National Resource Center for Academic Detailing [NaRCAD]     857.307.3801
NaRCAD
  • About Us
    • Our Team
    • Contact Us
  • Learning Center
    • The AD Core Toolkit >
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
    • Examples of Program Materials
    • News & Media Center
  • The Detailing Directory
  • EVENTS
    • Training Series
    • CONFERENCE SERIES
    • THE CONFERENCE HUB
  • Blog
  • Partner Network
    • Partners by Location
  • About Us
    • Our Team
    • Contact Us
  • Learning Center
    • The AD Core Toolkit >
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
    • Examples of Program Materials
    • News & Media Center
  • The Detailing Directory
  • EVENTS
    • Training Series
    • CONFERENCE SERIES
    • THE CONFERENCE HUB
  • Blog
  • Partner Network
    • Partners by Location

The DETAILS BLOG

Capturing Stories from the Field: Reflections, Challenges, & Best Practices in Clinical Outreach Education

Better Developmental Outcomes for Children: An Interview with Colorado ABCD

3/22/2016

1 Comment

 
Picture

​NaRCAD: Hi, Meagan and Mindy—thanks for taking the time to talk with us about your clinical outreach education programming at Colorado ABCD. Can you give us an overview about ABCD and its mission to improve child development?


Meagan Shallcross: Colorado Assuring Better Child Health & Development (ABCD) works with community partners, pediatric healthcare providers, early learning providers, and families across Colorado communities. The goal is to strengthen systems and identify children with developmental delays, connecting them with community services as early as possible.

ABCD’s primary focus has been on increasing rates of standardized screening for developmental delay and autism using validated tools and improving rates of referral completion. We’re also moving into working to improve screening and referral for pregnancy related depression (PRD), as PRD can impact children’s developmental outcomes.

​
"The goal isn’t to do all the work, but to help the practice find capacity to do it themselves." 


PictureMeagan Shallcross, MPH
NaRCAD: Tell us a bit about your backgrounds. How did you each get into healthcare improvement?
​
Meagan: My background in public health, along with experience working in clinical settings and behavioral science research, developed my interest in healthcare improvement that aims to bridge community work and clinical practice, standardize clinical workflows, and ultimately improve experiences and outcomes for patients and families

PictureMindy Craig, PA-C, M.S.
Mindy Craig: My path to healthcare improvement is a little different than what you might expect.  I worked for Northwest Airlines as a flight attendant for several years straight out of college.  At that time the airline industry was losing a large amount of money and needed to find a new way of operating.  They decided to utilize a Total Quality Management approach and enlisted people from every department to undergo training in TQM and then facilitate small departmental groups in quality efforts.  It was through this process that I began to understand the importance of doing business with a quality framework.

PictureLearn more at coloradoabcd.org.
Eventually, I left Northwest and started working in a Neurology clinic while going back to school with the goal of becoming a PA.   After completing my degree I worked in primary care settings for about 10 years.  I participated in small clinic QI efforts over the years and continued to be interested in quality improvement.

I was hired by ABCD 8 years ago to bring a clinical perspective to their physician outreach.   It was a natural progression for me to start approaching our work at ABCD with a quality improvement framework.  The power of engaging front line staff to implement changes that result in improvement remains as strong as it was when I worked in the airline industry. 
 
NaRCAD: Talk with us about your academic detailing programming at ABCD—you’ve been doing this for about 10 years, right?

Mindy: We started our work  encouraging the use of standardized developmental screening tools in the primary care settings.  This was supported by the American Academy of Pediatrics policy statement in 2006 recommending the use of these tools at well child visits.  We offered informal outreach to physicians providing instructions on screening tools, billing information, AAP recommendations and information on referral resources.
​
We quickly recognized that screening alone wasn’t sufficient and began talking about the referral process and how to ensure successful referrals were being made.  At around this time, research was showing us that only about 50% of children referred for Early Intervention services were actually connecting to that referral.  It was easy to identify children with concerns but not as easy to ensure they received needed support.
​
We decided to try formalizing our approach to outreach by offering Continuing Medical Education [CME] credits.  While we didn’t change content, offering CME changed the way providers saw us as detailers.  We appreciated the new credibility, but still struggled with recruiting new practices.

NaRCAD:  Recruiting practices to participate is a challenge for many programs. How did this struggle transform into quality improvement?

