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MISSION CHILDREN’S HOSPITAL – AREAS OF CRITICAL NEEDS
MISSION CHILDREN'S HOSPITAL CHILD LIFE PROGRAM
CHILD LIFE SPECIALISTS U S E T H E R A P E U T I C P L AY TO EASE THE STRESS AND ANXIETY
OF MEDICAL EXPERIENCES.
CHILD LIFE PROGRAM The Child Life Program of Mission Children’s Hospital plays an important role in helping pediatric patients and their families cope with hospitalization and treatment. As the only Child Life program in western North Carolina, the team serves children from all developmental levels and their unique medical needs. This program provides Child Life staff who can be present with each child to ease the stress and anxiety of medical experiences. They offer activities that support the child’s and family’s ability to cope with both inpatient and outpatient hospital visits through play, developmentally appropriate education for procedures and/or diagnoses, and expressive activities. Our Child Life specialists work closely with caregivers and the medical team to address each child’s concerns and stressors in order to provide a more comfortable hospital experience. Child Life’s ten child development experts work to ensure that life remains as normal as possible for the children receiving care at Mission Health. The team supports inpatient pediatrics, pediatric intensive care, neonatal intensive care, emergency medicine, surgery, outpatient specialty clinics, radiology, and hematology/oncology. According to the Child Life Council, children process information from the world around them much differently than adults; they have different needs for managing stress and trauma. Without the assistance of Child Life professionals, children of all ages could experience emotions that inhibit natural development and could have lasting negative effects on their wellbeing. By empowering children, our child life specialists help make the medical experience less frightening and even fun! The Child Life Program works with pediatric patients from infants up to age 21, as well as their siblings and caregivers. Using play, the specialist can assess, educate, and prepare children and their families for healthcare and procedures. Therapeutic play is also used to help children and their families cope with and process their medical experience. Play creates a healing environment where stress and anxiety are reduced. It provides an outlet for feelings, aids the clinical staff in assessments, speeds recovery, and restores a sense of control to the child in an unfamiliar environment. The team touched the lives of 14,460 children in 2013 by easing their minds, soothing worries, and empowering them to be in control of their diagnoses. As advocates of family-centered care, child life specialists work in partnership with doctors, nurses, social workers, and others to meet the unique emotional, developmental, and cultural needs of each child and family.
CHILD LIFE SPECIALISTS CAN: • • • • •
Prepare children for medical procedures or treatment using language that children understand. Introduce coping strategies to help reduce anxiety and enhance cooperation with the healthcare team. Provide support and distraction during medical procedures. Offer opportunities for play and expressive activities, encouraging normal development and a sense of fun in spite of challenging circumstances. Promote family-centered care by providing information, advocacy, and support to families of pediatric patients.
CHILD LIFE PROGRAM
RESEARCH HAS SHOWN THAT: • • • •
Preparing children for medical procedures reduces fear and anxiety, and results in better longterm adjustment to medical challenges. Engaging hospitalized children in therapeutic play with a trained professional reduces emotional distress, increases cooperation, and decreases negative physiological responses. Child Life interventions can increase cooperation and help to reduce procedural and postprocedural pain. Providing support for family members enhances psychosocial outcomes for young patients. A parent or caregiver’s behavior and anxiety levels are strongly correlated with how a child will respond to hospitalization.
The Child Life specialists understand the fears and concerns of children at different ages and tailor the play accordingly, using a variety of tools. For example, a private foundation generously funded the acquisition of video goggles that enable children undergoing MRIs to watch their favorite movies and cartoons, or listen to music. This technology also allows the technicians to seamlessly prompt and communicate with the child during the procedure. This innovative intervention has reduced the need to sedate children undergoing MRIs to virtually zero, gaining national recognition for Mission Children’s. Even before children undergo their MRI, the Child Life team utilizes child-sized puppets (purchased with grant funding) to demonstrate the procedure to the child. Recently, the program also received funding from Mattel for interactive “loose parts” play equipment. Mission Health research nurses are studying the impact of this new equipment on communication skills, anxiety, and patient satisfaction, thereby contributing to the child life knowledge base. The long-term vision is to provide a healing atmosphere of child- and family-centered care for Mission’s most vulnerable pediatric patients and families across the region.The vision is for all pediatric patients and families to effectively partner with the medical team to create an individualized care plan that meets their unique developmental needs, effectively addresses pain, and provides supportive strategies for growth, leaving them better able to cope with future medical encounters.
