Concerned About Development:Ohio’s Initiative to Improve Care and Outcomes for Children with Delayed Development, Autism, and Social-Emotional Concerns

A collaborative program effort among the Ohio chapter of the American Academy of Pediatrics, Akron Children’s Hospital, the Center for Health Care Quality

at Cincinnati Children’s Hospital, the Kent State Family and Child Learning Center and

The Ohio Department of Health and the Ohio Department of Job and Family Services

Concerned About Development Initiative

Raise awareness about importance of screening Marketing campaign Website

Train clinicians (learning collaboratives)

Develop diagnostic partnerships in local communities

Strengthen referral linkages

AUTISM DIAGNOSIS EDUCATION

PILOT PROJECT

Engage families, child care providers, educators, health care professionals, and community leaders in finding ways to promote early identification of autism using standardized methods, while facilitating regional coordination of timely service linkages for families of children with developmental delays like autism.

Ohio Department of Health to Ohio chapter of the American Academy of Pediatrics

Medtapp Developmental Screening Implementation Project

Ohio Department of Job and Family ServicesUniversity of Cincinnati/Cincinnati Children’s Hospital Medical Center

Outcomes to date 85 Practices trained through CADLC

8-month collaboratives beginning with Web-based (2) or Face-to-Face (12) Learning Sessions from 9/08 to 3/09

CADLC has reached nearly 900 of Ohio’s 2,173 licensed general pediatricians, including 6 residency programs.

Twenty-eight community-based diagnostic partnerships formed to aid in enhanced evaluation. 140 attended Diagnostic Partnership Training 4/15/10-4/16/10 100 attended ADOS Training 4/22/10-4/23/10 Ongoing support for reliability and implementation planned through

December 2010

Collaboration with ODJFS Bureau of Child Care and ODH Healthy Child Care Ohio Focus group held 4/29/10 with Child Care Providers to identify needs re:

developmental screening

13,000 visitors to www.concernedaboutdevelopment.org Extensive media placement across Ohio

CADLC: Screening for autism and delayed development

# of Participating

Teams

# of Teams with >25% Medicaid Patients

ADSLC (Pilot)Sept/Oct 08-May 09

22 12

CADLC Wave 2009Sept/Oct 09-May 10

30 22

CADLC Wave 2010Feb/Mar 10-Oct 10

33 28

TOTAL 85 62 (73%)

ADSLC (PILOT) ResultsIncrease in screening practices from 15% to ~70%

CADLC Wave 2009 (MONTH 8)

CADLC Wave 2010 (Month 4)

OHIO MEDICAID 96110 Claims Data – (Quarterly)

Note: about a 6-7 month lag time in Medicaid claims data availability

AAP GuidelinesIntroduced for

DevelopmentalScreening

AAP GuidelinesIntroduced for

AutismScreening

ADEPPBegins

ADSLCBegins

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

2006 2007 2008 2009

9611

0 S

cree

enin

g R

ates

at

EP

SD

T V

isit

sfo

r C

hil

dre

n o

n M

edic

aid

24 mo

18 mo

9 mo

LCL

UCL

Per JFS claims data, at least an additional 8258 screenings done in children on Medicaid between January 2008 and present (underestimate)

Baseline01.06-12.07

Intervention rate01.08-09.09

# kids screened > baseline

9 m 8.6% 10.0% 1801

12 m 8.8% 9.2% 803

18 m 7.4% 11.5% 3134

24 m 7.2% 10.7% 2520

Referrals to Ohio Help-Me-GrowReferrals July 2006-

June 2007July 2007-June 2008

2009 2010

Hospitals 41077 39212

Families 14609 14618

Child Protective Services

5226 6306

Social Service Agencies

7157 6169

Help Me Grow

5513 5896

Physicians 2099 1932 ?????? ??????

Early Care and Education

538 499 Obtaining

this data

Total 81432 78850

Findings from the Pilot Diagnostic Partnerships

Diagnoses (N = 45) Number %

Autism 14 31%

“ASD” (PDD-NOS) 5 11%

Aspergers 1 2%

TOTAL ASD 20 44%

Language Delay/Disorder

13 28%

Language + Behavior 4 9%

Language + Motor 1 2%

Global Delay 5 11%

ADD 1 2%

No Clinical Dx 1 2%

Findings from the Pilot Diagnostic Partnerships

Diagnosis x Age (N=45)

Age ASD Other

< 12 months 0 1

13-24 months 4 3

25-36 months 5 3

Total < 36 months 9 7

37-48 months 3 10

49-60 months 6 5

> 60 months 2 3

Total > 36 months 11 18

Findings from the Pilot Diagnostic Partnerships

Group(All groups are parent report)

Age ofFirst

Concern

Age First Talked to Someone

Age at Diagnosi

s

Concern-Diagnosi

sLag Time

ADEPP Initial Focus Groups(N = 43 children)

28 54 28

ADEPP Dx Partners (ASD, N = 17)

22.6 29.1 42.9 20.3

Findings from the Pilot Diagnostic Partnerships

Diagnostic Group(All groups are parent report)

Concern-Diagnosis Lag

Time(in months)

IAN 2010 Ohio

(N = 301)

ADEPP Dx Partners(N= 17)

Autism 21.6 17.1PDD-NOS 27.4 24 Asperger 55.3 44

Partners and Funding

ADEPP receives $300,000 in funding through ODH through June 30th 2010.

Cincinnati Center For Health Care Quality receives MEDTAPP funding through June 2011

ADEPP has received nearly $60,000 in regional and federal grants for added support.

Lessons Learned

Content and process both matter. We’re dealing with comprehensive

systems change. It’s hard work, but it can be done. When it works, it works well. Community spirit is essential. Local People. Local Situations.

Local Solutions.

Next Steps

April 2010-June 2011: Enhanced public awareness campaign through social and on-line media. Print campaign if funded.

June 2010: Distribute Resident Orientation to Developmental Screening Module to all Ohio Pediatric and Family Medicine Programs

April-December 2010: Support 2010 Diagnostic Partnerships

April 2010: Identify needs of child care providers re: developmental screening

May 2010: Wrap up 2009 CADLC May-September 2010: Complete 2010 CADLC

Next Steps May 2010: Develop Online Developmental screening

module in collaboration with American Board of Pediatrics for ongoing training of clinicians

July 2010- March 2011 : CADLC Learning Session 7/27/10, Akron16 sites, 90 additional practitioners already signed

up (58 physicians, 2 NP’s, and 30 residents)Will now include all 8 pediatric residencies in Ohio

Fall 2010- June 2011: Determine interest in training by Family Medicine

Residencies and develop planDiagnostic Partnership training and support

25 additional counties

Potential Next Steps--a pilot using subset of engaged group of Ohio pediatric practices: Addressing Mental Health Concerns in Primary Care (Using AAP recommendations and toolkit)

Mental Health Practice Readiness Inventory

Mental Health Care Delivery Algorithms • Algorithm A—for promoting social-emotional health, eliciting and addressing concerns or symptoms, and triaging for  problems that require further assessment or referral • Algorithm B—for assessing and managing social-emotional, mental health, or substance use problemsCommunity ResourcesHealth Care FinancingSupport for Children and FamiliesClinical Information Systems/Delivery System RedesignDecision Support for Clinicians

Potential Future Funding Sources ADEPP hopes to apply for an RFP from

ODH. ADEPP hopes to apply for grant

funding from the Robert Wood Johnson Foundation. It would require matching funds from the state.

UC/CCHMC MEDTAPP funding through June 2011