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Strategies and Best Practices to Spark Child Health Provider Engagement
HELP ME GROW NATIONAL FORUM
AUGUST 12, 2020
Jill Sells, MD, Early Childhood Systems Consultant (Facilitator)
Emily Sherer, MD, HMG Indiana, Pediatric Champion
Melissa Passarelli, MA, HMG Long Island, NY, Docs for Tots
Loren Farrar, HMG Alameda County, First 5 Alameda County, CA
Abby Alter, MPA, HMG Connecticut, Child Health and Development Institute
Taylor Caragan, MPH, HMG Pierce County, Tacoma-Pierce County Health Department, WA
Engaging Child Health Providers in Early Childhood Partnerships
J ILL SELLS, MD, FAAP
HELP ME GROW NATIONAL FORUM
AUGUST 12, 2020
Dr. Mary Ann Woodruff, Washington State(Photo courtesy Reach Out and Read)
Why engage child health providers?
Dr. Amy Shriver - Iowa - by United States Capitol (photo courtesy Shriver)
▪Access to young children
▪Support children in families
▪Child health and development expertise
▪Trusted by families
Roles child health providers can play
Dr. Nerissa Bauer - Indiana (photo courtesy Bauer)
▪ Service provider
▪ Advocate
▪ Systems connector
▪ Initiative partner
Advocate
▪Help educate decision-makers and funders
▪Influence policy agendas to include early childhood issues
▪Meet with government officials or testify at hearings
▪Speak at a press conference or community event
▪Write an Op-Ed or letter to the editor
Systems Connector
▪Share what the families they care for experience
▪Help build bridges across disciplines
▪Engage other medical providers and organizations
Initiative Partner
▪Provide pediatric health perspective to community planning
▪Provide pediatric voice in leadership groups
▪Facilitate the engagement of medical provider groups, such as the state AAP Chapter
Barriers to child health provider engagement
▪Provider time & schedule limitations
▪Opportunity-specific barriers
Dr. Dipesh Navsaria – Wisconsin State Legislature(photo courtesy Navsaria)
Provider time and schedule limitations▪Generally no time in their day to do partnership work, trainings, or attend community meetings
▪Canceling clinic time is rarely possible: impacts families, other staff, and access to health care
▪Using vacation time or days off usually only option
Common barriers to engagement▪Unaware of the need/opportunity
▪Lack a trusting relationship with the person or organization
▪Role/request is not clearly defined
▪Request is not well-matched to the provider’s interests
▪Time commitment is not clear
▪Potential for impact is not clear
Facilitators of provider engagement
▪Lay the groundwork
▪Define the “type” of child health provider you need
▪Find providers
▪Make your request easy to understand
▪Set them up for successDr. Nathan Chomilo and Minnesota colleagues
(Photo courtesy Chomilo)
Lay the groundwork
▪Learn about the medical world—culture, language, realities; be sympathetic
▪Build relationships over time with providers, clinics, and organizations
▪Clearly define the role you are asking a provider to play
▪Be able to explain why a medical provider is needed
Define the “type” of provider you need
▪Someone with general knowledge about pediatrics?
▪Someone representing a particular organization?
▪Someone with deeper knowledge or a skill set in a particular area?
Find child health provider partners
▪Who cares for your children?
▪Who cares for kids in your early childhood programs?
▪Who is serves on a Head Start/ECE health advisory group?
▪What partners can help: children’s clinics or hospitals, state AAP Chapters, Reach Out and Read affiliates?
Make your request easy to understand▪Be clear what you are trying to do
▪Explain things in simple terms; limit jargon and abbreviations
▪Provide context and key background information
▪Explain strategy and political context, including potential pitfalls
Set providers up for success
▪Make a personal ask
▪Make the time commitment explicit
▪Explain goals & impact potential
▪Ask what is feasible. Can you offer an alternative way to engage?
▪Offer support and coaching
▪Say thank you!
▪Follow up to let them know what happened
Bringing HMG to Indiana
Identifying a Physician Champion
Identify and Partner with existing Child Health Outreach
Involve Pediatricians in Planning Process for HMG Implementation
Referral form creation and revision
Referral process and EMR integration
Feedback to referring health provider
Utilize Pediatrician to Communicate the Concept of Help Me Grow
Physician Champion can connect HMG with key stakeholders in medical community
Forming Child Health Provider Outreach Workgroup
Spread the word about Help Me Grow
FORMAL PRESENTATION
FLYERS AND BROCHURES
INFORMATION TABLE
NEWSLETTER ARTICLES
Impact of the Pandemic
Potential for the utilization of ASQ online
Benefits of virtual meetings
Key Take Away Ideas
Child Health Provider OutreachMelissa Passarelli, MA
Overview
• Physician Outreach- Docs
for Tots’ model
• Physician Outreach Today
• Tips and Lessons
• COVID-19 Considerations
Background • Docs for Tots:
– Pediatrician-led nonprofit focused on practice transformation and systems change for the early years
– Organizing Entity for Help Me Grow – Long Island
• Docs for Tots model: Quality improvement via technical assistance– Full time practice coach worked with 5-6 clinics over the course
of 2 years per initiative
– Each site would get about 6 months of assistance; a few times a week in person at first, then tapered off over time, with monthly QI meetings to do PDSAs
– MOC credit, and CEUs for MAs
• Implemented developmental screening for young children at 5 FQHCs in Nassau County, NY.