FUNDING NEEDS Funding is needed to assist in providing these services for our pediatric population. The Child Life program is not revenue-generating, yet remains a critical service for both pediatric patients and their caregivers. The average annual cost to fund this program, which is essential in providing topquality care is $500,000.
MISSION CHILDREN’S HOSPITAL CHILD SAFETY TEAM
CHILD ABUSE IS COMMON IN OUR COMMUNITIES.
THE CHILD SAFETY TEAM AT MISSION CHILDREN'S HOSPITAL PROVIDES CRITICAL, INVALUABLE SERVICES TO ABUSED OR NEGLECTED CHILDREN - GUIDING THEM DOWN NEW PATHWAYS OF HOPE, HEALING, AND LOVE.
CHILD SAFETY TEAM INTRODUCTION Through the work of its Child Safety Team, Mission Health is committed to improving the health and wellbeing of children by addressing the issues of family violence, child maltreatment, and neglect. The appalling reality is that child abuse is common. Reports are made on more than 5 million children each year – nearly ten children every minute. One in five children will experience abuse or neglect. Most children reported for abuse/neglect are under five years of age. In the 21-county region of western NC served by Mission Children’s Child Safety Team, there were 18,626 children with concerns for abuse/neglect in 2013. The Child Safety Team at Mission Children’s Hospital provides medical evaluations for nearly 700 children, each with concerns of abuse or neglect. Mission’s program is part of a statewide network of child abuse specialists serving one of the largest areas with 20 counties. The Child Safety Team assesses children referred with a concern for possible physical, sexual, or emotional abuse. The child’s evaluation is performed by a specially trained child interviewer and a forensic pediatrician. The child’s interview is video recorded, the child is examined and injuries are documented. The video recording can, in some cases, serve as evidence so that the child does not have to face their abuser and testify in court, reducing emotional trauma for the child. Upon evaluation, the team arranges appropriate mental health services and support services for the child and family so they can begin the healing process. Investigators use the Child Safety Team’s detailed report, which is compiled to make decisions about the child’s safety and seek prosecution of the perpetrator. The clinical staff frequently testifies about their findings in court. In 2014 alone, the team received 168 subpoenas for testimony, and testified in more than 53 cases. Additionally, the team provided more than 280 hours of education to investigators, medical personnel, and legal professionals. Mission’s forensic practitioners provide consultation for the most complex cases involving suspected neglect or abuse of children from birth to 21 years of age. The program works closely with law enforcement officials, social services agencies, and child advocacy centers throughout western North Carolina. Child abuse has a long reach and is very costly. The pain of physical injuries is immediate, but the lack of nurturing and extreme stress that abused and neglected children experience can harm their developing nervous and immune systems. Research shows this leads to long-term health problems and a shorter lifespan. Appropriate intervention can change the trajectory for these children. In 2010, the average lifetime cost of child abuse for each victim was $210,012.
CHILD SAFETY TEAM
CHALLENGES FACING THE CHILD SAFETY TEAM There are many challenges facing the Child Safety Team. Because the program serves the entire western North Carolina region, there is often a waiting list of children who need to be seen. In addition: •
Many important services provided by the Child Safety Team are not reimbursed. The cost of the evaluation is not fully covered by insurance or other funders and is subsidized by Mission Hospital.
•
As the science in this field is always evolving, the Child Safety Team staff provides educational programs each year for investigators on the medical aspects of child abuse in order to maintain an evidence-based approach.
•
To maintain this critical service for the children of western North Carolina, support is needed for the current staff as well as additional funding which would allow for increased volume in Buncombe County and staff in outlying clinics. This will allow the Child Safety Team to serve more children and increase our educational outreach in western North Carolina.
