Episodes of Care: What is it?

 

Hello all - 

A few years ago, I made the switch from schools to a pediatric outpatient clinic within a hospital system. I love my new job! But we have been plagued with a waitlist problem since the day I started. We currently have over 60 kids on out waitlist - which is huge for a rural, midwest hospital. We started to brainstorm how we could see more of these kids, get through our waitlist more effectively, etc. That led us to Episodes of Care. 

Basically, this means we provide services to long-term patients in "episodes." Typically, an episode of 8-12 weeks of weekly or twice weekly therapy with parent involvement. We provide skilled services throughout this time and develop a home program for the patient. Then they are "off" from therapy for 8-12 weeks. During this time, they complete their home program. At the end of their program, they return to the office for a re-evaluation to determine if services are still necessary. 

It's imperative that families are involved in the process, as they will be the child's therapist throughout their "break." We encourage the parents to attend the sessions and practice implementing the strategies with their child. They are also indispensable in the goal-writing process. We require parents to think of specific things their child is struggling with so that we can target them effectively and functionally. None of this "I want my child to talk" stuff. They need to bring specific needs to the table - "I want them to be able to tell me when they want something to eat" or "I want them to be able to follow routine directions when getting ready in the morning." Things like that. When they return back to the office after their "break," the parents report on how the home programs went and what there new concerns are. 

By rotating through these "episodes," the therapist can be actively managing twice as many clients. You can be seeing another patient during the original patient's break. This allows us to see these kiddos that have been referred and at least give parents some help/advice rather than them just waiting on a list for months. Furthermore, we empower the parents to help their children and be active participants. Finally, it helps with attendance. Patients that aren't committed often don't return from the break. While this stinks for the child because they aren't getting the therapy they need, it helps us to get to families that will participate more quickly. Also, attendance becomes a priority for more of our families because they know they only have a limited number of sessions. 

The biggest negative is the amount of work it takes. Developing the home program and gathering up the resources takes quite a bit of time. Unfortunately, our hospital system has not allowed us to block of time in our schedule for this. When patients cancel, I use this time to work on home programs. However, if you are planning on doing this in your setting, I would highly encourage you to advocate for planning time. 

Episodes of Care is definitely not for all settings and situations. I have several patients that do not participate in this - Early Intervention, children with just a few articulation errors, children that are just learning an AAC device, etc. But I thought I would share information about it in case anyone is experiencing a similar problem. 

Thanks for stopping by!

Jessica