Life Care Plan. Kobe Williams. Projected Evaluations. Per Unit. Per Year

Transcription

1 Projected Evaluations Rehabilitation Long-Term Needs Assessment 4 8/16/ X Only Assess Handicapping Conditions 1 X Already accomplished as of 4/19/01 evaluation; reevaluations recommended at ages 16 and 21. Re-evals at a cost of $4,000 - $6,000 excluding travel. Act.) A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized, concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health care needs. IALCP - International Academy of ners.) Through the development of a comprehensive, a clear, concise, and sensible presentation of the complex requirements of the patient are identified as a means of documenting current and future medical needs for individuals who have experienced catastrophic injury or have chronic health care needs. The goals of a comprehensive are to: improve and maintain the clinical state of the patient; prevent secondary complications; provide the clinical and physical environment for optimal recovery; provide support for the family; and to provide a disability management program aimed at preventing unnecessary complications and minimizing the long-term care needs of the patient. 1 Evaluation by Developmental / Behavioral Psychologist X now, with repeat evaluations at ages 6, 8, 10, 12, 14, 16, 18 and 21. Evaluate and formulate treatment plan. $250 - $500 Act.) As indicated in the diagnostic clinical practice guidelines, other conditions commonly accompany ADHD in children. Clinicians such as developmental-behavioral pediatricians, child psychiatrists, psychologists or other mental health clinicians should be involved in treatment. Source: Clinical practice guideline: treatment of school-aged child with attention-deficit/hyperactivity disorder. American Academy of Pediatrics. Pediatrics 2001 Oct; 108(4): Table 2 Copyright page 1

2 Projected Evaluations Item / Service Age Year Replacement Speech Therapy 1 X / Year Formulate and monitor speech therapy program $155 Children with ADHD are more likely than non-disordered children to evidence difficulties in speech and language development, particularly difficulties with expressive language. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. $155 3 Vocational Evaluation X at age 16 to begin process and again at age 18 for vocational transition from school setting. Assess vocational potential and assist with program planning. $300 - $600 at age 16; then $900 - $1,200 at age 18. Paul M. Deutsch, Ph.D., CRC, CCM, CLCP based on a review of available medical information and client interview 4 Transitioning to adulthood should emphasize vocational evaluation, counseling and training as well as time management skills, organization and study skills. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. Table 2 Copyright page 2

3 Projected Therapeutic Modalities Behavioral Modification Program See Below Implement behavioral program in home and school. $125 $9,750 for initial 78 hours; $750 for 6 sessions of monitoring; thereafter $750 - $1,250 / year to age 25. Act.) NOTE: Intensive training will be needed in the beginning to teach parents, caregivers, teachers, and therapists. This schedule is an estimate, pending an actual evaluation and program design. 5 X / week for 2 weeks (40 hours); reduced to 3 X / week for 10 weeks (30 hours); then 1 X / week for 8 weeks (8 hours) for a total of 78 hours initially. Once the program is in place and the parents and teachers are trained, monitoring will be needed 1 X / month for 6 months. Followed by 6-10 sessions / year to implement changes in the program and train his family and new teachers. One of the most useful strategies a parent can undertake to improve harmony in the home is to learn ways to modify the child's behavior in a manner consistent with school focused behavior modification. This training can be obtained through formal classes, books or counseling. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. Social skills training (group or individual) instructs children in the execution of specific prosocial behaviors. Children with ADHD often show deficient use of functional, pragmatic language in social situations. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. 5 Group Counseling 2 X / month 8 months / year through developmental years Learn socialization skills within a group setting $125 $2000 Act.) ADHD Support Groups help parents learn more about ADHD through lectures or reading material and can help parents cope emotionally by communicating with other parents of ADHD children in a supportive setting. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. Social skills training (group or individual) instructs children in the execution of specific prosocial behaviors. Children with ADHD often show deficient use of functional, pragmatic language in social situations. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. 6 Table 2 Copyright page 3

4 Projected Therapeutic Modalities Parenting Classes 1 X / week for 3 months now; then 2 X / month for 3 months at ages 6, 8, 10, 12, 14, 16 and 18 Teach parents parenting methods for children with ADHD $125 $1,625 for 13 sessions now; then $750 for 6 sessions at ages 6, 8, 10, 12, 14, 16 and 18. Act.) One of the most useful strategies a parent can undertake to improve harmony in the home is to learn ways to modify the child's behavior in a manner consistent with school focused behavior modification. This training can be obtained through formal classes, books or counseling. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. Family Counseling 1 X / week for 3 months now; then 2 X / month for 3 months at ages 6, 8, 10, 12, 14, 16 and 18 Provide outlet to vent frustration and stress associated with raising a child with ADHD. $125 $1,625 for 13 sessions now; then $750 for 6 sessions at ages 6, 8, 10, 12, 14, 16 and 18. Act.) One of the most useful strategies a parent can undertake to improve harmony in the home is to learn ways to modify the child's behavior in a manner consistent with school focused behavior modification. This training can be obtained through formal classes, books or counseling. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. 7 8 Table 2 Copyright page 4

