Tracking Rehabilitative Advancement through Accountable Care (TRAAC)

Also known as: TRAAC.

What is tracking rehabilitative advancement through accountable care?

TRAAC (Tracking Rehabilitative Advancement through Accountable Care) is the service delivery model of care for rehabilitation at Nicklaus Children’s Hospital. This model provides the guidelines for determining the frequency and duration of therapy services for each child, based on his or her individual needs. Frequency is determined based on: objective findings during the evaluation and treatment, the therapist’s professional judgment, and on Evidence Based Practices.

We provide care to children throughout all stages of their life by providing Episodes of Care. An episode of care is the rehabilitative services provided for a specific condition, during a set period of time, either in intervals marked by brief separations from care, or on a continuous basis. Thus, our intervention and TRAAC model for each child changes across their childhood based on their needs & the best model of intervention (TRAAC) to address their needs.

What happens during the treatment?

The therapists work together with the patient and family in decision making throughout all episodes of care. The team chooses the TRAAC most appropriate for the child, develops a plan of care together, and the services and TRAAC model change or end based on the patient’s needs, goals and performance.

TRAAC 1: Intensive (3 or more weekly sessions)

For children who:
  • had surgery recently or have complex medical needs.
  • make fast progress towards short and long term functional goals.
  • may lose functional skills due to present medical condition.
  • need frequent changes to their plan of care.
  • need an intensive family education/training program.
  • with their parents’ help, follow the given home program.

TRAAC 2: Weekly (1 or 2 weekly sessions)

For children who:

  • were recently diagnosed with a condition or disorder.
  • are making steady progress towards short- and long-term functional goals.
  • need occasional changes to their plan of care.
  • need education/training and whose families follow the given home program.

TRAAC 3: Periodic (1 or 2 monthly sessions)

For children who:

  • are making slow or limited progress towards goals.
  • are achieving functional goals.
  • need education/training with frequent updates, and whose families follow the given home program.

TRAAC 4: Consultative

Frequency scheduled as needed (1 session every 2-6 months) with re-evaluations as recommended. For children who:

  • are slowly gaining functional skills.
  • require family education/training with infrequent updates, and family follows the given home program.
  • are receiving community services and require occasional consultation with a therapist to ensure continued progress in the therapy goals or to address concerns.
  • have specific new challenges identified by the child or family.
  • have a new need for or will require updating of specific adaptive equipment (e.g., wheelchairs, standers, gait trainers).

Evaluation/Re-Evaluation:

  • Completed every 6 months.
  • Information gathered during evaluation/re-evaluation is used to create a plan of care according to the TRAAC model, and to make treatment decisions, recommendations, and plans for discharge.

Skilled Therapy on Hold Criteria:

Treatment may be placed on hold due to:

  • medical reasons.
  • family choosing to stop receiving therapy due to inability to pay for services, after being offered available hospital financial assistance programs and after being referred to community resources.
  • after referral to another discipline, before starting or continuing skilled OT/PT/SLP/ABA.

Discharge Criteria:

Therapy services will end when:

  • the therapy needs and goals of the child have been met.
  • the condition, injury or disorder is resolved.
  • the child can use compensatory strategies by himself.
  • Evidence-Based Practices no longer result in measurable progress.
  • child’s functional skills are decreasing and cannot be improved by skilled therapy.
  • parents do not participate in therapy.
  • parents are unable to follow the Attendance Contract.
  • family chooses to stop therapy or moves away.
  • child is referred to another provider or community resource.
  • family chooses to stop therapy due to inability to pay for services.

Trial Therapy

Therapy may be given on a trial basis for a short period of time when:

  • a new program/treatment approach is started (e.g., Augmentative and Alternative Communication (AAC), Feeding and Swallowing Therapy).
  • child is not meeting measurable goals or improving test results in a period of 12 weeks.
  • child has a long history of therapy services as reported by parent or medical records.
  • prognosis or rehabilitation potential is fair or guarded.
  • child is preparing to transition to therapy services in academic or natural environment, and/or alternative therapies.
  • child is preparing to transition to community based or extracurricular activities.
  • a home program is being used to maintain general skills within natural environment.

Reviewed by: Maria Castaneda-McCann

This page was last updated on: December 02, 2019 02:42 PM

Pediatric Rehabilitation Services

The Rehabilitation Services at Nicklaus Children’s Hospital serve the therapeutic needs of infants, children and adolescents.

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