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Oct 24 CAPHC Lunch Symposium - Sponsored by Stantec
1. 1
Caring for the Whole Child:
Three Projects, One Shared
Vision for Child and Youth
Wellness
2016 CAPHC Annual Conference
Lunch Symposium #2
Halifax, Nova Scotia
Monday, October 24, 2016
2. 2
Our speakers
Alena
Fisher
Senior Associate,
Stantec
Jeanette Hay
Connolly
Director,
Wood Street
Centre Secure
Care
Deborah
Grisko
President and
Executive
Director, Almost
Home Kids
Robert
Hofmann
Principal
Hofmann PM inc
and Sr. Project
Manager,
ErinoakKids
Centre for
Treatment and
Development.
Barbara
Miszkiel
Senior Principal,
Specialty
Healthcare
Leader
Stantec
Brenda
Bush-Moline
Principal,
Healthcare
Leader,
Stantec
5. 5
10%
Physical Environment
20%
Clinical Care
30%
Health Behavior
40%
Socio-Economic
Factors
Graphic from Lauren Valdez and Carla Saporta, Community Benefit and Missed Opportunities.
A Case Study Of Three San Francisco Hospitals. T he Greenlining Institute. October 2014
8. Almost Home Kids
Naperville (opened 1999)
• 12-Bed facility on 2 acres
Chicago (opened 2012)
• 12-Bed facility, 6th floor RMHC
Mission: to provide transitional care in a home-like setting for children with
complicated health needs, as well as training for their families and respite
care.
Vision: opening new facilities to service the needs of children with complex medical
conditions and their families in other communities throughout the country.
Peoria (to open 2018)
• 12-Bed facility on 2 acres
9. Transitional Care
• Bridge from Hospital to Home
• Parent/Caregiver training
• Up to 120 day stay
• Community Supports – Home
Nursing, DMEs, Foster Care
• Adapt/revise Discharge Plan
• Subspecialty & PCP
Community Coordination
• Newborn – age 22
Respite Care
• Mission driven program keeping
families whole
• Planned or Emergency Short term
stay (up to 2 weeks)
• Opportunity to review Home
Medical Plan
• Respite Transportation
• Newborn – age 22
11. AHK Team
• On Site Medical Directors
• Director of Nursing Services
• Advanced Nurse
Practitioners
• Clinical Educator
• Social Workers
• Case Management Team
• Clinical Managers
• Direct Care RN’s 3-1 ratio
• Certified Nurses Aides
• Volunteers (1-2.5 FTE)
13. Programs Responding to Children’s Needs
Sleep Medicine: AHK Chicago
• Improve the quality of life for children who
have sleep difficulties or have outgrown the
need for medical technology.
• Significant cost savings over the child’s life.
• Free up ICU beds
Pediatric Surgery APN & Nutrition Consultations:
• Frees up clinical space and time
• Billed as outpatient
• Transportation costs reduced
Physical Therapy
Dental Consults
Telemedicine
Medical Education
14. Transition: Training the Next Generation
Keith Veselik
MD Medical Education Program
Most doctors can complete entire 7-10 yrs.
of training and never learn directly how to
serve and care for a child with medical
complexities in a community setting.
AHK has partnered with 5 Medical Centers
and 116 Residents and Medical Students
enrolled in first year of program
Loyola University Medical Center is offering
a 4-week elective at Almost Home Kids.
15. 15
Transition: Child and Caregiver Timeline
Pediatric Hospital admit
identified as Child with
Medical Complexities
Parent’s view AHK video
and Hospital Case
Management Team
introduces parents to AHK
Case Management Team
Parent’s visit AHK, meet
with Case management
team onsite
Child is stabilized in
hospital and is ready to
transfer home, but factors
exist that prevent a safe
transition home
Parents works in partnership with
AHK to learn necessary care in
120 days. Child is transported to
AHK via ambulance or medi-van
Child at AHK while parents trained
on child’s home technology, home-
health nursing staffed, DME supplier
identified, Government Agencies
and services are secured
Child safely transitions
home
Child is able to return
to AHK for Respite –
giving parents a
much needed rest
17. “You guys are amazing! You love the kids like they
are your own! I am certain Caitlyn will miss you all”
- Caitlyn’s mom
“I really want people to know how
important Almost Home Kids is; it
truly changes lives and sets parents
up with the knowledge and medical
support necessary to take care of
their child at home.”
