Early Childhood Rehabilitation Program Service Model Redesign. Jeanette Deere, BSc.PT. Team Lead Calgary, AB

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Alicia Newton
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1 Early Childhood Rehabilitation Program Service Model Redesign Jeanette Deere, BSc.PT. Team Lead Calgary, AB

2 Identified Issues Regarding Service Challenges

3 Program Context: Issues Motivating Change

4 Preliminary Data - Measure of Processes of Care (MPOC-20)

5 What did we know? 600 active Repeat 0 waitlist 200 PUF age 7 new per week We cannot fix, but we can.

6 Approach to Re-Design

7 Conceptual Frameworks

8 Program Evaluation Goals in the Redesign Create of a model of care that: Adopts the most current evidence; Increases efficiencies; Improves access and minimizes wait; Supports the needs of children and their families through transitions; Maximizes outcomes

efficiencies; Improves access and minimizes wait; Supports the

9 Logic Model and Evaluation Plan Outcomes Inputs Outputs Short Term Medium Term Long Term

10 Program Evaluation Plan Formative Evaluation Summative Evaluation Referral numbers and identified need Decline vs. accepted referrals Wait-times Cancellation/no show rates Caseload numbers per provider Number of appointments available per provider Workflow and process mapping Parent complaints Visit Satisfaction Questionnaire (VSQ-9) COPM parent and child Number of appointments required to improve parents comfort MPOC-20 Team STEPPS questionnaire MPOC-SP

available per provider Workflow and process mapping Parent complaints Visit Satisfaction Questionnaire (VSQ-9)

11 Key Results - Outputs/Deliverables Regular data collection and analysis on parent identified need Established caseload guidelines per FTE to match current demand Establish consistent team structures and process Developed a pamphlet outlining service mission and expectations Transitioning to a key worker model Adopting the Response to Intervention framework Implementing the COPM and a collaborative goal setting model Streamlining documentation Reassessing service mission and vision Established clear service inclusion and exclusion criteria and subsequent referral form. Negotiating service agreements with community partners Identified professional role to match parent identified need Re-evaluating changes on families with MPOC-20 Designed a new process map COPM chosen as outcome and training provide Continuous monitoring of wait-time data and clinical outcomes. Engaged community partners Implemented an electronic scheduling system Completed MPOC-SP and TeamStepp

collaborative goal setting model Streamlining documentation Reassessing service mission and vision Established clear service inclusion and exclusion criteria and subsequent referral form.

12 Key Findings -Parent Identified Need Data Oct-April Need (n=244) Fine Motor 8% Other 3% RITA 4% Communication 15% Feeding 9% General Dev 21% Gross Motor 40%

13 Monthly Availability vs. Demand 60 Supply vs Demand 50 % of demand App'ts Slots Identified Need 10 0 PT OT SLP CDS RD

14 Cumulative Wait-times and Referrals Numbers Average # of Days to App't Oct Nov Dec Jan Feb March April App't Intake

60 50 40 30 20 10 0 74 54 53 36 27 54 60

15 Children (0-4 yrs) with Disability in Calgary Metropolitan Area (CMA) Pop Served Total Pop Reference: Statistics Canada (2012). Focusing on Geography: Census Retrieved July 14, 2014 from

Focusing on Geography: Census 2011. Retrieved July 14, 2014 from http://www12.

16 Establishing Role Clarity for Key Worker

17 New Service Process Map Response to Intervention Pyramid Tier III: Individual Assessment & Treatment Block Tier II: Targeted Child Skill Building Group Tier I: Universal Support Parent Education Workshops

18 Lessons Learned Successes Staff awareness and desire to change was fueled by ongoing sharing of the evidence and created an understanding of the service expectations. Responding to staff identified learning needs and being responsive to their tolerance for change is pivotal to engagement. Collaboration with other centers across the country and ongoing input from families assisted in reinforcing the changes. Frameworks selected have created a foundation for the rehabilitation service across the site.

Responding to staff identified learning needs and being responsive to their tolerance for change is pivotal to engagement.

19 Lessons Learned Challenges and Opportunity

20 Conclusions/Take-Away Messages Service re-design should involve a multi-modal approach with clearly identified goals. A carefully planned evaluation throughout design and implementation phases is essential. Dedicated efforts are required to support the ongoing change management process. Engage staff, partners and families early in searching for the solution and constantly communicate.

A carefully planned evaluation throughout design and implementation phases is essential.

21 Questions

Analysis One Code Desc. Transaction Amount. Fiscal Period

Analysis One Code Desc. Transaction Amount. Fiscal Period Analysis One Code Desc Transaction Amount Fiscal Period 57.63 Oct-12 12.13 Oct-12-38.90 Oct-12-773.00 Oct-12-800.00 Oct-12-187.00 Oct-12-82.00 Oct-12-82.00 Oct-12-110.00 Oct-12-1115.25 Oct-12-71.00 Oct-12-41.00