VOL. 11 NUMBER 2: June 2014

Success Stories:A Perfect Home for Jesse

Crockett Is a Winner

Celebrating ServiceIT CornerProvider PerspectiveCongrats Are in Order :

A'Donna Corbin and

Kathy Gamble

IN THIS ISSUE:

Also: C2K Charity Bowling | Summer (Love it or Leave it)

THERAPY2000

We improve lives.

THERAPYTHERAPY

THEINS IDER

Editorial Staff

Jerre van den Bent, PT

EDITOR-IN-CHIEF

Kyle Butler

MANAGING EDITOR

Alex Paris

EXECUTIVE EDITOR

STAFF CONTRIBUTOR

Belinda Williams, OTR

STAFF CONTRIBUTOR

Josh Florence

SPECIAL CONTRIBUTOR

Marnie Stone

SPECIAL CONTRIBUTOR

Shannon Anderson

SPECIAL CONTRIBUTOR

FORGING AHEAD JERRE VAN DEN BENT, PT, ADMINISTRATOR

• Forging Ahead ............................2-3

• Success Story: Jesse ...................4-5

• Success Story: Crockett ............6-7

• IT Corner ................................8-9

• Congratulations ....................... 10

• Referral Spotlight .................... 11

• Customer Service ...................12

• Chari-T2000 ............................. 13

• Greater Risk? .....................14-17

• Partner Perspective ..........16-17

• Survey Says .........................18-20

Inside This Issue:

Editorial Staff

Jerre van den Bent, PT

EDITOR-IN-CHIEF

Kyle Butler

MANAGING EDITOR

Alex Paris

EXECUTIVE EDITOR

STAFF CONTRIBUTOR

Belinda Williams, OTR

STAFF CONTRIBUTOR

Josh Florence

SPECIAL CONTRIBUTOR

Marnie Stone

SPECIAL CONTRIBUTOR

Shannon Anderson

SPECIAL CONTRIBUTOR

Health care is complex and it’s getting more

complex daily. Changes in evidence-based

medicine, societal demand, and technology

mean it is more and more diffi cult to plan ef-

fectively for the future. These challenges are

compounded by the specifi c regulatory and

reimbursement challenges of home therapy in

Texas. Regardless, THERAPY 2000 wants to

set a clear and effective direction for the future

that will lead to better patient care, employee

experience, and fi nancial sustainability. For that

reason we have set four specifi c strategic priorities for 2014 and beyond:

Our goal is to deliver the highest quality care for our

patients. One of the rich advantages of home health is

that we deliver that care in a natural setting in partner-

ship with the patient’s surroundings, including caregivers. As a result, great home therapy

exists in the contexts of relationships, communication, and education. Customer focus

is one of the driving elements to help patients and their caregivers embrace the quality

interventions provided by our therapists on a daily basis. We’ve undertaken extensive

training and process evolution in our intake department to create faster service for the

families we serve. We’ve also implemented a new Community Relations service model

that emphasizes fostering meaningful partnerships with community referral sources that

address their unique concerns and priorities.

A large segment of our patient population undergoes

daily struggles to receive adequate and timely care. Pa-

tients that can only be seen during after school hours

Editorial Staff

Jerre van den Bent, PT

EDITOR-IN-CHIEF

Kyle Butler

MANAGING EDITOR

Alex Paris

EXECUTIVE EDITOR

STAFF CONTRIBUTOR

Maicol Nieto

STAFF CONTRIBUTOR

Josh Florence

SPECIAL CONTRIBUTOR

Marnie Stone

SPECIAL CONTRIBUTOR

Shannon Anderson

SPECIAL CONTRIBUTOR

Dr. David Harmon

SPECIAL CONTRIBUTOR

CustomerFocus

AfterschoolCare

FORGING AHEAD JERRE VAN DEN BENT, PT, ADMINISTRATOR

make up nearly half of our patient population but are typically only seen within a two to three hour window of the day.

As a result, these patients and their families can spend months on waiting lists with numerous providers hoping to receive

desperately needed interventions. Therefore, THERAPY 2000 is actively recruiting PRN therapists to new positions that

allow for more flexibility to better serve these populations. We have also added additional coordination efforts between

Community Relations, Recruiting, Staffing, and Division leadership to help these patients receive the treatment they need.

While changes in technology can create new challenges for any organization, they can also

create incredible opportunities for efficiency. THERAPY 2000 is in the process of developing a new internal web-based

network that will provide improved communication, collaboration, and reporting. This network will help employees get the

best support when they most need it so that they can provide better treatment for our patients. We have also begun phase

two of our THERAPY 2000 smartphone app which will provide on-demand resources for therapists in the field, including

contact information, job aids, and agency updates.

Our final strategic priority addresses the quality of care that is delivered to our patients.

It is our responsibility as health care providers to deliver services that are effective, nec-

essary, and appropriate. Therefore, we have appointed Cuyler Romeo as our new Direc-

tor of Clinical Innovation to lead our Clinical Program Directors and Division Directors in the delivery of evidence-based

clinical services. THERAPY 2000’s tradition of cutting-edge clinical care will continue to evolve as we put our specialists in

a position to forge meaningful relationships with hospitals, health plans, and community resources.

I am confident that our strategic priorities will position us for continued success in the current climate of change. Regard-

less of present circumstances, an investment in service delivery is an investment for the future.

