Medical Home in Pediatrics: The HOW TO Webinar Series brought to you by the National Center for Medical Home Implementation - PowerPoint PPT Presentation

1 / 43
About This Presentation
Title:

Medical Home in Pediatrics: The HOW TO Webinar Series brought to you by the National Center for Medical Home Implementation

Description:

Medical Home in Pediatrics: The HOW TO Webinar Series brought to you by the National Center for Medical Home Implementation How To Engage Youth in – PowerPoint PPT presentation

Number of Views:360
Avg rating:3.0/5.0
Slides: 44
Provided by: medicalho8
Category:

less

Transcript and Presenter's Notes

Title: Medical Home in Pediatrics: The HOW TO Webinar Series brought to you by the National Center for Medical Home Implementation


1
Medical Home in Pediatrics The HOW TO Webinar
Seriesbrought to you by the National Center for
Medical Home Implementation
How To Engage Youth in their Health CareKitty
OHare, MD, FAAPTeresa NguyenJustin
ThompsonFebruary 27, 2013
2
Disclosures
  • We have no relevant financial relationships with
    the manufacturers(s) of any commercial
    products(s) and/or provider of commercial
    services discussed in this CME activity.
  • I do not intend to discuss an unapproved/investiga
    tive use of a commercial product/device in my
    presentation.

3
Webinar Objectives
  • By the end of this webinar, the participant will
    be able to
  • Review the importance of empowering all youth in
    their health care using a strength-based approach
  • Describe promising practices for pediatric
    providers to empower youth, especially during the
    process of transition from pediatric to adult
    care
  • Describe the impact of empowerment on positive
    health outcomes and successful transition
    from pediatric to adult care

4
Case Presentation Maria
  • 20 yo Hispanic female h/o Type 1 diabetes
    presents to emergency room with sugars out of
    control.
  • Lost to follow-up since age 18 after she lost
    health insurance and stopped seeing her
    pediatrician.
  • She has weight loss and 2 years of amenorrhea.
  • She works part-time, but has difficulty
    maintaining her job since she rarely feels
    well.

5
Case Presentation Maria
Is there a better way to get Maria out of
pediatrics
and into adult-oriented care?
6
Definition of Transition
The purposeful, planned movement of adolescents
and young adults with chronic physical and
medical conditions from child-centered to
adult-oriented health care systems. -So
ciety for Adolescent Medicine
7
Goals of Transition and Empowerment
  • Transfer of care from child-oriented to
    adult-oriented services with uninterrupted
    services
  • Promote autonomy, self-care and
    self-determination
  • Allow assumption of adult roles and
    responsibilities when appropriate
  • Maximize life-long functioning and potential

8
Should we be transitioning and empowering
everyone?
Adults, including those with childhood-acquired
chronic conditions, should receive adult-oriented
primary health care from appropriately trained
and certified providers, in adult health care
settings.
-Society for Adolescent Medicine
9
Why not stay with the pediatric provider?
  • Expertise in adult medical care
  • Long-term effects of childhood diseases
  • Promote independence and autonomy
  • The population of adults with complex pediatric
    conditions continues to grow!

10
There are many barriers
11
Communication
12
MCHB Core Outcome 6
The National Survey of Children with Special
Health Care Needs, Data Resource Center for Child
and Adolescent Health. Retrieved on February 18,
2013 at http//www.childhealthdata.org/learn/NS-CS
HCN.
13
Patient-Centered Medical Home
14
A Team Effort
15
Strengths-Based Care
  • Providing strength-based care requires that
    pediatricians do the
  • following
  • ask questions,
  • provide feedback,
  • use a framework or checklist to identify the
    patients assets,
  • share decision-making, and
  • ask parents and the patient for feedback.
  • Empower to promote the self-actualization or
    influence of

16
Parent-Youth Interaction
  • How comfortably do the youth and parent interact,
    both verbally and nonverbally?
  • Who asks and answers most of the questions?
  • Does the youth express an interest in managing
    his own health issues (including youth who have
    special health care needs)?

17
Parent-Youth Interaction Teresa
  • Both parents are immigrants from Vietnam. I was
    born in the U.S.
  • I became an early self-advocate due to language
    barrier my parents spoke Vietnamese and
    understood minimal English
  • In healthcare this meant (at 16 yrs.)
  • Scheduling my own Doctors appointments
  • Interpreting
  • Becoming a key decision maker in important
    healthcare decisions equally with my parents
  • Begin transition conversation

18
Taking Charge of Healthcare Justin
  • Transition began around the age of 14.
  • Mom would take me, but would not go into the
    room.
  • Began going completely on my own at 16.
  • Before the appointment, parents would go over the
    visit with me.

