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