health care transition brown bag lunch training series: transition tips & tools to prepare for...
TRANSCRIPT
Health Care Transition
Brown Bag Lunch Training Series: Transition Tips & Tools
to prepare for health care transition
June 3, 2009
HRTW
Patti Hackett, MEdCo-Director & Founder
Natick, MA
Mallory Cyr, BFAYouth Coordinator
Health Care Policy Sabattus, ME
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Patti & Mal
• Ideas Speak too fast – tell me Patti
Have a question, ask it
• Promise: Agree Ah ha! Squirm Patti Disagree
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
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INTERACTIVE DISCUSSION
• Which ideas struck you?
WIIFM
TAKE AWAY MESSAGES
• Key points
• Strategies to DO
WIIFM
Growing Up Readyto try new things!
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Growing Up: Completing college
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Growing Up
and
are
Adults
Health & Wellness …. + Humor 8
Imagine the Possibilities….
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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 Roles11
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
• 1 step at a time strategies
Youth knows & shares cultural practices that impact health treatments/services
1 2 3 4 5
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
Health & Transitions: YOU & Your Child
• Fears & Anxiety
• 1 step at a time strategies
Youth carries portable medical summary 1 2 3 4 5
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
Health & Transitions: YOU & Your Child
• Fears & Anxiety
• 1 step at a time strategies
Youth Calls and Makes Appts 1 2 3 4 5
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
Health & Transitions: YOU & Your Child
• Fears & Anxiety
• 1 step at a time strategies
Youth Co-signs Medical Treatment 1 2 3 4 5
YOU
YOUR CHILD
YOUR DOCTOR & OFFICE STAFF
Skills Before10
Before 18
• Carry and present insurance card X
• Know wellness baseline, Dx, Meds X X
• Make own Doctor appts X
• Call in Rx refills X
• Learning Choice X
• Decision making (assent to consent) X
• Prepare for Doc visit: 5 Qs X X
• Present Co-pay X X
• Assess: Insurance, SSI, VR X
• Gather disability documentation X17
What are we What are we saying saying NONO to? to?
The opportunity to TRYThe opportunity to TRYTo fail, learn and to try againTo fail, learn and to try again
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You can’t do it as well
as I can
I don’t want you
to get hurt.
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/22
TOOL: Promote Individual
• Families - protective
• Children / Youth - being visible - community aware
*** be in charge of something
Simple Acts …..BIG Returns
Role in the family
- Grocery Store
- Nightly Charge Wheelchair
- Get Family Mail /sorting
- Medications – pill box
- 3 indicators on Rx bottle
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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 25
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The Ultimate Outcome: Transition to Adulthood !
What You Can Do Now!
Health Records
Preparing for the 15 minute or less, Doctor Visit: YES it can be done with practice!
MethodsPROBLEM
- Keep copies: test results, health visits receipts.- Request copies: hospital discharge summaries.- File: medical records- Share file with the Doctor when needed.
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.
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.
KNOW THE HOURS AND POLICIES
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 31. BE ON TIME. Call ahead to see if the Doc is running late.2. DRESS COMFORTABLE: clothes that are easy to take off3. 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.
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!).
2. Create 1 page Portable Medical Summary
• 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!
• HOW TO LIVE HEALTHY & WELL with chronic health issues and disability. Survive & Thrive!
• 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.
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.
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!
Before the Appointment
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: DOB: XX-XX-XXXXHEIGHT: WEIGHT: HOME PH: CELL: ADDEMAIL: ADDRESS: Name(s) of Custodial Parent: ___ N/AGuardian: ___ 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 NAMElevel 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 DOB: ??/??/??ALLERGIES: list
Reason Rx # Drug Dose 30 day Copay 90 day Copay Last Next Left Rx renewal
health issue
Add # Add name
Add dose
Add amount
Add amount
Add date
Add date
Add date
Add date
PHARMACY ONLINE: ADD NAME
ADD PH URL USER NAME: PASSWORD:
LOCAL: ADD NAME
ADD PH ADD ADDRESS
Reason Rx #
Drug
Dose
90 day copay
30 day copay
Last
Next
LeftRx renew
Depression
#082670254717
Effexor XR - 75mg
AM 3x1
$30.00 ----- 09/23/08
??? 01 12/12/08
Bipolar#1998367-01157
Lithium - 300 mg
AM 1x1 PM 2x1
----- $ 15.00
10/10/08
??? -0- NEED Month
ly
ADD#2003796-01157
Vyvanse - 40 mg
AM 1x1
----- $ 30.00
11/13/08
12/13/08
-0- NEED Month
ly
Thyroid# ADD Levoxyl
- .125 mg
Oppodays
----- $ ADD ?11/14/08
?12/14
/08
?? ???
# ADD Levoxy l - .137 mg
Oppodays
----- $ ADD ?11/14/08
?? ?? ??
END OF MONTH PILL COUNT
Rx # Pill Count -- Surplus as of xx/xx/08Effexor XR 75 mg 291995288-01157
30 Suspect improper daily dosage Surplus in two Rx bottles, last refill dated 9/23 @ 90 day supply/40 days remaining x 3=120082670254717 119
Lithium 300 mg 1051998367-01157 90 Suspect improper daily dosage
Q>Rx refill date was 11/10/08-no evidence of refill, surplus in Rx bottle 10/10/08Q>Rx states AM 1 x 1, PM 2 x 1, patient says he has been instructed to take 3 in AM, which is right?
1982471-01157 011985986-01157 14
Vyvanse 40 mg - 0-2003796-1157
previous refill 10/22/08, recent refill 11/13/08Suspect 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 DAYSVendor/
Supply # Item PACK Notes/Comments
ESSENTIALS
Pulmonetic – Notebook – Repairs and Working Info
01
Wheelchair battery charger
01
Allegiance 21211
Gloves No Powder /Latex Free- suction/urine cath)
150 Roll in group of 10s
NPB-40 DME - Pulse Stat - sensors ID G00854587
01 extra batteries
Flashlight 03 extra batteries
thermometer 01stethoscope 01Electrical Surge Strips
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
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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
EASY: Things to Do by Next Tuesday
HRTW 8 TIPS: Thriving Health & Wellness
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 ThanksgivingBest 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……
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INTERACTIVE DISCUSSION
• Which ideas struck you?
WIIFM
What are we saying NO to? What are we saying NO to? 44
DO or NOT DO, there is no “try”.
Jedi Master Yoda
