Systems Integration Project for Children and Youth with Special Healthcare Needs

Advisory Council Meeting

Friday, December 11, 2015

Agenda

ChildServe Welcome

• Dr. Teri Wahlig, Senior Vice President and Chief Medical Officer

Arch Pediatr Adolesc Med. 2007;161(10):933-936. doi:10.1001/archpedi.161.10.933

• Systems integration is our overall goal

• The medical home measure is a proxy measure for systems integration

• Systems integration will be achieved through 3 common strategies across 16 states

• Advisory Council assists in scaling these strategies state-wide by participating in implementation resource teams

Project Review

Shared Resource

• Strategy: Develop a web-based portal that provides current and well-vetted information to improve the care and outcomes of children and youth with special health care needs (CYSHCN) and their families

• Aim Statement: By October 2017, 50% of families and medical home providers of CYSHCN contacting the shared resource for a needed specialist, support or service, will obtain a needed specialist, support, or service

• Measure: Online survey of site visitors

Shared Resource

Cross-System Care Coordination

• Strategy: Develop and implement protocols for the utilization of a Shared Plan of Care to improve coordination of care

• Target Sub-Population: Those CYSHCN stratified at the severe level and enrolled in the Pediatric Integrated Health Home (P-IHH) Program

• Aim Statement: By October 2017, 20% of CYSHCN enrolled in P-IHH programs and stratified at the severe level will have a Shared Plan of Care (SPoC) in place

• Measure: Chart review for pilot program

Integration

• Strategy: Working with partners on strategies for integrating care for CYSHCN with the goal of working towards creating a comprehensive system of care for CYSHCN

• Aim Statement: By October 2017, an agency-level written agreement will be developed between two or more state or regional-level entities to improve the rate of timely exchange of information for CYSHCN

• Interim Measures:

• Documentation of meetings with agency representatives

• Complete agenda and attendance logs from education of stakeholders

• Documentation of consensus for data sharing processes

• Documentation of consensus regarding draft agreement

Driver Diagram

Ten Main Drivers:

• Use of Resources

• Community Support

• Training & Education

• Engagement

• Cultural Competence

• Outreach & Marketing

• Infrastructure

• Data Sharing

• Engaged Leadership

• Health Information Technology

State Plan Overview • The refined state plan is a road map to unify system level components to

ensure articulation, communication, integration, and synergy in creating a seamless System of Care for Iowa's children and youth with special health care needs and their families.

What is Title V?

Friday, December 11, 2015

Politicians & Medical Scholars Recognized

Health of a Nation Means Health of

Infants and Children

The Title V Vision

Title V envisions a nation where all

mothers, children and youth, including

CYSHCN, and their families are healthy

and thriving.

1930s Epidemic of Physical Disabilities

Title V added funds to create “crippled children” programs

Public health prevention

initiative of supplementing

milk with vitamin D led to

the eventual eradication of

rickets in US

Typhoid

Influenza and pneumonia

Tuberculosis

Diarrhea

Polio

Childhood Injury

Decline in Childhood

Infectious Diseases

What Is Title V? Enacted in 1935 as a part of the Social Security Act, the Title V Maternal and Child Health (MCH) Program is the Nation’s oldest Federal-State partnership.

4 parts: 1) Maternal & Child Health

2) Services for Crippled Children

3) Child-Welfare Services

4) Vocational Rehabilitation

1950s-1960s

Title V provided programs for maternal, infant, and

child care, as well as a full range of medical services

for children.

Direct health care services focused on children in

poverty with orthopedic impairments ~ 1950-1970s.

Leaders in 1960’s described the "new morbidity"

of childhood as behavior disorders and relatively

rare chronic conditions.

What Is Title V Block Grant?

Title V converted to a Block Grant

Program in 1981. States apply for and

receive a formula grant each year.

States use their Title V funds to design and

carry-out a wide range of MCH and

CYSHCN activities that address National

and State needs (and respond to National

and State Performance Measures).