TechnologyInfrastucture

Evidence-BasedTherapy

A PERFECT HOME FOR JESSE ALEX PARIS, EXECUTIVE EDITOR, STAFF CONTRIBUTOR

“This story plays like a made for TV movie,” shared Jes-

se’s SLP, Mayra Perez. Jesse is a sweet four-year-old boy

with Down syndrome who receives ST, OT and PT from

THERAPY 2000. As a child once in foster care, he met his

future family in a unique way.

Loy and his wife Kristie had one son, Justin, who is now

eight. They had been trying to have a second child for

years with no success. Loy was a bus driver for Hutto

ISD. He was driving his normal bus route for the local

middle school when his boss asked him to pick up an ear-

ly afternoon shift driving home children from a Preschool

Program for Children with Disabilities (PPCD). That is

when Loy met Jesse. The three-year-old was riding the

bus home to his foster family. Jesse was unable to walk on

his own at that point. Loy was asked by the school to pick

Jesse up in his arms and carry him onto the bus to get him

home safely. Loy’s heart quickly melted from Jesse’s sweet

smile. Loy shared, “It just felt right.” Loy was soon picking

up Jesse and other kids from PPCD two or three times a

week. Loy shared the stories of his encounters with Jesse

with his wife, Kristie. She asked Loy after one of these

conversations, “What do we need to do to adopt him?”

Clearly, they were on the same page.

As the weeks went by Loy learned more information

about Jesse and his history from the school staff and foster

mom. He learned that Jesse’s parents were in the process

of losing their parental rights and Jesse had already been

in foster care for half his life. CPS was looking for perma-

Jesse

Jesse and daddy Loy, on National Adoption Day Jesse and momma, Kristie Jesse and Justin

A PERFECT HOME FOR JESSE ALEX PARIS, EXECUTIVE EDITOR, STAFF CONTRIBUTOR

nent adoptive parents. Loy and Kristie took action. The

couple attended a CPS foster care meeting and began

working with The Bair Foundation to start the foster-

to-adopt process. They became certifi ed foster parents

and began fostering Jesse in their home in July, 2013.

He was thriving. They transitioned the same THERAPY

2000, SLP, OT and PT therapists Jesse had been working

with at his previous foster home to their home. They

wanted to make sure Jesse continued progressing. Usu-

ally, a foster child has to live six months in a home be-

fore the family can begin the adoption process. In

this case the court made an exception. The judge

ruled that Jesse was offi cially the Beene’s son on

National Adoption Day in Austin, Texas, Novem-

ber 7, 2013. The whole process took four months

from fostering to adoption. The family could not

be prouder. Jesse is doing great. He began walk-

ing shortly after he started physical therapy and his

communication, both verbal and sign language, has

increased since he began speech therapy. He only

receives PT and OT once a week

now. He is running, jumping, and

learning to slide bases to keep up

with his older brother in baseball!

couple attended a CPS foster care meeting and began couple attended a CPS foster care meeting and began

working with The Bair Foundation to start the foster-working with The Bair Foundation to start the foster-

to-adopt process. They became certifi ed foster parents to-adopt process. They became certifi ed foster parents

and began fostering Jesse in their home in July, 2013. and began fostering Jesse in their home in July, 2013.

He was thriving. They transitioned the same THERAPY He was thriving. They transitioned the same THERAPY

2000, SLP, OT and PT therapists Jesse had been working 2000, SLP, OT and PT therapists Jesse had been working

with at his previous foster home to their home. They with at his previous foster home to their home. They

wanted to make sure Jesse continued progressing. Usu-wanted to make sure Jesse continued progressing. Usu-

ally, a foster child has to live six months in a home be-ally, a foster child has to live six months in a home be-

working with The Bair Foundation to start the foster-working with The Bair Foundation to start the foster-

to-adopt process. They became certifi ed foster parents to-adopt process. They became certifi ed foster parents

and began fostering Jesse in their home in July, 2013. and began fostering Jesse in their home in July, 2013.

He was thriving. They transitioned the same THERAPY He was thriving. They transitioned the same THERAPY

2000, SLP, OT and PT therapists Jesse had been working 2000, SLP, OT and PT therapists Jesse had been working

with at his previous foster home to their home. They with at his previous foster home to their home. They

wanted to make sure Jesse continued progressing. Usu-wanted to make sure Jesse continued progressing. Usu-

ally, a foster child has to live six months in a home be-ally, a foster child has to live six months in a home be-

The family celebrating Jesse's adoption on National Adoption DayJesse and Justin

Crockett’s mom, Terri, shared, “He has just come such a long way.” Crockett is almost fifteen and has a rare chro-mosomal disorder, Smith-Magenis Syndrome (SMS). This syndrome occurs when genetic material from a region of chromosome 17 is missing. It is estimated 1 in 25,000 is born with the syndrome though it is often under-diag-nosed. Those with SMS often have unique physical, behav-ioral and developmental features. Crockett displays many common features of SMS including: feeding issues, devel-opmental delay, low muscle tone, early speech/language delay, hearing loss, and problems focusing for long periods of time. His two therapists, Courtni Marshall, SLP, and Melody Millsap, COTA, and his loving family have been working hard together over the last two years to give Crockett the tools to live a fuller and more independent life.

