Pre-work Baseline Data Analysis I. Quality Measures (Annual Dental, Dental Varnishing, ED Utilization, WCV) II. New Measures (BMI, ABCD, Autism, Soc-Emot) III. Survey Results (Provider, Mental Health, OSI)

Baseline Quality Measures – ED Utilization Reported as visits per 1000 Member Months Max ED Utilization at 131 Min ED Utilization 62 Service Date: 10/1/09 – 9/30/10

Baseline Quality Measures – Annual Dental Peak at ages 7-10 and then decline… This is a measure of patients that had at least one dental visit during the measurement period Service Date: 10/1/09 – 9/30/10

Baseline Quality Measures – Dental Varnish On average 63% are receiving 3 or more varnishes and 44% are receiving 4 or more Graphs show percent of patients with 3+ and 4+ varnishes in first 42 months of life Service Date: 10/1/09 – 9/30/10

Baseline Quality Measures – Well Child Visit On average our practices see more 3-6 year olds for Well Child Visits On average 3-6 year olds are getting more of their expected visits Service Date: 10/1/09 – 9/30/10

Baseline Quality Measures – Well Child Most of the children have had 3+ visits at 15 Months Service Date: 10/1/09 – 9/30/10

Pre-work Baseline Data Analysis I. Quality Measures (Annual Dental, Dental Varnishing, ED Utilization, WCV) II. New Measures (BMI, ABCD, Autism, Soc-Emot) III. Survey Results (Provider, Mental Health, OSI)

Baseline Results - ABCD Max 93% Reporting percent of health check visits that had the necessary development screen Service Date: 10/1/10 – 12/31/10

Baseline Results - Autism Reporting percent of health check visits that had the necessary MCHAT screen for age range 18 – 30 months Service Date: 10/1/10 – 12/31/10

WCV School Age & Adolescent Screen PSC Covers ages 6 – 10 Brightfutures ages Max 3.81% Max 3.86% Service Date: 10/1/10 – 12/31/10

Baseline Results - BMI BMI V Code usage low state-wide Coding for this will help to show Meaningful Use Service Date: 10/1/09 – 9/30/10

Pre-work Baseline Data Analysis I. Quality Measures (Annual Dental, Dental Varnishing, ED Utilization, WCV) II. New Measures (BMI, ABCD, Autism, Soc-Emot) III. Survey Results (Provider, Mental Health, OSI)

Office Systems Inventory Tool Average percentage of total possible score decreases as you move from left to right Average overall score was 14 out of 21 possible points

Mental Health Practice Readiness Average scores range from 71% of the total possible in the “Clinical IS” domain to 58% in “Community Resources” Average overall score was 62 out of a possible 96

Baseline Survey Results – Provider Practice Type and Location?

Baseline Survey Results – Provider What proportion (percent%) of your practice population is: Racial/ethnic minority20% - 95% <=200% Federal Poverty Level Years Olds 12 – 21 Years Olds 15% - 90% 5% - 80% 20% - 75%

Baseline Survey Results – Provider Estimate the number of children/youth you see per month presenting for the first time with:

Baseline Survey Results – Provider Estimate the number of children/youth you see per month where you would consider or make the following diagnosis: #1 ADHD 57% said 5 or more, w/ 25% > 15 #2 Language/communication problems 60% said 5 or more #3 Developmental disabilities 52% said 5 or more #4 Mood disorders 21% said 5 or more #5 Autism spectrum disorders 11% said 5 or more #6 Substance abuse 7% said 5 or more #7 Attachment disorders 5% said 5 or more #8 PTSD 2% said 5 or more

Baseline Survey Results – Provider Please rate your level of comfort in screening and/or diagnosing children/youth who present with: behavior, soc-emot, ADHD… 86% ADHD and 92% Developmental Disabilities “Comfortable” or “Very Comfortable” 82% PTSD and 77% Attachment Disorders “Uncomfortable” or “Very Uncomfortable”

Baseline Survey Results – Provider Please rate your level of comfort in managing children/youth with: behavior, soc-emot, ADHD… 85% Developmental Disabilities and 83% Language and ADHD “Comfortable” or “Very Comfortable” 88% PTSD and 85% Attachment Disorders “Uncomfortable” or “Very Uncomfortable”

Baseline Survey Results – Provider Please rate your level of skill in screening and/or diagnosing children/youth who present with: behavior, soc-emot, ADHD… 87% ADHD and 85% Developmental Disabilities “Proficient” or “Highly Proficient” - Also highly skilled with behavior and language problems 82% Attachment Disorders and 77% PTSD “Limited” or “Very Limited”

Baseline Survey Results – Provider Please rate your level of effectiveness in managing children/youth with: behavior, soc-emot, ADHD… 85% ADHD and 79% Language/Communication “Proficient” or “Highly Proficient” 81% PTSD and 80% Substance Abuse “Limited” or “Very Limited”

