Yakima Washington

Children’s Village / LEND

Cindy Carroll Clinical Director Children’s Village

May 11, 2020

Yakima County

Yakima

County

˜ Seattle Spokane. Naches

. Selah

Toppenish .

. Mabton

. Sunnyside.

Granger .

. MoxeeYakima .

Union Gap .Wapato .

. Harrah

Tieton .

. Zillah

Grandview .

Population: 253,000 (8th in state) Land Area in Sq. Mi: 4,295.40 – 2x as big as King County

About Children’s Village –

Our Current Mission Statement

Our Mission:

– Crossing the bridge together, we

connect children with special needs

and their families to supportive

services

All Rights Reserved Cross Cultural Health Care

Program 2009

The Beginning of Children’s Village

• Started with 5 organizations coming together, 3

remain current trustees

• Built on the premise of collaborative care for children

with special needs

• Saw just a couple hundred families

6

54

The “Why” of Children’s Village

Before Children’s Village…

A child might require a half

dozen services at a half

dozen different locations

and have to fill out a dozen

forms or more. Many times

families would have to

travel long distances for

their child’s care

Our Services:

35 Different Specialties Under One Roof• Specialties from SCH

– Cardiology

– Orthopedics

– Neurodevelopmental

– GI

– Neurology

– Genetics

• Our Specialties

– Therapy Services

– Developmental Pediatrics

– Behavioral Health

– Dental

– Nursing

– Deaf Education

– Parent 2 Parent

Services Outside of the Building

• Home visiting services

– Early Intervention

– Home Therapy

– Nurse Family Partnership

• And even more in the community

– BAT

Who Are Our Patients and Families?

• All are under 21, largest population are

under 5

• 60% Hispanic or LatinX

• Over 6500 families served, with 25,000

visits this year

Where Do Our Families Come From?

Our Medical Specialty Patients (2018)

Therapy

Benton-Franklin 60 23

Klickitat 14 2

Walla Walla 44 6

Kittitas 137 28

Yakima 2371 2221

Other 104 33

Our Payer Mix

• One of the largest Medicaid populations in the state

83%

15%

2%0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Medicaid/Healthy

Options

Private Insurance Champus (Military) Self Pay

Our Total Funding Sources

18%

7%

50%

17%

8%

Sources

Federal Funding

State Funding

School/County Contracts

Insurance/MAA

Foundation

Partners

And What About the Future….

• Strategic plan /501C3

• Continue to bring more services to Yakima

Valley with new partnerships

• The go-to for expertise in specialized pediatric

care for the central and east side of our state

• The expert in pediatric rural health care for

children with special healthcare needs –

– In our state

– And in the nation!

• COVID-19 – new possibilities

Thank You!

Developmental Screening Central

Washington

Began as Universal Developmental Screening Group in 2010

Teams to train medical providers using ASQs

By Feb 2013 – a total of 26 medical providers and 8 practices were trained by team

100% local pediatric providers participating in universal developmental screening with ASQ/SWYC (some practices also using MCHAT)

Community awareness of developmental screening has significantly increased

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Referrals 565 609 643 569 590 562 659 776 847 1013 1177

500

600

700

800

900

1000

1100

1200

1300

# of EI Referrals per Year

Eligibility Rates

322

354

585

238

268

496

16971%

23688%

36173%

0

100

200

300

400

500

600

700

Jan - June 2010 Jan - June 2014 Jan - June 2018

Early Intervention Referrals17% Eligibility Rate IncreaseFollowed by 15% Decrease

Total Referrals

Total Evaluated

Total Eligible

The Help Me Grow system is designed to help states and communities leverage existing resources to ensure communities

• identify vulnerable children

• link families to community-based services and

• empower families to support their children’s healthy development

through the implementation of four Core Components:

https://helpmegrownational.org/

Centralized Access Point assists families and professionals in

connecting children to community resources that help them

thrive.

In Washington we are calling this the Coordinated Access

Point

Family & Community Outreach builds parent and provider

understanding of healthy child development, supportive

services available to families in the community, and how both

are important to improving children’s outcomes.

Child Health Care Provider Outreach supports early detection

and intervention efforts and connects medical providers to the

grid of community resources to best support families.

Data Collection & Analysis supports evaluation, helps identify

systemic gaps, bolsters advocacy efforts, and guides quality

improvement.

HMG Affialiates

Washington State Help Me Grow

Affiliate: Within Reach (based in King county)

Sub affiliates in Pierce, King, Skagit and Central

Washington

2 additional model components:

Equity

Advocacy and Sustainability

Help Me Grow/Ayúdame a Crecer

Central Washington

In addition to the improving developmental

screening

Our community participated in two phases of

Project Launch, which focused on developmental

screening and child care providers

2017, began working with Within Reach

August 2019, Project HOPE grant to continue work

Highlights

Strong health care provider connection

Survey of families

Leveraging existing community resources to build

components

Parent leadership collaborative development

Early Learning Regional Coalitions

Inland Northwest Early Learning Alliance:

Ferry, Stevens, Pend Oreille, Lincoln, Spokane, Adams, Whitman

King County Early Learning Coalition: King

North Central Early Learning Collaborative:

Okanogan, Chelan, Douglas, Grant

Northwest Early Learning:

Island, San Juan, Skagit, Snohomish & Whatcom

Olympic-Kitsap Peninsula Early Learning Coalition:

Kitsap, Jefferson, & Clallam

Project Child Success: Pierce

Southeast Early Learning Coalition:

Benton, Franklin, Walla Walla, Columbia, Garfield, Asotin

Help Me Grow - Pierce County

A community planning process launched in the summer of

2018, beginning a 5-year Help Me Grow pilot project to

design a system that would be accessible to all parents.