• Replicated for maternal depression screening in pediatrics for pregnant and postpartum mothers.
Process:
Sustainability plan
Maintenance of Certification credits
Monthly QI measures
Email/phone communication
Weekly site visits for 4 months, then every other week
Launching screening
Trainings for each level of staff
Buy-in with practice leadership
Results (cont’d)
0
10
20
30
40
50
60
70
80
90
100
Av
era
ge
Pe
rce
nt
Sc
ree
ne
d o
f
Elig
ibile
Ch
ild
ren
Maternal Depression Screening Rate
Clinic A
Clinic B
Clinic D
Clinic E
The Need for HMG-LI: Making the Case to Doctors
Universal screening
• Patient-centered Medical Home
• Compliance with AAP screening recommendations
• Maintenance of Certification Credits
Referral coordination/expertise
• Ongoing communication and follow-up to ensure linkage
• “Referred but not eligible” population
• Other referral options outside of Early Intervention
Physician Outreach with HMG-LI Today
TA and MOC credit available for developmental
screening
Main focus: strengthening
referral pathways
Multiple staff in-services
Ongoing individual communication
and follow-up with each participating
site
Quarterly “Provider Reports”
Tips and Lessons Learned
One-off trainings or presentations are never enough. Ongoing
communications and support are key
Don’t make assumptions
Screening v. surveillance, standardized screening v. checklists
Universal screening as a concept
Physician Champions are great but are not everything
Pediatricians aren’t the only ones that see families!
Make the case around local statistics and benefits for the health
sector
Offer credit opportunities
Be mindful of meeting
times/length
Always have a clear ask and agenda
Keep meetings with physicians to half an hour
Make them accessible (i.e. by phone or computer)
Best times: 8AM, Noon, or after hours
Physician Engagement During COVID-19
• For the federally-qualified health centers that DFT worked with to screen:– At the beginning of COVID, in-person visits
were suspended, and virtual well-visits were canceled or not utilized
– Working on a permanent telehealth option utilizing a platform that would allow the doctors to share the screen and send files, which would allow screening to resume (in addition to in-person well-visits resuming)
• The established referral pathways still worked well as needed
Resources
• Docs for Tots’ Developmental Screening Toolkit
• DFT’s MOC Course for American Board of Pediatrics
and American Board of Family Medicine:
https://docsfortots.org/moc-credit/
• For more questions, contact Melissa Passarelli at
Health Care Provider Engagement
Loren FarrarHelp Me Grow Senior Program Administrator
• Alameda County– Population=1.5 million (2010)– Urban, diverse
• HMG since 2011• Pediatric Outreach
– 58 offices– 14991 screens FY 1819
• 9900 ASQ• 5091 MCHAT
41
Help Me Grow Alameda County
HCP Outreach & Engagement
• Training
– On-site, site specific
– Developmental Screening: ASQ-3, MCHAT
– Referring to HMG
– Monthly visits, communication
– Workflow support
– Data collection – annual review (screening & referring to HMG data)
Other Screening SupportPart of JPB Funded Pilot
– 2 participating practices in Oakland
• Postpartum Depression– 1 hour training– Referral algorithm– Prepared HMG Phone Line
• Protective Factors– 1 hour training –
including protective factors question asking at visit
44
Pediatric ACEs Screening Referrals
7 10
51 52
23
0
20
40
60
Total Referrals to HMG from Kaiser, FY1516 –FY1920 (Dec), n=143
Kaiser (S. Alameda County – 3 clinics)
• Began screening with their own tool in 2016
• Screen at 3 year well-child visit
• HMG Partnership for referrals– Redesign referral form
Connections to Services
41
2520
1410 10
05
1015202530354045
MentalHealth
Services
RegionalCenter
SchoolDistrict
SDOH Playgroupsand
activities
ParentEducation
andSupport
Top 5 Referrals HMG Made for Families Referred by Kaiser n=141 referrals, 85
children, 2016-2019
ACEs/Trauma Referrals – All Pediatric Clinics, n=295
7 10
51 52
2319 17
32 33
51
0
10
20
30
40
50
60
70
80
90
FY15-16 FY16-17 FY17-18 FY18-19 FY19-20
Kaiser Non-Kaiser
• CA initiative to increase awareness of ACEs and routine screening
• FY 20-21 ACEs Aware Grant– Partnership with HMG Contra Costa– Train pediatric providers on implementing ACEs
screening (PEARLS tool) and integrating ACEs screening with developmental and maternal depression screening
– Provide ongoing support and convene a peer-to-peer learning community
47
• Impact on HCP outreach approach
• Impact on screening rates
– ASQ Online option offered
• Strengthening our resources for SDOH to support families and related messaging
48
COVID-19
Recommendations
• Meet providers where they are and provide ongoing support
• Collect and use data for continuous quality improvement
• Explore tech solutions for increased screening & referral rates
Provider Outreach through
Academic Detailing Program
Educating Practices
Abby Alter, MPA
51
Educating PracticesThe Child Health and Development’s (CHDI) Educating Practices program
includes 21 training topics that help pediatric and family medicine better meet
the needs of children. CHDI acts as the provider outreach component of CT’s
Help Me Grow Program.
