Building a Community of Caring

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Building a Community of Caring

• The WATCH Project
• Using Technology to Promote Communication and
  Collaboration within the Early Intervention
  System
• Juliellen Simpson-Vos, M.Ed, Joshua J. Alexander,
  MD
• The University of North Carolina at Chapel Hill
• School of Medicine

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Who Are We?

• Joshua Alexander, MDDirector of Pediatric
  Rehabilitation and TelAbility Program Director
• UNC School of Medicine
• Juliellen Simpson-Vos, M.Ed
• TelAbility/WATCH Project Director

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Where did we come from?

• Our TelAbility Center is located in Chapel Hill,
  NC.

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What are we going to talk about?

• History of our telemedicine programs
• Services and Outcomes of the WATCH Project
• Successes, Challenges, Lessons Learned
• Definition and Elements of a Successful Community
  of Practice
• Goals and Possibilities
• How could you do it?
• Questions and Resources

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What is TelAbility?

• An Internet-Based
• Telehealth Program For
• Young Children with Disabilities
• http//www.telability/org

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Goal 1

• Connect people in different locations
  to increase access to specialized healthcare
  services for families and decrease professional
  isolation

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Goal 2

• Serve as a resource for parents and
  professionals seeking credible and reliable
  information on topics related to children with
  disabilities

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Population Served

• Birth 5 years old
• Cerebral Palsy
• Spina Bifida
• Down Syndrome
• Brain Injury
• Feeding Difficulties
• Developmental Disabilities
• Special Needs

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1998
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End-user Locations
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WATCH

• Wake Area
• Telehealth Collaborative
• Helping Children
• with special needs

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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.

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Who does WATCH Serve?

• There are over 1000 children ages birth-3, who
  meet the eligibility criteria, to currently
  receive early intervention services through the
  Raleigh CDSA.
• There are over 1100 children ages three through
  five, who meet the eligibility criteria, to
  currently receive intervention services through
  Wake County Preschool Services.

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Inclusive Child Care Centers

• Learning Together
• Lucy Daniels Center
• Project Enlightenment
• Tammy Lynn Center
• White Plains Childrens Center

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Service Programs

• Community Partnerships for Children
• Learning Together
• Pediatric Therapy Associates
• Carolina Pediatric Dysphagia
• Project Enlightenment
• Lucy Daniels Center
• Developmental Therapy Associates

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State Agencies

• The Raleigh Childrens Developmental Services
  Agency (ages birth-3)
• Wake County Preschool Services (ages 3-5)

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Residential Care The Tammy Lynn Center for
Developmental Disabilities

• TLC employs over 180 people including therapists,
  administrators, nurses, psychologists, social
  workers, teachers, and residential staff.
• TLC serves a total of 42 residents, 30 in the
  ICF/MR residences (10/residence) and 12 in the
  community residential group homes (4/home)
• 11 children are served in residential services
• 45 children are served in the school (including 6
  residential children and 14 More _at_ Four children)
• 50 children are served through Early
  Intervention Services
• 115 children are served through Respite Services
• Primary serve children with autism (especially
  within EI services) and cerebral palsy. The
  majority of the children served through the
  school are severely/profoundly mentally retarded.

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WATCH Current Programming

• Website Content /Expertise Directory
• Listserv
• Newsletters
• Videoconferencing

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(No Transcript)
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Other Website Features

• Expertise Directory
• Handouts
• Links
• Calendar
• Books
• Articles
• Videos
• More!

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Expertise Directory

• 2005 60
• 2008 310

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WATCH_at_listserv.unc.edu

• 2005 29
• 2008 (253)

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Electronic Newsletter

• Subscribers 395
• Website Updates
• Event Listings
• Center Descriptions
• Article Reviews
• Tips and Topics
• Project Updates

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

• December 2005-February 2008

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Videoclinics and consults

• 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

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Professional Development Sessions

• 26 Professional Development Session have been
  held via videoconference
• Involving 943 therapists, EISC, parents,
  teachers, EI providers
• Satisfaction level average 4.1 out of 5.0
• Comfort level average 4.3 out of 5.0

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Professional Development Data Continued

