August 31, 2020

Expecting mothers will soon receive even higher quality service when they visit The Center for Children and Women.

In response to patient feedback, the obstetrics services at both the Greenspoint and Southwest locations will treat patients with a new personal care team model. This will prevent families from seeing up to 10 different providers and instead offer them their own team of no more than four providers.

“We are excited about this change, especially because it has been made in direct response to one of our most common patient complaints,” said Dr. Faunda Armstrong, assistant medical director for The Center at Greenspoint. “The smaller team model will allow providers to develop a patient plan together, build a closer relationship with families and increase trust at every appointment.”

To ensure that this change – set for mid-September – achieves the intended results, The Center will continue to use the patient satisfaction firm, Press Ganey. The firm’s annual survey results will show the effects of the change.

Additional recent changes include an increased use of telemedicine appointments to keep patients and families safe amid COVID-19 concerns. For more information about The Center for Children and Women visit https://www.jointhecenter.org/.

August 24, 2020

It’s Cultural Competency Week at Texas Children’s Health Plan – a celebration of the cultural differences that exists among the organization’s more than 900 employees, 11,000 providers and 480,000 members.

In celebration, employees will participate in team discussions, have a chance to win prizes by answering a question of the day and learn more about the 15 national cultural competency standards through a state-mandated training course. The course – available until September 30 – is focused on understanding the diversity that exists in people of different races, languages, genders, socioeconomic statuses and beliefs.

“There is no time like the present to pause and celebrate diversity,” said Johnna Carlson, director of Government Programs. “The Health Plan is so excited to be a leader in this conversation. Our entire mission is to serve those who need us – regardless of who they are, what they look like, or what language they speak. This week is simply a highlight on the way we do our jobs each day.”

Although there are 15 national standards around cultural competency, these are rooted in one principal standard, which is to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

This is the standard of highest priority that employees are expected to uphold.

“For me, coming to a country that is so diverse, certainly took me out of my comfort zone and has been such a positive experience,” said Donna Jackson, senior administrative assistant. “To learn and participate in a new cultural experience has made me more open minded and accepting. In general, this makes The Health Plan a more pleasurable work environment.”

Jackson adds that understanding one another’s differences breaks down barriers and makes people feel heard and therefore valued. “As we learn more and become advocates for each other, our children also get to reap the benefits. I truly believe that history will show Texas Children’s will be a better organization because of our focus on cultural competency.”

Watch Connect in the coming weeks to learn more about the national standards. All Health Plan employees are required to take the Cultural Competency training course in HealthStream by Wednesday, September 30.

 

August 10, 2020

One in four youth in the U.S. have a diagnosable mental health disorder that often is a direct response to what is happening in their lives. The COVID-19 pandemic, along with many other societal factors, have affected all of us, but for children who already suffer from anxiety or depression, the emotional impact can be severely magnified.

Many pediatricians are seeing more children and adolescents with mental health problems, and they are playing an increasingly significant role in the diagnosis and treatment of mental illness in young people. While numerous surveys of pediatricians indicate they feel they lack the necessary training and skill to manage their patients’ mild to moderate mental health care disorders, a new program at Texas Children’s is providing the support they need.

On May 18, Texas launched the Child Psychiatry Access Network (CPAN), a new statewide pediatric mental health initiative that Texas Children’s and Baylor College of Medicine are partnering on for our region. This state-funded program provides pediatricians, family physicians and other health care providers direct and immediate access to a pediatric mental health specialist to help them manage their patients’ mental health care needs more effectively.

“We want our pediatricians to feel more comfortable managing the mental health care needs of their patients,” said Jennifer Evans, assistant director of the Meyer Center for Developmental Pediatrics and the Psychiatry Service at Texas Children’s and associate program director for the Central Operational Support Hub (COSH) for the Texas Child Mental Health Care Consortium that oversees the state implementation of CPAN. “Pediatricians at our TCPs and The Centers for Children and Women can collaborate directly with our CPAN team about their patient’s plan of care instead of having to refer their patient to our child psychiatry clinic where they would be placed on a lengthy waitlist.”

When a pediatrician calls the CPAN hotline (1-888-901-CPAN Monday – Friday from 8-5 excluding holidays) to reach the Baylor hub, a Texas Children’s behavioral specialist, licensed counselor or licensed clinical social worker will answer the phone. Depending on the patient’s needs, they will connect the pediatrician to a Texas Children’s psychiatrist who can provide real time consultation on various mental health issues. For instance, if there is a question about a patient’s medication, they can advise whether to adjust the medication dosage. The CPAN team can also help pediatricians develop a behavioral or safety plan for patients with depression or suicidal tendencies, and other mental health disorders. Pediatricians can also call the CPAN hotline to access educational resource materials on mental health.