CHILD SAFETY TEAM
FUNDING NEEDS The Child Safety Team requires ongoing financial support in order to sustain the services these children and families need. The average annual cost to operate this program is $560,000. We will use funds for meeting the clinical needs through: •
Maintaining highly qualified staff (two specialized medical providers, two forensic interviewers, a coordinator, and a medical assistant).
•
Providing peer review for medical providers and forensic interviewers involved in child abuse cases to ensure quality services in our region.
•
Offering education/training in recognition of child abuse for pediatricians, family practitioners, nurses, EMTs, emergency department personnel, and mental health providers.
•
Improving services to children through collaborative evaluations and interventions with law enforcement detectives, Child Protective Service workers, attorneys, and prosecutors involved in the investigation and prosecution of child abuse.
•
Enhancing a broader understanding of the physical and emotional impact of abuse in children in our community, and facilitating community prevention efforts.
Funding will allow the Child Safety Team to better meet this critical community need. Currently some children may wait two to three weeks for an appointment. Funding will allow for improved access to services for 80% of all cases received by the Child Safety Team. A Family Advocate will meet with families before leaving the Child Advocacy Center to serve as a navigator to multiple social needs, including but not limited to: housing, food, legal, child care, and counseling. By providing these critical services, the Child Safety Team plays an invaluable and irreplaceable role in redirecting abused or neglected children in our communities down a new pathway of hope, healing, and love.
MISSION CHILDREN’S HOSPITAL DENTAL PROGRAM - THE TOOTHBUS
EVERY CHILD IN OUR COMMUNITY DESERVES A SMILE THAT STARTS WITH HEALTHY TEETH.
THE MISSION TOOTHBUS INTRODUCTION Dental care is the single most common chronic disease and greatest unmet health need of children in western North Carolina. Every child in our community deserves a smile that starts with healthy teeth. Mission Children’s Dental Program knows that it is never too early to start taking care of a child’s teeth. The mouth is a gateway to the body, and whatever is put into the mouth affects the whole person and his or her lifelong health. Baby teeth are not just important for a pretty smile, but are essential for speech, chewing food properly, and laying the foundation for permanent adult teeth. Healthy teeth are critical to overall health. Poor dental care as a child can result in serious infections and other problems linked to high-risk issues, such as cardiac disease. In addition, oral health problems, such as oral pain, infections, and missing teeth can affect a child’s physical, mental, and social wellbeing, bringing complications to their lives that are unnecessary and avoidable. Teaching proper dental care is essential to avoid these harmful outcomes, and this is a major focus of the Mission Children’s Dental Program. Our dentists and staff are dedicated to improving the health of at-risk children by addressing their dental needs at little or no cost to their families. Surgically trained dentists and dental assistants bring preventative and restorative dental care directly to kids in their own communities through the ToothBus, a 40-foot mobile dental clinic. The ToothBus is set up to provide the same services offered in a traditional dental office in remote areas that have no other access to care. The bus traverses rural, mountainous roads to take care of children during the day at their elementary school so that parents do not have to take time off from work. The primary goal of the ToothBus program is to see patients at least once a year and serve as their primary dental home. Our program also provides child-friendly surgical care in an operating room under general anesthesia when children have special needs or require extensive dental care. This program offers services that are not otherwise available for children in rural areas of western North Carolina. Mission supports the program because it treats and prevents dental diseases that affects children’s long-term health. This is increasingly important, since communities form partnerships in anticipation of population-based reimbursement, which is determined by how healthy we keep our community.