Crockett was nonverbal until he was six. Courtni Mar-shall, SLP, has been seeing Crockett for about two years now. When they first started therapy together he was having difficulty with feeding skills. He was eating fast and in small amounts. Courtni utilized VitalStim® to increase his overall muscular strength which also helped with his feeding skills. Crockett has also been working on articulation dur-ing his therapy sessions. Hearing loss, another effect of SMS, created the need for Crockett to wear hearing aids. Until seven months ago Crockett would wear his hearing aids for approximately five minutes of the session because they were uncomfortable for him. Over the past seven months, Crockett has been consistently wearing his hearing aids in therapy sessions and has made huge strides in his articulation skills.

When Melody Millsap, COTA, started therapy with Crockett a little over a year ago he would use his fist to hit his chest to receive sensory input for self-regulation. Melody worked on giving Crock-ett some techniques to help fulfill his sensory needs. She helped Crockett learn to squeeze his hands instead when he was feeling the need for sensory input. Both therapists have helped Crockett to re-alize and verbalize when he is frustrated or upset. Now he shares, “I am frustrated,” and squeezes his hands. Crockett has also responded well to reflex techniques/facilitation that have helped him integrate the reflexes that were making it difficult for him to carry out activi-ties throughout the day both at home and in the community. Crock-ett is now able to regulate his behavior and sensory system while in different environments. He was given a sensory diet that has greatly increased his ability to interact with others at home and in the com-

CROCKETT MAKES HUGE STRIDES ALEX PARIS, EXECUTIVE EDITOR, STAFF CONTRIBUTOR

Crockett

Crockett wins 2nd place at theHenderson County Livestock Show

munity. Now Crockett has the tools he needs to significantly impact his behavior and his ability to process each situation he encounters. In addition, in the last year and a half Crockett has learned to double tie his shoes, shower by himself, use the restroom by himself and zip his jacket. All ADLs (activities of daily living) important to his independence.

Crockett has made leaps and bounds over the last year. His sensory issues and motor planning difficulties have greatly improved. His independence has grown exponentially. He is actively participating in life outside his home and using the tools his therapists have taught him. Crockett and his family believe strongly in the power of prayer. Now Crockett can lead prayers out loud before others. He also at-tends church and can sit through Sunday school. Last December he was even able to participate in his church’s Christmas pageant play-ing a wise man. He also won second place at the Henderson County Livestock Show showing his Holland Lops rabbit, W.A. These days he also serves as a water boy for his older brother’s baseball team. Crockett’s family is proud of him for doing his best and his ability to cooperate and staying focused and on task. Crockett is a great example of the success that can be achieved when a team works together.

Learn more about Smith-Magenis Syndrome (SMS) at prisms.org

CROCKETT MAKES HUGE STRIDES ALEX PARIS, EXECUTIVE EDITOR, STAFF CONTRIBUTOR

Crockett and Courtni Marshall, SLP

Crockett takes a cruise

Crockett and Melody Millsap, COTA

In this edition of the IT Corner, I want to showcase some of the apps/utilities that are in devel-opment for T2K.

Let’s start with the Templates Editor. This project came out of a collaboration with Joseph Valdez, the Patient Services Manager in Austin/San Antonio who was ex-periencing some issues.

The problem (in Joseph’s words): “I found myself sending out emails every month asking that the therapists remember to include new pieces of in-formation. Due to all the changes in requirements from insurance providers, it was getting overwhelming to keep up with. I thought if we could have a template with prompts, it would eliminate the need for the therapist to remember the new requirements each month, or the need to hunt down the emails looking for that information. I was hoping we could have an easily editable template so as insurance requirements change, the template could be updated.

-Joseph Valdez RN CMPatient Services Manager San Antonio /Austin

The solution:In response to this issue, I created the Template Editor. The application is basically a text editor that I built to distribute narrative templates made by Joseph Valdez. The application software is simple but highly customizable. The templates are meant to replace integrated PEDI notes so that they satisfy all QA and insurance requirements.

Originally, the templates were meant to be sent out as sep-arate text fi les. The user would need to open them one by one and edit, save, copy, and paste the text. I found this pro-cess confusing and because I understand how diffi cult it is to work on a small netbook decided to fi gure out an easier way to use these templates.

The Templates Editor tackles some of the common issues found when working with MobileWyse and small netbooks. When you open the program you have a drop down menu

with all the templates available. After choosing a template you are ready to start editing inside the program.

The program also features tablet ready buttons for those users that have been assigned touch screen netbooks. These buttons are:

Copy All: After you are done editing the template, this but-ton allows you to copy all text without the need to "select all," or "right-click," etc. You just click copy all and the text will be sent to your clipboard and is ready to be pasted into MobileWyse or any other application.

Export: This exports the edited text to a notepad docu-ment you can save.

Update Templates: This is my favorite feature. This button will update your templates or program to the latest version. So at any time if you aren’t sure that you are working on the latest template, you just click the button to download the latest templates. They are hosted in the cloud allowing fi les to be downloaded by many people at the same time at fast speeds and are available 24/7.

Michael Nieto - IT AssociateWhat’s cooking in the IT department?

The T2K app is another project in the making, brought to me by Ira Kirkley, Executive Director. The aim was to convert his app into an easy to use platform to access T2K resources from the palm of your hand.

