Oct 24 CAPHC Lunch Symposium - Sponsored by Stantec

1

Caring for the Whole Child: Three Projects, One Shared

Vision for Child and Youth

Wellness

2016 CAPHC Annual Conference Lunch Symposium #2 Halifax, Nova Scotia Monday, October 24, 2016

2

Our speakers

Alena Fisher

Senior Associate, Stantec

Jeanette Hay Connolly

Director,

Wood Street

Centre Secure

Care

Deborah Grisko

President and

Executive

Director, Almost

Home Kids

Robert Hofmann

Principal

Hofmann PM inc

and Sr. Project

Manager,

ErinoakKids

Centre for

Treatment and Development.

Barbara Miszkiel

Senior Principal,

Specialty

Healthcare

Leader Stantec

Brenda Bush-Moline

Principal,

Healthcare

Leader, Stantec

3

Care Resourcing

Education

Hospitality

Healthcare

Retail

Workplace

Cultural

5

10% Physical Environment

20% Clinical Care

30% Health Behavior

40% Socio-Economic Factors

Graphic from Lauren Valdez and Carla Saporta, Community Benefit and Missed Opportunities.

A Case Study Of Three San Francisco Hospitals. T he Greenlining Institute. October 2014

6

ErinoakKids Almost Home Kids Wood Street

Treatment Centre

7 7

Caring for the Whole Child

Almost Home Kids

Naperville (opened 1999)

• 12-Bed facility on 2 acres

Chicago (opened 2012)

• 12-Bed facility, 6th floor RMHC

Mission: to provide transitional care in a home-like setting for children with complicated health needs, as well as training for their families and respite care. Vision: opening new facilities to service the needs of children with complex medical conditions and their families in other communities throughout the country.

Peoria (to open 2018)

• 12-Bed facility on 2 acres

Transitional Care • Bridge from Hospital to Home

• Parent/Caregiver training • Up to 120 day stay

• Community Supports – Home Nursing, DMEs, Foster Care

• Adapt/revise Discharge Plan

• Subspecialty & PCP

Community Coordination • Newborn – age 22

Respite Care • Mission driven program keeping

families whole

• Planned or Emergency Short term stay (up to 2 weeks)

• Opportunity to review Home

Medical Plan

• Respite Transportation • Newborn – age 22

Diagnosis

• Neuromuscular Disease

• Spinal Muscular Atrophy (Type 0, I

& II)

• Premature Birth

• Central Hypoventilation Syndrome

• Metabolic Disorders

• Cerebral Palsy

• Spina Bifida

• Oncology

• Chromosomal Disorders

• Cardiac Anomalies

• Traumatic Brain & Spinal Cord

Injury

• Gastric Anomalies - Short Gut

Syndrome

• Hospice

• Neonatal Withdrawal Syndrome

AHK Team • On Site Medical Directors

• Director of Nursing Services

• Advanced Nurse Practitioners

• Clinical Educator

• Social Workers

• Case Management Team

• Clinical Managers

• Direct Care RN’s 3-1 ratio

• Certified Nurses Aides

• Volunteers (1-2.5 FTE)

Clinical Capabilities

• Ventilators

• Tracheostomies

• CPap (Continuous Positive Airway

Pressure)

• BiPap (Bi-level Positive Airway

Pressure)

• Remodulin Pumps

• PICC lines (Peripherally Inserted

Central Catheter)

• Feeding tubes

• Urinary catheters

• Ostomies

• Orthopedic external fixation devices

• Oxygen therapies

• Spica cast

• Peritoneal Dialysis

• Blood Draws

Programs Responding to Children’s Needs

Sleep Medicine: AHK Chicago

• Improve the quality of life for children who have sleep difficulties or have outgrown the need for medical technology.

• Significant cost savings over the child’s life.

• Free up ICU beds

Pediatric Surgery APN & Nutrition Consultations:

• Frees up clinical space and time

• Billed as outpatient

• Transportation costs reduced

Physical Therapy

Dental Consults

Telemedicine

Medical Education

Transition: Training the Next Generation

Keith Veselik

MD Medical Education Program Most doctors can complete entire 7-10 yrs. of training and never learn directly how to

serve and care for a child with medical complexities in a community setting.

AHK has partnered with 5 Medical Centers and 116 Residents and Medical Students

enrolled in first year of program Loyola University Medical Center is offering a 4-week elective at Almost Home Kids.

