Upload
bcpsqc
View
63
Download
1
Embed Size (px)
Citation preview
Implementing an Innovative Model of Care to Reduce Wait Times and Add Value to the
Family and Clinicians Experience
Tracy ConleyBC Autism Assessment NetworkPHSA
BCAAN
• Provincial network that provides diagnostic assessments for children and youth (0 to 19) who have been referred for a suspected ASD
• Most children living in the lower mainland, have their assessments take place at Sunny Hill Health Centre for Children, which is part of BC Children's Hospital
Multidisciplinary
• All children under 6 received an autism assessment, a language assessment, and a psychology assessment as part of their clinical diagnostic assessment package
• Very time consuming and costly
• Current research shows that early intervention before the age of 4 1/2 provides the best outcomes for children diagnosed with Autism Spectrum Disorders (ASD)
Problem - Wait Times
• Average wait time of 8 weeks from 1st appointment to diagnosis. Children and families were often coming back for up to 4 appointments
• Children would start their assessments and then wait up to 8-10 weeks for a psychology assessment
Psychology• Psychology assessments look at
cognitive functioning of a child –intellectual deficits
• Psychology resources have chronically been a long wait due to limited numbers of psychologists in the public sector in BC
• Recruitment and retention issues
• Not often is an Intellectual Disability (ID) diagnosed in a child under the age of 4
How can we use the scarce and specialized psychology resources where they are best serving these kids?
Data
• Reviewed charts of all children under 36 months who had an assessment in the last year to determine how many had a diagnosis for Intellectual Disability (ID)
• What we found:
ID Diagnosis
Age Total assessedTotal number with
+ve ID DxPercent of
total
Ages 0-36 months 71 10 14%
One Year Pilot
• A team of experienced clinicians and leadership where brought together for a one day Kaizan(workshop) where the philosophy and tools of Lean were used to develop a novel way of providing Autism assessments
• Arena Assessment model
• Developmental Pediatrician and a Speech Language Pathologist assessed the child simultaneously during one 3 hour appointment
The Arena Assessment Pilot
• A PDSA (Plan Do Study Act) cycle was used to pilot the new model of care with a small team for a year and the data was analyzed at 3, 6, and 12 months
• Every family that was involved in the pilot was told in advance that they would be part of a new model of care and asked to complete a post assessment evaluation form
• The team was comprised of one Developmental Pediatrician, 2 Speech Language Pathologists and one Psychologist on stand by (if an ID was suspected)
• Limited scope – no ESL, no Tier 4 (complex cases)
First 3 Months
• Challenges:‒ The Speech Language
Pathologists had to learn a new assessment tool
‒ The logistics of 2 clinicians working simultaneously
‒ A vigorous pace of work
‒ Concern about psychologist colleagues
‒ Self doubt - what if we miss something?
4 - 6 Months• Getting into a good rhythm
• Building arena assessment teams – added another Developmental Pediatrician and Speech Language Pathologist
• Family satisfaction – 100%
• Clinician satisfaction – improved
– 2 of the clinicians presented the new model of care to Sunny Hill staff
– Excited about giving families a diagnosis so quickly
One Year of Data
n
1st Appointment to Diagnosis (weeks)
Date of Referall to Diagnosis (weeks)
Average Range Average Range
June 2012 – May 2013 229 8 0-28 38 13-82
June 2013 – May 2014 31 2 0-6 31 18-43
nAverage # of
visitsRange # of
visits
June 2012 – May 2013 229 3 1-5
June 2013 – May 2014 31 2 1 to 3
Outcomes
• Between June 2013 and May 2014 BCAAN assessed 31 children in the pilot project
• Majority of families were provided a diagnosis within 0-2 weeks (some families received the diagnosis the same day as the assessment)
• Families were 100% satisfied with the process
• Discussed progress at a Performance Wall where staff met once a week • Formally reviewed the data at 3, 6, 12 months
• The median wait time from date of referral to diagnosis had gone from 38 weeks to 31 weeks
Results
• 31 psychology assessments spots were redirected to service older children who need more than a developmental assessment
• Decreased the wait times for young children and older children
• Avoided doing unnecessary assessments on young children
• Less number of visits
• More satisfaction for families
• Reduced cost of assessments for children under 36 months
• High clinician satisfaction with results
Challenges
• Getting buy-in from the clinicians to try a new model of care
• Lots of concern that the clinicians would not be able to get the information they needed from the family and the child in a 3 hour session
• The Speech Language Pathologists had to learn a new assessment tool
• Concern that they were ‘taking away work’ from their psychology colleagues
Next Steps
• In June 2014 we increased the age of eligibility for this
assessment model from 36 to 42 months
• Included ESL and doing some Tier 4 assessments using this format (2 clinicians doing multiple assessments)
• Now have 4 Developmental Pediatricians and 4 Speech Language Pathologists doing the arena assessments
Lessons Learned
• Gather data and share it along the way as this shows the team the progress they are making and increases during the initial phase and the planning of phase 2.
• Pilot, pilot, pilot. Use the PDSA cycle to trial new initiatives before full implementation
• Ensure you have a small, competent team involved in thedevelopment from the beginning
• Change is difficult and the learning of new processes can bechallenging but can be managed with ongoing support andcommunication