Providing Speech Therapy at Home for the Medically Fragile Children Jessica Buringrud, MA, CCC-SLP Sarah Focke, MS, CCC-SLP Leandre Gerwin, MA, CCC-SLP Kirsten Keppner, MS, CCC-SLP Snow Wilfong, MS, CCC-SLP
Learning Outcomes Identify CCHMC Eligibility for Services and Criteria for Discharge. Identify additional training required for CCHMC home health care SLPs Identify possible benefits speech, language and oral motor feeding therapy in the home. Identify appropriate locations of services provided. Identify additional training required for CCHMC home health care SLPs
Home Health Care Home care is a short term alternative to standard outpatient care. American Federation for Home Health Agencies indicated that home health care is the fastest growing segment of health care services (1998). The National Outcomes Management System (NOMS) data collected from ASHA indicated that home health care clients ranged from 50 years and older. This data did not account for the increasing need for home health care in the pediatric population.
Six Areas of Home Health Care at Cincinnati Children s (CCHMC) Skilled Nursing Shift Nursing Pharmacy Hospice Occupational and Physical Therapy Speech Therapy
Eligibility for Home Health Care Live within 50 miles of CCHMC main campus Reside within Ohio Mechanical ventilation Continuous drip feeds Chronic respiratory illness that impedes patient mobility Infectious disease Immununosuppression Lack of strength or endurance to travel to an outpatient setting as determined by an evaluation by CCHMC Home Care Respiratory or other conditions that are negatively impacted by a particular seasonal condition.
Referral Sources RICNIC (Regional Infant Care-Neonatal Intensive Care) Gastroenterology Hematology/Oncology High Risk Clinic Pulmonary Neurology The Center for Infants and Children with Special Needs Community Physicians
Orientation to HHC General information Management structure Workflow (referral to discharge) Professionalism in the home Driving Safety Personal Safety Infection Control Hospice
Safety Supplies goggles gowns mask CPR mask paper towels hand wipes hand sanitizer disinfect wipes cell phone supply bag
Home Health Care competencies Basic competencies completed during orientation process Encourage HHC SLP diverse specialty competencies for treatment and evaluations through CCCHMC Speech Pathology Brain Injury Oral Motor Feeding AAC Birth to Three Apraxia Autism Down Syndrome Video Swallow Study
Continuity of Care Specialty competencies and affiliations with of variety of clinics/departments serving inpatient and outpatients within the medical center support our mission to provide continuity of care.
Why? To avoid fragmentation of care. Continuity in primary care literature is mainly viewed as the relationship between a single practitioner and a patient that extends beyond specific episodes of illness or disease. (Haggarty et.al.) Continuity implies a sense of affiliation between patients and their practitioners, often expressed in terms of an implicit contract of loyalty by the patient and clinical responsibility by the provider. (Haggarty et.al.)
Direct Affiliations within CCHMC Bone Marrow Transplant Hematology and Oncology Interdisciplinary Feeding Team Eosinophilic Disorders Neonatology High Risk Clinic GI Clinic Outpatient therapy (Division of Speech Pathology Specialty Teams) Inpatient therapy
Locations within the community where therapy provided
Family Residence
Family Residence
Alternative Residence Foster family Grandparents
Ronald McDonald House The purpose The RMH of Cincinnati
Temporary Housing within the community specified by CCHMC WHY?? Ronald McDonald House overflow or deemed inappropriate Hotels Apartment Complex
Benefits of home care therapy Clinical Observations Improved parent education and involvement Increased carry-over of therapy techniques Increased variety of food choices within therapy Consistent interactions with additional caregivers and siblings (nurses, family members) Improves behavioral management
Parent and Caregiver Education
Parent and Caregiver Education
Parent and Caregiver Education
Criteria for Discharge Goals met Parent request Patient has become to ill to participate Transitioning to school Medical conditions stabilize and allow transition to OP setting, per physician Three consecutive incidences of intentional non-compliance (ie: intentionally missed appointments)
?????? Questions
Contact Information Jessica.Buringrud@cchmc.org Sarah.Focke@cchmc.org Leandre.Gerwin@cchmc.org Kirsten.Keppner@cchmc.org Snow.Wilfong@cchmc.org
References Haggerty, J., Reid, R., Freeman, G., Starfeild, B., Adair, C., McKendry, R. Continuity of care: a Multidisclinary Review, Education and Debate, Vol. 327, Nov. 2003 Weingling, F. (2000). Speech-Language Pathology: A Home Care Viewpoint. American Journal of Speech-Language Pathology, 9, 99-106. http://www.asha.org/slp/healthcare/start_home. htm