THE MISSION TOOTHBUS
INNOVATION: BRINGING DENTAL CARE DIRECTLY TO CHILDREN IN THE REGION Healthcare models have proven that taking medical care to the patient is the most effective way to reach the greatest number of people. Mission’s Children’s Dental Program has found this to be very true. Struggling families do not have to worry about finding a way to get their children to the dentist, because the dentist comes to them. The ToothBus visits 33 elementary schools in seven counties across western North Carolina. Every child who participates in the program receives a regular check-up, cleaning, and restorative care from our exceptional dentists. 100% of children who are served by the ToothBus are either covered by Medicaid/Health Choice, or are uninsured. On the ToothBus, children not only receive dental care but also a healthy dose of education about good oral hygiene and eating habits so that they have healthy teeth throughout their lives. Our goal is to expand these education opportunities in order to reach more families in western North Carolina. The delivery of care through the Toothbus makes an impact on healthy outcomes for our region. Annually, the Toothbus provides care for nearly 1,200 children. In addition, over 1,000 children receive more extensive care and are treated under general anesthesia in an operating room. • • • • •
More children will have access to dental care close to home. More families will receive education on proper oral health care. Children benefit from improved self-esteem. School attendance improves. Children experience improved levels of concentration and engagement in the classroom.
THE MISSION TOOTHBUS
THE NEED: INCREASING ACCESS AND QUALITY OF CARE The program operates at an annual loss due to the charitable nature of the services. Operating costs include staff salaries, supplies, utilities, and fuel. The ToothBus runs from 6:30 a.m. to 3:30 p.m., Monday through Thursday, to deliver care directly to the children of our region. The ToothBus program is composed of five dentists, 11 dental assistants, and two bus drivers, and the monthly fuel cost across the ToothBus fleet is roughly $1,000. This innovative program has received national recognition and continues to work with local communities to explore new strategies to improve oral health. Since the program’s inception, great strides have been achieved with decreasing rates of dental disease in children. With the partnership and support of philanthropy, Mission Health System has the opportunity to introduce a transformational innovation in health and wellness to areas throughout western North Carolina with the greatest need. Over the course of time, our community’s health and financial welfare will improve as a result of this initiative and your support. Philanthropic support is needed to sustain and enhance this innovative program for western North Carolina. $130,000 annually.
MISSION CHILDREN’S HOSPITAL DIABETES MANAGEMENT PROGRAM
MISSION CHILDREN’S HOSPITAL SEES 5 0 C H I L D R E N W I T H NE W LY DIAGNOSED DIABETES EVERY YEAR.
MISSION CHILDREN’S DIABETES MANAGEMENT PROGRAM
INTRODUCTION For many of our young children, there is a frightening problem on the rise.That problem is diabetes, a condition in which the pancreas does not prod enough insulin and blood sugar rises. Children with type 1 Diabetes produce no insulin, and are often diagnosed at young ages and require intensive medical care. They and their families must learn to monitor and manage their blood sugar hourly throughout the day. Long thought to be an adult disease, type 2 diabetes is now a skyrocketing diagnosis in the pediatric population due to the increased prevalence of childhood obesity, and it is impacting about one in three U.S. children. Both type 1 and type 2 diabetes diagnoses in children require skillful interventions, coordination of care, and ongoing support for the child and their family. Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading cause of death. This challenging illness lowers life expectancy by up to 15 years, increases the risk of heart disease by two to four times, and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. According to the American Diabetes Association’s findings in 2012, both type 1 and type 2 diabetes are rising among U.S. Children. There are approximately 50 children newly diagnosed with diabetes within the Mission Health System each year. 50% of these pediatric patients are admitted to the hospital, but do not necessarily have to be.
MISSION CHILDREN’S DIABETES MANAGEMENT PROGRAM
IMPLEMENTATION OF PEDIATRIC DIABETES CARE TEAM According to the American Diabetes Association’s Standards of Medical Care, diabetes care for children should be provided by a team that can deal with the special medical, educational, nutritional, and behavioral issues associated with the illness. The team consists of a physician, diabetes educator, dietitian, social worker, or psychologist, along with the patient and family. Children should be seen by the team at diagnosis and in follow-up, as agreed upon by the primary care provider and the diabetes team. The goals of the pediatric diabetes program are: • • •
Reduce the disease and economic burden of diabetes; Improve the quality of life and increase access for children who have diabetes by limiting the need for inpatient hospitalization with newly diagnosed diabetes; Provide Nurse Certified Diabetes Educator support in our clinic for families who are struggling with management and need additional hours of education, whether new to diabetes or established patients.
