Transcript Slide 1

Health Care Transition
HRTW
Patti Hackett, MEd
Co-Director & Founder
Natick, MA
Brown Bag Lunch Training Series:
Transition Tips & Tools
to prepare
for health care transition
Mallory Cyr, BFA
Youth Coordinator
Health Care Policy
Sabattus, ME
June 3, 2009
1
Patti & Mal
• Ideas
• Promise:
Speak too fast – tell me
Have a question, ask it
Agree
Ah ha!
Squirm  Patti
Disagree
 Patti
WIIFM
60 min – Making Changes to Make a Difference
Section 01: KNOWLEDGE, SKILLS, & ABILITIES
• Essential skills to help families promote youth involvement
in health care decision making, reporting and
health/wellness management.
Section 02: YOUTH INVOLVEMENT
• Avoiding making children and youth invisible by doing all
the work. What does NO really say to child/youth and
about their parents?
Section 03: PERSONAL ACTION
• How to model this approach with the families you assist &
tools to help
3
INTERACTIVE DISCUSSION
• Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
• Key points
• Strategies to DO
WIIFM
Growing Up Ready
to try new things!
6
Growing Up: Completing college
7
Growing
Up
and
are
Adults
Health & Wellness …. + Humor
8
Imagine the Possibilities….
9
Knowledge
Skills
Abilities
what needs
to be
learned
teach it,
practice it,
master it
Automatic
response,
solution
orientated
Strengthen
Circle of
Support
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60 min – Making Changes to Make a Difference
Section 01: KNOWLEDGE, SKILLS, & ABILITIES
• Essential skills to help families promote youth involvement
in health care decision making, reporting and
health/wellness management.
• Launching Adults not raising children- importance of
children/youth having a role in the family and their health
issues.
HRTW TOOL: Changing Roles
11
Health & Transitions: YOU & Your Child
• HANDOUT: Changing Roles
• Fears & Anxiety
• 1 new step at a time strategies
Carry & Present Health Insurance Card
1
2 3 4 5
YOU
YOUR CHILD
YOUR STUDENT
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Health & Transitions: YOU & Your Child
• Fears & Anxiety
Youth knows & shares cultural practices
that impact health treatments/services
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
• 1 step at a time strategies
1
2 3 4 5
Health & Transitions: YOU & Your Child
• Fears & Anxiety
Youth carries portable medical summary 1 2 3 4 5
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
• 1 step at a time strategies
Health & Transitions: YOU & Your Child
• Fears & Anxiety
Youth Calls and Makes Appts
1
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
• 1 step at a time strategies
2 3 4 5
Health & Transitions: YOU & Your Child
• Fears & Anxiety
Youth Co-signs Medical Treatment
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
• 1 step at a time strategies
1
2 3 4 5
Skills
Before
10
• Carry and present insurance card
X
• Know wellness baseline, Dx, Meds
• Make own Doctor appts
X
• Call in Rx refills
• Learning Choice
Before
18
X
X
X
X
• Decision making (assent to consent)
X
• Prepare for Doc visit: 5 Qs
X
X
• Present Co-pay
• Assess: Insurance, SSI, VR
X
X
• Gather disability documentation
X
X
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You can’t
do it as
well as
I can
What are we
saying NO to?
I don’t
want you
to get hurt.
The opportunity to TRY
To fail, learn and to try again
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INTERACTIVE DISCUSSION
• Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
• Key points
- start the conversation
- remember WHO is the system for?
• Strategies to DO
WIIFM
60 min – Making Changes to Make a Difference
Section 02: YOUTH INVOLVEMENT
• Avoiding making children and youth invisible by doing all
the work. What does NO really say to child/youth and
about their parents?
•
•
•
•
•
HRTW TOOLS:
HRTW Tool: Portable medical summary
HRTW Tips: 15 min or less Doctor Visit
Template & Sample - RX tracking
Concise reporting- documentation of supports needed
Sample - checklist for travel, medical/support needs
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FAMILIES: Prepare for Changing Roles
• Self-Differentiation is a progressive, internal
interplay between autonomy (separation)
and connection (togetherness) while progressing
toward developing and known goals.
SOURCE: http://rodesmith.com/2006/03/25/bowen-differentiation/
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TOOL: Promote
Individual
• Families
- protective
•
Children / Youth
- being visible
- community aware
Simple Acts …..BIG Returns
Role in the family
- Grocery Store
- Nightly Charge Wheelchair
- Get Family Mail /sorting
- Medications – pill box
*** be in charge
of something
- 3 indicators on Rx bottle
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Knowledge
Skills
Abilities
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Handout: Portable Medical Summary
Carry in your wallet
Good Days
- Cheat Sheet: Use as a reference tool
- Accurate medical history
- Correct contact #s
- Document disability
Health Crisis
- Expedite EMS transport & ER/ED care
- Paper talks when you can not
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Preparing for the 15 minute or less, Doctor Visit: YES it can be done with practice!
What You Can Do Now!
Before the Appointment
PROBLEM
GET THE DATE AND TIME THAT WORKS FOR YOU
Know your schedule before making an appointment.
