Community Collaboration for Child Health

The 6 Trends in WCC: considerations for change 1. The changing epidemiology of

pediatric practice. 2. The emergence of new technology. 3. The impact of racial and ethnic

disparities. 4. The greater prevalence of women in

pediatric practice 5. Changes in health care financing. 6. International models.

Changing Epidemiology Better disease prevention Improved care of kids with chronic disease Increased survival of VLBW babies

Results: 75% of health care dollars goes to kids with chronic and disabling conditions

CSHN are 12.8% of kids <18 Almost 60% of parents of CSHCN do not feel

partnership with providers of care

CSHCN Parental Report: Health Care Coord. Weekly

<1 hour 2-5 hours 6-10 hours > 11 hours0

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We Need to Play Together…

The child is a 5 year old born full term to a woman with bipolar disorder and p.t.s.d. Normal L&D. 4 mos of age: surgery for a vascular ring ended badly. Chylothorax, chest tube, seizures, acidosis, ventilator. Child currently has a developmental level of a two year old, is in special education, has required a g-tube, orthopedic procedures for contractures and dislocated hips. Currently in the Model Waiver Program.

The Patient

Parent/Guardian Pediatrician School Staff Funding Agency Attorney/ GAL

Who is Involved in the Child’s Care? The Community Team…

Different Definitions Different Styles Different Perceptions of Self/Others

Everybody thinks they’re the most important

This sounds easy, but…

GoalsObjectivesMethods

Metrics of Success…..Progress…..End Point(s)

How/Who…define the problem

Early Pediatricians Understood Collaboration…..

Smith

Baker

The use of lay health workers, compared to usual healthcare services:

- probably leads to an increase in the number of women who start to breastfeed their child; who breastfeed their child at all; and who

feed their child with breastmilk only; - probably leads to an increase in the number of children

who have their immunization schedule up to date; - may lead to slightly fewer children who suffer from

fever, diarrhoea and pneumonia; - may lead to fewer deaths among children under five; - may increase the number of parents who seek help for

their sick child.

Using Community Partners

What Gets in Our Way: The Lessons of Cap’n Cook

Role Separation Overestimation and Disappointment Realistic Appraisal Accommodation Integration

The Stages of Collaboration

Structure of Stages:

1. Information Exchange 2. Role Clarification 3. Goal Clarification 4. Negotiation 5. Decision Making

A Model for Collaboration…

Role Sep: Traditional Boundaries Disappointment: Inapp. Expectations Realism: Open to accepting info from each

team member Accommodation: Info shared compliments

that from other team members Integration: Recognition of expertise and

special knowledge

Information Exchange

Role separation: Maintain traditional roles Disappointment: Role Ambiguity Realism: Recog of potential contribution;

less boundaries Accommodation: Permeability of boundaries Integration: recog of expertise and spec.

capabilities

Role Clarification

Goal setting remains separate---- Systemic view of Goals

Negotiation Anxiety, competitiveness---- Non-threatening, open comm

Goal Clarification

Role Separation: Power of position Disappointment: Overestimate of ability to

make decisions Realism: More open to mutually-agreed

upon decisions Accommodation: Increasing agreement on

decisions of intervention Integration: Sharing of moral responsibility

Decision Making

Increasing numbers of children with special needs demand a collaborative approach

Community Partners need to understand the new model of the, “office without walls.”

The new model requires an appreciation of the models for collaboration

In summary…

Thanks