The Mission Reuter Children’s Outpatient Center has many components of the Pediatric Diabetes Care Team in place. Brought together, the team could provide several hours of one-onone attention in the clinical setting. The child and family would see the physician but spend the majority of time with the registered nurse, certified diabetes educator, and dietitian. This intensity of service currently requires hospital admission. With these supports in place, the clinical team will be able to accommodate newly diagnosed or struggling patients and families in the clinic right when they need to be seen, avoiding hospital admission. For those patients seen in the outpatient setting, it takes three to four hours for a provider to care for and educate the patient and family on diabetes and care needed. With increasing caseloads, currently there are not enough resources to fully implement this innovative redesign of care for children and families with diabetes. However, this new model of care can prevent disruptive and costly hospitalizations, and will be necessary as we move toward a more comprehensive approach to population health.
MISSION CHILDREN’S DIABETES MANAGEMENT PROGRAM
FUNDING NEEDS The total cost of diabetes in the U.S. is $245 billion (2012). This total is composed of $176 billion in direct medical costs and $69 billion in indirect costs, including disability, work loss, and premature mortality. From both the perspective of the patient and the healthcare system, it is more cost-effective to manage patients in the outpatient setting. In addition, outpatient education allows for increased flexibility to accommodate family schedules and/or learning constraints, and improves the coping skills of patient and family. Implementation of the Pediatric Diabetes Care Team will provide for the following forecasted improvements: 1. Reduce number of newly diagnosed patients admitted into the Emergency Department by 25%. 2. Increase access of new diabetes patients by 10% in Reuter Children’s Outpatient Clinic. 3. Decrease costs of care for children with diabetes by reducing inpatients admission. 4. Improve patient outcomes with comprehensive care. 5. Enhance the patient’s and family’s experience by empowering them with knowledge and reassuring them with easy access to comprehensive care in a child-friendly, ambulatory setting. The funding needed to implement the team is $460,000 annually. Philanthropic support is essential for Mission to provide these lifesaving services that build lives of health, hope, and joy for the children in need in our community.
MISSION CHILDREN’S HOSPITAL - SAFE KIDS WNC
SAFE KIDS WNC STRIVES TO PREVENT INJURIES IN CHILDREN,
THE LEADING CAUSE OF DEATH TO CHILDREN
AGE 14 AND UNDER.
SAFE KIDS WNC INTRODUCTION Safe Kids WNC, a program of Mission Children’s Hospital, is committed to reducing accidental injury among children in western North Carolina. Our children are not only our future, but they are a family’s joy to be loved every day.When a child’s life is tragically cut short from a preventable accidental injury, we are all negatively impacted. The most effective prevention happens before a child is harmed. The goal of Safe Kids WNC is to address the most prevalent childhood injuries in our region through evidence-based target programs, to increase public awareness of ways to prevent childhood injuries, and collaborate with community agencies in their efforts to keep our children safe. Safe Kids WNC focuses on the major areas where most injuries occur: traffic injury (passenger, pedestrian, and bicycle), poisoning, choking/suffocation, drowning, falls, fire, and burns. Safe Kids WNC has been a local coalition of Safe Kids Worldwide since 1994. Our coalition partners include schools, fire departments, EMS, law enforcement, medical professionals, and business leaders.