15

Transition: Child and Caregiver Timeline

Pediatric Hospital admit

identified as Child with

Medical Complexities

Parent’s view AHK video

and Hospital Case

Management Team

introduces parents to AHK

Case Management Team

Parent’s visit AHK, meet

with Case management

team onsite

Child is stabilized in

hospital and is ready to

transfer home, but factors

exist that prevent a safe

transition home

Parents works in partnership with

AHK to learn necessary care in

120 days. Child is transported to

AHK via ambulance or medi-van

Child at AHK while parents trained

on child’s home technology, home-

health nursing staffed, DME supplier

identified, Government Agencies

and services are secured

Child safely transitions

home

Child is able to return

to AHK for Respite –

giving parents a

much needed rest

16

View

video

https://youtu.be/ENHL8VzPphY

https://youtu.be/ENHL8VzPphY

“You guys are amazing! You love the kids like they

are your own! I am certain Caitlyn will miss you all”

- Caitlyn’s mom

“I really want people to know how

important Almost Home Kids is; it

truly changes lives and sets parents

up with the knowledge and medical

support necessary to take care of

their child at home.”

- Audrey’s mom

Parent Quotes

Reduced Costs, Improved Care • Less than 2% of our children were

re-admitted

• 75% of parents report a reduction of stress

• In Illinois, AHK has saved the Medicaid system $10million per site per year

• IRB Longitudinal follow-up study of children and caregivers – Describing the caregiver experience of transitional care – measuring caregiver competency and stress levels – Sarah Sobotka MD, University of Chicago

Our Kids are Medically Complex

19 Source: 2010-2015 AHK Program Committee Outcomes Report

Infantile cerebral palsy, unspecified

36%

Trisomy 21 (Down's syndrome)

5%

Spinal muscular atrophy, unspecified

2%

Other specified disorders of brain

2%

Spina bifida without mention of hydrocephalus (Chronic)

6%

Arhinencephaly 6%

Other congenital malformations of

musculoskeletal system 2%

Chromosomal abnormality, unspecified

2%

Chronic respiratory disease arising in the perinatal

period 27%

Unspecified convulsions 12%

Medical Complexities Data

Source: 2015 AHK Program Committee Outcomes Report

21% on Vent

47%

36%

17%

Medication Complexity

Complex >=7 Moderate 3-6 Simple 1-2

Tracheostomy

Yes No

55% 45%

Tube Fed

Bolus Continuous None

63%

15%

22%

Medical Complexities

1-3 Diagnosis 4-6 Diagnosis 7+ Diagnosis

28%

17%

55%

Lowering the Hospital Length of Stay

0

50

100

150

200

250

300

Kylie Gabe Jamri Alexis

Average Length of Stay

Actual Length of Stay

Tracheostomy Cardiac

Procedures

Premature Premature

Number

of Days

Hospital stays for

children with

complex medical

conditions can

exceed APR-DRG

National Average

Length of Stay

(ALOS)

233 excess days

$1,025,000

109 excess days

$304,000

142 excess

days

$395,000

199 excess

days

$610,000

Based on actual $/day

Recognized for Excellent Health Outcomes

An extraordinary place for healing and family-centered care, evidence-based design and advanced technology:

• Ranked 6th over-all in the US News & World Report Survey and the only pediatric hospital in Illinois to be ranked in all 10 specialties

• First children’s hospital in country to earn Magnet Award for Nursing Excellence – Received 4th re-designation in Sept. 2015

• Almost Home Kids program received Magnet Exemplar 2015

• 9 out of 10 parents would recommend our hospital

National & International Children’s Healthcare Centers

Guiding Principles – Almost Home Kids in Peoria

• Enhance brand identity

• Community focused setting

• Immediate connection to

nature

• Infection Control

• Privacy

• Ample natural light

• Adjust and “flex”

• Access to nature

Almost Home Kids in Peoria

• 12 private bedrooms -

with parent

accommodations

• 9 Bathrooms

• Open Concept Great

Room & Kitchen

• Welcoming Family

Receiving Area

• Ample Storage

Almost Home Kids in Peoria

• Administration offices

& amenities

• Private Consultation

and Conference

Rooms

• Refection/Meditation

Area

• Healing Garden

31

Wood Street Centre Campus, Level 3 Program

CAPHC Conference October 2016

Jeanette Hay Connolly, WSC Campus

Alena Fisher, Stantec

32

Wood Street Centre Campus & Level 3

Program

33

Deliver an interdisciplinary

residential treatment service

model for youth in the care of the

Minister of Community Services

• Capacity

• Age group

• Length of stay

Goal

34

Objective

• Engage youth in treatment

and facilitate development

of internal self controls

35

Design Philosophy

• Design inspiration

• Facility Layout

36

Informed

Collaborative Design

• Pillar of program

• Safety First

37

Building Program

• Inner Street

• Houses

• Program Spaces

• Administration and

Clinical Offices

38

Desired Outcomes

• Develop/increase social

competency or functioning

• Decrease emotional and

behavioural issues

• Reduction in need for

restraint and isolation

• Readiness for transition to

community

41

Residential

Treatment Services

• Interdisciplinary Team

• Therapeutic milieu

• Trauma informed services

• Behavioural management

techniques and strategies

• Psychoeducational

programming

• Classroom education

42

Purpose Designed

and Built • Building program and residential

treatment needs

• Classrooms and computers

• Psychoeducational

programming including;

• Aggression Replacement

Training (ART)

• Experiential Education

• Mindfulness

• Dialectical Behaviour Therapy

43

Purpose Designed

and Built

• Therapy counseling and

psychological

assessments services

• Recreation, leisure

activities

• Youth self-regulation

activities

45

ErinoakKids Centre for Treatment

and Development 3 Sites, One Vision

Oakville

Mississauga

Brampton

CAPHC Conference – October 2016

Robert Hofmann, EOK

Barbara Miszkiel, Stantec

46

The Project Partners

• ErinoakKids

• Infrastructure Ontario (IO)

• Ministry of Children and

Youth Services (MCYS)

• Design Compliance - Parkin

• Architect of Record - Stantec

47

We are . . . . .