“Through CPAN, our pediatricians are given the knowledge, skill, training, and support they need to address and treat mild to moderate mental illness,” said Dr. Laurel Williams, medical director for COSH and Division Head of the Child and Adolescent Psychiatry Division at the Menninger Department of Psychiatry. “If we can collaborate more directly with our PCPs, our psychiatry team will have greater access for youth and families that need more regular, intensive specialty care.”

Baylor College of Medicine is one of 11 centers participating in the CPAN initiative. Each Department of Psychiatry across the state of Texas has a region that they are responsible for supporting. Baylor and Texas Children’s are providing support to the seven counties in the Greater Houston area. However, there are times when our CPAN team has provided mental health consultation and training to pediatricians in other parts of the state including El Paso.

Extending our reach in the community

Along with the CPAN initiative, Texas Children’s psychiatrists also provide mental health care support to patients and children in the community in other ways. Through a 4-year grant from the Substance Abuse and Mental Health Services (SAMHSA), our teams at Texas Children’s and Health and Human Services are able to provide more comprehensive evidence informed treatments for youth with serious mental health disorders (SMD) like bipolar and psychosis. The grant provides assistance in building infrastructure that can be maintained beyond the life of the grant through cultivating collaborations and coalitions across important teams that assist children with SMD.

“We transfer 6 to 7 kids per week to inpatient units and these are mainly bipolar patients who are having a really hard time,” Evans said. “SAMHSA has changed the dynamic of care for these patients. Instead of sending them to the hospital, we can have intensive services in the home. It’s like an intensive outpatient service in your home.”

As part of the Texas Child Health Access Through Telemedicine (TCHATT) program, our psychiatric team is also collaborating with various independent school districts – Houston, Spring, Conroe, Pasadena, Center for Success Charter School and Sheldon – to provide in-school behavioral telemedicine care to at-risk children and adolescents that include free comprehensive assessments and up to four clinical sessions either with a physician or a therapist.

“Through our CPAN, TCHATT and SAMHSA partnerships, our psychiatry section will be able to grow by three physicians and over 10 licensed therapists allowing our team to provide these new services without taking away from our current services,” Williams said. “In collaboration with Dr. Kirti Saxena, our interim chief of psychiatry at Texas Children’s, we have six physicians, along with our child psychiatry fellows, social work interns and trainees who will spend a portion of their time working on these programs to ensure every child gets the care they need.”

August 3, 2020

Aimee Martin’s two-year-old daughter Hope is extremely social. She chats up anyone she sees whether they are a stranger or a friend, and she does so at close range. Telling her to keep her distance to protect herself and others from COVID-19 is something she has a hard time comprehending to say the least.

So, when a routine trip to the ophthalmologist popped up on Amiee’s calendar, she cringed because she knew Hope’s eyes would need to be dilated and that they would have to spend at least 30 minutes in the waiting room of Texas Children’s Ophthalmology Clinic.

“Sitting in the waiting room with Hope during a pandemic or not is a train wreck,” Amiee said. “She wants to hug and talk to everyone she sees.”

To help prevent situations such as these and ease people’s anxiety about coming to the hospital during a challenging time, a handful of departments, including Ophthalmology, are offering some of their services via Patient Express, a drive-thru service at Texas Children’s Hospital’s Medical Center Campus.

Set up near the ambulance bay at Wallace Tower, patients call about five minutes before arriving for their appointment, pull up and are seen by a clinician. To ensure everyone’s safety, all patients and family members are asked a series of COVID-19 screening questions, their temperatures are taken and they are required to wear a Texas Children’s-issued mask. Texas Children’s employees participating in Patient Express are required to wear personal protective equipment including a mask, gown, gloves and facial shield.

“It’s great to be part of a project that is good for everyone,” said Ophthalmology Clinic Supervisor Veronica Gonzalez. “I feel like we are taking an extra step to make everyone feel safe – staff, patients and family members.”

Gonzalez’s team is using Patient Express to treat otherwise healthy patients who need to come in for a routine eye exam that requires dilation. Before going into the clinic for their exam, patients get their eyes dilated car side at Patient Express. By the time they park and make their way up to the clinic, it’s about time for their appointment.

Most patients are in and out of the clinic in 30 minutes. Prior to using Patient Express, they would spend an hour to an hour and a half in the facility, half of which was spent in the waiting room during the dilation process.