19
Surveillance of Development Does the Youth
  • Demonstrate physical, cognitive, emotional,
    social, and moral competencies
  • Engage in behaviors that promote wellness and
    contribute to a healthy lifestyle
  • Form a caring, supportive relationship with
    family, other adults, and peers
  • Engage in a positive way in the life of the
    community
  • Display a sense of self-confidence, hopefulness,
    and well-being
  • Demonstrate resiliency when confronted with life
    stressors
  • Demonstrate increasingly responsible and
    independent decision making

20
Building Resilience
  • Nurture disabled and non-disabled friends
  • Seek family and peer support
  • Encourage parental support without
    over-protectiveness
  • Develop self-perception as not handicapped
  • Involve in household chores

21
Six Core Elements of Health Care Transition
22
1 Transition Policy
Martha Eliot Health Center is committed to a
smooth transition from childhood to adolescence
to young adulthood.  This process requires
collaboration between patients/families and the
medical team.  By age 14 years, all youth in our
practice will begin transition planning by moving
to an adolescent medicine care model.  By age 18
years, all youth will participate in their own
care as adults, with modifications as needed for
youth with special needs.  By age 22 years, all
patients will receive primary care from an adult
medicine provider.
23
1 Transition Policy
24
2 Transitioning Youth Registry
25
2 Transitioning Youth Registry
  • Especially critical for CSHCN
  • But helpful for all transitioning youth
  • Track by diagnosis, progress
  • Establish a timeline

26
3 Transition Preparation
Medical Needs
Non-Medical Needs
  • Patient has opportunity to talk to provider alone
  • Review of disease-specific guidelines
  • Review of age-specific guidelines
  • Checklist in visit notes
  • Patient is developing self-efficacy
  • Education-gt vocation
  • Plans for independent living
  • Plans for adult support services
  • Legal services

27
3 Transition Preparation - Assessment
28
3 Transition Preparation EMR Checklist
  • Ages 12 to 14 years
  • Patient can name their chronic conditions
  • Patient can name their allergies
  • Patient can name their medications
  • Patient has attended an IEP meeting
  • The IEP includes a transition plan
  • Family has started to keep their own health
    record
  • Patient is assigned household chores and
    participates in family life
  • Patient has hobbies and engages in exercise
  • Family has discussed sexuality
  • Family is working with patient to help them
    live independently
  • Ages 15 to 17 years
  • Patient can describe how their chronic
    conditions impact their health
  • Patient can describe what each medication is
    for
  • Patient can take their medication without
    supervision
  • Patient has tried to refill a medication
  • Patient is carrying their insurance card
  • Patient has scheduled a doctor's appointment
    on their own
  • Patient is updating their own health summary
  • Patient is investigating adult doctors for
    primary and specialty care
  • Patient/family are investigating secondary
    education, employment or vocational opportunities
  • Family has begun guardianship applications
  •  
  • Age 18 years
  • Signed HIPAA form (Patient or Guardian) is in
    EMR
  • Patient has selected adult doctors for primary
    and specialty care
  • Patient can refill their medication
  • Patient has insurance/SSI benefits
  • There is a formal plan in place for adult
    living/vocation

29
4 Transition Planning
30
4 Transition Planning Action Plan
31
4 Transition Planning Portable Medical Summary
32
4 Transition Planning Emergency Plan
33
5 Transfer of Care
34
5 Transfer of Care
35
6 Completion
  • Review of the adult model of care
  • Opportunity for feedback

36
Acknowledgements
  • Patti Hackett-Hunter, Med
  • Niraj Sharma, MD MPH
  • Richard Antonelli, MD
  • Additional Resource The Spina Bifida
    Experience Managing Your Own Medical Care from
    the National Center on Birth Defects and
    Developmental Disabilities (Video)

37
Got Transition?
  • HRSA/MCHB funded collaborative
  • Tools to implement health care transition
  • Links to other transition sites
  • Free webinars

www.gottransition.org
38
Teresa
  • 24 years old
  • Graduated from Univ. of Colorado Boulder in
    2011.
  • Has worked with Got Transition in the past with
    webinars.
  • Halfway transitioned to adult care in D.C. for
    an internship.
  • Not yet transitioned in home town-Denver, CO.
  • Has worked closely with with the Colorado Medical
    Home Initiative, and served on the Medical Home
    Youth Leadership Council.

39
Teresa My Health Care Experience
  • The Transition to Adult Care conversation
    started when I was 17 or 18 years old
  • Many aspects of early advocacy helped me feel
    comfortable with managing my own health care
  • For me factors of a successful transition
    include
  • Provider/Specialist/Insurance matchup
  • Provider is in area accessible by public
    transportation
  • Best possible health condition for transition
  • My taste of transition happened when I moved to
    DC for an internship.
  • Things I loved
  • New Provider took time with me during our consult
    appt.
  • Portable Medical Summary
  • Being put in touch with other providers that have
    expertise in transitioning special needs
    patients.
  • Knowing that theres an option to always contact
    my previous provider.
  • Transition is still in-the-works in Denver, CO
    for me

40
Justin The College Years
  • Made to transition to making all of my
    appointments.
  • Primary doctors were still in hometown.
  • Was not comfortable or equipped to find new
    primary care physicians.
  • Medical Emergency.

41
Early Adulthood
  • A move for a job forced me to find new doctors.
  • Transition between insurance was eased by job.
  • Company insurance changed during employment.
  • Insurance forms can be intimidating.

42
Questions?
43
Were Here to Help You!
  • Have a question about medical home?
  • Contact us!
  • Medical_home_at_aap.org800/433-9016 ext 7605
Write a Comment
User Comments (0)
About PowerShow.com