SAFE KIDS WNC
REACHING OUT TO WESTERN NORTH CAROLINA’S CHILDREN The primary goal of Safe Kids WNC is to prevent injuries in children, the leading cause of death to children age 14 and under. We strive to teach children and their caregivers how to avoid accidental injuries and death by providing resources and educational material. We partner with many agencies and child advocacy groups across the state and nationally to educate the public in a variety of venues on the most prevalent injury areas, including safety in and around vehicles, bike and pedestrian safety, poison and choking prevention, fire and burn prevention, drowning prevention, and falls prevention. Through these partnerships, we are able to reach at-risk families to prevent both injury and the tragedy of young lives cut short. Some families are unable to provide adequate equipment to keep their children safe. No child’s life should be put at peril because of unfortunate economics. We must maintain inventory of safety equipment (primarily car seats and bike helmets) to assist families in need so that their children’s risk of injury or death can be reduced. Motor vehicle crashes are the number one cause of death to children under the age of 14. Unfortunately, car seats for some children with special needs are very expensive and not covered through health insurance. Many families are using old, expired, recalled, unsafe car seats and are improperly installing them. Having the specialized seats can mean a lifesaving difference in protecting a child from serious injury or death in an accident. In 2015, Safe Kids WNC proactively served our community by providing: •
307 conventional car seats to children in need and car seat installation education to each family. • 98 special needs car seats to children in need and intensive instruction for families. • 230 children with education on bike safety and proper helmet fit. • 17,000 people with injury prevention education and materials. • 146 caregivers with education on child passenger safety who have received citations from local law enforcement. • 60 new teen parents with classes on child safety through the YMCA Mother Love Program. Through our network of partners (fire, law, EMS) in our region, Safe Kids WNC has assisted an average of 1,000 families annually with car seat installation education. Safe Kids WNC provides these agencies with critical supplies and educational materials, certification classes, and continuing education classes for car seat technicians.
SAFE KIDS WNC
THE FUTURE OF SAFE KIDS WNC Mission Safe Kids is an invaluable resource to the community for childhood injury prevention with educational materials, programs, events, and safety resources including car seats and bicycle helmets. We provide education and specialized car seats for Mission Health’s Trauma Center, along with Pediatrics, Mother Baby, Neonatal Intensive Care Unit (NICU) and Mission Children’s Outpatient units. In addition to our community work to prevent injuries, the Safe Kids team works with all care areas to provide safe transport to any child leaving Mission Hospital. In order to meet the growing need, Safe Kids maintains car seat inventory and helmet inventory to meet the needs of children with various health conditions.We serve as a resource for the state for transporting children with special healthcare needs and provide consultation to many families - not only in our region, but across the state. To continue to operate and expand our reach, the following annual are funding opportunities: Special Needs Car Seats $40,000 Conventional Car Seats $25,000 Bicycle Helmets $5,000 Training seats for certification classes $5,000 Additional supplies, printed educational materials and classes $23,200 Safe Kids WNC is here to ensure that every child in western North Carolina grows up protected and safe from unintentional injuries. With your help, we can make that a vision a reality.
THE OLSON HUFF CENTER FOR CHILD DEVELOPMENT
THE OLSON HUFF CENTER FOR CHILD DEVELOPMENT ALLOWS FOR TREATMENT OF THE WHOLE CHILD
BY INTEGRATING CARE FOR BOTH BEHAVIORAL AND MEDICAL HEALTH NEEDS
THE OLSON HUFF CENTER FOR CHILD DEVELOPMENT
INTRODUCTION The Olson Huff Center for Child Development is named in honor of Dr. Olson Huff, a developmental pediatrician, who looks beyond the medical record to ensure that each child develops his or her full potential. Dr. Huff combines the warmth of his care for children with a steely resolve to improve their lot in life. He is known nationwide as a humanitarian who has worked for the betterment of children for 35 years. The services provided by the Olson Huff Center for Child Development allow for the treatment of the whole child by integrating behavioral and medical health needs seamlessly. Our comprehensive team of developmental pediatricians, psychologists, social workers, and family therapists work together to address each child’s health needs, as well as the emotional needs of the family. We strive to make normal childhood behaviors the rule, not the exception, for every child. The team works collaboratively to empower parents to understand challenging behavior and to develop strategies for teaching the child more adaptive behavior. In western North Carolina, there are more than 55,000 children with disabilities, almost 10,000 in Buncombe County alone. The prevalence of autism spectrum disorder has more than doubled in the past 15 years. Conservative population estimates of common issues addressed by the Olson Huff Center include: • • • • •
