Outreach to Physicians to Increase Early Identification and Referrals

to Early Intervention

Linda Tuchman-Ginsberg, PhDDirector of the Early Childhood Professional

Development ProgramWaisman Center

Elizabeth Wahl, MSW APSWBirth to 3 Professional Development Specialist

Waisman Center

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

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

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)

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

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

Partnering- UCEDD, Part C and Title V

•Optimized resources through shared training and staff

–Webcast series

•http://www.waisman.wisc.edu/connections/webcast.php

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

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

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)

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•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

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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_rev

1.html

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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

608-266-367424

Questions & Discussions

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