- Audrey’s mom
Parent Quotes
18. Reduced Costs, Improved Care
• Less than 2% of our children were
re-admitted
• 75% of parents report a reduction of
stress
• In Illinois, AHK has saved the
Medicaid system $10million per site
per year
• IRB Longitudinal follow-up study of
children and caregivers –
Describing the caregiver
experience of transitional care –
measuring caregiver competency
and stress levels – Sarah Sobotka
MD, University of Chicago
19. Our Kids are Medically Complex
19Source: 2010-2015 AHK Program Committee Outcomes Report
Infantile cerebral palsy,
unspecified
36%
Trisomy 21 (Down's
syndrome)
5%
Spinal muscular atrophy,
unspecified
2%
Other specified disorders of
brain
2%
Spina bifida without mention
of hydrocephalus (Chronic)
6%
Arhinencephaly
6%
Other congenital
malformations of
musculoskeletal system
2%
Chromosomal abnormality,
unspecified
2%
Chronic respiratory disease
arising in the perinatal
period
27%
Unspecified convulsions
12%
20. Medical Complexities Data
Source: 2015 AHK Program Committee Outcomes Report
21% on Vent
47%
36%
17%
Medication Complexity
Complex >=7 Moderate 3-6 Simple 1-2
Tracheostomy
Yes No
55%45%
Tube Fed
Bolus Continuous None
63%
15%
22%
Medical Complexities
1-3 Diagnosis 4-6 Diagnosis 7+ Diagnosis
28%
17%
55%
21. Lowering the Hospital Length of Stay
0
50
100
150
200
250
300
Kylie Gabe Jamri Alexis
Average Length of Stay
Actual Length of Stay
Tracheostomy Cardiac
Procedures
Premature Premature
Number
of Days
Hospital stays for
children with
complex medical
conditions can
exceed APR-DRG
National Average
Length of Stay
(ALOS)
233 excess days
$1,025,000
109 excess days
$304,000
142 excess
days
$395,000
199 excess
days
$610,000
Based on actual $/day
22. Recognized for Excellent Health Outcomes
An extraordinary place for healing and family-
centered care, evidence-based design and
advanced technology:
• Ranked 6th over-all in the US News & World
Report Survey and the only pediatric hospital
in Illinois to be ranked in all 10 specialties
• First children’s hospital in country to earn
Magnet Award for Nursing Excellence –
Received 4th re-designation in Sept. 2015
• Almost Home Kids program received
Magnet Exemplar 2015
• 9 out of 10 parents would recommend our
hospital
24. Guiding Principles – Almost Home Kids in Peoria
• Enhance brand identity
• Community focused setting
• Immediate connection to
nature
• Infection Control
• Privacy
• Ample natural light
• Adjust and “flex”
• Access to nature
25. Almost Home Kids in Peoria
• 12 private bedrooms -
with parent
accommodations
• 9 Bathrooms
• Open Concept Great
Room & Kitchen
• Welcoming Family
Receiving Area
• Ample Storage
26. Almost Home Kids in Peoria
• Administration offices
& amenities
• Private Consultation
and Conference
Rooms
• Refection/Meditation
Area
• Healing Garden
27.
28.
29.
30.
31. 31
Wood Street Centre Campus, Level 3 Program
CAPHC Conference October 2016
Jeanette Hay Connolly, WSC Campus
Alena Fisher, Stantec
33. 33
Deliver an interdisciplinary
residential treatment service
model for youth in the care of the
Minister of Community Services
• Capacity
• Age group
• Length of stay
Goal
38. 38
Desired Outcomes
• Develop/increase social
competency or functioning
• Decrease emotional and
behavioural issues
• Reduction in need for
restraint and isolation
• Readiness for transition to
community
42. 42
Purpose Designed
and Built
• Building program and residential
treatment needs
• Classrooms and computers
• Psychoeducational
programming including;
• Aggression Replacement
Training (ART)
• Experiential Education
• Mindfulness
• Dialectical Behaviour Therapy
43. 43
Purpose Designed
and Built
• Therapy counseling and
psychological
assessments services
• Recreation, leisure
activities
• Youth self-regulation
activities
45. 45
ErinoakKids Centre for Treatment
and Development
3 Sites, One Vision
Oakville
Mississauga
Brampton
CAPHC Conference – October 2016
Robert Hofmann, EOK
Barbara Miszkiel, Stantec
46. 46
The Project Partners
• ErinoakKids
• Infrastructure Ontario (IO)
• Ministry of Children and
Youth Services (MCYS)
• Design Compliance - Parkin
• Architect of Record - Stantec
47. 47
We are . . . . .
• Ontario’s largest children’s
Treatment Centre
• Wide range of services
• Day treatment(10 sites)
• Overnight respite – 1 site
• 650+ staff serving 15,000 kids
annually
always Learning . . . . . .
48. 48
Existing
• Mississauga site– end of life
cycle
• 9 other leased sites
• converted office buildings,
accessibility, space and
code issues
• Lack of exterior therapeutic
play areas (two for all the sites)
• Demand for services increasing
10-20% annually
49. 49
Design Philosophy
• Building as therapy tool
• Landscape as therapy tool
• Technical therapy tools
• Positive staff environment
51. 51
Design Philosophy
• Consistency across all 3 sites
• Each child is unique but must have
similar opportunities
• Equal access to medical, therapy,
support services
• Celebrate Joy in their successes
• Respond to all physical and
behavioural challenges
• All ages: child-friendly vs. child-like
130. 130
Final slide is actually a short fly-through. Great last impression….
131. 131
Q & A
Deborah A. Grisko, RN, President & Executive Director
Almost Home Kids
dgrisko@almosthomekids.org
Jeanette Hay Connolly, Director,
Nova Scotia Department of Community Services
jeanette.HayConnolly@novascotia.ca
Robert Hofmann, Sr. Project Manager,
ErinoakKids, Ontario
rhofmann@erinoakkids.ca
Alena Fisher, Sr. Associate
Stantec Architecture Ltd.
Alena.fisher@stantec.com
Brenda Bush-Moline, Principal , Healthcare Leader
Stantec Architecture Ltd.
Brenda.bush-moline@stantec.com
Wood Street Centre
Barbara Miszkiel, Sr. Principal, Specialty Healthcare Leader
Stantec Architecture Ltd.
Barbara.miszkiel@stantec.com
Article on Design for kids with ASD, (Erinoak):
Go to dimhn.org October 2016 Issue
