Community Collaboration for Child Health

1. Community Collaboration for Child Health

2. The 6 Trends in WCC: considerations for change • 1. The changing epidemiology of pediatric practice. • 2. The emergence of new technology. • 3. The impact of racial and ethnic disparities. • 4. The greater prevalence of women in pediatric practice • 5. Changes in health care financing. • 6. International models.

3. Changing Epidemiology • Better disease prevention • Improved care of kids with chronic disease • Increased survival of VLBW babies • Results: 75% of health care dollars goes to kids with chronic and disabling conditions • CSHN are 12.8% of kids <18 • Almost 60% of parents of CSHCN do not feel partnership with providers of care

4. CSHCN Parental Report: Health Care Coord. Weekly

5. We Need to Play Together…

6. The Patient The child is a 5 year old born full term to a woman with bipolar disorder and p.t.s.d. Normal L&D. 4 mos of age: surgery for a vascular ring ended badly. Chylothorax, chest tube, seizures, acidosis, ventilator. Child currently has a developmental level of a two year old, is in special education, has required a g-tube, orthopedic procedures for contractures and dislocated hips. Currently in the Model Waiver Program.

7. Who is Involved in the Child’s Care? The Community Team… • Parent/Guardian • Pediatrician • School Staff • Funding Agency • Attorney/ GAL

8. This sounds easy, but… • Different Definitions • Different Styles • Different Perceptions of Self/Others • Everybody thinks they’re the most important

9. How/Who…define the problem Goals Objectives Methods Metrics of Success …..Progress …..End Point(s)

10. Early Pediatricians Understood Collaboration…..

11. Smith

12. Baker

13. Using Community Partners • The use of lay health workers, compared to usual healthcare services: • - probably leads to an increase in the number of women who start to breastfeed their child; who breastfeed their child at all; and who • feed their child with breastmilk only; • - probably leads to an increase in the number of children who have their immunization schedule up to date; • - may lead to slightly fewer children who suffer from fever, diarrhoea and pneumonia; • - may lead to fewer deaths among children under five; • - may increase the number of parents who seek help for their sick child.

14. What Gets in Our Way: The Lessons of Cap’n Cook

15. The Stages of Collaboration • Role Separation • Overestimation and Disappointment • Realistic Appraisal • Accommodation • Integration

16. A Model for Collaboration… • Structure of Stages: • 1. Information Exchange • 2. Role Clarification • 3. Goal Clarification • 4. Negotiation • 5. Decision Making

17. Information Exchange • Role Sep: Traditional Boundaries • Disappointment: Inapp. Expectations • Realism: Open to accepting info from each team member • Accommodation: Info shared compliments that from other team members • Integration: Recognition of expertise and special knowledge

18. Role Clarification • Role separation: Maintain traditional roles • Disappointment: Role Ambiguity • Realism: Recog of potential contribution; less boundaries • Accommodation: Permeability of boundaries • Integration: recog of expertise and spec. capabilities

19. Goal Clarification • Goal setting remains separate---- • Systemic view of Goals Negotiation Anxiety, competitiveness---- Non-threatening, open comm

20. Decision Making • Role Separation: Power of position • Disappointment: Overestimate of ability to make decisions • Realism: More open to mutually-agreed upon decisions • Accommodation: Increasing agreement on decisions of intervention • Integration: Sharing of moral responsibility

21. In summary… • Increasing numbers of children with special needs demand a collaborative approach • Community Partners need to understand the new model of the, “office without walls.” • The new model requires an appreciation of the models for collaboration

22. Thanks