Check for conflicts with school events, community
activities, family functions and work schedules.
Methods
1. Know Your Health & Wellness Baseline
•
How does your body feel on a good day?
•
What is your typical body temperature, respiration count,
elimination habits plus skin quality?
•
Recognize signs, symptoms of when you are getting sick
and take action (have a plan!).
GATHER THE PAPERWORK
• Have there been tests done since the last visit?
- Bring copies with you.
- Change in insurance, call in info before the appt.
• Make copies of the insurance card.
- Every family member has and carries his/her
own insurance card. (yes, children/youth too!)
• Update your portable medical summary.
2. Create 1 page Portable Medical Summary
KNOW THE HOURS AND POLICIES
• HOW TO LIVE HEALTHY & WELL with chronic health
issues and disability. Survive & Thrive!
Yes, sometimes it is a matter of timing. Avoid calling
the Doctor’s Office on Mondays and Fridays. Know who
to call, or where to go when there is an urgent issue or
an emergency. In the hospital, learn when shift change
occurs and do not go to the nurses’ station 30 min
before or after the shift begins (they need prep time).
GIVE A CONCISE MEDICAL REPORT
Practice what you want to say before the day of the
appointment. Use the 5 Qs and Multi-System Medical
History Tools to help you identify what you consider to
be a priority. It may require another office visit. This is
partly due to time limits for office appointments and
may also be due to what your insurance will pay for in
one visit.
Day of the Appointment
1 2 3
1. BE ON TIME. Call ahead to see if the Doc is running late.
2. DRESS COMFORTABLE: clothes that are easy to take off
3. BRING: insurance card, medical reports, questions to ask
(write them down), money or a check for the co-pay and
your calendar schedule to book next appointment.
•
Reference tool to provide accurate medical history
•
Emergency Info and contact numbers
•
Carry in your wallet, share with love ones & trusted others
3. Teach Skills EARLY!
• INCREASE CHILD/YOUTH INVOLVEMENT
Ask 5 questions at each visit, co-sign treatment plans
(assent). Call for appointments and Rx refills.
• GIVE CONCISE MEDICAL REPORT
Give brief overviews about health status and needs.
Know the emergency plan when health changes.
www.hrtw.org
We provide information and connections to health and
transition expertise nationwide – from those in the
know, doing the work and living it!
This website focuses on understanding systems,
access to quality health care, and increasing the
involvement of youth. It also includes provider
preparation plus tools and resources needed to make
more informed choices!
4. Getting Ready to Move On
• PREPARE FOR THE DIFFERENCE - Understand the
difference in the way health care services are provided by
pediatricians and by adult health care providers.
• ASK OTHERS – Ask health allies and other families for
names of physicians who have the skills and expertise
needed, and who may match styles in co-managing health
care.
• INTERVIEW- Encourage youth to check out new physician,
the practice and hospital before the official transfer.
• HEALTH INSURANCE PLAN. Before age 18-check the
plan. Many states have extended coverage for adult
disabled dependent child.
The Ultimate Outcome: Transition to Adulthood !
Health Records
-
Keep copies: test results, health visits receipts.
Request copies: hospital discharge summaries.
File: medical records
Share file with the Doctor when needed.
Health Surrogate
- Yearly talk with your family or trusted
friends about what health care treatments
you want and do not want.
- Legally identify WHO you want to speak on
your behalf when you are unable to.
NAME:
Insert/affix picture
AGE:
HEIGHT:
HOME PH:
EMAIL:
ADDRESS:
DOB: XX-XX-XXXX
WEIGHT:
CELL: ADD
Name(s) of Custodial Parent: ___ N/A
Guardian: ___ Y ___ N
Limited Guardian: ___ Y ___ N
Who filled in this form? Check all that apply.
___ Patient/Consumer
___ Parent
___Other family member
___Guardian
___Other, specify
ADL Area - Skill Level
Description and Medical Supports and Needs
ADD Medicaid Regulation Bed Mobility:
FIRST NAME
level of functioning
___Independent
___Needs assistance
___Able to direct others
___Unable to perform
How person moves to and from lying position, turns side to side, and
positions body while in bed;
Sufficient mobility to move into or out of a bed, chair, or wheelchair, or
to move from place to place, whether by walking, using a wheelchair or
by other means.
5 – 10 minutes
FORM: Tracking Poly Pharm
Patient: ADD NAME
ALLERGIES: list
Reason
Rx #
health Add #
issue
Drug
Add
name
ONLINE:
PHARMACY ADD NAME
LOCAL:
ADD NAME
Dose
DOB: ??/??/??
30 day Copay
Add
dose
90 day Copay
Last
Next
Left
Rx renewal
Add
Add Add Add Add
amount amount date date date
ADD PH
ADD PH
URL
USER NAME:
PASSWORD:
ADD ADDRESS
Add
date
Reason
Depressi
on
Bipolar
ADD
Thyroid
Rx #
Drug
#08267025 Effexor
4717
XR 75mg
90
30
Last Next
Dose day
day
copay copay
AM
3x1
$30.00
Left
Rx
renew
----- 09/2
3/08
???
