RCHC Developmental Screening and Referral project for Children 0-5 served by Sonoma County Community Health Centers

Why are we here together today?

Developmental Assessment: Why it Matters? Nearly 85% of brain development happens in first 3 years of life Developmental disabilities common 14% of children (1 in 6 children) Children insured with Medicaid have twice the prevalence of developmental disabilities as commercially insured kids Children from families below the federal poverty level have higher rates of developmental disabilities Latino children are diagnosed with autism an average of 2 ½ years later than White non-Latino children

Developmental Assessment: Why it Matters? Less than 1 in 3 children in California receive timely developmental screening 2 in 5 California parents with children under age 6 report having concerns regarding their child’s physical, behavioral or social development

Sonoma County Health Centers serve 14,498 Patients 0-5 years Health insurance* 5.9% uninsured 88.8% Medi-Cal 5.3% commercial Poverty level* 81.5% < 100% FPL 16.1% < 200% FPL 2.4% > 200% FPL Majority are Latino* Sample from 6 eCW health centers from 3/1/2014 to 2/28/2015

Sonoma County health centers are the health homes for the population of children in Sonoma County at highest risk of developmental delay and late diagnosis of autism

Surveillance and Screening Guidelines: American Academy of Pediatrics (AAP) Perform developmental surveillance at every well-child visit Perform developmental screening using a standardized screening tool at 9, 18, and 30* months or when concern is expressed If screening results are concerning, refer to developmental and medical evaluations and early intervention services Follow up on referrals made and continually track child’s developmental status

Findings from analysis of data and survey of Sonoma County health centers Room for improvement in developmental surveillance Well child visit for children 4-6 years range from 55.8% to 86.2% Routine standardized developmental screening with a validated tool not occurring across providers in health centers

Findings from analysis of data and survey of Sonoma County health centers ACA expansion presents challenge to increasing well child/developmental screening visits Significant disconnect between health centers and community developmental services in perception of available resources and level of bidirectional communication Referral complex and confusing for families and providers Routine streamlined referral process needed

First 5 Grant Activities Advisory Group established and meeting monthly Assessment of current clinical and billing practices in health centers Identify best practices for surveillance, screening Identify preferred evidence-based tool for developmental screening Improve and streamline the referral process Develop financial model that maximizes financial opportunities and leverages available funding

First 5 Grant Activities Align developmental surveillance, screening and referral processes and resources with related health center efforts related to trauma informed care and addressing social determinants of health in children 0-5 years

Advisory Group Established and Meeting Regularly First 5 Sonoma County RCHC Community Health Centers Sonoma County Office of Education (SCOE) Sonoma County Special Education Local Area Plan (SELPA) North Bay Regional Center (NBRC) Early Learning Institute (ELI) Easter Seals Child Parent Institute (CPI) Sonoma County Public Health Partnership Health Plan of California

Improve and Streamline the Referral Process Build upon health center centralized referral process and staff Electronic referral process implemented using P2P (Provider-to-Provider) direct health information exchange Developing shared knowledge and relationships between health center and early intervention referral staff

First 5 Grant Activities Support training of health center providers and care team members Support implementation of health center pilots to improve developmental surveillance, screening and referral in a fiscally sustainable model

Developmental Assessment Pilots 19 month pilots: October 1, 2015- April 29, 2017 4 Health Centers Santa Rosa Community Health Centers Sonoma County Indian Health Project Petaluma Health Center

Making Development Screening Work Developmental Screening in Health Center Medical Evaluation by PCP (and pediatric subspecialists as needed) Referral of Child with Possible Developmental Delay for Diagnostic Developmental Evaluation Referral to Local Early Intervention and Related Services Communication with Health Center Provider to Assure Care Coordination

Referral Process for Children Ages 0-3 For further developmental evaluations: Refer to North Bay Regional Center (NBRC) in one of the following 3 ways: Use P2P or Join the Network to send electronic referral (Contact Lisa Israel, lisrael@rchc.net for assistance) Call the Warm Line: (707) 569-2022 and leave a message – parent will receive a call back (You can also use:1 800 6 INFANT) Send a Fax (707) 542-9727

Thank you! RCHC appreciates the generous support of First 5 Sonoma County If you have any questions, please contact: Mary Maddux-Gonzalez, MD, MPH Chief Medical Officer mmgonzalez@rchc.net (707)285-2970 office Michelle Rosaschi, MPH Population Health Coordinator mrosaschi@rchc.net (707) 285-2977 office

Why are we here together today?