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Clarissa Kripke, M.D., Dir. of Developmental Primary Care,
A Profile in Health Care Reform
PERSPECTIVES
Clarissa Kripke, M.D., Director of Developmental Primary Care at UCSF
Dr. Kripke, The Arc and other strategic partners are part of a landmark Health Care Reform Initiative for people with developmental disabilities.
How did you become involved in working with people with disabilities?
A number of group home residents were coming to see us in Family Medicine. These were people with complex disabilities and it was obvious that short appointments at our offices were not working. I suggested that I go to them where they are comfortable and their caregivers can provide helpful information, and this model of care proved much more effective. Also, when my son was diagnosed with autism 7 years ago, I became a lot more interested in the system. The new models of care we set up today will serve him in the future, and I take comfort knowing what The Arc, UCSF and GGRC (Golden Gate Regional Center) are doing to sustain my child.
Why does the current health care system fail people with developmental disabilities?
Today’s model focuses on 15-minute visits. Many patients have trouble getting into an exam room in that time frame, much less provide helpful history. Patients need more time, and doctors need better information. There is no structure in place to involve caregivers and those who know the patient best, and for these patients, care can be complicated involving many agencies and many different services. Without caregiver involvement, and without doctors being reimbursed for the extra time they need to spend, quality care is difficult to provide.
How do Health Advocates make a difference?
The advocates know the people they are caring for. Doctors may see hundreds of patients with ‘normal’ findings, but only someone close to a patient with developmental disabilities knows what ‘normal’ is for that particular individual. This information is key to how we care for that person.
People with disabilities have both common and uncommon medical problems. Oftentimes an illness is recognized late, so it has to be addressed quickly. You need coordinated, responsive support to make that happen, and health advocates can facilitate that. Their role is critical—there really isn’t any other way to do this right.
What improvements can be made to training and supporting clinicians?
The Department of Family and Community Medicine at UCSF is developing a curriculum on Developmental Primary Care with updated lectures, better online resources, and more opportunities for medical students to get clinical experience with these patients—including teaching classes at The Arc. These classes are helpful to clients and give our medical students a chance to see people with disabilities living their lives and enjoying their health.
It’s an opportunity for everyone involved to see how good health is a joint effort.