Partnership for Change

The Role of the Medical Home for CSHCN

Calvin C.J. Sia, MD, FAAP

Design of an Integrated System of Services

Focus upon the well-being of the child, within the context of the family.

Implement the concept that every child will have a “medical home” that provides primary health care services, which are comprehensive in addressing the needs of the whole child.

Early Childhood: The Importance of Prevention and Early Intervention

Due to the extremely rapid physical, emotional, cognitive and social growth rate of the first several years of life, the young child is most vulnerable and has special needs, which, if not met, can result in less than optimal development or permanent damage.

Family Centered Care (D-link)

The philosophy of family-centered care reflects the recognition that families should be at the center of service delivery systems designed to serve them.

Risk Factors (D-link)

The multiple and pervasive nature of risk factors challenging today’s families require comprehensive solutions and integrated programs.

Components of the Medical Home (D-link)

Definition of a Medical Home

Care that is:

• Accessible
• Family-centered
• Comprehensive
• Continuous
• Coordinated
• Comprehensive
• Culturally competent
• Compassionate

And for which the pediatrician:

• Shares responsibility

AAP Policy Statement 1992

Family-Centered Care

Recognizes that:

• Family is child’s primary source of strength and support.
• Parents are experts on their own children and hold essential information.
• Families and professionals working together best shape practices and improve children’s care.

Continuous

• Same primary pediatric health care professions available from infancy through adolescence
• Assistance with transitions (to school, home, adult services)

Comprehensive

• Preventive and primary care is provided.
• Pediatricians have a knowledge of the full range of child health problems.
• Pediatricians are knowledgeable about resources within the community.
• 24-hour illness or emergency care is provided.

Coordinated

• Families are linked to appropriate support services.
• Information from other service providers is centralized.
• Pediatrician communicates effectively and collaborates on plan for child’s care with all service providers.

Compassionate

Family’s cultural background is recognized, valued, and respected.

Sharing Responsibility

• Pediatrician accepts responsibility for services rendered.
• Pediatrician maximizes quality while minimizing cost.
• Pediatrician ensures that all needed services are delivered and avoids duplication.

Definition of Children with Special Health Care Needs

Children with special health care needs are those who have or are at elevated risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health related services of a type or amount not usually required by children.

-- Federal Maternal and Child Health Bureau (1995)

Who is the Child with Special Needs?

Biologically at risk

• Prematurity
• Failure to thrive
• Genetic disorders
• Asphyxia
• Sensory impairment
• Fetal alcohol syndrome

Environmentally at risk

• Teen parents
• Disturbed bonding/ attachment
• Economically disadvantaged
• Parental disability

Developmentally at risk

• Language/speech
• Self help
• Social
• Fine motor

Behavioral problems

• Attention deficit disorder
• Specific learning disability
• Conduct disorder
• Hyperactivity

Making the Medical Home a Reality

1) Physical education and training to enhance skills and awareness of these children with special needs.

Medical Home Training Module

• Disease/Deficit-oriented—Preventive health care-oriented
• New morbidity; periodic screening, early intervention, Dx, Rx
• Related services—communication, collaboration
• Family partnership—“empowerment” CSHCN

American Academy of Pediatrics

Division of Community Pediatrics

National Center for Medical Home Initiatives

Medical home training in many states

CATCH Vision

Community Access to Child Health

Every child in every community has a medical home and other needed services to reach optimal health and well-being.

Annie E. Dyson Initiative

Pediatric Residency training in community pediatrics

Pilot 5-year grant

• University of Rochester
• Columbia University
• Children’s Hospital Philadelphia
• Wisconsin
• UC San Diego
• University of Hawaii

Making the Medical Home a Reality

2) Public-private coordination to assure coordination of services.

Challenges

Integrated system of services for CSHCN

Family support, health, education, care coordination vs. case management

Services for CSHCN- Public

Individuals with Disabilities Education Act (IDEA)

• Part H - birth to three years
• Part B - three years to school age
• Eligibility defined by state

What do children and families receive through IDEA?

• Multi-disciplinary action
• Individualized programs
• Education for the child and services for the family
• Plans written into an Individualized Family Service Plan (IFSP) or Individualized Educational Plan (IEP)

Services for CSHCN- Public

Title V—MCHB support, family-centered, community-based, coordinated care for CSHCN—system development

• Medicaid—EPSDT
• SCHIP
• Eligibility defined by state
• Reimbursement issue

Services for CSHCN- Private

Challenges- Medical Necessity

• Appropriate for age and developmental status
• Achieving health and/or functional capacity

Challenges- Appropriate Services/ Reimbursement Issues

Dependent on individual states budget/advocacy

Community Based Team (D-link)

Go to: Final Summary | Disability Conference | Provider Reimbursement | HRSA | HHS