The app features access to our T2K news site, connections, click to call, click to email, click to GPS, and many other features.

Do you need to call your AOS? Just look them up under "Connections" and press the "Call" button. Do you need to drive to our West division? Just go to “Contact” select your division and click “Take Me There.”

The Clinical Guide, Tips, and Programs sections are still un-der construction. If you know of content that should be included in those sections, feel free to share.michael.nieto@t2000.com

You must have an access code in order to download the application.

D O W N LO A D AT A P P. T 2 0 0 0 . C O MO R S C A N T H E Q R C O D E B E LO W

Slide-in menu

THE T2K APP

This application is in beta stage and is currently being used by Austin and San Antonio therapists. Some have provided valu-able feedback. For the next release I plan to have checkmarks for the physical/neuromuscular status, pain assessment, etc., a feature suggested by Laurie David’s feedback (PT, Austin).

If you’d like to try it out and give feedback, send me an email: michael.nieto@t2000.com.

T2K App Interface

10

A'Donna Corbin Awarded National Scholarship

Congratulations are in order for Dr. A’Donna Corbin, DPT. She was recently awarded a national Minority Scholarship from the American Physical Therapy Association. On May 16th she graduated from the University of North Texas Health Science Center, with a Doctorate of Physical Therapy. This prestigious scholarship is awarded annually to physical therapy students in their final year of physical therapy education who excel academically and are deeply in-volved in community service. A’Donna has been pursuing her Doctorate of Physical Therapy over the last 33 months. Prior she served a PTA for twelve years. A’Donna shared, “The hardest part of going back to school was getting in the swing of being back to school fulltime.” Congrats, A’Donna, on a job well done! She will be re-joining THERAPY 2000 as a PT this summer.

CONGRATULATIONS ARE IN ORDER

Kathy Gamble, PTA awarded the APTARecognition of Advanced Proficiency in Pediatrics

It all started with a challenge issued from Jerre five and a half years ago. Kathy Gamble, PTA, was interviewing with Jerre for a job with THERAPY 2000. In the interview he passed along a unique challenge. He challenged Kathy to earn the APTA Recognition of Advanced Proficiency in Pediatrics award. Kathy was hired and worked towards the challenge since that day. She received the prestigious award this February. Woohoo!

Earning the award is not easy and no THERAPY 2000 PTA has ever received it, until now. The PTA Recognition of Advanced Proficiency Program recognizes physical therapist assistants (PTAs) who have achieved advanced proficiency through education, experience, leadership and as part of the PT/PTA team in a specified area of work. The recipient has to have gone above and beyond entry-level education in his/her selected area of work, setting the recipient apart from other providers. To be eligible to receive the award, the participant must have five years of experience in pediatrics and exceed the required continuing education, with 75% in the area of pediatrics. In addition, he/she must display leadership, volunteer, and receive two letters of referral. Alice Anderson, PT, DPT, PCS, and Tara Wisdom, PT, wrote Kathy’s letters of referral. Kathy has spent part of the last three years on volunteer trips to Haiti working in their only trauma hospital. Lo-cally she volunteered with Lose the Training Wheels (now called iCan Shine), a camp that teaches individuals with disabilities to ride a conventional two wheel bicycle and become lifelong independent riders.

Kathy shared, “THERAPY 2000 has been instrumental in my career path, from Jerre’s initial challenge to the com-pany’s support of PTAs.” In addition to Kathy’s work as a PTA for THERAPY 2000, she also teaches a class at Tarrant County College. Now she is also going back to school! Kathy has begun the journey to earn her Bachelor of Childhood Development at TWU. Congrats, Kathy, on a job well done.

Dr. Corbin gets photobombed on Graduation Day!

Proud PTA, Kathy Gamble

11

REFERRAL SOURCE SPOTLIGHT: DENISE HINOJOSA, LCSW By: Shannon Anderson, LMSW

In this edition of the Insider, we want to spotlight Denise Hino-

josa, a clinical social worker at Methodist Children’s Hospital in

San Antonio, Texas.

Q: What does a typical day of case management look

like for a Neonatal ICU Social Worker?

A: We are unique at Methodist, because we follow the pa-

tient from admission to discharge. The social worker is

responsible for completing a psych-social assessment with

the family to identify needs. We then provide community re-

sources and support to the family, work with CPS on com-

plicated cases, and discharge planning. There are four Neo-

natal ICU social workers, they work 8:30-5 (usually longer)

and rotate being on call.

Q: How many patients are you typically responsible for?

A: Approximately 16-20 at a time depending on the census.

Q: What does the discharge process entail?

A: The social worker works with the physician and together

they identify the services the child will need upon discharge.

The SW is then responsible for finding and setting up the

services for the patient. These services can include nursing,

dme, therapy, financial resources, etc. The case can become

even more complicated at discharge if the patient has CPS

involved. Patients can come in from outside San Antonio

(for example, areas without a NICU), so the SW can also be

responsible for finding resources outside of the hospital’s

local community and in another city,

Q: What is the hardest part of the discharge process?

A: Finding the right company that has availability and takes

the right insurance, in a timely manner. There are some pa-

tients where the social worker has an entire week’s notice

of discharge and some are given notice the day of discharge.

Q: THERAPY 2000 decided a little over a year ago to

move intake from San Antonio to our corporate offices

in Dallas, how did that affect the referral process for

you?

