Health Smart Start Activity Logic Model – ABCD Project
Partnership: INSERT NAME
Activity Name: Assuring Better Child Health and Development (ABCD)
PBIS ID: H10
PSC: 5410
If this condition exists / For this population / And we implement these strategies / This many times, for these individuals / We expect this short-term changeNeed Statement
Why? / Target Population
Who? / Program or Activity Elements
What? / Outputs
How Many? / Outcomes
So What?
Nationally, about 16% of children have developmental delays or disabilities, or emotional /behavioral issues. Of those children, about 70% enter school with undetected delays or disabilities.[1]
The American Academy of Pediatrics strongly recommends – and Medicaid requires – that birth - 5 children receive validated standardized developmental screening. In NC it is required at 6 months, 12 months, 18 or 24 months, and at 3, 4, and 5 years of age (NC Medicaid, July 2012) and autism-specific screening at 18 and 24 months (AAP, Feb 2010 and NC Medicaid, 2012).[2]
Of the approximately ____children birth-5 in ____ County/Counties, it is estimated that 16% (insert #) have a developmental delay, disability, or social-emotional-behavioral problem.
It is estimated that as many as 8% of children (insert #) birth-5 in ____ County/Counties have a significant developmental delay or disability and would qualify for our state’s Early Intervention2.
In ____ (year), ____% of children age birth-3 yrs in ____ County/ies were identified with special needs and received early intervention services (PBIS saturation data for birth-3 yrs).
In ____ (year), ____% of children age 3-5 yrs in ____ County/ies were identified with special needs and received early intervention through Preschool Exceptional Children’s services (PBIS saturation data for 3-5).
A total of ____ (#) primary care medical practices in ____ County/ies serve Medicaid enrolled children and provide well child care to children age birth-5. Of these ____ of practices, there are _____ practices that provide at least 40 Medicaid well visits per year (DMA Report).
The child poverty rate in _____ County/ies is ____ %. (#) children living in poverty are at a higher risk for developmental delays. (http://www.nccp.org/publications/ pub_1073.html) / This activity will target ____ (#) primary care practices/medical homes and children ages birth to 5. The practices will receive three levels of service.
Level 1 – Basic ABCD Implementation - up to 6 months. Requires minimum of monthly visits to practice.
Level 2 – Intensive Services – up to 12 months. Requires monthly visits plus calls, emails, etc.
Level 3 – Maintenance Services – 18 months and beyond. Contact periodic/upon request.
The ____ (#) total participating practices will serve an estimated ____% of ____ County/counties’ children age birth – 5 during level 1 and 2 of ABCD services.
The ____ (#) total participating practices will serve (estimated) _____ Medicaid-enrolled children ages birth – 5 during level 1 and 2 of ABCD services. / ABCD Coordinators will provide training, technical assistance, and materials to participating primary care practices.
ABCD coordinators will work as part of a team that includes CHIPRA, CC4C, Nurse Care Management, and other CCNC staff, as applicable.
Level 1 – Basic ABCD Implementation
§ Develop working relationships between local Smart Start contractor/staff and appropriate pediatric CCNC staff to decide on highest need practices
§ Enroll primary health care practices that serve children age birth-5 to participate in ABCD.
§ Determine key players & introduce/ establish community collaborations; work with CDSAs and Exceptional Children’s programs to establish and enhance a referral system and referral feedback loop
§ Introduce practices to the NC ABCD model, supporting their implementation of routine developmental and autism-specific screenings, referral and follow-up
§ Assess medical provider’s strengths and needs; review workflow
§ Involve all staff in the medical practice and find a champion to promote ABCD
§ Develop Technical Assistance plan
§ Conduct first chart review to establish baseline
Level 2 – Intensive Services
§ Provide training to practice staff regarding:
o administration and scoring of validated standardized developmental screening tools (e.g. ASQ3, PEDS);
o autism-specific screening tools (e.g. MCHAT);
o referral processes/ procedures for children who score at-risk and need further evaluation/ services at the CDSA or the local school system’s Exceptional Children’s Program.
