1. the changing epidemiology of pediatric practice. 2. the emergence of new technology. 3. the...
TRANSCRIPT
Community Collaboration for Child Health
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.
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
CSHCN Parental Report: Health Care Coord. Weekly
<1 hour 2-5 hours 6-10 hours > 11 hours0
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We Need to Play Together…
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.
The Patient
Parent/Guardian Pediatrician School Staff Funding Agency Attorney/ GAL
Who is Involved in the Child’s Care? The Community Team…
Different Definitions Different Styles Different Perceptions of Self/Others
Everybody thinks they’re the most important
This sounds easy, but…
GoalsObjectivesMethods
Metrics of Success…..Progress…..End Point(s)
How/Who…define the problem
Early Pediatricians Understood Collaboration…..
Smith
Baker
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.
Using Community Partners
What Gets in Our Way: The Lessons of Cap’n Cook
Role Separation Overestimation and Disappointment Realistic Appraisal Accommodation Integration
The Stages of Collaboration
Structure of Stages:
1. Information Exchange 2. Role Clarification 3. Goal Clarification 4. Negotiation 5. Decision Making
A Model for Collaboration…
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
Information Exchange
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
Role Clarification
Goal setting remains separate---- Systemic view of Goals
Negotiation Anxiety, competitiveness---- Non-threatening, open comm
Goal Clarification
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
Decision Making
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
In summary…
Thanks