A: It made communication much harder. I would sometimes

talk to multiple people, often playing phone tag. I some-

times felt like I had to rehash the situation over and over

again, which wasn’t efficient. Sometimes it took a lot of

time I didn’t have and it was especially hard when there was

a complicated case. Sometimes it was hard to even get a

simple answer about the insurance and it took a lot longer

to find out if staff would be available.

Q: How did it impact you when Sabrina (the staffer in

San Antonio for THERAPY 2000) contacted you and

said she wanted to brainstorm a way to make the refer-

ral process easier for you?

A: It was fantastic. Sabrina is easy to get along with and is

a great communicator. She usually has an answer the same

day if we are going to have staff available and an instant an-

swer on insurance. Sabrina is very helpful and responsive.

This has made things so much easier for me.

Q: What do you like about THERAPY 2000?

A: The therapists. I have received good feedback from fami-

lies I have referred about the quality of the therapists and I

know the patients are going to get quality care when I refer

to THERAPY 2000. Also, Sabrina works really hard with the

insurances to get approval and authorization for services as

soon as possible, so the patients don’t have to wait long for

the services to start.

In the last edition of the Insider, we introduced one of THERAPY 2000’s strategic priorities: customer focus. Not only is

it a strategic priority, it is also one of our performance-based competencies. That means we, as individual employees of the

agency, need to know how to become proficient in customer focus! With that goal in mind, I would like to present a new

paradigm for you to consider as you interact with external customers (families, patients, referral sources, peer providers)

and internal customers (therapists, staffers, division directors, etc.).

As a company, we are in the process of providing customer focus training. (Don’t worry, if we haven’t reached you yet, we

will!) The curriculum we are using, Patient’s VOICE, teaches how to listen to the customer’s VOICE and how to share our

VOICE. Here's a visual:

Each letter in VOICE represents a part of a customer’s

communication that needs to be heard and a part of your

communication that needs to be expressed in the interac-

tion between the two. Why is that important? It is based

on research. According to statistics and research gathered

by the author of Patient’s VOICE:

• Only 6% of patients are asked their Values and Opin-ions.

• Health care professionals over-estimate the amount of Information we provide to customers by 900%. (That is a lot!)

• Only 11% of customers say they told the health care professional all of their Concerns.

• 76% of customers are dealing with the Emotion of fear and are afraid to ask questions.

In order to provide quality, outcomes-based and cost-ef-

fective health care, we need to tackle these statistics and

change them! We need to ask, listen and validate our cus-

tomer’s VOICE. We also need to ensure we are commu-

nicating our VOICE effectively. Did you notice what the

BOLD letters in the statistics spell?

More to come on how to be attuned to the customer’s

VOICE and how to effectively use your VOICE! If you can-

not stand the suspense, ask someone who is currently en-

rolled in the customer focus training: Business Office staff,

East Texas office staff, DFW office and marketing staff, and

the Houston office and marketing staff.

USE YOUR "VOICE"BY MARNIE STONE, DIRECTOR OF BUSINESS RELATIONS

Patient’s VOICE© Your VOICE©

CALLING ALL AMERICA'S TEAM FANS!

12

Come bowling with Dallas Cowboy Barry Church

and friends in support of Chari-T2000.

Main Event Frisco, July 19th, 10a-Noon

Chari-T2000 will be hosting a bowling fundraiser with some

of your favorite Dallas Cowboys, including Barry Church and

friends! Don’t miss out on the fun and raise money for a great

cause - Chari-T2000. Come out and enjoy bowling, raffl es and

prizes, and get pictures and autographs with the Cowboys that

day.

Chari-T2000 wants to thank Barry Church, for his generous

donation he made to Chari-T2000! Barry recently partici-

pated and won the Home Run Derby held at Globe Life Park.

Church hit ten dingers at the event and donated $1,000 of his charity winnings to Chari-T2000.

Thank you Barry!

Keep an eye out for emails with more information to come.

Want to help make the bowling event run smoothly and meet some Cowboys?

Contact amy.bihl@t2000.com if you'd like to help with the event.

CALLING ALL AMERICA'S TEAM FANS!

Barry wants YOU to come bowl with him!

IS THERE A GREATER RISK...? JOSHUA FLORENCE, PT

The Florence Family

Is There Greater

Risk of Divorce In

Families With Spe-

cial Needs Children?

From the time we

are children, we

dream about our

future. What job

will we have? What

car will we drive?

Where will we live?

We dream about getting married, having children and living

happily ever after. Very rarely are our predictions right but

that’s life and it's OK.

What happens when that happily ever after is interrupted

with the news that something might seriously be wrong

with your child? Do all those dreams come crashing down?

More specifi cally, is a couple with a child with special needs

at a greater risk of divorce?

Our daughter was born on June 21st, 2010, with a rare chro-

mosomal disorder, Tetrasomy 13q associated with neocen-

tromeric inverted duplication 13q. Since Elle’s birth she has

undergone multiple operations including heart, stomach,

and hand surgery. She has worn glasses since she was four

months old and has had a hearing aid since she was three

and one half. My wife and I have been through many sleep-

less nights in and out of the hospital. We have cried a lot,

and we have laughed a lot, together. We have been married

eight years now.

