Standardizing Service Delivery in ErinoakKids Child

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Standardizing Service Delivery in ErinoakKids
Child Youth Rehab Team

• Functional Client Groupings for Children with
  Physical Developmental Disabilities

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ErinoakKids is a

• Childrens Treatment Centre serving over 8000
  children
• Six separate programs including
• Central West Infant Hearing
• Halton Peel Speech Language Program
• Central West Blind Low Vision Program
• Central West Autism Intervention Program
• Central West School Support Program Autism
  Spectrum Disorders
• Multidisciplinary Program

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Multidisciplinary Program

• Serves approx 1900 children from 0-19 in Peel
  Halton with Physical Developmental Delays
• One of 20 Ontario Association of Childrens
  Rehabilitation Services (OACRS) Centres

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The Mulitidisciplinary Program Provides

• Occupational, Physio Speech Therapy Family
  Support services on site, in the community
  school
• Medical assessment medical clinics eg.
  Orthopedics, Neurology
• Specialized support services eg. Seating,
  orthotics, feeding, technical aids (computers,
  augmentative communication)
• Specialized therapeutic camps eg. Independent
  Living Program

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• Goal To develop a systematic method of caseload
  management using available resources which would
• Reduce practice variation
• Service delivery guided by evidence based
  practice clinical expertise
• Serve as a guideline for clients/families
• Enable resource allocation (capacity)
• Serve as a teaching tool for new staff
• Utilize International Classification of Function
  (ICF) as a framework

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Methodology

• External consultant retained to provide
  stewardship
• Panel of Erinoak MDT experts assembled
• Modified Delphi technique utilized to develop
  Client Grouping Model and critical junctures
• Communication with feedback from front line
  staff

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The Steps to Achieving the Goals

• Identify ErinoakKids clients
• Determine the typical client journey/critical
  junctures
• Identify develop clinical practice pathways
  based on best available evidence clinical
  experience
• Project resources required to serve each client
  group determine workload

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2001 International Classification of
Functioning, Disability and Health (ICF)
Interaction of Concepts
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P H Y S I C A L F U N C T I O N L I M I T A
T I O N
Includes Fine Motor Speech See overlay
Key AA Age appropriate/expected, /- May or
may not be present
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Client Group C2P3
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Is the Client Groupings Model a Reliable Tool?

• Pre-school team evaluated caseloads June 06
• School age team independently evaluated caseloads
  Dec 06 (approx 66 agreement)
• Decision to further define cognitive physical
  descriptions
• School age team evaluated the clients where there
  was disagreement Feb 07
• Pre-school team further evaluated June 07
• Client grouping assignment was entered into
  Meditech to allow analysis
• Re-evaluation of clients June 08

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Client Groupings Model Physical Cognitive
Descriptors
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Total Demand by Distribution of Clients
GroupingsTotal for MDT Program (March 2007)
N1,918
P H Y S I C A L F U N C T I O N L I M I T A T I
O N
Note 66 of clients are C1P1and C2P1
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ErinoakKids Workload Project Description of
Client Phases
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Features of the service model

• Describes clients functional abilities rather
  than diagnoses (ICF)
• Identifies key junctures from 0 to 19 years that
  have an impact on service needs
• Assists in the development of clinical practice
  pathways

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What does workload look like for a client
grouping?C1P3
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Total Average Hours of Service by Distribution of
Clients MD Program
P H Y S I C A L F U N C T I O N L I M I T A T I
O N
Notes average hours of service per client 54.2
hours
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Total Hours of Service by Distribution of Clients
Pre- School MDT Program
School Age MD Program
P H Y S I C A L F U N C T I O N L I M I T A T I
O N
P H Y S I C A L F U N C T I O N L I M I T A T I
O N
Notes Total average hours of service 78.1
hours includes OTAs and SLTAs
Note Total average hours of service per client
30.3 hours includes assistants
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Average Hours of Service by Discipline-C1P3
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Projected Total Hours Vs Actual Workload
Hours-C1P3
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C1P3 Projected caseload visits for MDT
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A Clinical Practice Pathway May Take Different
Forms

• Based on development (feeding, gross motor,
  written productivity)
• Based on a specific problem (acquired brain
  injury)
• Based on a specific condition (Muscular
  Dystrophy)
• Based on a set of functional similarities
• (Functional Client Groupings Model)

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Four essential components of a Clinical Pathway
(Hill 1998)
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Model of Clinical Decision Making in
Occupational Therapy Service
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Oral Anatomy
Ax
Intervention
Re-Ax
Goal Accom
Goal Not Accom
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Use It or Lose It
Education Research New staff education Outside
Presentations External Validation
Tools Maintenance Model Descriptions Glossary Ma
cro Flow
Functional Client Grouping Model
Client assignment workload
Clinical Practice Pathways Based on Client
group Diagnosis Development Event Process
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Next Steps

• Functional Client Grouping updates into Meditech
• Further evaluation of data from all client groups
• Predictive function for determining client
  workload
• Need for development of other CPPs, and resources
  to support the development
• Peer Validation of the Functional Client Grouping
  Model

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Thank you Questions?

• Heather Marrin
• Clinical Coordinator
• ErinoakKids
• hmarrin_at_erinoakkids.ca