Concerned About Development : Ohio’s Initiative to Improve Care and Outcomes for Children with Delayed Development, Autism, and Social-Emotional Concerns A collaborative program effort among the Ohio chapter of the American Academy of Pediatrics, Akron Children’s Hospital, the Center for Health Care Quality at Cincinnati Children’s Hospital, the Kent State Family and Child Learning Center and The Ohio Department of Health and the Ohio Department of Job and Family Services

Concerned About Development Initiative Raise awareness about importance of screening Marketing campaign Website Train clinicians (learning collaboratives) Develop diagnostic partnerships in local communities Strengthen referral linkages

A UTISM D IAGNOSIS E DUCATION P ILOT P ROJECT Engage families, child care providers, educators, health care professionals, and community leaders in finding ways to promote early identification of autism using standardized methods, while facilitating regional coordination of timely service linkages for families of children with developmental delays like autism. Ohio Department of Health to Ohio chapter of the American Academy of Pediatrics

Medtapp Developmental Screening Implementation Project Ohio Department of Job and Family Services University of Cincinnati/Cincinnati Children’s Hospital Medical Center

Outcomes to date 85 Practices trained through CADLC 8-month collaboratives beginning with Web-based (2) or Face-to-Face (12) Learning Sessions from 9/08 to 3/09 CADLC has reached nearly 900 of Ohio’s 2,173 licensed general pediatricians, including 6 residency programs. Twenty-eight community-based diagnostic partnerships formed to aid in enhanced evaluation. 140 attended Diagnostic Partnership Training 4/15/10-4/16/ attended ADOS Training 4/22/10-4/23/10 Ongoing support for reliability and implementation planned through December 2010 Collaboration with ODJFS Bureau of Child Care and ODH Healthy Child Care Ohio Focus group held 4/29/10 with Child Care Providers to identify needs re: developmental screening 13,000 visitors to Extensive media placement across Ohio

CADLC: Screening for autism and delayed development # of Participating Teams # of Teams with >25% Medicaid Patients ADSLC (Pilot) Sept/Oct 08-May CADLC Wave 2009 Sept/Oct 09-May CADLC Wave 2010 Feb/Mar 10-Oct TOTAL8562 (73%)

ADSLC (PILOT) Results Increase in screening practices from 15% to ~70%

CADLC Wave 2009 (MONTH 8)

CADLC Wave 2010 (Month 4)

OHIO MEDICAID Claims Data – (Quarterly) Note: about a 6-7 month lag time in Medicaid claims data availability

Per JFS claims data, at least an additional 8258 screenings done in children on Medicaid between January 2008 and present (underestimate) Baseline Intervention rate # kids screened > baseline 9 m8.6%10.0% m8.8%9.2% m7.4%11.5% m7.2%10.7%2520

Referrals to Ohio Help-Me-Grow ReferralsJuly June 2007 July June Hospitals Families Child Protective Services Social Service Agencies Help Me Grow Physicians ?????? Early Care and Education Obtainingthis data Total

Findings from the Pilot Diagnostic Partnerships Diagnoses (N = 45)Number% Autism1431% “ASD” (PDD-NOS) 511% Aspergers12% TOTAL ASD20 44% Language Delay/Disorder 1328% Language + Behavior49% Language + Motor12% Global Delay511% ADD12% No Clinical Dx12%

Findings from the Pilot Diagnostic Partnerships Diagnosis x Age (N=45) AgeASDOther < 12 months months months53 Total < 36 months months months65 > 60 months23 Total > 36 months1118

Findings from the Pilot Diagnostic Partnerships Group (All groups are parent report) Age of First Concern Age First Talked to Someone Age at Diagnosis Concern- Diagnosis Lag Time ADEPP Initial Focus Groups (N = 43 children) ADEPP Dx Partners (ASD, N = 17)

Findings from the Pilot Diagnostic Partnerships Diagnostic Group (All groups are parent report) Concern- Diagnosis Lag Time (in months) IAN 2010 Ohio (N = 301) ADEPP Dx Partners (N= 17) Autism PDD-NOS Asperger

Partners and Funding ADEPP receives $300,000 in funding through ODH through June 30 th Cincinnati Center For Health Care Quality receives MEDTAPP funding through June 2011 ADEPP has received nearly $60,000 in regional and federal grants for added support.

Lessons Learned Content and process both matter. We’re dealing with comprehensive systems change. It’s hard work, but it can be done. When it works, it works well. Community spirit is essential. Local People. Local Situations. Local Solutions.

Next Steps April 2010-June 2011: Enhanced public awareness campaign through social and on-line media. Print campaign if funded. June 2010: Distribute Resident Orientation to Developmental Screening Module to all Ohio Pediatric and Family Medicine Programs April-December 2010: Support 2010 Diagnostic Partnerships April 2010: Identify needs of child care providers re: developmental screening May 2010: Wrap up 2009 CADLC May-September 2010: Complete 2010 CADLC

Next Steps May 2010: Develop Online Developmental screening module in collaboration with American Board of Pediatrics for ongoing training of clinicians July March 2011 : CADLC Learning Session 7/27/10, Akron 16 sites, 90 additional practitioners already signed up (58 physicians, 2 NP’s, and 30 residents) Will now include all 8 pediatric residencies in Ohio Fall June 2011: Determine interest in training by Family Medicine Residencies and develop plan Diagnostic Partnership training and support 25 additional counties

Potential Next Steps--a pilot using subset of engaged group of Ohio pediatric practices: Addressing Mental Health Concerns in Primary Care (Using AAP recommendations and toolkit) Mental Health Practice Readiness Inventory Mental Health Care Delivery Algorithms Algorithm A—for promoting social-emotional health, eliciting and addressing concerns or symptoms, and triaging for problems that require further assessment or referral Algorithm B—for assessing and managing social-emotional, mental health, or substance use problems Community Resources Health Care Financing Support for Children and Families Clinical Information Systems/ Delivery System Redesign Decision Support for Clinicians

Potential Future Funding Sources ADEPP hopes to apply for an RFP from ODH. ADEPP hopes to apply for grant funding from the Robert Wood Johnson Foundation. It would require matching funds from the state. UC/CCHMC MEDTAPP funding through June 2011