In 2011, the US marriage rate was 6.8, with a divorce rate

at 3.6 , for 1,000 people. For every two marriages each year,

one will end in divorce. As members of the general popula-

tion, my wife and I have a 50/50 chance of staying married.

When Elle was born, we were told by many people our mar-

riage was now at risk. Consensus is that having a child with

special needs adds stress to a family and marriage, raising

the possibility of divorce.

According to the Journal of Divorce & Remarriage, the major-

ity of marriages end because of two general reasons, “grow-

ing apart” and “not being able to talk together.” More spe-

cifi cally the eight most common reasons for divorce include:

infi delity, communication breakdown, physical-emotional-

psychological abuse, marital fi nancial issues, incompatibility,

religious and cultural strains, addiction, and differences in

expectations and priorities. These issues can build over time

until they reach a breaking point, and there seems to be no

other answer except to divorce.

These eight issues could affect any family whether they have

a child with special needs or not. I can see how three of

these issues in particular could put extra strain on a family

like ours. They include fi nancial issues, differences in expec-

tations and priorities and communication breakdowns.

Children are expensive. A child with special needs can be

very expensive. There are multiple doctors’ visits, therapies,

surgeries and equipment needs. What if your child starts

out in the NICU? In the state of California, the mean daily

cost for an infant born less than thirty-two weeks gestation

was $1,535 a day or a mean hospital stay of $66,813. This

was compared to $440 a day or $1,929 total for babies born

over thirty-six weeks gestation. This study was in the year

2000 so I can imagine those costs have risen. When our

daughter was little we were very fortunate to be able to

enroll her in a Medicaid waiver program that allowed her to

receive Medicaid benefi ts based on her income and disabil-

ity status. Since the day she was born she has been covered

by my private insurance as well as Texas Medicaid. This has

allowed my family not to be burdened with the increased fi -

nancial cost of having a child with special needs. Not all fami-

lies have this luxury. I can easily see how all the extra bills

for a child with special needs would put an enormous strain

on a marriage. Luckily my family has bypassed this issue.

Differences in priorities and expectations is another reason

cited for divorce among couples. I easily see this could cause

a higher rate of divorce among families raising children with

special needs. After we had received a prenatal diagnosis for

our daughter and the potential prognosis of her A) not be-

ing born alive B) living a few minutes or days C) the possible

chance that she would live longer, my wife and I went about

the grieving process very differently. My wife would con-

tinue to pray for complete healing and believed that until the

day she was born, there was no way to know what the future

IS THERE A GREATER RISK...? JOSHUA FLORENCE, PT

would hold. I had come to the conclusion and expectation

that she was going to be born with many special healthcare

needs. I wouldn’t say that at that time it was a confl ict of

expectations, but it was a different way of looking at the fu-

ture and handling the grieving process. As our daughter has

gotten older our expectations have evolved. Our perspec-

tives on Elle and the life she will lead are more similar than

when she was fi rst born. This is because she has continued

to develop and we now have a better understanding of her.

Over the past four years, our priorities have changed and

evolved as we have been forced to truly understand what is

important in our lives. Luckily we landed on the same page.

Communication breakdown is another reason cited for

couples breaking up. I know that I am not the best commu-

nicator, but raising a child with special needs has forced me

to learn to communicate better with Sharon. Throughout

our daughter’s life there has been the need to make many

important decisions about her care. This has forced us to

have deep discussions and communicate our thoughts and

feelings. Raising a child with special needs can also become

very isolating. Taking your atypically developing child out can

be physically and emotionally exhausting. This takes a large

toll on the ability to maintain the social life couples might

have had prior to having their child with special needs. For

this reason, my wife and I have spent a lot more time togeth-

er than we might have if both our daughters were typically

developing. In fact, we probably have more conversations

about not communicating well because we are forced to be

aware that there are breakdowns in communication. I be-

lieve many couples are not aware of their inabilities to com-

municate until very late in the relationship. Elle has forced us

to be on top of this issue.

The more I think about our marriage over the past eight

years, and more specifi cally the last four years with our

youngest daughter, the less I am convinced that just because

we have a child with special needs we are at a greater risk

of having our marriage end in divorce. This has been my own

personal take based on my marriage but what do studies on

the subject say?

I decided to look at two common diagnoses that are affect-

ing families today, Down syndrome and Autism. In 2007, Ur-

bano and Hodapp completed a study that looked at parents

of a child with Down syndrome and compared them to two

other groups, those with children with another birth defect

and those with no identifi able disability. What they reported

was that the divorce rates among families of children with

Down syndrome were lower than in the other two groups.

When divorce did occur in the Down syndrome group, a

higher proportion occurred within the fi rst two years after

the child’s birth. This study is very encouraging to me and

makes a claim that by having a child with Down syndrome,

you actually have an advantage over the general population

when it comes to having a lasting marriage. While it specifi -

cally looks at the Down syndrome population I think that it

is important to note that a lot of the additional stress that

comes with having a child with special needs occurs early

in the child’s life. Even though our daughter does not have

Down syndrome, she does have a chromosomal duplication

which was predicted before birth. Since Elle is almost four

now, I am choosing to pull encouragement from these fi nd-

ings.

