Cost Models in Early Intervention

1
Cost Models in Early Intervention

• Robin McWilliam
• Vanderbilt University Medical Center

2
Benefits of PSP Model

• Family receives strong support from one person,
  not having to get to know multiple people
• Program for child and family is coordinated, not
  fragmented
• Weekly, family has to host only one visit in the
  home, not multiple visits
• Service providers, especially therapists, can
  serve more families
• Cost to system is reduced, so more families can
  be served more flexibly and families can receive
  better service coordination (with saved, hire
  more SCs)
• Expected outcomes same for child, better for
  family, lower costs

3
Multidisciplinary Time Allotment
4
The Numbers

• 20 visits
• 20 children

5
Transdisciplinary Time Allotment
6
The Numbers

• 20 visits (same !)
• 5 children as PSP
• 15 children consulting

7
In 1 month

• Multidisciplinary 20 children
• Transdisciplinary 5 as PSP
• 15 as consultant X 4 weeks 60 children
• 65 children
• Same !

8
The Impact of the Dedicated-Service-Coordinator
Model

• No continuity through the process
• Many service coordination needs unmet
• Poorly trained or qualified service coordinators
• Poor coordination of existing services
• Multidisciplinary, therapist-driven, expensive,
  disjointed services

9
2-Year-Old With Down Syndrome

• OT once a week (65)
• PT once a week (65)
• SLP once a week (65)
• Special instruction once a week (45)
• Subtotal x 50 weeks 12,000
• Service coordination twice a year (280/yr.)
• Total 12,280/yr.

• Service coordinator/
• Interventionist once a week (65)
• Other specialist twice a monthgenerous!
  (130/mo.)
• Total 4,810

10
Conclusions

• With the PSP approach, generalists spend most of
  their time seeing their own families, and
  specialists spend most of their time seeing
  others families
• Generalists are sometimes specialist consultants
  to other PSPs
• Specialists are sometimes PSPs
• The problem with dedicated service coordination
  is that services are generally fragmented and
  using a multidisciplinary approach and therefore
  expensive
• Furthermore, you have to pay for the SC on top of
  all the other services
• Dont get me started on cost models for
  evaluations!

11
Disclaimer

• My views are my own and do not reflect the views
  of any State agencies doing business with the
  Center for Child Development at Vanderbilt
  University Medical Center.