THE PEDIATRIC MEDICAL HOME: OPPORTUNITY FOR

INTERPROFESSIONAL PRACTICE & EDUCATION

Joan Burttram Carlisle, PhD., RN, PPCNP-BC

Interprofessional Practice

A primary care pediatricpractice providingcomprehensive carefor children of allabilities, includingwell child care andsick appointments.

Sparks Pediatrics strives to be a medical homefor all children including those with

special health care needs.

SPARKS PEDIATRICSThe University of Alabama at Birmingham

Snehal Khatri, MD, FAAP◦ Associate Professor of Pediatrics University of Alabama

School of Medicine (board-certified developmental pediatrician)

Jennifer Kimbrell, MSN, RN, CPNP◦ Board-certified Pediatric Nurse Practitioner

Services are provided within an inter-professional team

Maliea Box, RN

Anola Ennis, MSN, RN, CPNP (part-time)◦ Board-certified Pediatric Nurse Practitioner

Joan Carlisle, PhD, RN, PPCNP-BC (faculty practice)◦ Board-certified Pediatric Nurse Practitioner

Velesha Heard, Office Associate

Additional interprofessional team members are available to see patients on-site:

Nutrition

Dentistry

Psychology (including Autism Evaluations, Social Skills Group for Teens with ASD, and Behavior Assessments)

Audiology including Augmentative/ Alternative Communication

Speech/Language

Occupational Therapy, and Constraint Therapy

Multiple Disabilities Services

Neurology: Rett Syndrome Clinic and Research

Newborn Follow-Up for Very Premature Births

Psychoeducational Services (IQ testing and Special Ed)

Optometry

Social Work

Newborn to 19 years of age

Well baby/well child health care

Physical and behavioral assessments according to American Academy of Pediatrics, Bright Futures, and Medicaid guidelines

Many children have special health care needs

Some children are considered to be medically fragile

Large percentage of children are in foster care, or child protective service is involved

Practice Profile

Patients come from a variety of traditional and non-traditional family situations: Two parent home Single parent Foster placement Group homes Grandparents, great-grandparents, aunts,

uncles, cousins, and friends/neighbors

To serve as a medical home ◦ Assessments

◦ Management plans

◦ Anticipatory guidance

◦ Facilitate communication between family and providers (primary and specialists)

◦ Facilitate management plan/communication with schools, teachers (i.e. individual education plans)

A continual challenge is to coordinate care and communication with our limited practice staff.

Purpose

All staff work collaboratively in managing patients.◦ Morning team meeting to discuss patients for the day.

◦ No pre-scheduled provider (MD, PNP) unless a new consult is made with MD for behavior.

◦ Patient care conferences and consults held between providers during the course of the day.

◦ Consults with interprofessional colleagues, as needed.

◦ Referrals and consults made to outside providers within the healthcare community, as needed.

Collaboration—to work jointly with others or together

Recognition in Birmingham Parent Magazine

(as voted by parents)

The “M” family Husband and wife accepted custody of their two GREAT grandsons. Tyler

◦ DX: Behavior issues, developmental delays, later diagnosed with ADHD

Tanner

◦ DX: Congenital Cytomegalo Virus, hearing loss, delayed speech, behavior issues, developmental delays; later diagnosed with ADHD and aggression

Case Example (used with permission)

Shortly after we began seeing this family, a third great-grandson, Taylin, was born; they accepted this child into their care as well.

◦ All brothers would be together

◦ Maintain their family

Behavior of older boys Behavior of youngest as he got older and

learned to copy his older brothers Visitation after-effects when boys visited with

birth mother Frequent visits to multidisciplinary specialists

(i.e., hearing aids, behavior counseling, etc.) Retirement of both Mr. & Mrs. M Health challenges for both Mr. & Mrs. M

Family Stressors

Sparks served as medical home Assisting with referrals and needed services

Acted as intermediary with psychology, audiology, speech, schools

Flexible scheduling of primary care appointments and sick visits to better accommodate family needs and other appointments

Able to ‘drop in’ for questions when in building for other services

Medical Home

My husband and I have custody of our great grandsons; all are ADHD but the middle child has aggression as well. This has been quite a challenge to us. At times, the aggression is so severe we have to hold Tanner to keep him from hurting himself or others.

Had I not had the support of Dr. Khatri and her staff, I would not have been able to handle this as I should. Sparks Clinic is much more than a Doctor’s office. They are a support for parents and grandparents with children with special needs.

The Words of Mrs. M

We also use the audiology department of Sparks for the middle grandson with hearing loss. He has been in hearing aids since 9 months old and we have had great support from Dr. Woodruff in getting Tanner the tools he needs in public school. She helped us get the FM system for him to use in all his classes.

Dr. Khatri also referred us to a great psychologist and a psychiatrist to help manage the ADHD. I have told many people that Dr. Khatri and her staff are my lifeline.

They have been there for us in the best of times… but most importantly, they have been there in the worst of times!

“Elvis” is in the building (Halloween)

Interprofessional Education

Serves as a clinical site for: Nursing

◦ BSN programs

◦ MSN practitioner (PNP, FNP)

Medicine◦ Third year medical students

◦ Pediatric residents

◦ Pediatric fellows

High School (shadow programs)

Traditional Partnerships

Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program

National training program funded through the Maternal and Child Health Bureau◦ Idea for LEND began in the 1950s

◦ Currently there are 43 LENDS in 37 states

◦ Only LEND program that includes a pediatric primary care component

Traineeship Opportunity

Purpose: to improve the health of infants, children and adolescents with disabilities by advancing the knowledge and skills of all child health professionals.

The curriculum is

◦Organized around core competencies

with

◦Individualized training plans for each student

Students are Master’s level or higher (1-2 year program) Audiology Dentistry Nursing Nutrition OT Psychology Speech-Language Pathology Social Work

Interprofessional Students

Sparks Pediatrics

Multiple Disabilities Clinic

Autism Evaluations

Psychoeducational Evaluations

Interdisciplinary Developmental Evaluations

Home Observation of a Family of a Child with Special Needs

Weekly Lectures

Leadership and Advocacy Activities

Interdisciplinary Patient-Specific Team Meetings

Family Conferences

Discipline-Specific Training

Clinical Rotations

SPARKS: CELEBRATING 45 YEARS OF EXCELLENCE

Contact Information

Joan Carlisle

jcarlisl@westga.edu