Another population group I researched was families with

a child with Autism Spectrum Disorder or ASD. There was

much more recent literature on marriage relationships of

families with a child that has ASD, likely due to its recent

increase in prevalence. In a study completed in 2010, parents

of children with ASD had a higher rate (23.5%) of divorce

when compared to parents of typically developing children

(13.8%). They further state that the rate of divorce begins

to taper off around the age of eight. The difference in how

these two conditions are diagnosed likely accounts for the

later onset of tapering. Genetic testing for Down syndrome

can begin prenatally while ASD is diagnosed by criteria at a

later age. Parents of Down syndrome children can begin ad-

justing before the child’s birth while those of ASD children

may not be aware of the child’s condition until several years

after the birth.

Another study completed in 2012, using data from 2007,

says that there is no evidence to suggest that children with

ASD are at an increased risk of living in a divorced home.

Furthermore, despite the additional demands and stresses

placed specifi cally on parents of children with ASD, most of

(continued on page 17)

PARTNER PERSPECTIVE DR. DAVID HARMON, MD, FAAP, CHIEF MEDICAL DIRECTOR, SUPERIOR HEALTHPLAN

16

The Role of Therapy in Texas Medicaid Health Care Reform

Health care, especially the economics of health care, has undergone a dramatic change over the past several years in Texas

and continues to evolve. The unsustainably increasing cost of medical care, the Patient Protection and Accountable Care

Act of 2010 (ACA), and the increasing demands for quality, efficiency, and accountability by regulators, health care rating

organizations, accrediting bodies, employers, commercial payers, and the public continue to drive this change. Changes are

focused on achieving the Triple Aim, promoted by the Institute for Health Care Improvement (IHI):

• improving the patient experience of care (including quality and satisfaction),

• improving the health of populations, and

• reducing the per capita cost of health care.

The concept of value in health care is featured prominently as a key part of health care reform where value is defined as

the ratio of quality and safety over total cost per unit. The health care system in the Texas is on a rapid course of change

wherein payment will be based on results instead of on the volume of procedures, services, or interventions delivered.

Value-based care is patient centered, produces superior outcomes, and is delivered efficiently, streamlining care processes

to increase access and reduce waste.

Dr. David Harmon is the Chief Medical Director for Superior HealthPlan (Superior). He received his MD degree from the Uniformed Services University of the Health Sciences in 1987. Fol-lowing his pediatric internship and residency at the National Naval Medical Center in Bethesda, Maryland, he was stationed at the US Naval Hospital, Yokosuka, Japan. During this time, he was assigned to be the co-chairman of the Case Review Sub-Committee (child and spouse abuse) and received informal training in the area of child abuse and neglect.

In 2002, Dr. Harmon co-founded Kids ‘N Care Health Center (KNC), the first medical home for children in foster care in the State of Florida, and served as the regional medical director of the Medical Foster Care program, a statewide program for children in foster care with special healthcare needs, as well as the statewide physician consultant.

In 2008, Dr. Harmon joined Superior to assist with the implementation of STAR Health. STAR Health is the State of Texas’ Medicaid managed care solution for children in foster care, providing immediate eligibility as well as integrated behavioral health and physical health case management and care coordination services.

Dr. Harmon is a current member of the Executive Committee for the AAP Council on Foster Care, Adoption, and Kinship Care. He was the lead presenter for the 2006 Pediatric Academic Society workshop, “The Early Identification of Mental Health and Develop-mental Problems in Foster Care Youth: Tools and Innovative Treatment Strategies.”

The current climate of health care in Texas has led to growing concerns about increases in therapy utilization. THERAPY 2000 prides itself in collaborating with associations, government staff, legislative leaders and our payers in finding innovative solutions to the rising costs of therapy. We recently asked Dr. David Harmon, Chief Medical Director of Superior HealthPlan of Texas to share his viewpoints. Much thanks to Dr. Harmon for taking the time to share his thoughts with the INSIDER.

PARTNER PERSPECTIVE DR. DAVID HARMON, MD, FAAP, CHIEF MEDICAL DIRECTOR, SUPERIOR HEALTHPLAN

17

The concept of patient centered care is not new, but continues to evolve as well. The American Academy of Pediatrics

(AAP) introduced the term “medical home” in 1967, the heart of which was family centered care. The medical home has

since grown into the Patient Centered Medical Home (PCMH), Health Homes, and now Medical Neighborhoods. Regard-

less of the term that is used, patient centeredness is at the core and primary care providers (PCP), though not exclusive,

are coordinating care for the patient and family.

Therapy companies that participate in Texas Medicaid have already seen the impact of health care reform on the way that

they practice, especially as more and more Texas Medicaid recipients have been rolled into Managed Care. Managed Care

Organizations, in support of patient centered models such as PCMH, are requiring the PCP to screen children for develop-

mental delays using standardized screening tools and then coordinate evaluations for those who fall out on their screens.

While the PCP is expected to drive patient centered care through coordination, other practitioners, including therapists,

are key members of the PCMH model, Health Home model, and Medical Neighborhoods. Therapy specialty societies such

as ASHA, AOTA, and APTA have already begun to address the roles that therapist could and should play in these settings.

Central to most statements is the belief that therapists must be able to demonstrate their value through the measurement

of health outcomes and they must be able to collaborate with other health care professionals, especially the PCP.