• Ontario’s largest children’s

Treatment Centre

• Wide range of services

• Day treatment(10 sites)

• Overnight respite – 1 site

• 650+ staff serving 15,000 kids

annually

always Learning . . . . . .

48

Existing

• Mississauga site– end of life

cycle

• 9 other leased sites

• converted office buildings,

accessibility, space and

code issues

• Lack of exterior therapeutic

play areas (two for all the sites)

• Demand for services increasing

10-20% annually

49

Design Philosophy

• Building as therapy tool

• Landscape as therapy tool

• Technical therapy tools

• Positive staff environment

50

Design Philosophy

• EOK serves 15,000+ kids annually

• Wide range of

• Challenges

• Ages

• Cultural backgrounds

• Locations

• Services (autism,

communication,

hearing, medical, OT, PT, vision)

51

Design Philosophy

• Consistency across all 3 sites

• Each child is unique but must have

similar opportunities

• Equal access to medical, therapy,

support services

• Celebrate Joy in their successes

• Respond to all physical and

behavioural challenges

• All ages: child-friendly vs. child-like

52

EOK Oakville

EOK Mississauga

EOK Brampton

1

2 3

53

Oakville Mississauga Brampton

Concept Diagrams

54


55


56


57


58


59


60


61


62


63


64


65


66


67

Play Achievement Memory

68

Play

77

Achievement

78

Treehouse stairs

79

Exterior expression on Gym wall

80

Main Street and Gym

81

Memory

86

EOK Oakville

EOK Mississauga

EOK Brampton

1

2 3

87

Level 1 Level 2

88

BURNHAMTHORPE ROAD

TH

IRD

LIN

E

89

BURNHAMTHORPE ROAD

TH

IRD

LIN

E

90

BURNHAMTHORPE ROAD

TH

IRD

LIN

E

91

Main Street, Lobby and Family & Staff Resource Centre

92 Treehouse Rest Area

93 Treehouse and Solar Calendar

94

Oakville – Central Courtyard

95

Oakville – Exterior Therapeutic Play Area

96

Oakville – Level 2 Exterior Therapeutic Terrace

98

EOK Oakville

EOK Mississauga

EOK Brampton

1

2 3

99

Level 1 Level 2

100

CENTRAL PARKWAY WEST

101

CENTRAL PARKWAY WEST

102

EOK Oakville

EOK Mississauga

EOK Brampton

1

2 3

103

Level 1 Level 2

104

CASTLEMORE ROAD

MC

VE

AN

DR

IVE

105

CASTLEMORE ROAD

MC

VE

AN

DR

IVE

107 Day in the Life - Anjuli

Respite Centre

110

Brampton – Respite Area

111

Treatment Area

Lunch Areas

Activity Areas

112

ART WORKS

117

MISSISSAUGA OAKVILLE BRAMPTON

118

EASTERN MOOSE OAKVILLE

119


120


ART. WORK.

121

POLAR BEAR MISSISSAUGA

122


ART. WORK.

123


124


125

ARCTIC FOX BRAMPTON

126

ARCTIC FOX BRAMPTON

ART. WORK.

127

ARCTIC FOX BRAMPTON

ART. WORK.

128

ARCTIC FOX BRAMPTON

130

Final slide is actually a short fly-through. Great last impression….

131

Q & A

Deborah A. Grisko, RN, President & Executive Director Almost Home Kids

[email protected]

Jeanette Hay Connolly, Director, Nova Scotia Department of Community Services [email protected]

Robert Hofmann, Sr. Project Manager, ErinoakKids, Ontario [email protected]

Alena Fisher, Sr. Associate Stantec Architecture Ltd. [email protected]

Brenda Bush-Moline, Principal , Healthcare Leader Stantec Architecture Ltd. [email protected]

Wood Street Centre

Barbara Miszkiel, Sr. Principal, Specialty Healthcare Leader Stantec Architecture Ltd. [email protected]

Article on Design for kids with ASD, (Erinoak): Go to dimhn.org October 2016 Issue

mailto:[email protected]

Oct 24 CAPHC Lunch Symposium - Sponsored by Stantec

Healthcare

Transcript of Oct 24 CAPHC Lunch Symposium - Sponsored by Stantec