• Uses academic detailing model. Academic detailing involves educational outreach through a personal visit by a trained person to health professionals
and their staff in their own settings
• Educating Practices trainings are brief, free and offered in the comfort of the
provider’s office over lunch or another convenient time to all practice staff
• The trainings are tailored to connect practices to existing state and community
resources and include up-to-date clinical information, helpful resources and
office tools
• Many modules offer Maintenance of Certification/Quality Improvement Credit
opportunities
Educating Practices Modules
Available to HMG and Pediatric
Providers
➢ Help Me Grow Developmental Monitoring
and Connecting Children to Services
➢ Social and Emotional Health & Development
in Infants
➢ Addressing Postpartum Depression and
Anxiety: Opportunities in the Pediatric Setting
53
Photos of Educating Practices Modules in Provider
Offices
54
Photos of Educating Practices Modules in Provider
Offices
55
Successful Provider Outreach Strategies
Obtain updated list of child health providers in your target community-need to get to know your community
Conduct a mailing/and or make calls to introduce HMG and the other services you offer. Usually ask for the office manager who might be in charge of physician education.
Follow up mailing and/or call with an offer to come in person. Make sure you offer the following:
• bring a free meal
• offer to come during lunchtime or be very flexible to meet their scheduling needs
• bring promotional materials and resources
• bring copies of screening tools (you can only bring the ones that are free)
PEDS AND ASQ ARE NOT FREE
• explain the value you are bringing to their office
• HMG centralized access point
• Developmental monitoring training
• Personal commitment of HMG staff to assist child health providers
• Connections to state/local policies
• Access to MOC/Quality Improvement projects
• before you leave ask to set up another time to meet with physicians and other appropriate staff to introduce HMG to them
56
Other incentives to offer child health providers✓ Developmental Screening Incentives:
• National Committee on Quality Assurance (NCQA) includes developmental screening with a formal tool according to AAP schedule in standards for achieving medical home recognition
• Some state’s Medicaid and some private insurers are paying more for services delivered in NCQA recognized medical homes
• Some state’s Medicaid medical home performance measures include developmental screening; adherence to schedules earns practice bonus payments
✓Quality Improvement Projects
✓ Bring billing code information for public and private payers so provider’s offices can know how to bill for screening in their state
✓Remember that Help Me Grow adds value to the community and to play up that information when conducting outreach—HMG can help providers alleviate barriers to screening by assisting practices and offering them assistance
✓ Bring resources-HMG is a great resource in itself, but there may be others in the community. Make sure to always leave materials
57
Tips for Successful Outreach
• Be persistent but affable
• Do not take any rejection personally
• Try and identify the right person in the office-sometimes you
may not get the person that has influence in the office, so try
and identify that person
• Food goes a long way-always bring a meal and check for
food allergies
• Follow-up on any requests they may have given you. If you
don’t know the answer to their questions offer to find out and
make sure you get back to them on a timely basis.
• Send a thank you note via email or card
58
Replacing onsite visits
• Recorded presentations
• Zoom training
• New module with special topics
Supporting Families During Well-Child
and Other Visits: New Issues in the
COVID-19 Environment
59
Maintenance of
Certification
Connecticut Children’s became an MOC Part IV portfolio
sponsor approved by the ABP in May 2013.
As a portfolio sponsor, Connecticut Children’s can develop
and approve its own QI/MOC projects.
25 MOC Part 4 credit
12 CME credits (13 with Educating Practices)
• Carry outplan
• Document problems
• Analyzedata
• Summarize what was learned
• Objectives
• Who, what, When Where
• Datacollection
• Whatchanges
need to be made?
• Nextcycle?
Act Plan
Study Do
61
EXAMPLE RUN CHART FROM MOC
Taylor Caragan, MPH
Health Care Liaison
Help Me Grow Pierce County
Health Provider Outreach: COVID-19 Response
Provider Referral Form Pilot Project
Conduct outreach to prenatal and pediatric care providers ◦Vaccinations◦Well Child Visits◦Screening Tools
Help Me Grow Pierce CountyHealth Provider Outreach: COVID-19 Response
Help Me Grow supports work
Closing feedback loop
Rely on partners and action teams
Recommendations
Questions?