“Patient Express is a much better alternative,” Martin said. “I appreciate Texas Children’s coming up with the idea and for making our safety and health a priority during such challenging times.”

The drive-through or car side concept began in May when Texas Children’s Pavilion for Women opened a drive-through prenatal clinic at our Medical Center Campus to reduce the anxiety of expectant moms and to lower their risk of COVID-19 exposure and infection.

The clinic, which was recently phased out due to an increase in telemedicine and in-person visits, allowed pregnant women who do not need to be seen in the clinic to remain in their vehicles while being assessed by a health care professional. The drive-through visits included key elements of a prenatal exam such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction.

In June, Texas Children’s Dermatology started offering drive-through service via Patient Express to patients who need basic dermatological treatments for conditions such as warts and/or molluscum. The service is being offered every two weeks and has been very successful with both patients and clinicians.

Ophthalmology offers dilating services via Patient Express daily. Pulmonology offers services every other week through Patient Express to cystic fibrosis patients who are undergoing eradication treatment for two types of bacteria they are susceptible to getting and possibly having complications from.

“There is no need to bring them on site and expose them if we don’t have to,” said Caroline Hanson, who manages the outpatient nursing team for Pulmonology. “Our parents have been very appreciative of our efforts to best care for them and their children.”

To help create a fun environment at Patient Express, Hanson said she plays kid-friendly music when appropriate and hands out stickers any time she can. She said her staff forms a special bond with their patients since they tend to come in frequently and that being able to serve them in this way has been very fulfilling.

Valdemar Garza, practice administrator for Ophthalmology, said he has been impressed with the success of the drive-through service and with the collaboration between several teams to make it happen.

“We received a lot of help from Pulmonology, Dermatology and Women’s Services to come up with our Patient Express plan,” Garza said. “I’m grateful to work for an organization that values such creativity and innovation. It goes a long way in forwarding patient care.”

Click here to watch a video of Patient Express when it began with Dermatology.

This week on Mark Wallace’s blog, he reflects on the many accomplishments of Texas Children’s Pediatrics in celebration of the group’s 25th anniversary. Read more

Twenty-five years ago, Texas Children’s launched what is now the largest pediatric network in the nation with more than 250 board-certified pediatricians and more than 60 practices throughout the greater Houston area, College Station and in Austin. The group cares for over 400,000 patients and completes more than a million visits each year.

The physician network was formed in 1995 under the guidance of Dr. Ralph Feigin with the acquisition of the Ashford practice in west Houston owned and operated by four brothers – Drs. Paul, Morris, Ben and Harry Rosenthal. Because of its success, more and more pediatricians joined the group, making it what it is today.

In addition to its ever-growing primary care network, Texas Children’s Pediatrics operates 11 urgent care centers in the greater Houston area and one in Austin. The group also includes the Community Cares Program that provides trusted, high-quality pediatric medical services at designated locations to children who otherwise would seek care from emergency rooms or possibly go without care or treatment due to low family incomes and/or lack of health insurance.

Texas Children’s Pediatrics has consistently adapted to the needs of patients and their families while continuing to provide high-quality care. In celebration of the group’s 25 years of service, Texas Children’s Pediatrics President Kay Tittle answered a few questions about the group’s beginnings, present challenges amid the pandemic and future success.

Why, 25 years ago, did Texas Children’s start offering primary care services to patients and families across the greater Houston area and beyond?

Texas Children’s Pediatrics was part of Texas Children’s President and CEO Mark Wallace’s vision of what Texas Children’s needed to thrive in the changing environment in the 1990s. Many community pediatricians had reached out to Texas Children’s to ask for help as they were struggling to manage the increased complexities of running a practice. Managed care in particular was a large challenge for the practices as they worked to understand the changes in insurance coverage.

How did the group grow and become such a success?

Our focus has always been to provide the support needed to help physicians, advanced practice providers and staff provide the highest quality of care possible. We do this by providing physicians with administrative, financial and management expertise. Our reputation for providing such support helped us grow 25 years ago and continues to help us flourish today.

What are some of the things Texas Children’s Pediatrics has had to do over the years to maintain quality of care while also meeting the ever-growing and changing demands of patients and families?

In 2011, we made the decision to pursue National Committee for Quality Assurance (NCQA) recognition as a patient-centered medical home. This program focuses on how practices use data to improve the care they provide. The program provided the structure to help us maintain our focus on quality care and patient needs. We have been recognized every three years since as a Level III patient-centered medical home by NCQA, which is the highest recognition the organization gives out.