Mindy: The progression to QI really came out of a need to reach more physicians.  We hypothesized that offering Maintenance of Certification Part 4 credit would be a substantial motivator for physician participation.  This turned out to be true and it additionally gave us the opportunity to develop stronger relationships with the physicians who participate.  Doing our outreach under the MOC Part 4 umbrella has been very successful for ABCD.


​"We're very passionate about making sure the connection with community and health care occurs."

We now offer Quality Improvement [QI] and MOC projects for implementing developmental screening, autism screening and postpartum depression screening in addition to a project that aims to increase the percentage of children who successfully connect with Early Intervention when referred from their primary care provider.  We have been thrilled with the response from physicians for participating in these projects and just received funding to continue and grow our outreach efforts. 

NaRCAD: What have been some other challenges you’ve faced when going in to talk to clinicians about implementing developmental screening?

Mindy:  I started working at ABCD unsure of how to provide physician outreach, so I naturally modeled my efforts on the one successful approach I knew very well, which was pharmaceutical sales.  As the recipient of pharmaceutical detailing, it was pretty easy to begin my outreach efforts in a similar fashion.  I quickly learned how it feels to be a detailer.  Front office staff rejected me repeatedly, I made hundreds of phone calls that didn’t get returned, and when I did get to speak to a provider I had to speak quickly and to the point to keep their attention.  The challenge of gaining access was the biggest barrier I confronted early on and remains at the top of the list.


"Providers are overwhelmed [...] and adding anything new to their plate can be daunting."​

Another huge challenge has been the convincing providers that this new screening recommendation is important enough to add to the list of the many other screenings they do every day.  Providers are overwhelmed right now and adding anything new to their plate can be daunting. ​
PictureA key challenge: gaining access to clinicians.
​NaRCAD: When dealing with those challenges, what’s helped you to build relationships with clinicians in order to gain commitment?

Meagan: To deal with the challenges that arise, we have found that it helps to get creative in our approach to gain access to clinicians and add credibility to our messages. A barrier we have encountered when trying to schedule times to meet with clinicians is the expectation that we will provide food. Our funders and budgets do not allow us to pay for food, so we have opted to provide other incentives for clinicians, such as CME or MOC credit. Not only is offering CME/MOC credits an educational incentive for providers, but it lends credibility to our messages. We facilitate our QI projects through multiple meetings at the practice and have found that, by developing relationships and a presence in the office, we can overcome clinicians’ resistance to implementing screening or other changes in their practice. 

Building rapport and credibility with clinicians is crucial to gaining commitment to change, and as emphasized through the academic detailing approach, making multiple in-person visits really enables this by allowing us to learn about and be responsive to the practice’s unique strengths and needs.


​"Building rapport and credibility with clinicians is crucial to gaining commitment to change."

PictureResource and best practices exchange at #NaRCAD2015
NaRCAD: We were happy to see you at our 3rd International Conference on Academic Detailing here in Boston a few months ago. Tell us more about how the conference helped you think about your work in a different way.

Mindy:
  We were thrilled to be able to attend the conference and came away very energized.  We highly recommend the conference to anyone doing similar work.  Some of our key “take-aways” were around the fundamentals of academic detailing, including the need for profession materials and repeated visits to develop relationships.  We came home committed to find money for developing professional materials and to attend the two-day intensive training offered by NaRCAD.





​"We were thrilled to be able to attend the [NaRCAD] conference and came away very energized." 

One thing that I came away from the conference thinking about was how the work we are doing fits into the new landscape of practice facilitation around payment reform.  There are many efforts in our state looking at models of payment reform that intersect with the work we are doing at ABCD.   Some of the measures that practices are asked to provide data on will be around developmental and mental health screening.  There is clearly a need to provide practice facilitation on meeting these and other measures as practices try to navigate the transition to new payment models.
However, I’ve struggled with our role as a non-profit in meeting these needs.  Up to this point, ABCD has utilized a very hands-on approach.  We plan meetings, take notes, write up PDSA cycles, make “To Do” lists – anything we can do to make the process easy for the practice and allow the providers to concentrate on patient care.  A true practice facilitation model is more concerned with increasing the capacity of the practice to continue quality improvement work after the facilitation had ended. The goal isn’t to do all the work, but to help the practice find capacity to do it themselves.  ​​
NaRCAD:  What other advice would give to a new and emerging AD program that’s just getting started, or that you’d give yourself if you could go back in time 10 years?