Goals:

Reduce dependency filings for children ages birth to 3 in

target zip codes

Gain population information on services offered and

needed

Improve child health outcomes by reducing low and very

low birth weight babies

www.helpmegrowpierce.org

Designed to serve all families in Pierce County, the pilot area focuses on three target

zip codes in three jurisdictions:

• City of Lakewood (98499)

• City of Tacoma (98408)

• Unincorporated Pierce County (98444)

Help Me Grow King County aka Best Starts

Help Me Grow framework

Based out of King County department of Community

Human Services

Best Starts for Kids Initiative as part of their Prenatal to

Five Strategies

prenatal-to-five service coordination

improved access to information for families,

https://www.kingcounty.gov/depts/community-human-

services/initiatives/best-starts-for-kids/programs.aspx

Help Me Grow Oregon & Alaska

www.oregon.providence.org/our-

services/h/help-me-grow-Oregon

www.helpmegrowak.org

COMPASSIONATE LEADERSHIP IN

HEALTHCARELaura Crooks, OTR, MHA

CEO, Children’s Village

LEND Presentation

May 11, 2020

COMPASSION: AN ETHICAL OBLIGATION

“Compassion is an ethical obligation that reminds us of our responsibility to always act in the best interest of patients while caring for ourselves as well.”

Beth Lown, MD

Chief Medical Offer

Schwartz Center for Compassionate Care

COMPASSION-A DESCRIPTION

Compassionate care involves responding with kindness and sensitivity to the vulnerability and suffering of patients (and their relatives), who may be experiencing frightening junctures in their lives, with the threat of losing their autonomy, dignity, control over their bodies

We are going to talk about “Compassionate Leadership”, but remember leaders come in many forms not just in title!

GROUNDING OURSELVES

Compassion begins with empathy but includes the desire to then do something to relieve the suffering or burden of another. Not merely the understanding but the “what next”

https://www.youtube.com/watch?v=Xytn4fuxok4https://www.youtube.com/watch?v=pIGzPsfnpoc

MY STORY

My Career: 25 years at Seattle Children’s Hospital

Started as an Occupational Therapist

Left as Chief Experience Officer for SCH

Personal: Married for over 30 years

4 kids (three are triplets)

Our story with Chad

SO WHAT IS COMPASSIONATE LEADERSHIP?

Command and Control versus Compassionate Leadership Compassionate leadership encompasses Servant Leadership: serving others by investing in their development and well being for the

acomplishment of tasks and goals towards the common good Adaptive Leadership: Assumes complexities knowing there are new challenges requiring new

solutions “wicked problems” require team input

Transformational Leadership Inspire and motivate Demonstrate genuine concern for needs and feelings of others Challenge others to be innovative and creative

WHY?

Alarming statistics Over half US physicians experience symptoms of burnout

43% of nurses experience emotional exhaustion on a regular basis

90% of providers assessed in a burnout study from the NIH also met diagnostic criteria for depression

IHI has moved to the Quadruple Aim Includes focus on Joy in Work

Care of the patient includes care of the staff and providers

WHY? SOME OF THE DOLLARS AND “SENSE”

There is a financial business case for compassionate leadership in healthcare: According to the AHA, the replacement cost for:

Physician = $500,000 to $1,000,000

Nurse = $37,000 to $58,000

IHI has been explicit about the results in lack of compassion:

Increased risk of workplace accidents

Lower-quality care with increased safety risks have been documented

COMPONENTS OF COMPASSIONATE LEADERSHIP

Compassionate leadership foundations: provide appropriate training and well-being programs

sustain high levels of trust and mutually supportive interpersonal connections

foster the sharing of knowledge, skills and workloads across silos.

It requires enabling people to experiment without fear of reprisal

reflect on their work

view errors as opportunities for learning and improvement.

MOVING TOWARDS COMPASSION

Define what compassion means

Recognize the effects when compassion is missing

Consider the power of teamwork

Scan the data for red flags

Don’t just change the culture, change the operation

Get everyone on board

Recruit people who fit into the mission

When in doubt be supportive

WHAT DOES THIS ALL MEAN FOR US?

Serving patients and families with special healthcare needs provides it’s own risks for burnout, complications, and need for compassion

Rural healthcare adds complexity and challenges

Must be done collaboratively, compassion is relational

Really important that you have self compassion as well

SOME EXAMPLES OF COMPASSIONATE LEADERSHIP IN THE FACE OF A PANDEMIC

Recognizing business is not “as usual” People need flexibility in their work

Constant and consistent leadership check in

Intentionally provide ability for people to connect

Never enough communication Need for constant updates in a way that meets individual needs

Provide ability to ask questions, express needs

An express need for clarity in the face of uncertainty

Recognize the big and the small Examples of excellence

Recognize challenges

Attention to those who are silent

TO CONCLUDE

“In the absence of compassion,

we have no care.”

Gary Gottlieb, MDPresident and CEO, Partners in HealthCareBoston, MD

ADDITIONAL RESOURCES

AHRQ “What Is Patient Experience?” www.ahrq.gov. 2017 .

Beryl Institute

Institute for Healthcare Improvement: ”Triple Aim for Populations. www.ihi.org

IHI Framework for Improving Joy in Work. Ihi.org. Cambridge MA, 2017.

Kindred Healthcare. Enhancing patient and provider experience with every single word. November, 2014.

NIH Reith, Thomas P. Burnout in United States healthcare professionals: a narrative review. Cureus. 2018

Dec; 10(12).

Schwartz Center for Compassionate Healthcare Pohle, Allison. The 8 ways to make healthcare more compassionate. Athena Insight, December, 2016. Recommendations from a Conference on Advancing Compassionate, Person- and Family-Centered

Care through Interprofessional Education for Collaborative Practice. Emory Conference Center, Atlanta Georgia. 2014.