VISION: Possibilities, Potentials and ProgressAddressing unmet Regional Healthcare Access for Children

Need: SE TN was an Underserved Region for

Developmental Behavioral Pediatrics• 2007 National Survey of

Children with Special Health Care Needs in TN revealed: Approx. 132,000 children [46.1%] age 4 months to 5 years were at moderate to high risk for developmental, behavioral or social deficit conditions

CDC DATA on Child Prevalence:

9/1000 Autism Spectrum Disorder

12/1000 Intellectual Disability

3.1/1000 Cerebral Palsy

Children Need Early Identification and Treatment for Best Developmental Outcome

LESSON:Development of a new subspecialty service line is challenging and incredibly rewarding for the patient, the provider, the community and the region.

Nationally, about 17 percent of children under the age of 18 are affected by a developmental, behavioral, or learning disability. In 2007, data from TN and GA indicate up to 23% of children have special health care needs.

For children in SE TN/North GA region, Developmental Behavioral Pediatric services were available in Nashville, Knoxville or Atlanta with local services by consulting MDs from these areas available on a limited basis.

Wait times for DBP specialty evaluations were reported to exceed a year.

Building a Vision

• Community collaboration to deliver unmet regional healthcare needs for children with the opening of the Center for Developmental Behavioral Pediatrics

• Planning, fundraising, construction, staff recruitment to open was a 2 year endeavor

• Our CDBP is located at SCI in downtown Chattanooga, TN

• The CDBP is staffed by TCTCH clinical and administrative personnel.

Mission:

To improve the health of children with or at risk for developmental behavioral pediatric conditions from birth to teens.

Vision:

To deliver healthcare access to multi-specialty services for comprehensive assessment, diagnosis and family centered treatment, optimizing potentials and long term developmental outcomes in infants and children.

Delivery of quality healthcare requires a MISSION and a VISION

CDBP

Recruitment of Qualified Staff

• National search for a Board Certified Developmental Pediatrician to provide Leadership and Clinical expertise for the CDBP

• Clinical Staff– DB Pediatrician– Psychologist– Advanced Nurse

Practitioners– LPN

• Therapy Staff– Physical Therapist– Occupational Therapist– Speech Pathologist– Feeding Team

• Administrative Staff– Program Director– Admin Assistant– Financial/Insurance Admin– Receptionist

Regional Notification to Primary Care Physicians of New Service

• Center construction and furnishing completed early July 2009• CDBP doors opened for patients on July 22.• Region referrals have steadily increased over the first 8 months from TN,

GA, and NC• Currently, new referrals are seen within 2-6 months • Recruitment for a second DB Pediatrician to reduce wait time has begun

Progress: YTD First 8 months

0

50

100

150

200

250

July Aug Sept Oct Nov Dec Jan Feb

Pediatric Patient Visits Therapy Visits

Total Patient Visits:

Pediatric: 705

Therapy: 1304

Presenting Primary Diagnosis in Pediatric Patients

Most Common: Diagnosis Code Description

Dev Delay Disorder

Disruptive Behaviors

ADHD and Hyperkinesis

Speech / Language Disorder

Autism Spectrum Disorders

Anxiety disorders

Sleep Disorders

Cognitive Impairment

Family Counseling

Premature Infants

Chromosomal Abnormalities

Less Common: Diagnosis Code DescriptionCerebral Palsy

Spina Bifida / Encephalocele

Developmental Coordination Disorders

Neuromotor Disorders

Oculomotor Apraxia

Rare Disorders

Post Perinatal HIE/Asphyxia

Down Syndrome

Bereavement

Verbal –Motor Apraxia

Hearing Impairment

Vision Impairment

Impact on Improving Access to Care

• Adding an essential subspecialty service to a region has a direct impact on access to care for that service

• It also improves access to care to other subspecialty service needs for patients with referral needs identified during the patient’s appointment

Referrals from CDBP [downstream effect] have included:

• Other Specialties– Neurology– Genetics– Endocrinology– Orthopedics– Ophthalmology– Cardiology– Pulmonology– Dermatology

• Lab/X-Ray/MRI/EEG/EKG

• Therapy: PT/OT/Speech/Feeding

• School

• State Early Intervention and Child Find

Conclusion• It is easy to say, we can not provide that service here and send a

family a great distance to find care for their child or to have a child wait an extensive period of time to see a specialist. It is hard on a child to make this journey and detrimental to their long term outcome to delay care.

• As physicians, we have the opportunity to make a change and to expand our impact in medicine. We must be able to see the bigger picture of needs for patients. To do this means we must at times step outside the comfort of our practice and recognize broader needs in the community or our field of practice.

• By engaging and restating problems as manageable possibilities, closed doors become unlocked to future potentials within our communities.

• The ripple effect of a single new subspecialty service line touches far beyond the individual field of endeavor. Downstream effects are felt in improved healthcare for the patient and increased utilization of resources within and outside of the medical facility. Relationships are enhanced across the community. And progress is seen with improved healthcare access.