Pediatricians, Medical Students and the Early Intervention System in Hawaii

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Pediatricians, Medical Students and the Early
Intervention System in Hawaii

• Marge Wada CCC-SLP
• State of Hawaii Early Intervention Programs
• Jeffrey Okamoto M.D.
• John A. Burns School of Medicine
• University of Hawaii At Manoa

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Required Statement

• We and/or an immediate family member including
  our spouses/partners DO NOT have a financial
  interest, arrangement or affiliation with a
  commercial organization (currently or within the
  past 12 months) that may have a direct or
  indirect interest in the subject matter of my
  presentation.
• Our presentation or participation will not
  involve comments or discussion concerning
  unapproved or off-label uses of a medical device
  or pharmaceuticals.

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Objectives

• Explore collaborations between Pediatricians and
  Early Intervention Programs
• Discuss a training program for medical students
  to be oriented to early intervention activities
  and physician roles

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IDEA

• Individuals with Disabilities Education Act
  (Federal Law)
• Guarantees children with learning, physical, and
  behavioral disabilities a free and appropriate
  education
• Special education and zero-to-three programs are
  included under this law

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IFSP

• Federal legislation requires each child
  identified as having a disability to have a
  written plan of service
• Individual Family Service Plan (IFSP) for
  children from birth to age three years

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Eligibility for EI

• Physicians should be aware that each State
  determines their own eligibility criteria
• Hawaii has a biological at-risk category and an
  environmental at-risk category

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Referral

• Who should be referred?
• How should physicians do this with their families
  when they refer children?
• Once referral is made, then what happens?

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Materials Providing Guidance

• School Health Policy and Practice
• (Committee on School Health, American Academy of
  Pediatrics)
• Pediatricians Role in the Development and
  Implementation of an IEP and/or an IFSP
• (Committee on Children with Disabilities,
  American Academy of Pediatrics)
• The Pediatricians Role in School and Child Care
  Settings
• (Ambulatory Pediatrics Association)

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Current JABSOM Medical Student Training

• Third Year Medical Students
• 1/2 day experience for each medical student in an
  early intervention(EI) program, each student
  concentrating on a different discipline at the
  program but all around the same child at the
  program
• End of block colloquium with early intervention
  staff, family and child observed, and medical
  students all sharing perspectives of the various
  disciplines at the EI program

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Benefits to Early Intervention Training

• Physicians are trained to be more responsive to
  early intervention program needs
• Programs received inservices and information
  about health related topics

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The Medical Students Study These Roles

• Family
• Physician
• Physician subspecialist
• Program Consultant
• Primary Service Provider
• Care Coordinator

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Scenario 1

• Infant just delivered, diagnosed with Down
  Syndrome. He has several medical problems,
  including an endocardial cushion defect, and
  feeding issues.
• How is the infant referred to an early
  intervention program?
• How does the primary care physician and the
  subspecialists work with the early intervention
  program?

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Scenario 2

• A 2 1/2 year old has significant language delay.
  The child is not talking but rather grunting and
  pointing. Receptive language and motor skills
  appear to be normal.
• How would you talk to the family about referral
  to early intervention services? What services
  would you expect to be provided?

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• Youve been invited to an IFSP meeting.
• Will you attend?
• What do you see as your role whether or not you
  attend?
• How do you propose how the communication lines be
  kept open to work optimally?

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• How has early intervention been working in your
  situation?
• If there has been barriers, how do you propose
  problem solving them?

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Challenges to Training

• Going from the OT/PT/SLP/Audiology clinical model
  to a community based transdisciplinary model
• How sophisticated should the discussion be for
  medical students?

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Important Discussion Points

• Transdisciplinary versus Traditional Provision of
  Services (Multidisciplinary)
• Natural Environments versus Center-based programs
• Coaching versus direct treatment
• Provision of care to children with profound
  retardation that show minimal response
• Specific skill development versus routine based
  intervention