Eastern North Carolina Pediatric Seating and Equipment Clinic

by

Christine Lysaght, MPT, CSCS

 

 

Introduction

The purpose of my capstone is to provide children with disabilities (CWD) in Eastern North Carolina (ENC) improved access to specialized seating and equipment services.  I used this capstone as a means to expand my pediatric equipment knowledge and propose a pediatric seating and equipment clinic (PSEC) for ENC.  The need for a ENC PSEC is supported by a thorough literature review in addition to a local health care provider survey. (see products)   ENC encompasses a large geographic area and population without a regional PSEC. (Figure 1.)    Twenty-four ENC providers responded to a survey monkey digital survey ranking their confidence in pediatric seating and equipment assessment process in addition to their likelihood of referral to a ENC PSEC.   Of the 24 respondents, 86% were physical therapists or physical therapy assistants and 10% were assistive technology providers.  The survey indicated a positive response to a PSEC with 62% (15/24) in favor of referring patients to an ENC PSEC. Even though the majority of respondents were confident in their abilities, the results of the survey support the creation of a local PSEC. (see proposal link below for full details)

Figure 1. Map of ENC PSEC Geographic Service Area

Project Development

tDPT Coursework:

Throughout my tDPT education I  aligned many papers, discussion board posts and projects with my interest in children with disabilities.  For this project I incorporated epidemiology data for children with disabilities in ENC from my Health and Wellness course, research from assignments and posts from multiple courses (Child and Family Assessment, Neuromuscular Seminar, Patient Management and Education Seminar), and evidence from my CAT in Evidence Based Practice II supporting the importance of  assessment from a specialized professionals.

Additional Education:

I sought multiple avenues to expand my knowledge of pediatric equipment and equipment evaluation/intervention delivered by a specialized seating clinic.  I attended three different continuing education opportunities, connected with experts in the AT field and spent a day in a successful pediatric seating clinic.

In-person continuing education opportunities included an 8-hour Manual Wheelchair Course, offered by Sunrise Medical, 4-hour Pediatric Power Mobility Course offered by Permobil, and attendance at the 3-day International Seating Symposium in Nashville, TN.

I also spent time with multiple area Assistive Technology Professionals (ATPs) as well as experts in seating and mobility.  I met with Barbara Crume PT, ATP at ISS to discuss reimbursement and financial issues related to seating clinics. I traveled to Norfolk, VA to observe Beth Beach, OTR/ATP manager of The King’s Daughters’ Pediatric Seating and Equipment Clinic to learn the procedures and set-up of a successful seating clinic.

Products

I developed a survey that was sent to area OTs, PTs, ATPs, vendors, Physicians and blasted via NCPTA to the Coastal Pines District. The results of this survey, additional research and evidence table were used to develop a detailed proposal to support an ECU sponsored ENC PSEC. I also created a patient brochure  describing the ENC PSEC.  The brochure incorporated health literacy principles.

Evaluation, Feedback and Reflection

PSEC Evaluation: Once established patient satisfaction and equipment outcomes will be collected. (see proposal for specific measures.)

Feedback: The results of the survey represented a positive likelihood of referral and need for an ENC PSEC. (See proposal for survey results) I elicited feedback add different points along the project process from Amy Gross-McMiillan PhD, PT, Stacey Meardon, PhD, PT, families of CWD, Lisa Cox PT, ATP, and Karen McCulloch PhD, PT.

Karen McCulloch was instrumental in helping me narrow the focus of my project towards a proposal and family brochure. Families of my current and past patients provided images of their children in equipment advised me to add time lines to the brochure. Amy Gross McMillan, Stacey Meardon, Lisa Cox and Kirstin Tart reviewed my written products and provided additional constructive advice on layout, optimal wording and organization.

Reflection:

Throughout this project I gained significant experience, knowledge and professional growth. I am more confident with professional networking and communication with colleagues, executives, vendors, and administrators. I also learned that getting reimbursement answers from Medicaid and Medicare is difficult at best and sometimes even contradictory! I expanded my equipment knowledge, confidence in writing letters of medical necessity, proposal skills, and understanding of best practices in equipment evaluations/documentation. I experienced difficulties using Word to design brochure  and will use Publisher instead in the future. If I were to create a repeat survey  I would gather additional information from respondents such as; years of pediatric experience, amount of AT training and frequency of power mobility recommendations.  Lastly, although I am an independent learner, in the future I would reach out sooner for feedback and guidance to avoid spending excessive time on additional research and analysis.

 

Future Plans

This project is only the staring point! The next steps are to present this proposal to ECU Department Chair, update the ECU Electronic Health Record templates, complete my credentialing with ECU physicians group practice to bill for services, apply for ATP certification, sit for ATP exam Fall 2015, and meet with local physicians and local therapist to explain the role and mission of the ECU sponsored ENC PSEC. I also hope to implement a interdisciplinary AT seminar course for ECU DPT students.

References

See Proposal and Evidence table for complete list of references.

Acknowledgments:

This project would not have been possible without the generous support and encouragement from Dr. Amy Gross-McMillan. I am blessed to have her as a mentor and colleague. I also want to thank my UNC advisor Dr. Karen McCulloch for her knowledge and expertise throughout this project and tDPT program. She is a role model for neuro PTs and an amazing student advocate at UNC. Thank you also to my other supporters, Dr. Stacey Meardon, Lisa Cox, Barbara Crume, Beth Beach and local ATPs Doug Walter (with Carolina Home Medical) and Drew Robinson (with NuMotion). Lastly, to my husband Mike and children, Jake, Kate, Jon and Drew; thank you for sacrificing family time to allow me to achieve this degree. You are my inspiration and joy!