1. Creating Effective Family- Professional Partnerships Richard C. Antonelli, MD, MS Associate Professor of Pediatrics University of Connecticut School of Medicine Transition and Medical Home Advisor, National Center HRTW Hawai’I Convergence Meeting November, 2006

2. Learning Objectives What Do Families Think of the Quality of their Health Care? What Can Be Achieved When Families are Empowered?

4. What do families report? Your Voice Counts Survey, Family Voices 80% report PCP has necessary skill 1/3 report PCP not easy to reach in emergency or for phone advice 1/3 PCP communicates with school, and EI

5. Barriers to Care Coordination AAP Periodic Survey #44 August 2000 Alway s NeverBarriers Primary Care Coordinator71%5%1. Time Discuss non-medical needs41%14%2. Staff Assist with discharge plan24%41% Contact with school24%16%1. Time 2. Communic. Post-specialist appointment19%28%1. Time 2. Reimburs.

6. Definition of Medical Home Care that is:  Accessible  Family-centered  Comprehensive  Continuous  Coordinated  Compassionate  Culturally-effective

7. Definition of Medical Home And for which the primary care provider shares responsibility. AAP/ AAFP/ NAPNAP/ ACP

8. What is Medical Home Really? A Medical Home is a community-based, primary care setting that integrates high quality, evidence-based standards in providing and coordinating family-centered health promotion as well as acute and chronic condition management.

9. Medical Home: Families’ View Starts from doctors- they set pace for everyone from reception to staff Everyone from the receptionist to the insurance clerk to the nurses should understand the need for holistic care. Some groups don’t yet understand the impact of Medical Home. Education is key in explaining to them how it impacts the whole community.

10. Medical Home It is an “Attitude”. Building trust. Education. Care Coordination addressing medical as well as non- medical issues. Coordination in form of letters and communication with other providers. Referrals to Drs who embrace similar philosophies. Parent- Professional Partnership.

11. How Does a Family Know If We Have a Medical Home? Front staff friendly, non-judgmental. They know child and family. Answer phone immediately. Will call back in a short amount of time. All Drs and Nurses know you. Don’t have to worry if your Dr. is away or if you need to reach the “on call” Dr. Education: families, providers, community.

12. How to build the relationship: the “foundation” of the Medical Home Knock when entering the room. Listening. If a new family member joins get to know them Make contact with each person in the room Eye contact Neutrality Relationship – warm, empathetic, and genuine. Respect the family’s “space” while in office

13. Building the relationship Interest in child and family. Ask questions. Assessing the situation as a whole not just the symptom Feeling of caring- ie, when you call they ask about how child is. Don’t need to spell last name all time. Staff know children. Redirect the focus in a nice manner if things get off track.

14. Building the Relationship Involve parents in the decision making process. Compliance rates are higher if we feel like we are involved in the process. Families need to feel a sense of control over our care. Staff call families by name. Taking the time to make an informed decision.

16. Empowerment- What is it? Collaborative effort between family and Dr. Dr. is expert on medical issues but parent is expert on their child. They must work together for a good result. Belief that the family knows what is best for them. Belief that the family is capable of problem solving. Family decides what it needs help with.

17. Empowerment Suggestions based on medical fact and family situation. What is going on with family? Recognizing family strengths and capitalizing on what the family does best. Realizing what the family can and cannot handle. Working on helping the family access supports so they can build their strengths to help their child. Compliments to family to build confidence.

18. Culturally Effective Aware of cultural issues and specific family cultures and experiences. No assumptions are made. Issues are discussed. Family styles, heritage and social status are taken into account.

19. Parent Professional Partnership Parent professional partnership is fluid, ever-changing and dynamic. Be on the same page for goals. There needs to be motivation for change. Identify strengths. Reframe problems. See what has been helpful and not helpful in the past.

21. Creating Medical Homes at the Office Staff Level Process embraced by entire office staff Clinical and clerical Telephone as a tool Respect for confidentiality, culture, special health care needs Flexibility in scheduling

22. Supporting the Office-Based Team Physicians collaborating as partners with nurses, medical assistants, clerical, and administrative staff Sense of team work and pride in outcomes Example: quality improvement project to create triage manual

24. The Roles of the Nashaway Pediatrics PAG Parent Advisory Group  Identify strengths and weaknesses of the service delivery  Provide means for families to express satisfaction and concerns  Keep practice informed about supports, resources, and opportunities in the community  On-going educational programming for families and staff

25. Parent Advisory Group (P.A.G.) Coordinated I.E.P. Workshop; for public featuring a speaker from The Federation of Children with Special Needs. Parents feel part of the process. Resource Bulletin board Still seeking new ways to make the board accessible to those who are hesitant or in denial. It is “my family’s practice”: ownership and investment!

26. Pre Visit Surveys Idea brought up May 2002. Survey drafted Summer 2002. Discussions of what types of questions should be included. What would be helpful Several rough drafts were done. Placed in several areas of waiting room and in each exam room March 2003. Option was given to families to place in file or not. Gets families to think systemically.

30. Medical Home Based Tools “Tickler” system: reminds staff, and families, about upcoming tests, procedures, screenings Written notes to families summarizing laboratory test results Internal flow sheet templates to track acute, episodic events Group share files for commonly requested items On-going staff development: QI Strong connection with Title V

31. Informed, Activated Child/Family Prepared, Proactive Practice Team Functional and Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Care Partnership Support Health System Resources and Policies Community Health Care Organization (Medical Home) Care Model for Child Health in the Medical Home Adapted from Wagner, et al Family- centered Coordinated Timely & efficient Evidence- based & safe