5 Projected Therapeutic Modalities Item / Service Age Year Replacement Speech Therapy 1 X / week for 48 To address speech, weeks per year. language and learning $162 deficits Children with ADHD are more likely than non-disordered children to evidence difficulties in speech and language development, particularly difficulties with expressive language. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. $ Career Guidance and Counseling X / week for 3 months. This will need to be repeated an estimated 3 X over the course of his work life to assist with job changes. Assist with vocational planning $ $3000 Career guidance to include: (A) career exploration; (B) career decision making; (C) matching of interests, job satisfiers, motivators, and abilities to available alternatives vocationally or avocationally; (D) goal setting; (E) job seeking skills training; (F) selective placement assistance Transitioning to adulthood should emphasize vocational evaluation, counseling and training as well as time management skills, organization and study skills. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. 10 Table 2 Copyright page 5

6 Diagnostic/Educational Testing Educational Testing (for use by supplemental therapists) 1 X / Year To assist supplemental therapist in coordinating with school program $250 - $300 $250 - $ Option #1 Special Education Program through the Public School System Daily education program Behavioral education program working in conjunction with behavioral psychologist, family and speech therapist. Costs covered under PL (IDEA) with appropriate supplemental therapies. Special education can be offered to age 21 if deemed necessary, however, it is my feeling that Kobe will be transitioned out of school by age 18. NOTE: Kobe will require a highly structured environment and a small classroom setting with preferably no more than eight to ten students to a class. If he remains within the public school system, he should be in a program for the learning disabled with a resource room with mainstreaming. The alternative is a public school setting for children with ADHD and behavioral disorders that could then transition into a vocational high school program. However, in light of the severity of Kobe s problems, a private school setting designed for ADHD children should be considered. 12 Table 2 Copyright page 6

7 Diagnostic/Educational Testing Item / Service Age Year Replacement Option #1 Last 3 years of Prepare him to enter the This program is offered at no charge Vocational High School High School competitive labor market through the Seminole County Critial Program or a supported work Intervention Enterprises., program. Transitioning to adulthood should emphasize vocational evaluation, counseling and training as well as time management skills, organization and study skills. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. 13 Option #2 Special Education Program through the Public School System Daily education program Behavioral education program working in conjunction with behavioral psychologist, family and speech therapist. Costs covered under PL (IDEA) with appropriate supplemental therapies. Special education can be offered to age 21 if deemed necessary, however, it is my feeling that Kobe will be transitioned out of school by age 18. NOTE: Kobe will require a highly structured environment and a small classroom setting with preferably no more than eight to ten students to a class. If he remains within the public school system, he should be in a program for the learning disabled with a resource room with mainstreaming. The alternative is a public school setting for children with ADHD and behavioral disorders that could then transition into a vocational high school program. However, in light of the severity of Kobe s problems, a private school setting designed for ADHD children should be considered. 14 Table 2 Copyright page 7

8 Diagnostic/Educational Testing Item / Service Age Year Replacement Option #2 Regular school Provide specialized This private school is specifically for Private School for year education for students children with ADHD. The students Students with ADHD with ADHD and range from age 8 to age 16. The associated learning schools goal is to work with the disabilities. students and return them to the public $21450 school system. 15 NOTE: Each child has to attend a summer session prior to beginning their first school year enrolled at Churchill School. The cost of this summer session is $4,350 for six weeks. This is a one time only cost. Option #2 Vocational High School Program Last 3 years of High School Prepare him to enter the competitive labor market or a supported work program. This program is offered at no charge through the Seminole County Critical Intervention Enterprises Transitioning to adulthood should emphasize vocational evaluation, counseling and training as well as time management skills, organization and study skills. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. 16 Option #1 and Option #2 Tutor hour / week for 48 weeks / year Reinforce classroom studies during the school year and summer $30 $ Table 2 Copyright page 8

9 Aids for Independent Function Computer Setup 1 X / 5-7 Years Educational, recreational and vocational use. $ $ Maintenance and/or Update of Computer Software X / Year Maintain equipment Teith Simpson, M.D $150 - $ Table 2 Copyright page 9