Health care reform is inevitable and those involved in health care must get onboard or they will be left behind. Therapists

have the opportunity to play a critical role in health care transformation by providing patient centered, valuable care. They

must be able to demonstrate their value through evidence based treatments that lead to measurable health outcomes.

They must look at their neighborhoods and collaborate effectively with PCPs, both in demonstrating their value in a con-

sistent, measureable way and through educating PCPs on the value they provide.

these parents stay married. They also report that the experi-

ence has strengthened their marriage relationship. There is

a general consensus that having a child with ASD does place

additional stress on a marriage. But the assumption that

this stress leads to a higher divorce rate cannot be made.

As a pediatric therapist I work with families every day with

special need children. There is one thing I always tell them,

especially when they are early in their journey. I let them

know that the journey they are embarking on will be one

of the hardest things they will ever have to do in their lives.

There will be times when they want to give up and when

they feel as though they can’t take one more defeat. For

all that pain there is one thing they will experience that is

greater that all of it. JOY! The joy they will experience will

be like none other. It will be the joy that they draw their

strength from, the one thing that will allow them to get back

up when they get knocked down. Joy will be the lasting im-

pression and emotion they will celebrate with their spouse

and it will be what helps keep them together. It is this joy

that makes me excited about the future and makes me look

forward to growing old with my wife. You see, in the end,

it wouldn’t matter what the research said. What matters

is that my wife and I have made our minds up, we choose

joy. The fact the research doesn’t say we are doomed for

divorce is just the icing on the cake.

GREATER RISK...? (CONTINUED FROM PAGE 15)

Survey SAYS: SUMMER: LOVE IT or LEAVE IT?!

LOVE IT

I can take the top off my Jeep.

Vicki Calvery — OT

I love that I can move all of my after-schoolers up to earlier

times of the day, allowing me to enjoy the extra hours of

daylight with my son while he's out of school for the sum-

mer!

Molly Wood — ST

I love hot summer days and evenings! I enjoy being at the

lake with family and around a campfi re at night during the

summer. Summer has signifi ed a "break" in the year since

Kindergarten! I still feel like summer offers a nice break

even when working year around! My kids love summer, too!

We have more opportunities to do fun family stuff during

the summer! So, love, love, love it!!!!

Kristy Easley — SLP

1. After schoolers become day timers! Woohoo!

2. Longer days 3. Outdoor fun 4. Flowers 5. Children

playing outside

Edith McCollom — SLP

Summer is a magical time. It probably goes back to the

time in my life in between school years when summer

meant freedom from what 16-year-old me thought

was responsibility. It was a time for friends and adven-

tures and doing my best to stay out of trouble (not get

caught). Joseph Valdez — RN

Sodapaloosa at Racetrac. Pools. Everyone is a daytimer!

Haley Hilton — OTR

1. I can work with some of my patients in the pool. 2. I

usually wrap up patient visits earlier since kids aren't in

school. 3. Families are often in a more laid back mode.

Alice Anderson — PT

LEAVE IT

Joseph Valdez — RN

Alice Anderson — PT

Survey SAYS: SUMMER: LOVE IT or LEAVE IT?!

Now that we have weekly vis-

its, it will be very hard to

get make-up visits in for

patient vacations and my

own vacation! I don't see

how I can take more than

a week off.

Carol Kretchmar — ST

Too hot, home health materials

get hot and melt.

Maryam Berenberg — SLP

Too hot!!! Much rather have winter to cuddle up under a

blanket with the fi replace and drinking hot cocoa.

Viviana Feemster — PTA

Texas summers are too hot for outdoor activities (not

to mention the sweat box of an offi ce...my car).

Courtney Quinn-Scott — PT, DPT

It's too hot! It's hard to stay hydrated and I feel melted by

the end of the day.

Anne Marie Pinkenburg — SLP

Now that we have weekly vis-

Carol Kretchmar — ST

Too hot, home health materials

get hot and melt.

LOVE IT!

83.87%

LEAVE IT!

21.51%HERE'S HOW

THE MASSES

FEEL ABOUT

SUMMER

THERAPY 2000

2535 Lone Star Dr.

Dallas, TX 75212

Bucket listGoing to the Colorado mountains (my

fave part of summer!) and returning to

school. Possibly nursing my husband

through a shoulder replacement.

Kathy Gamble — PTA

Tan, Have picnic, go to the lake a cou-

ple of times and just enjoy it with my

10-year-old before his twin brother and

sister arrive!

Maria Aguilar — Physician Liaison/AOS

I already have a "bucket" list trip planned to Vancouver and

a cruise through Alaska.

Nancy Estes — SLP

Going back home to Cape Cod for the 4th, yoga on a stand

up paddle board, wake boarding at hydro park.

Jessica Rossman — PT

To travel to Australia and New Zealand and return to Fiji.

Dana Gonzales — PT

Seeing the Grand Canyon and rafting down the

Colorado River!

Dawn Lo — SLP

Get a tan on my white legs, travel, visit friends/

family.

Hollye Peters — SLP

Home and yard renovations!

Vicki Prouty, — SLP

Vegas with my hubby for our 20th wedding anniversary. Port

Aransas with my family for my daughter's graduation from

college. San Antonio for my mother-in-law's 80th birthday.

Maybe throw in a little rest and relaxation.

Elizabeth Darby — SLP

Floating on a raft in our new pool!!

Marcia Thomas — ST

What's on your summer bucket list?