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Pediatric Palliative Care

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Post CRITERIA FOR SERVICES
Author: mmtalbot
Date: Mar 16, 2012 10:26 am
I am a CPNP recently hired by the state of Vermont to develop and implement a pediatric palliative care program for children throughout the state. The program will provide the following services:

1. Care Coordination
2. Respite
3. Family Trainin
4. Expressive Therapies (art, music, play)
5. Bereavement Counseling

It is the thought of some of my peers that we need to have objective screening criteria built in to our needs assessment tool in order to determine if and how much of each service a child and family needs.

If anyone has a system they use to determine service eligibility, I'd be very appreciative. If you conciously chose not to run your program that way, I'd also be curious as to why.

Many thanks,

Monica
Replies: order by [Date] [Author] [Subject]
Re:CRITERIA FOR SERVICES (by StacyRemke on 04/11/2012)
Hi. If I understand your question correctly, you are looking for tools to plan for community based care for these kids? We have developed a few different things but that said, this is still very much a work in progress for us. It seems that individualized planning is essential, and the changes in acuity, needs, preferences and resources are all moving targets that complicate standardization. We have developed a Green/ yellow/ red scale where we compare referral information to our capacity to meet the needs: green light are obviously "yes" and red "no" while yellow get referred for discussion and decision making. Criteria include things like diagnosis is appropriate (per trigger list in CAPC tools site), family goals appropriate for PPC, payor in place, etc.

We have also developed some standards of care. For example, if Child Life is involved, a bi-monthly SW visit is required to ensure appropriate planning for family mental health
and support needs. That helps us avoid situations like families preferring child life and hoping more severe depression and anxiety symptoms are managed through that intervention. Same with music therapy, etc.

Nursing and SW visits which provide the core case manager/ assessment functions have a default expectation of q 60 days as a minimum. If the child is stable pr family doesn't want / need visits that often, we may determine they are not in need of community based services at this time. Conversely, when a child is changing, or family needs change, we may add services/ resources as they child develops more complex needs or is more home bound, so we want to be sure we are reassessing needs as we go at some reasonable interval.

The short answer is that we have developed a loose structure that is highly adaptable, but based upon our constant need to manage limited resources fairly, and provide effective palliative care. Hope that helps! I would be interested to hear if others have had other strategies thatw orked for them?
Re:CRITERIA FOR SERVICES (by mmtalbot on 04/25/2012)
Thanks Stacy-

That's very helpful. Understanding that needs in palliative care are often a moving target, do you have a form that you use every 60 days in order to establish some type of measurable criteria from which you determine this green/yellow/red? Would you be willing to share it?

Since I am developing this program under Medicaid, it's important to them that I be mindful of spending and ensure that I'm making decisions not just based on what I feel a family deserves but also based on some formalized assessment.

Many thanks again, Monica

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