1. Building a Community of Caring The WATCH Project: Using Technology to Promote Communication and Collaboration within the Early Intervention System

2. Who Are We? n Joshua Alexander, MD Director of Pediatric Rehabilitation and TelAbility Program Director UNC School of Medicine n Juliellen Simpson-Vos, M.Ed TelAbility/WATCH Project Director n Emily Williams, Senior Psychologist, Raleigh CDSA n Nora Roehm, Early Interventionist, Community Partnerships n Brian Gentry, Physical Therapist, Practice Coordinator Pediatric Therapy Associates n Lillian Matthews, Community Services Director The Tammy Lynn Center for Developmental Disabilities n Charles Kronberg, Assistant Director Project Enlightenment n Anna Troutman, Director of Program Coordination and Evaluation Wake County Smart Start

3. n Who are you?? From NC or Out of State Therapists Early Interventionists Funding Agency State Agency Early Care and Education

4. What are we going to talk about? n History of our telemedicine programs n Services and Outcomes of the WATCH Project n Panel Members: Successes, Challenges, Lessons Learned n Definition and Elements of a Successful Community of Practice n How could you do it? n Questions and Resources

5. What is TelAbility? What is TelAbility? An Internet-Based Telehealth Program For Young Children with Disabilities http://www.telability/org

6. Goal #1 Connect people in different locations to increase access to specialized healthcare services for families and decrease professional isolation

7. Goal #2 Serve as a resource for parents and professionals seeking credible and reliable information on topics related to children with disabilities

8. Population Served n Birth – 5 years old n Cerebral Palsy n Spina Bifida n Down Syndrome n Brain Injury n Feeding Difficulties n Developmental Disabilities n Special Needs n Mental Health Issues

9. WATCH Wake Area Telehealth Collaborative Helping Children with special needs 2004-present

10. Building a Community of Practice “ A group of people who share a concern, set of problems, or passion about a topic and who deepen their knowledge and expertise in this area by interaction on an ongoing basis.”

11. Who does WATCH Serve? n There are over 1000 children ages birth-three identified, who meet the eligibility criteria, to currently receive early intervention services through the Raleigh CDSA. n There are over 1100 children ages three through five identified, who meet the eligibility criteria, to currently receive intervention services through Wake County Preschool Services.

12. Inclusive Child Care Centers n Learning Together n Lucy Daniels Center n Project Enlightenment n Tammy Lynn Center n White Plains Children’s Center

13. Service Programs n Community Partnerships for Children n Learning Together n Pediatric Therapy Associates n Carolina Pediatric Dysphagia n Project Enlightenment n Lucy Daniels Center n Developmental Therapy Associates

14. State Agencies n The Raleigh Children’s Developmental Services Agency (ages birth-3) - Implements IDEA Part C n Wake County Preschool Services (ages 3-5) -Implements IDEA Part B

15. WATCH Current Programming Website Content /Expertise Directory Listserv Newsletters Videoconferencing

17. Other Website Features n Expertise Directory n Handouts n Links n Calendar n Books n Articles n Videos n More!

18. n 2005 = 60 n 2008 = 310+ Expertise Directory

19. WATCH@listserv.unc.edu n 2005= 29 n 2008= 250+

20. Electronic Newsletter Subscribers= 400+ n Website Updates n Event Listings n Center Descriptions n Article Reviews n Tips and Topics n Project Updates

21. Videoconferencing Videoclinics Videoconsults Professional Development Sessions Point to point meetings (administrative, family visits, etc.)

22. Videoconferences By Type December 2005-April 2008

23. Videoclinics and consults n 44 videoclinics and consults have been held Involving 358 families, therapists, and medical personnel Satisfaction level average =4.81 out of 5.0 Comfort level average = 4.96 out of 5.0

24. Professional Development Sessions n 28 Professional Development Session have been held via videoconference Involving 968 therapists, EISC, parents, teachers, EI providers Satisfaction level average =4.1 out of 5.0 Comfort level average = 4.3 out of 5.0

25. Professional Development Data Continued… n Sessions were held free of charge to participants n Over 50 Infant Toddler Certification credits/CEUs have been issued to participants n Sessions are based on WATCH Member needs, interests and suggestions n Session cover all EI domains (PT, OTR/L, SLP. Medical, Mental Health, Developmental, Education)

26. Networking Data n 13 Networking sessions have been held via videoconference 100 people participated Satisfaction level average= 4.16 out of 5.0 Comfort level average= 4.5 out of 5.0

