Oct 24 CAPHC Lunch Symposium - Sponsored by Stantec
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Stantec Lunch Symposium Caring for the Whole Child: Three Projects, One Shared Vision for Child and Youth Wellness
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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
- 6. 6 ErinoakKidsAlmost Home Kids Wood Street Treatment Centre
- 7. 77 Caring for the Whole Child
- 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
- 10. Diagnosis • Neuromuscular Disease • Spinal Muscular Atrophy (Type 0, I & II) • Premature Birth • Central Hypoventilation Syndrome • Metabolic Disorders • Cerebral Palsy • Spina Bifida • Oncology • Chromosomal Disorders • Cardiac Anomalies • Traumatic Brain & Spinal Cord Injury • Gastric Anomalies - Short Gut Syndrome • Hospice • Neonatal Withdrawal Syndrome
- 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)
- 12. Clinical Capabilities • Ventilators • Tracheostomies • CPap (Continuous Positive Airway Pressure) • BiPap (Bi-level Positive Airway Pressure) • Remodulin Pumps • PICC lines (Peripherally Inserted Central Catheter) • Feeding tubes • Urinary catheters • Ostomies • Orthopedic external fixation devices • Oxygen therapies • Spica cast • Peritoneal Dialysis • Blood Draws
- 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
- 16. 16 View video
- 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
- 23. National & International Children’s Healthcare Centers
- 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
- 31. 31 Wood Street Centre Campus, Level 3 Program CAPHC Conference October 2016 Jeanette Hay Connolly, WSC Campus Alena Fisher, Stantec
- 32. 32 Wood Street Centre Campus & Level 3 Program
- 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
- 34. 34 Objective • Engage youth in treatment and facilitate development of internal self controls
- 35. 35 Design Philosophy • Design inspiration • Facility Layout
- 36. 36 Informed Collaborative Design • Pillar of program • Safety First
- 37. 37 Building Program • Inner Street • Houses • Program Spaces • Administration and Clinical Offices
- 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
- 39. 39
- 40. 40
- 41. 41 Residential Treatment Services • Interdisciplinary Team • Therapeutic milieu • Trauma informed services • Behavioural management techniques and strategies • Psychoeducational programming • Classroom education
- 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
- 44. 44
- 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
- 50. 50 Design Philosophy • EOK serves 15,000+ kids annually • Wide range of • Challenges • Ages • Cultural backgrounds • Locations • Services (autism, communication, hearing, medical, OT, PT, vision)
- 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
- 53. 53 Oakville Mississauga Brampton Concept Diagrams
- 68. 68 Play
- 69. 69
- 70. 70
- 71. 71
- 72. 72
- 73. 73
- 74. 74
- 75. 75
- 76. 76
- 77. 77 Achievement
- 79. 79 Exterior expression on Gym wall
- 80. 80 Main Street and Gym
- 81. 81 Memory
- 82. 82
- 83. 83
- 84. 84
- 85. 85
- 87. 87 Level 1 Level 2
- 91. 91 Main Street, Lobby and Family & Staff Resource Centre
- 93. 93Treehouse and Solar Calendar
- 94. 94 Oakville – Central Courtyard
- 95. 95 Oakville – Exterior Therapeutic Play Area
- 96. 96 Oakville – Level 2 Exterior Therapeutic Terrace
- 97. 97
- 99. 99 Level 1 Level 2
- 103. 103 Level 1 Level 2
- 106. 106
- 107. 107Day in the Life - Anjuli Respite Centre
- 108. 108
- 109. 109
- 110. 110 Brampton – Respite Area
- 111. 111 Treatment Area Lunch Areas Activity Areas
- 112. 112 ART WORKS
- 113. 113
- 114. 114
- 115. 115
- 116. 116
- 129. 129
- 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