Who Title V Serves

http://mchb.hrsa.gov/pdfs/statemchmedicaid.pdfhttp://mchb.hrsa.gov/pdfs/statemchmedicaid.pdf

HOW DOES IT WORK IN IOWA?

Credit for photo: http://www.raygunsite.com/collections/womens-t-shirts/products/iowa-fly-over-2

Structure

IDPH-DCCH partnership

Maternal and Child Health: Local public or private non-profit organizations participate in a competitive bid process every 5 years for funding

CYSHCN: Child Health Specialty Clinics, within the Division of Child and Community Health at the UI Carver College of Medicine, administers Iowa’s Title V program for CYSHCN

Child Health Service Regions

Child Health Services 22 organizations receive Title V funds for the CH program

and all 99 counties are served

CH contractors:

◦ Help families access preventive health services for their child.

◦ Actively promote medical homes for children and provide technical assistance.

◦ Provide care coordination; developmental/social-emotional screening; gap-filling direct care services (immunizations, blood lead screening, and nutrition screening) when needed; health education; and dental screenings, preventive services, education, and referrals

◦ Link with adolescent health programs to promote positive youth development, empower youth to make healthy choices, and link health programs to schools, communities, youth groups, and faith-based organizations.

Maternal Health Service Regions

Maternal Health Services 21 organizations receive Title V funds for the MH

program across all 99 counties

MH contractors: ◦ link women to available prenatal services,

◦ coordinate closely with state Medicaid programs to improve outreach and enrollment,

◦ assure capacity to meet the needs of women in Iowa,

◦ provide parent education visits,

◦ link families to health and social services

◦ preconception care, and

◦ provide oral health education and link women to preventive and restorative dental services.

Target population includes Medicaid eligible and other low income women

Maternal and Child Health Services

MCH Contractors also:

◦ Link to other community providers and

programs

◦ Participate in community needs assessment

and health planning

◦ Conduct social marketing campaigns

◦ Participate in local taskforces and committees

◦ Link with Local Boards of Health

CHSC Regional Centers

CYSHCN Services

Title V funds services for children and youth, (0-21 years) who have a chronic condition or are at increased risk for a chronic condition and also have a need for special services.

◦ Partners with public and private entities that share the goal of providing quality family centered and community based services.

◦ Supports community-based medical homes and best practice protocols.

◦ Provides care coordination, family to family support, and gap-filling direct clinical services

Iowa’s Title V Funding – 2014, blended

funding for maximum impact

$6.5 million Federal Award

$6.1 million State Match

$5.6 million Other

Federal/ State funds

$18.2 million Total

Funding

Iowa MCH Title V Needs Assessment

Ranking of 24 Needs for Iowa’s Maternal and Child Health (MCH) Population

1. Access to Specialists for MCH

2. Transportation Resources

3. Transition to Adulthood Planning for CYSHCN

4. Adolescent Health Systems Coordination

5. Developmental Screenings

6. Maternal Mental Health System

7. Access to Child Care

8. Care Coordination for CYSHCN through a Medical/Health Home

9. Integration of Services for CYSHCN

10. Data Coordination for CYSHCN Complete report available at http://idph.iowa.gov/hpcdp/titlev-needs-assessment

Title V 3.0 Performance Measures

8 National Performance Measures selected from list of 15 developed by HRSA/MCHB

Developing 5 State Performance Measures for unique needs of Iowa

National Health

Outcome Measures

National & State

Performance Measures

Strategy

Measures

of Iowa’s

Activities

Out with the Old, and In with the New

Title V State Performance Measures = 8

The degree to which the state MCH Title V program improves the system of

care for mothers and children in Iowa.

The degree to which components of a coordinated statewide system of care

for CYSHCN are implemented.

The degree to which Iowa’s state MCH Title V program addresses health equity

in MCH programs measured through the MCH Title V index.