How has the COVID-19 pandemic changed the way Texas Children’s Pediatrics and Texas Children’s Urgent Care delivers care?

The pandemic has changed many things in our organization. Our focus has been to provide safe care and a safe environment for our patients as well as our staff while meeting the changing needs of our patients and families. We have received a positive response to changes such as Precheck-in using MyChart, waiting in one’s vehicle instead of our waiting rooms, being taken to an exam room as quickly as possible after arriving, scheduling well visits in the morning and sick visits in the afternoon, and car side immunizations. We were also able to quickly incorporate a telemedicine program with support from across the system. More than 20 percent of our encounters are now completed via telemedicine, which has helped meet the needs of patients and families in so many ways. The comments on our Press Ganey surveys are good reminders of the challenges our families are facing, and what we as an organization need to focus on to help them receive the right care, at the right time and at the right place.

What are some of the things the group will need to do in the future to remain successful?

We will need to continue to adapt to the needs of our patients and families as well as to the health care industry as a whole. We want to continue to lead the change and innovation necessary to grow and provide the highest quality of care no matter the circumstances.

In looking back and ahead, what are some of your most memorable moments as president?

Our team has created many great memories over the past 25 years. I think the move to an electronic medical record was notable and most exciting when paper charts were no longer needed. It has also been great fun to grow in Austin and College Station over the past few years. They are both exciting areas. As we look ahead, I look forward to making more great memories with the team.

July 28, 2020

When Nurmeen Khokhr called her pediatrician’s office to schedule a time to come in and get the vaccinations she needed before going off to college in the fall, she was pleased to hear she didn’t have to step out of her car.

A new program called Car Side Care is being piloted at Texas Children’s Pediatrics Cypresswood in Spring and allows patients nine and older to receive vaccinations from the comfort and safety of their vehicles. All patients have to do is make an appointment, answer a few screening questions, get their temperature taken and roll up their sleeves.

“We are providing the same high-quality care in parking spaces outside our practices as we provide inside our buildings,” said Assistant Vice President Sara Montenegro. “In doing so, we are helping reduce patients’ and staff members’ potential exposure to COVID-19.”

The idea for Car Side Care followed a national drop in the number of patients coming in to get their routine vaccinations. When asked, many patients and/or their family members sited fear of being exposed to the virus as their reason for delaying their shots.

Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics, said he doesn’t blame people for being cautious, but emphasized the importance of routine childhood vaccines does not lessen during a pandemic. In fact, Spinner said, children should be getting them now more than ever with back to school and flu season right around the corner.

“Vaccines are arguably the most effective public health measure we have next to clean water,” Spinner said. “They are that important, and with the pandemic, they are even more so. I would hate to see a child sick with both COVID-19 and something else like the flu.”

In addition to routine vaccinations, getting kids inoculated against the flu is one of the main drivers behind Car Side Care. Prior to the pandemic, patients needing a flu vaccine often would call their pediatrician’s office, make a nurse’s appointment, and drop by and get their vaccine. That won’t work today with COVID-19 when so many extra precautions are necessary to limit exposure.

“Our offices are very cautious about safety precautions, and with that, needed creative solutions to see hundreds of children for flu vaccine and childhood immunizations quickly, without needing to come in our facilities,” Montenegro said. “Care Side Care is a perfect way to handle this and to hopefully remain on top of the upcoming flu season by vaccinating as many children as possible.”

Car Side Care was launched as a pilot at Texas Children’s Pediatrics Cypresswood and has grown across more than 15 Texas Children’s Pediatrics sites, as we work closely with our landlords to allocate parking spaces to support this program.

Each location will designate four parking spots a couple of times a week to patients wanting to come by and get their vaccines. An appointment will be necessary as well as a COVID-19 screening. Patients and anyone else in the vehicle will be required to wear a mask. Clinicians will wear a mask, goggles and a protective gown. The program has also been expanded from caring for older children to caring fo children of any age over the past two months.

“Texas Children’s Pediatrics has done a very good job at continually finding ways to provide the care our kids need in the safest possible environment,” Spinner said. “Our families seem very happy with the modifications we’ve made thus far and they seem pleased with our commitment to maintain the quality of care we’ve always provided.”

Khokhr said she was very pleased with her Car Side Care experience. It was convenient and gave her the sense of safety she needed to get the shots required by her school.

“I’m glad Texas Children’s Pediatrics is doing this,” she said. “I think it will help ease the nerves of a lot of patients who want to come in and get their vaccines.”