§ Assist practices with mapping office workflow and integrating developmental screenings into their routine.
§ Assist medical providers on how to make informed referrals to community resources and assure feedback on each referral.
§ Assist medical providers with information to educate families about child development.
§ Assist medical providers in how to discuss children’s screening results with caregivers.
§ Continued chart reviews
§ Provision of materials
§ Continue to strengthen the team approach between Smart Start and CCNC, implementing the ABCD project.
Level 3 – Maintenance Services
§ Team incorporates ABCD in their daily work with medical practices
§ Upon team’s request, ABCD coordinator to provide refresher training.
Team will:
o Provide quarterly screening & referral rates (for Medicaid children served)
o Provide new screening tools & other materials
o Provide ABCD orientation/training to new providers and other key practice staff
o Support practices to correctly code and bill for services rendered
o Ensure medical provider remains connected to community resources
o Assist to close the referral feedback loop / 1. ____ (#) of community meetings and presentations (e.g. LICC meetings) to promote the ABCD program, help establish and maintain communication between physicians & EI agencies, and support established referral procedures.
2. ____(#) primary care practices will participate in this activity
3.____(#) health care providers will participate
4. ____(#) total children age birth-5 (estimated) are served in participating practices
5. ____(#) Medicaid-enrolled children age birth-5 yrs (estimated) are served in participating practices
6. ____ (#) practices will complete the survey (completed by providers and key practice staff).
7. ____ (#) baseline chart audit(s)[3] will be performed (during level 1 services).
8. ____ (#) ongoing chart audits will be performed every 6 months.
9. ____ (#) on-site training sessions will be conducted as needed.
10. ____ (#) technical assistance sessions will be provided (via phone, email, and onsite visits) / 5% of the total birth through age 2 population will have been identified and will have received early intervention services
AND
5% of the total three to five year old population will have been identified and will have received special education
Source: Performance-Based Incentive System (PBIS)
Criteria and Standards,
NCPC Board Approved March 2009, PBIS ID H10
90% of reviewed charts will note that children received developmental screenings with a validated screening tool at their most recent well-child visit.
70% of reviewed charts will note that children received autism-specific screening at designated well-child visits (18 and 24 mos).
Chart reviews will show a 10% increase of the percent of children ages birth-5 with developmental concerns who have been referred for further assessment to the CDSA or the Exceptional Children’s program.
Race to the Top – State-wide Outcomes
(will be tracked via Medicaid data)
· 75% of Medicaid-enrolled children at 15 months and at 3-6 years are up-to-date in the schedule of well-child care.
· By 12 months of age, 95% of Medicaid-enrolled children will receive developmental screenings.
· By 24 months of age, 85% of Medicaid-enrolled children will receive developmental screening in the previous year.
· By 36 months of age, 75% of Medicaid-enrolled children will receive developmental screening in the previous year.
· By age 5, 75% of Medicaid-enrolled children will receive developmental screening in the previous two years.
(will be tracked at state-level or via chart reviews by region)
· 70% of children with developmental concerns in participating medical practices will be referred for further assessment or services.
· 55% of children referred for developmental assessment or services by participating medical practices receive the follow-up services.
STAFFING REQUIREMENTS
ü ABCD Coordinator must have BA/BS in child development, social work, public health, nursing, or related field and minimum of five years experience in public health or health care setting; Master’s degree preferred; in some instances, a combination of relevant education and experience may be approved. Experience working in a consultative role in a primary health care setting and experience working with young children and families is strongly preferred. ABCD Coordinator must complete the ABCD Coordinator’s training facilitated by the designated state ABCD Office.
1
[1] Glascoe, Shapiro. “ Introduction to Developmental and Behavioral Screening”. Available at www.dbpeds.org. July 2007; revised March 2008
[2] Marian F. Earls and Sherry Shackelford Hay. “Setting the Stage for Success – The NC ABCD Project”; Pediatrics 2006; p.3
[3] Note: minimum of 10 charts per provider at baseline; but no more than 50 charts audited per practice. This guidance applies to all chart reviews.