Percent of family planning clients (women and men) who are counseled about

developing a reproductive life plan.

The degree to which the health care system implements evidence based

prenatal and perinatal care.

Percent of Medicaid enrolled women receiving preventive dental health services

during pregnancy.

The percent of Medicaid-enrolled children ages 0-5 years who receive a dental

service.

Rate of hospitalizations due to unintentional injuries among children ages 0-14.

Benefits of Title V - Examples Potential Benefits

1)increase the utilization of Title XIX

Title V and others by mutual efforts.

2) maximize resources and expertise of

the Agency and the Contractor to

increase the quality and continuity of

care

Agency shall coordinate and

collaborate with Contractor staff for

administering services, includes

planning, financing, implementing &

evaluating Medicaid Svc.

Contractor shall develop standards

and implement a credentialing

process for Title V MCH, CHC, and

coordinate and collaborate with

Agency staff…

Examples

1) Pilot of the SAMSHA Community Circle of Care model for behavioral health, lead to state sponsored program and then the Pediatric Integrated Health Home program with Magellan

2) IDPH assigned development of algorithm for delineating what children are “children and youth with special health care needs.”

Benefits of Title V - Examples

Potential Benefits (con’t)

3) to promote cooperation and collaboration at the state level. Develop policy decisions for

implementation of agreement.

Provide reciprocal notification to partner agencies.

4) provide early identification of children under age 21 in need of medical or remedial services.

5) make reciprocal referrals to respective programs.

Examples (con’t)

3) contracts to develop quality metrics

4) Quality initiatives

5) others? 1st Five Healthy Development

Initiative

ESPDT

Early ACCESS – input into well child screening, dental screens

VIS measures that could be used for CYSHCN

Workforce Development & Peer to Peer Training/ Certificaiton

DCCH’s System of Care

Includes:

Systems Development &

Infrastructure through Public

and Private Partnerships

Care Coordination

Family/Peer to Peer Support

Clinical Services/Communities

Telehealth

Connections for Research –

clinical trials, registries, data,

evaluation, publication

Policy, Advocacy, Education

Being part of the System of Care

Developing a telehealth network

throughout the Regional Centers

Creating access to pediatric specialists

from UI Children’s Hospital/others (?)

Maintaining Community Child Health

Teams

Training and embedding Family Navigators

into the CYSHCN delivery model/PIHH

Leading the Systems Integration Grant

Take-Away

IDPH-DCCH serve as Service Provider as

well as Title V agency.

Both are engaged in

◦ CONNECTING

◦ PARTNERING

◦ WORKFORCE DEVELOPMENT

◦ QUALITY IMPROVEMENT METRICS

◦ SYSTEMS BUILDING

Stakeholder Panel

• Sarah Brown, Bureau Chief

• Bureau of Learner Strategies and Supports, Iowa Department of Education

• Laura Larkin, Program Planner

• Division of Mental Health and Disability Services, Iowa Department of Human Services

• Sally Oudekerk, Medicaid Policy Specialist

• Iowa Medicaid Enterprise, Iowa Department of Human Services

• Dr. Teri Wahlig, Senior Vice President and Chief Medical Officer

• ChildServe

Integration Brainstorm

1. What role do you and your organization play in the system of care for CYSHCN?

2. What is your experience of how the different system parts currently work together to serve families?

3. What barriers do you see for integration and ideas to overcome them?

4. What experience do you have with information sharing?

5. What collaboration successes have you been a part of and what made them successful?

Project Next Steps

• Shared Resource

• Develop a dissemination plan and launch website

• Cross-System Care Coordination

• Build consensus on components of Shared Plan of Care

• Integration

• Continue to engage agency representatives to draft agreements

Advisory Council Next Steps

• Doodle Survey for Go To Meeting in February

• Newsletter in January

• Additional staff to contribute to implementation resource teams

• Others?

Stay Connected

• Link: cchii.org/member-login

• Username: SIG

• Password: integration