• Sessions were held free of charge to participants
• Infant Toddler Certification credit was offered
  for all sessions
• Sessions are based on WATCH Member needs,
  interests and suggestions
• Session cover all EI domains (PT, OTR/L, SLP.
  Medical, Mental Health, Developmental, Education)

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Networking Data

• 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

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Administrative Videoconferences

• 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

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Residential Care

• Tammy Lynn Center
• Videoconference Usage
• Since December of 2005
• 26 videoconference session have occurred
• 14 Professional Development Sessions
• 6 Videoclinics and 2 Videoconsults
• 3 Administrative meetings
• 1 Networking meeting
• Involving over 625 people
• The average satisfaction rating for video
  conference sessions is 4.4 (out of 5)
• The average comfort level for video conference
  sessions is 4.6 (out of 5)
• The program has saved 37.5 hours of travel time
  and 997.00 in travel mileage.

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WATCH Recap

• Since December of 2005
• 80 videoconference session have occurred
• Involving over 1358 people
• The average satisfaction rating for video
  conference sessions is 4.4 (out of 5)
• The average comfort level for video conference
  sessions is 4.6 (out of 5)

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Todays Travel Data

• We will be driving 396 miles to get here and back
  home.
• Had we conducted this session via videoconference
  we
• would have saved 199.98 and 7 hours of
  driving
• time.

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Travel Savings

• April 2007-February 2008
• 518 participants have participated in
  videoconferences
• Miles saved by offering sessions via
  videoconference 31,603
• Travel costs saved 15,959 in gas (31,603 x
  .505)
• Doesnt include time out of the office, food, etc.

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WATCH Benefits for Providers

• Responsive to communitys needs and interests
• Increases professional development and education
  opportunities
• Increases collaboration with other locations and
  professionals
• Reduces professional isolation
• Improves communication and care coordination
  efforts
• Reduces travel time and costs

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WATCH Benefits for Parents

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

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Challenges

• Lack of technical knowledge and support at sites
• Sustainable funds to cover costs of high speed
  internet connection
• NC wont reimburse therapists for care offered
  via videoconference.
• Small monitors of the Tandberg 1500
• Buy in/consistent participation from all sites
• (turnover, time constraints, etc.)
• Establishing a public network/technical support
  issues
• Modems provided by local services providers are
  often incompatible with unit software upgrades

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Lessons Learned

• 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.

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Lessons Learned cont.

• 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..

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Quote from WATCH Service Agency Director

• Some days things can be very difficult with the
  day to day demands of patient care and
  administration of a practice but your educational
  options, along with your organization
  communication skills are a very positive exciting
  thing for a provider. It is so much easier to
  participate in these sessions because 1.They
  are on practical topics of interest 2.They are
  on a Friday, not in the middle of a patient care
  day. 3.They are well organized and the handouts
  are sent by you ahead of the presentations 4.
  You take care of the registration and curriculum
  outlines and the speaker organization 5. The
  scope of the presentations are well organized for
  the time segments allowed 6. They are free, and
  obviously very appreciated.

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D.I.Y.

• OR
• How to Establish Your Own Telemedicine
  Collaborative

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Elements of a Successful Community of Practice

• Taken from Meeting the Health Care Needs of
  Californias Children The Role of Telemedicine
• Written by The Childrens Partnership

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A Champion for Your Cause

• A respected leader in the community, committed to
  investing in and sustaining the program.
• Can articulate the benefits.
• Has access to resources and can build
  infrastructure.

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A Collaborative Coordinator

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

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Technological Support

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

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Member Buy-in

• Search out the experts in your community.
• What are their areas of strength and need?
• Where are the gaps?
• What are the common goals?
• How can you help them meet their goals?
• Give them what they need.
• Build sustainability.

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Question to Consider

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

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• 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.

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Future Goals
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(No Transcript)
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• Questions for us?
• Joshua Alexander
• Joshua_alexander_at_med.unc.edu
• Juliellen Simpson-Vos
• jsimpvos_at_med.unc.edu
• [phone]
• http//www.telability/org

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Resources

• TelAbility website
• http//www.telability.org
• The Childrens 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)