27. Administrative Videoconferences n 11 Administrative meetings have been held between WATCH Sites and Wake County Agencies Involving 113 participants Satisfaction level average = 3.8 out of 5.0 Comfort level average= 4.45 out of 5.0

28. WATCH Recap Since December of 2005… n 81 videoconference session have occurred n Involving over 1383 people n The average satisfaction rating for video conference sessions is 4.4 (out of 5) n The average comfort level for video conference sessions is 4.6 (out of 5)

29. Travel Savings n April 2007-April 2008 543 participants have participated in videoconferences Miles saved by offering sessions via videoconference = 31,633 Travel costs saved = $16,036 in gas (31,633 x.505) Doesn’t include time out of the office, food, etc.

30. Straight Talk from the Experts WATCH Panel Members

31. WATCH Benefits for Providers n Responsive to community’s needs and interests n Increases professional development and education opportunities n Increases collaboration with other locations and professionals n Reduces professional isolation n Improves communication and care coordination efforts n Reduces travel time and costs

32. WATCH Benefits for Parents n Improves communication and care coordination efforts n Reduces feelings of isolation from their child or the professionals caring for their child n Reduces travel time and costs n Allows for long term care coordination n No extra charge to use the technology

33. Challenges n Lack of technical knowledge and support at sites n Sustainable funds to cover costs of high speed internet connection n NC won’t reimburse therapists for care offered via videoconference. n Small monitors of the Tandberg 1500 n Buy in/consistent participation from all sites (turnover, time constraints, etc.) n Establishing a public network/technical support issues Modems provided by local services providers are often incompatible with unit software upgrades

34. Lessons Learned n Technical Support Need for a consistent, knowledgeable, easily accessible IT support person. First attempts to establish a public network system was unreliable. Purchase and installation of a border controller has helped to stabilize the network.

35. Lessons Learned cont. n Programmatic Support Fully funded Project director position is necessary to coordinate communication and activities within the project and be point person for IT problems. Needs assessments of each site and frequent communication with each site is vital to success. The collaborative should consist of sites with specific expertise to help meet the collective needs of the members. Professional development opportunities great opportunities for sites to network, share expertise, and gain knowledge Reimbursement of therapists through grant funding increases the likelihood of participation in videoclinics and consults..

36. D.I.Y. OR How to Establish Your Own Telemedicine Collaborative

37. Elements of a Successful Community of Practice Taken from: Meeting the Health Care Needs of California’s Children: The Role of Telemedicine Written by The Children’s Partnership

38. A Champion for Your Cause n A respected leader in the community, committed to investing in and sustaining the program. n Can articulate the benefits. n Has access to resources and can build infrastructure.

39. A Collaborative Coordinator n Detail oriented person who can make the infrastructure work. n Facilitates communication among collaborative members. n Responds to needs and concerns. n Builds relationships within and among collaborative members. n Requires support and resources. (personnel and funding)

40. A Collaborative Coordinator n Notes from the Panel Collaborative Coordinator should be… Non-territorial Credible (know the field) Trusted by the participating agencies Involved Inquisitive and responsive

41. Technological Support n Access to reliable equipment. n Responsive tech support person with the ability to problem solve. n Make the technology easy for your members to use. n Provide on-site training and face to face support.

42. Member Buy-in n Search out the experts in your community. n Start with agencies committed to the mission. n What are their areas of strength and need? n Where are the gaps? n What are the common goals? n How can you help them meet their goals? n Give them what they need. n Build sustainability.

43. Question to Consider… n What is your need? n How would a telemedicine collaborative help to meet those needs? n Who would you look to be a part of your collaborative? (agencies, services) n What services could your agency offer the collaborative? n Who might be your champions? n What do you see as the initial challenges?

44. n “Instead of all competing or working as separate entities, WATCH allows for us all to come together for the greater good of the child and family.”

45. Future Goals

47. Questions for us? Juliellen Simpson-Vos jsimpvos@med.unc.edu (919) 843.0427 http://www.telability/org

48. Resources TelAbility website http://www.telability.org The Children’s Partnership Brief: The Role of Telemedicine http://home.graffiti.net/tcpaccessible/ telemedicine.html American Telemedicine Association website http://www.atmeda.org Information Exchange http://tie.telemed.org/default.asp Cultivating Communities of Practice (Hardcover) by Etienne Wenger (Author), Richard McDermott (Author), William M. Snyder (Author)Etienne WengerRichard McDermottWilliam M. Snyder