25,000 children with attention deficit hyperactivity disorder (ADHD) 35,000 children with learning disabilities 5,000 children with autism 7,000 children with intellectual disability 1,000 children with cerebral palsy
THE OLSON HUFF CENTER FOR CHILD DEVELOPMENT
IMPROVING ACCESS TO CARE Our goal is to maintain the Olson Huff Center (OHC) as a sustainable, nationally recognized institute and a regional center of excellence serving children with disabilities and their families. Demand for the Center’s services and programs continues to grow – as do the waiting lists. National data shows a lack of availability of pediatric subspecialties serving children with disabilities, and strong need among primary care doctors for training in the care of children with disabilities. Local survey data among pediatric behavioral health providers also shows an urgent need for training in autism-related care. In 2013, over 2,000 new patients were evaluated by Developmental Pediatrics at the Olson Huff Center, and another 1,200 by physical therapy, occupational therapy, and speech therapy. Each year the Olson Huff Center provides 20,000 pediatric patient visits across all disciplines. The demand is real and growing. In order to meet the referral demands and assist the health system in improving the primary care management of the children with disabilities population, the OHC is redesigning care to maintain our current staffing but allow providers time to educate, consult, and collaborate with regional care providers. This will include providing timely and exemplary individualized, comprehensive, specialized, interdisciplinary, family-centered care for children with disabilities in the region by: •
Working with primary care practices, behavioral health services, schools, and other partners to build a regional network of care that has the capacity to manage the growing needs of this vulnerable population in our region.
•
Ensuring sufficient staffing of talented clinicians to meet population health demands through a specialized care team of two physicians, three advanced practitioners, two psychologists, three therapists, a RN, LPN, medical assistant, referral coordinator, and care manager.
•
Working with parents and other stakeholders to identify critical areas of need for children with disabilities in the region, and seek sustainable ways to meet those needs.
•
Working with primary care practices (Pediatric and Family Medicine) to enhance capacity to provide primary care medical home for children with disabilities.
•
Providing ongoing training and supervision of regional behavioral health programs in the care of children with disabilities, including autism.
THE OLSON HUFF CENTER FOR CHILD DEVELOPMENT
IMPROVING ACCESS TO CARE
CURRENT STATE: • • • •
Children may have to wait >4 months for a new evaluation appointment. Current budget requires significant subsidies therefore challenged to fill vacancies. Primary care providers need enhanced knowledge and skills to care for children with disabilities. Clinician leaders at the Olson Huff Center for Child Development have very limited opportunity and support for innovation and program development.
FUTURE STATE: • • • • •
Improved access to care, with wait times no more than six weeks. Redesigned staffing model to better meet community needs. Primary care has skills, tools, and support to provide for CWD in medical home. Children with disabilities and their families have access to a network of community-based behavioral supports and therapists. Clinician leaders have the supportive environment to build programs and solve problems that benefit children with disabilities and their families.
FUNDING NEEDS The Olson Huff Center relies heavily on philanthropy to support program needs. Funding is needed at an annual cost of $1,050,000 to provide the critical support for these services to be offered in our community.
MISSION CHILDREN’S HOSPITAL REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM
400,499 NORTH CAROLINA CHILDREN
H AV E B E E N TO L D BY A HEALTHCARE PROVIDER THAT
THEY HAVE ASTHMA.
THE MISSION CHILDREN’S HOSPITAL REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM OFFERS CHILDREN AND THEIR FAMILIES EVIDENCE-BASED CARE AND EDUCATION IN THEIR LOCAL COMMUNITIES.
