A Collaborative Project:

1

• A Collaborative Project
• Hospitals
• Nebraska Health Human Services System
• Nebraska Department of Education
• Local Planning Region Teams
• Family Members
• Community Providers

2
Why Follow-Up?

• Monitor Infants Development through
  Developmental Surveillance to assure early
  identification of developmental problems
• Provide ongoing support to families of young
  children
• Identify outcomes of this population of children

3
A Statewide Project
Targeted Communities

• Omaha
• Kearney
• Lincoln
• Scottsbluff

4
Who Is Eligible?

• All infants with a NICU stay over 48 hours
• Infants in one of 7 hospitals in Nebraska
• Infants hospitalized in Denver or Rapid City

5
Determining Level of Risk

• High Risk Factors
• Environmental Factors
• Criteria for School Referral

6
What Babies are at High Risk for Health Factors?

• Low Birth Weight (lt1500 Grams)
• Multiple Congenital Anomalies Related to
  Developmental Problems
• Syndromes Related to Developmental Problems
• Grade III-IV IVH
• Ventilatory Support Greater than Four Days (96?
  or more)
• Oscillatory ventilation or ECMO
• Exchange Transfusion
• 5 minute Apgar lt 3
• Physician Referral
• Seizures
• Cystic Periventricular Leukomalacia
• Grade III ROP
• Multiple birth sibs
• Failed hearing screening at time of discharge

7
What Babies are at High Risk-Environmental
Factors?

• Children/families living in poverty
• Children whose mothers had no prenatal care

8
Three-Tiered Model of Follow-UP

• Total Followed 924 (5/2000-9/2001)
• Low Risk 430
• High Risk 361
• School Referral - 67

9
Level One Follow-Up through Questionnaire

• Survey Information from Physician
• Developmental Survey based on Parent Report

10
Level Two Follow-Up through Screening Clinics

• Core Team Completes neurodevelopmental screening
  and developmental screening
• Provides educational support to the family

11
Level 3 Follow-Up through Comprehensive
Assessment

• Referral to Early Intervention and/or Medical
  Clinics
• Interdisciplinary Team provides Comprehensive
  Developmental Assessment
• Team provides educational support to families
• Outcome Data Collected

12
Baby Admitted to NICU
Parents provided Information on Developmental
Tips
Parents Agree to Participate
Health Care Team with Family Identify Follow-Up
Plans
Comprehensive Assessment
Questionnaire
Screening
Discharge Data Entered on Internet Database
13
Direct School Referral Criteria

• Syndromes or congenital anomalies associated with
  known developmental delay.
• ROP requiring therapy beyond laser.
• Confirmed hearing impairment.

14
Where are we now?

• 489 infants are currently enrolled
• All 7 hospitals have enrolled children
• The first TIPS follow-up occurred in September
  2000
• All 5 clinic sites have now seen TIPS children
  for follow-up, including a traveling clinic to
  Norfolk