budget of >$500 million by 2013 • (Right when I’ll be starting practice!) • There are only 2 Illinois NFP programs: • Kane County and Jefferson & Marion Counties • My expertise in Developmental-Behavioral Pediatrics and NFP will put me in the ideal spot to make Illinois a national leader of this expansion and will be another avenue by which I can serve those most underserved in Illinois.

  26. Added Bonus #2 • My wife, Narina, is in the process of obtaining her Master’s degree in school counseling and just began working for an organization that works with children with developmental disabilities. • She can complete her degree during my time in fellowship and will be an additional resource to the Illinois community where we return.

  27. Letters of Support- Families • Charlotte Cronin • Parent and Family Support Network Executive Director (Peoria, IL) • Lucia Stegemeyer • Parent (Danville, IL) • Judith C. Meckley • Parent (Dwight, IL) • Michelle M. Mollet • Parent (Stanford, IL) • Melissa Hoerner • Parent (Champaign, IL)

  28. Letters of Support-Community/Organizations • Rep. David Leitch • Illinois General Assembly Member (73rd District) • Steven Thompson • President and CEO, Easter Seals of Central Illinois • Georgia Winson, M.S., LCPC • Chief, The Autism Program of Illinois, The Hope Institute for Children and Families (Springfield, IL) • Betty Davies • Family Support Director, The Arc of Iroquois County (Watseka, IL)

  29. Letters of Support-Physicians • Charles Morton, MD • Developmental Behavioral Pediatrician (Champaign-Urbana, IL) • Kevin Jeffries, MD • Family Physician (Galva, IL) • Lynn Garfunkel, MD • General Pediatrician and Associate Program Director of University of Rochester Pediatrics Residency (Rochester, NY) • Jeff Kaczorowski, MD • General Pediatrician and founder of Children’s Agenda, an organization that advocates for Monroe County children (Rochester, NY)

  30. Letters of Support-Physicians • Ann Cutler, MD • Developmental Behavior Pediatrician (Chicago, IL) • Martin Stein, MD • Developmental Behavior Pediatrician (San Diego, CA)

  31. Voice of Support-Physicians • Rod Curtis, MD • Illinois Dept. of Human Services, Bureau of Clinical Services, Division of Developmental Disabilities, Dept. of Human Services • Plans to contact you directly next week to further discuss this matter

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