01 12/12/
08
#1998367- Lithium - AM
01157
300 mg 1x1
PM
2x1
----- $ 15.00 10/1
0/08
???
-0-
NEED
Month
ly
#2003796- Vyvanse AM
01157
- 40 mg 1x1
----- $ 30.00 11/1 12/13
3/08
/08
-0-
NEED
Month
ly
# ADD
Levoxyl - Oppo
.125 mg days
----- $ ADD ?11/ ?12/1
14/0 4/08
8
??
???
# ADD
Levoxy l - Oppo
.137 mg days
----- $ ADD ?11/
14/0
8
??
??
??
END OF MONTH PILL COUNT
Rx #
Pill Count -- Surplus as of xx/xx/08
Effexor XR 75 mg 29
1995288-01157
30 Suspect improper daily dosage
082670254717
119 Surplus in two Rx bottles, last refill dated 9/23 @ 90 day
supply/40 days remaining x 3=120
Lithium
300 mg 105
1998367-01157
90 Suspect improper daily dosage
1982471-01157
01 Q>Rx refill date was 11/10/08-no evidence of refill,
surplus in Rx bottle 10/10/08
1985986-01157
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Q>Rx states AM 1 x 1, PM 2 x 1, patient says he has been
instructed to take 3 in AM, which is right?
Vyvanse 40 mg
2003796-1157
- 0previous refill 10/22/08, recent refill 11/13/08
Suspect overuse of daily dosage, giving it away or selling
it??
- Why did he run out this month 11 days beforehand
- Why did Pharm refill 11 days beforehand?
Q>Any contradictions with taking No-Doze?
Unable to monitor intake, but spent wrappers indicate
daily ? use of multiple doses?
TRAVEL SUPPLY LIST - 30 DAYS
Vendor/
Supply #
ESSENTIALS
Allegiance
21211
NPB-40
Item
Pulmonetic –
Notebook
– Repairs and
Working Info
Wheelchair battery
charger
Gloves No Powder
/Latex Freesuction/urine cath)
PACK
01
Notes/Comments
01
150
Roll in group of 10s
DME - Pulse Stat sensors
ID G00854587
01
extra batteries
Flashlight
03
extra batteries
thermometer
stethoscope
Electrical Surge Strips
01
01
02
RX - all & herbs +
butt cream
-
BRING LIST AND #s
INTERACTIVE DISCUSSION
• Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
• Key points
- teach though tip sheets
- checklists reduce forgetting
• Strategies to DO
WIIFM
60 min – Making Changes to Make a Difference
Section 03: PERSONAL ACTION
• How to model this approach with the families you assist &
tools to help
HRTW TOOLS:
• Health & life Qs to Ask
• 8 Steps To Thriving
• Postcard -- in 1 week, 1 month, 3 months
declaring what to do
36
Key Areas for Transition Planning
– How does health affect/impact ……
Employment and job training
Post-secondary experiences/ education
Independent/home living
Community Life
Leisure and Recreation
Wellness Baseline
37
HRTW
8 TIPS: Thriving Health & Wellness
EASY: Things to Do by Next Tuesday
1. Paying for health care: Carry your Health
Insurance Card in your wallet
2
Who to Call? Put “ICE” contacts in your cell
phone (in case of emergency)
3. Staying Well: Make an appointment with your
primary physician for your annual well visit.
Review the Screening Guidelines to see what
tests you may need to schedule this year.
4. Health & Wellness Baseline: write down your
typical body temperature, respiration rate, nail
color, elimination habits.
TAKES TIME: Start by next month
5. Health Information at your finger tips.
Create a one page portable medical summary. This is a
record of your health issues, medications (prescriptions,
over the counter and herbs), test results, contact
information of providers, list of hospitalizations and other
information that maybe asked during routine doctor visits
and also during emergency care.
6. Your Health Insurance Plan: Check out the website for
your health insurance plan. Read over the “benefit
package.” Learn what services are covered, what is
excluded. Find the forms you need to submit claims.
7. Find Mentors: Identify people who knows how to make
the health care system work easier less stressful for such
as” how to get bills paid and who can teach you how to
prepare paperwork for insurance claims, program
eligibility (SSI, VR).
HARD DECISIONS: Due by Thanksgiving
Best made during non-stressful times.
8. Advance Directives:
Who have you named to be your health care
decision maker in the event you are unable to
make decisions for yourself? – AND – what
treatments do you want or do not want in the
event you are in a serious health crisis?
Action Plan
I Did It!
7 days - Step 1:
• In one week I will commit to do……
30 days - Step 2:
By next month I will commit to do……
90 days - Step 3:
In three months I will commit to do……
41
Knowledge
Information
Learning
Skills
Teach
Practice
Abilities
Automatic
Demonstrate
42
INTERACTIVE DISCUSSION
• Which ideas struck you?
WIIFM
Jedi Master Yoda
DO or NOT DO,
there is no “try”.
What are we saying NO to?
44
Q&A
Patti Hackett
[email protected]
[email protected]
Mallory H. Cyr
[email protected]
[email protected]
45