Baseline Survey Results – Provider We would like to know what you usually tend to do when confronted with a child/youth who presents with: Behavior problems, Social-emotional difficulties, ADHD…. “Evaluate & Manage Yourself” I.60% ADHD II.25% Behavioral Problems III.13% Social-emotional difficulties “Evaluate & Refer Management” I.38% Language, Autism spectrum disorders II.36% Substance Abuse III.33% Developmental Disabilities “Refer out for Evaluation & Management” I.49% Attachment disorders & PTSD II.38% Substance abuse III.25% Language problems

Baseline Survey Results – Provider How satisfied do you feel in your role as a provider of care to children and families with behavioral and emotional problems? 46% “Unsatisfied or Very Unsatisfied” of which: 94% said constraints with the healthcare system 45% lack knowledge and skills for dealing with these problems 34% do not like evaluating and treating these patients “Not enough training in behavior issues”

Baseline Survey Results – Provider Challenges or obstacles to you in providing effective care to children/youth with behavior and emotional problems. Top 5 reasons were: 1.Lack of time required for patient care 2.Lack of access to specialist medical consultations (e.g. psychiatrists) 3.Difficulty in contacting teachers, social workers and other community professionals 4.Lack of access to patient/community treatment resources 5.Lack of remuneration received for patient care “Lack of good home environment/parents w/ appropriate priorities/etc.” “Multiple co-morbidities.”

Baseline Survey Results – Provider Which measures/interventions would help or assist you to provide better care to the children/youth with psychosocial problems in your practice: Top 5 reasons were: 1.Scheduled educational meeting or event 2.Education outreach visit to your practice by an expert in the field 3.Better access to medical specialist consultant support 4.Different fee (billing) codes to remunerate for time required for patient care 5.Patient/community resources list for your area

Baseline Survey Results – Provider Please indicate your beliefs about primary care management of children and youth with psychosocial problems: 88% Agreed that the primary care physician is uniquely positioned to address these issues with family because of their longitudinal relationship. 75% These problems/conditions are usually related to stresses in the family which are hard to manage 50%/50% Diagnosis of these problems is Often subjective and difficult

Baseline Survey Results – Provider Do you have established relationships with mental health professionals in your area? 85% Yes 15% No Do you receive feedback from the mental health professionals when you make a referral? 70% Yes 30% No

Baseline Survey Results – Provider What is the quality of you communication with mental health professionals? Very GoodPoorAverageGood 18%33%30%20%

Baseline Survey Results – Provider Please indicate your level of knowledge of community resources for children and youth with behavior, emotional, and/or psychosocial problems. ExtensiveMinimal 0%43%45%13%

Baseline Survey Results – Provider Please indicate your level of comfort making referrals to community resources for children and youth with behavior, emotional, and/or psychosocial problems: ExtensiveMinimal 0%10%58%33%

Baseline Survey Results – Provider Does your practice use a formal developmental/behavioral screening tool periodically with each child or adolescent 0 to 21 years old? 88% Yes 12% No

Baseline Survey Results – Provider Which tools does your practice use?

Baseline Survey Results – Provider How frequently do children /adolescents in your practice receive these screenings? Of the 19 providers that use the ASQ, 84% say they use it routinely at specified Well Visits Of the25 providers that use the PEDS, 92% say they use it routinely at specified Well Visits Of the 32 providers that use the MCHAT, 94% say they use it routinely at specified Well Visits Of the 10 providers that use the PSC, 30% say they use it routinely at specified Well Visits Of the 14 providers that use the Edinburgh, 71% say they use it routinely at specified Well Visits Of the 7 providers that use the Brightfutures, 57% say they use it routinely at specified Well Visits Of the 7 providers that use the GAPS,57% say they use it routinely at specified Well Visits

Baseline Survey Results – Provider How frequently do children /adolescents in your practice receive these screenings? Of the 4 providers that use the PHQA, 25% say they use it routinely at specified Well Visits Of the 6 providers that use the CRAFFT, 50% say they use it routinely at specified Well Visits Of the 29 providers that use the Vanderbilt, 10% say they use it routinely at specified Well Visits Of the 11 providers that use the Conner’s Scale, 9% say they use it routinely at specified Well Visits Of the 5 providers that use the SDQ, 20% say they use it routinely at specified Well Visits

Baseline Survey Results – Provider How frequently do families of children/adolescents with, or at risk for, developmental delay(s) receive information on early intervention (0-5 year olds)/school-based interventions or community programs (6-20 years old)? RoutinelyNeverRarelySometimes 0% 14%86% RoutinelyNeverRarelySometimes 2%7%37%54% 0-5 year olds 6-20 year olds

Baseline Survey Results – Provider How frequently do families of children/adolescents with, or at risk for, developmental/social-emotional, behavioral/mental health problems receive information on family support services (e.g. Family Support Network, NAMI, Family Voices, Autism Society, etc.)? RoutinelyNeverRarelySometimes 0%21%56%23% RoutinelyNeverRarelySometimes 2%33%51%14% 0-5 year olds 6-20 year olds