10 Medications Medications Annual cost To be prescribed by treating physician NOTE: Kobe is not currently on any medications. He will more likely than not, require medication to help control his behavior, as he enters school and particularly as he enters adolescence. The cost of such medications will have to be determined after he is evaluated by a psychiatrist and medications are prescribed. Examples of probable medications are Ritalin; Anti-anxiety Drugs (Valium, Buspar, Thorazine, etc.) and Antidepressant Drugs (Prozac, Zoloft, Wellbutrin, etc.) Stimulant medications are considered first-line therapy as they are effective in 70 to 80% of children with ADHD. Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and management of attention deficit hyperactivity disorder in primary care for school age children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2003 Mar. 66p. Stimulants are the first-line treatment and have proven benefit to most people. If one class of stimulant fails or has unacceptable side effects then another should be tried (see Tables 5-7 of the original guideline document). Atomoxetine (Strattera ) is a secondary choice. (One reported side effect is suicidal thinking.). Other medications may be used alone or in combination depending upon the ADHD type or with comorbidity profile: e.g., Alpha-II agonists (clonidine, guanfacine) with hyperactivity or impulsivity; bupropion (over age 8) with comorbid depression; risperidone (atypical antipsychotic) for aggression (see Table 8 of the original guideline document). Tricyclic antidepressants may rarely be used to treat ADHD; selective serotonin reuptake inhibitors (SSRIs) may be useful for depressive disorders. (There is a reported increase of suicidal ideation for SSRIs but SSRIs are not used to treat ADHD.) Source: University of Michigan Health System. Attention-deficit hyperactivity disorder. Ann Arbor (MI): University of Michigan Health System; 2005 Oct. 35 p. National Guideline Clearinghouse 20 Table 2 Copyright page 10

11 Home Care / Facility Care Pre-Age 18: Respite Care 1 night / week for 4 hours and 1 weekend / month for 36 hours to age 12; thereafter only 1 weekend / month for 36 hours Prevent parental burn out $13 - $18 $8,320 - $11,520 for 640 hours / year to age 12; thereafter $5,616 - $7,776 / for 432 hours / year to age 18. NOTE: Respite care is used to ensure continued implementation of the behavioral program and structured environment while giving parents a break. Weekend respite care is continued from age 12 to age 18, because of the high risk of leaving a behaviorally involved adolescent unsupervised overnight. Caregiver burnout is a state of physical, emotional and psychological exhaustion that is accompanied by a shift in attitude from positive and caring to negative and apathetic. Most underlying causes of caregiver burnout come directly from the nature of caregiving, which is a balancing act between tasks and responsibilities on one hand and self-esteem, coping skills and social support on the other. If that balance gets tipped, the increased emotional pressure can overwhelm even the most dedicated caregiver. Source; Sherman, James r., Ph.D., Preventing Caregiver Burnout. Home Healthcare Consultant, the Journal of Alternative Site Medicine and Management by MultiMedia HealthCare/Freedom LLC Case Management 4-6 hours / month (48-72 hours / year) Coordinate services, oversee care, and offer support. $85 $ $ Post-Age 18: Option I: Case Management (Best Case Scenario) 4-6 hours / month (48-72 hours / year) Independent living with case management to help coordinate services, oversee care, offer support and liaison with employer. $85 $ $ Post-Age 18: Option II: Group Home (Worst Case Scenario) Daily care and supervision Provide support and supervision. $103 $37595 Adult Congregate Living Facility 24 Table 2 Copyright page 11

12 Home Care / Facility Care Item / Service Age Year Replacement Option II: 4-6 hours / Independent living with Case Management month (48-72 case management to help hours / year) $85 coordinate services, oversee care, and offer support. $ $ Option II: Supported Work Program to 30 hours / week for 4 weeks; reduced to 5 to 10 hours / week for 4 weeks; then 1 to 2 hours / week for 6 weeks. Job training, placement assistance and on-site supervision. $29.25 $3,686 to $5,031 for 126 to 172 hours. This program will need to be repeated at least 3 times over the course of his work-life expectancy in order to facilitate job changes. 26 Table 2 Copyright page 12

13 Future Medical Care Routine Pediatrician / Internist Psychiatrist 2 X / Year 1 X now for initial evaluation; then 4 X / year thereafter. Provide care due to his increased tendency to have respiratory infections. Evaluate and monitor the need for medications to address his behavioral disorder. $59 - $129 $118 - $258 This represents two visits above and beyond the annual visits per year everyone should have. $175 for initial evaluation; then $360 / year thereafter According to the American Family Physicians further assessment by a psychiatrist or developmental-behavioral pediatrician may be beneficial for children with ADHD who have comorbid conditions. Follow-up visits should occur as often as needed to monitor the effect of a comprehensive treatment plan. The MTA Cooperative Group study used monthly 30-minute medication management visits to encourage and advise children and parents, review ADHD rating scales and adjust medication dosages. Source: Evaluation and Treatment of ADHD (attention-deficit/hyperactivity disorder). American Family Physicians. Sept 1, 2001, by William D. Smucker, Marjaneh Hedavat. (Printed from Ophthalmologist 1 X now for evaluation, with the need for further treatment to be determined. Evaluate vision due to prematurity $ Pathology Laboratory Work 1-2 X / Year Monitor side effects of medications to be prescribed to help control his behavior $133 $133 - $266 CBC - $41, Comp Metabolic Panel - $92 30 Table 2 Copyright page 13