Meagan: We have found NaRCAD’s training and tips to be very helpful, so we would recommend that new clinical educators attend a NaRCAD techniques training to hone their skills in communicating their messages with clinicians and gaining commitment to behavior change. One of our main takeaways from the NaRCAD conference was the importance of high-quality, professional materials, so we would recommend that new programs budget for the development of professional materials as well as food, which can be an incentive when setting up meetings with clinicians.

Over the years, we’ve realized how critical it is to work with community partners before going into healthcare practices to ensure that clinical workflows, such as processes for making referrals to external agencies, are aligned with community-defined processes and so that clinicians are aware of the resources available to patients and families in their communities.

NaRCAD: Thanks so much for sharing important insights from your program to improve childhood health outcomes. We look forward to seeing you at a future training and hearing more about your program's future successes!

Biographies

Mindy Craig, PA-C, M.S., Director of Physician Outreach, has been with the ABCD team for 8 years and brings with her experience in the clinical setting.  She earned her physician assistant degree at the University of Colorado Health Science Center’s Child Health Associate/Physician Assistant program in May 2000.  Concurrently, she completed additional course work and research to earn her Master of Science degree in Pediatrics.  Ms. Craig worked as a physician assistant in a number of settings for ten years prior to joining the ABCD team.  Her medical career has included a variety of medical office positions from medical records clerk to practice manager.  This range of experience positions her to fully understand the unique dynamics and flow in a typical office, which allows her to deliver technical assistance to practices at a meaningful level.
 
Ms. Craig’s quality improvement experience began in the business sector where she was extensively trained on Total Quality Management (TQM) at Northwest Airlines.  She worked at the airline as a facilitator, training inflight and ground personnel in the principles of quality improvement.  This experience with quality continued in the clinical setting, as she has participated in and/or chaired a number of quality improvement projects over her career as a physician assistant. In addition to her work at ABCD, Ms. Craig also does consulting work for organizations needing assistance with physician outreach and education. 

Meagan Shallcross, MPH, Healthy Steps/Physician Outreach Coordinator, joined the ABCD team in June 2015 as the Healthy Steps and Physician Outreach Coordinator. Meagan is passionate about building systems and environments that support children’s healthy development through clinical-community partnerships and integrated care delivery approaches. Meagan earned a Master of Public Health degree at the University of Michigan, where she supported Patient and Family Centered Care projects at the university health system and was involved with community-based participatory research addressing health equity, as well as research focused on provider-patient communication. 

Learn more at www.coloradoabcd.org. All photos used with permission. 
1 Comment

    Highlighting Best Practices

    We highlight what's working in clinical education through interviews, features, event recaps, and guest blogs, offering clinical educators the chance to share successes and lessons learned from around the country & beyond.

    Search Archives
    by Topic:

    All
    21st Century Cures Act
    5 Year Anniversary
    80% By 2018 Campaign
    Academic Detailing
    Addiction
    ADHD
    Affordable Care Act
    AHRQ
    AIDS
    Alaska
    Alosa Health
    Alternative Facts
    American Academy Of Pediatrics
    American Cancer Society
    Annual Community Survey
    Antibiotics
    Apply To Present
    Aspirin
    Atrius
    Autism
    Autism Screening
    Behavior Change
    Best Practices
    Big Data
    Blood Pressure
    Boston
    Breast Cancer
    California
    Cancer Roundtable
    Cancer Screening
    Cardiology
    Cardiovascular Health
    Care Delivery
    CDC
    Centers For Disease Control
    Cholesterol
    Chronic Disease
    Chronic Illness
    Clinical Education
    Clinical Outreach Education
    Clinical Pharmacists
    Clinical Pharmacy
    Clinician
    Clinician Education
    Clinicians
    CME
    Coaching
    Collaboration
    Colorado
    Colorado ABCD
    Colorado Department Of Public Health And Environment
    Colorectal Cancer
    Communications Skills
    Community-based
    Compliance
    Conference
    Conference Series
    Connecticut
    Consultation
    COPD
    COrE Series
    Cost Savings
    Cultural Competency
    CVS Health
    Data
    Decision Making
    Denver
    Department Of Health
    Dependence
    Depression
    Detailing Aid
    Developmental Delays
    Diabetes
    Director's Letter
    Drug Approval
    Drug Costs
    Drug Regulation
    Drugs
    Drug Safety
    Early Childhood Development
    Education
    Educational Materials
    Efficacy
    Engagement
    Evaluating Evidence
    Evaluation
    Event
    Events
    Evidence
    Evidence-based
    Evidence Based Medicine
    Evidence-based Medicine
    Expert Insight Series
    Expert Panels
    Fall 2016 Training
    Fall 2017 Training
    FDA
    Florida
    Former Trainee
    Formularies
    Gaining Access
    Gatekeeper
    Geronotology
    Getting To Zero
    Guest Blog
    Healthcare
    Healthcare Improvement
    Healthcare Reform
    Health Care System
    Healthcare Transformation
    Health System
    Health Systems
    HealthTeamWorks
    Heart Disease
    Heart Failure
    HEDIS
    HepC
    HIV
    HPV
    Hypertension
    Idaho
    IDIS
    Incontinence
    Interactivity
    Interdisciplinary
    Interview
    Jerry Avorn
    Kaiser Permanente
    Kentucky
    Key Messages
    Keynote Speakers
    Kidney Disease
    LaNet
    LA Net
    Las Vegas
    Learning Center
    Letter
    Lifestyle Management
    Local Response
    Long-term Care
    Los Angeles
    Lung Disease
    Mammography
    Manchester
    Massachusetts
    Massachusetts Department Of Health
    MAT
    Materials Development
    Medical Centers
    Medication
    Medication Assisted Treatment
    Medicine
    Mental Health
    Messaging
    Michigan
    Mississippi
    Morphine Milligram Equivalents
    NACCHO
    Naloxone
    #NaRCAD2014
    #NaRCAD2015
    #NaRCAD2016
    #NaRCAD2017
    #NaRCAD2018
    National AD Service
    Needs Assessment
    Networking
    Nevada
    New Hampshire
    New Mexico
    New York
    North Carolina
    NYDOHMH
    Obesity
    Ohio
    Oklahoma
    On The Road
    Opioid
    Opioid Crisis
    Opioids
    Opioid Use Disorder
    Oregon
    Outreach
    Outreach Education
    Overdose
    Overdose Prevention
    Overprescribing
    Pain Medication
    Partner Network
    Patient Care
    Patients
    PCORI
    PDMP
    PDSA Cycle
    Pediatrics
    Pediatric Screening
    Pennsylvania
    Pertussis
    Pharma
    Pharmaceutial
    Pharmaceutical
    Pharmaceuticals
    Pharmacology
    Pharmacotherapy
    Pharmacy
    Pharmageddon
    Pilot Project
    Policy
    Polypharmacy
    Practice-centered
    Practice Facilitation
    Pregnancy
    Pregnancy-related Depression
    Prenatal Health
    PrEP
    Prescribers
    Prescribing
    Prescribing Guidelines
    Prescription Drug Management
    Prescriptions
    Prevention
    Primary Care
    Primary Care Burnout
    Prisoner Health
    Program Evaluation
    Program Management
    Project PrIDE
    Provider Education
    Providers
    PTSD
    Public Health
    Pulmonology
    Quality Improvement
    RAPID
    Readmission
    Referral
    Registration Open
    Research
    Research Study
    Resources
    Rhode Island
    Role Play
    Rural AD Programs
    Safe Prescribing Guidelines
    San Francisco
    San Francisco Department Of Public Health
    Save The Date
    Scaling Up
    Screening
    Serious Mental Illness
    Sexual Health
    SFDPH
    Smoking Cessation
    Social Marketing
    Social Marketing Skills
    Stakeholders
    Statins
    STDs
    Strategies
    Stroke
    Team Approach
    Technical Assistance
    Technology
    Tennessee
    Texas
    The New Yorker
    Tobacco Treatment
    Total Quality Management
    Training
    Training And Support
    Training Recap
    Training Series
    Transgender
    Transitional Care
    Treatment
    Trends
    VA
    Vaccination
    Vaccinations
    Vermont
    Veterans
    Veterans Affairs
    Veterans Health
    Virginia
    Washington D.C.
    Washington State
    West Virginia
    Workshop
    Zika Virus

    RSS Feed

Picture

​NaRCAD is a program of the Division of Pharmacoepidemiology & Pharmacoeconomics [DoPE], Department of Medicine at Brigham & Women's Hospital and Harvard Medical School, and is funded by  the Agency for Healthcare Research and Quality [AHRQ].

Proudly powered by Weebly