MISSION CHILDREN’S HOSPITAL REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM INTRODUCTION Asthma is a chronic disease that impacts multiple aspects of the healthcare system. Some 39.5 million people, including 10.5 million children in the United States, have been diagnosed with asthma. Even closer to home, 400,499 North Carolina children (17.5%) have been told by a healthcare provider that they have asthma. Yet only 5% of 6-8 graders and 8% high school students who have asthma have an asthma management plan on file at school. In addition, the cost of NC hospitalizations exceeds $132 million a year, and children ages 0 to 4 are the highest hospital utilizers in NC. Sadly, more than 26% of children with asthma in NC visit an emergency department or urgent care clinic, due to often preventable asthma-related symptoms. Mission Children’s Hospital Regional Asthma Disease Management Program was designed for rural western North Carolina to address health disparities in underserved and impoverished children suffering from asthma. Poverty is present in many of the rural areas throughout our region. Addressing social determinants of health, such as housing conditions, family socioeconomic dynamics, transportation, and access to care cannot be overlooked, as these children are at risk for lower school performance, decreased school attendance, fragile nutritional status, and inadequate housing. Other health conditions may include hypertension, diabetes, and obesity. To address these multiple issues and steer a child back on the road to health and well-being, a multifaceted approach aids families in building skills for managing environmental triggers and connecting them with community resources.
MISSION CHILDREN’S HOSPITAL REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM
COMPREHENSIVE ASTHMA TREATMENT AND MANAGEMENT FOR THE CHILDREN OF WESTERN NORTH CAROLINA Through Mission Children’s asthma program, children and families are given evidence-based care and education in their local settings – homes, childcare centers, schools, and other community sites. Most families live with challenging social and environmental circumstances, with daily exposure to multiple asthma triggers. The program’s ultimate goal is to subjectively improve a patient’s quality of life, decrease school absenteeism, decrease emergency department utilization and/or inpatient visits, resulting in cost avoidance for the family, the healthcare provider, and the wider community. The Regional Asthma Disease Management Program embraces a holistic approach to patient care through clinical assessments, developing an individual asthma plan for each patient, home or inschool visits by a respiratory therapist, educational workshops for parents, children, schools, and medical providers on risk, prevention, and treatment protocols, ongoing case management, and an environment assessment and remediation to remove asthma triggers. The positive impact of the program is evident. In 2012, a study of 61 children in western North Carolina with asthma demonstrated 102 visits to the emergency room 12 months prior to the Regional Asthma Disease Management Program intervention. Post-intervention, this number dropped to eight. This represents an incredible 92% decrease in emergency visits. In the same study, 56 children were hospitalized prior to the intervention, and this number decreased to seven with our program’s work. As a result of the asthma treatment issues, the average days missed from school prior to the program intervention was 13.1; post intervention was 3.7 days. These numbers represent the positive impact on the dayto-day lives of each of these children—more days in school and less days in the hospital. The results are extraordinary; this program works and is saving children’s lives.
MISSION CHILDREN’S HOSPITAL REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM
INNOVATION: CONSTRUCTING PROACTIVE ASTHMA CARE REGIMES AND EDUCATION PROGRAMS To further meet the needs of the children in our region, we need support for this successful population health approach to asthma care and to expand our program to serve more children in need. In addition, we will provide education and marketing to schools,local churches,child care centers,community organizations, and primary care providers across the region to identify the children in need of services.
CURRENT PROGRAM: 1. 100 children in the egion were referred to the Regional Asthma Disease Management Program in FY 15. 2. Waiting list for new patients is 3 months. 3. Emergency Department is discharging patients with rescue inhalers, not medication to control long-term symptoms. 4. Patients have obstacles to transportation, limiting access to medical care. 5. Identifying unfriendly environments triggering asthmatic attacks.
FUTURE PROGRAM: 1. A goal of tripling children in the region will be referred to the Regional Asthma Disease Management Program by FY19. 2. Reduce time for new evaluations. 3. Build Electronic Health Record for use with emergency visits to identify proper medication to dispense based on level of severity and individual need. 4. Effectively use care management to meet the child at the home or in the school. 5. Create asthmatic-friendly environments by enlisting volunteers to replace bedding & encasements with hypoallergenic materials, mold remediation, carpet removal, and put HEPA filters on air systems.
FUNDING NEEDS To expand the program, additional staff and materials will be needed. Specifically: • • •
Additional staff to meet population need ($55,000 per year, per Respiratory Therapist) Training ($25,000 per year) to include: o Asthma Educator certification o Nicotine Dependence National Certification Environmental Remediation ($30,000 per year)