Vermont Department of Health

Integrating Community-Based Services for Children & CYSHCN within Vermont

Beth Cheng Tolmie, MSW, Ed.D.May 5 & 6, 2009

Vermont Department of Health

2005/6 CSHCN Survey in Vermont Six MCHB Performance Outcomes

Outcome 1 59.8% of families partner and satisfied with services

Outcome 2 51.6% CSHCN receive coordinated, ongoing care within a medical home

Outcome 3 69.4% of families have adequate insurance to pay for services

Outcome 4 74.4% are screened early and continuously

Outcome 5 89.3% report that services are organized in ways that families can use them easily

Outcome 6 52.0% youth receive services to transition to adult health care

2005/2006 CSHCN survey data indicates fewer report none, and more report four or more functional difficulties in Vermont when compared to the national non-Hispanic white population

Vermont Department of Health

Key Staff & Partners Vermont Department of Health:

• Beth Cheng Tolmie, Grant Coordinator; Carol Hassler, MD, CSHN Medical Director; Steve Brooks, CSHN Operations Director; Sally Kerschner, Title V Coordinator; Garry Schaedel, EPSDT; John Burley, SSDI Coordinator; Office of Local Health Leadership

Agency of Human Services:• AHS Secretary’s Office• Department of Aging & Independent Living • Department for Children & Families• Department of Mental Health• Office of Vermont Health Access (Medicaid)

Vermont Child Health Improvement Program at the University of VT Vermont Family Network (merged P2P / parent information

organizations) American Academy of Pediatrics – Vermont Chapter; Vermont

Academy of Family Physicians

Vermont Department of Health

Project Goals & Objectives Easily Accessible Community-Based Services

• Integrate CSHN programs into the development of Local Children’s Integrated Services (CIS) Teams in each region of the state Intake and triage function Consultation re: CYSHCN considerations and complexities

• CIS is a Vermont Agency of Human Services effort to combine Healthy Babies, Kids and Families (home visiting), Family Infant & Toddler (Part C) and Children’s Upstream Services (mental health) programs

• Connect existing CSHN staff to local public health / maternal child health coordinator staff, who are part of the CIS intake and triage team in the community

Vermont Department of Health

Project Goals & Objectives Early and Continuous Developmental Screening

• Complete Vermont Child Health Improvement Program practice improvement project, in partnership with the Agency of Human Services to:

Increase the use of standardized developmental screening tools within the medical home

Offer financial support to medical homes for the completion of developmental screens according to Bright Futures © Guidelines

Measure and improve family-centered care within the medical home using the Promoting Healthy Development Survey (PHDS)

• Improve Child Development Clinic practice operations and support of the medical home within the CSHN program at the Vermont Department of Health

Vermont Child Health Improvement Program will utilize a practice improvement model to support scheduling and reporting functions with baseline data from:

– Pediatrician informal inquiry– Baseline chart review of Burlington clinic operations

Vermont Department of Health

Project Goals & Objectives Family-Centered Services

• Improve access to CSHN programs, information and services Website development and enhancement Database improvements

• Implement Vermont Family Network Family Support Consultant / Parent Liaison in CSHN operations

Liaison available to assist families with access to Child Development Clinic and other CSHN services

Financing• Reduce reliance on Title V support for the financing of direct

services for CSHN

Youth in Transition• Utilize current opportunities to support health considerations as

CYSHCN transition from youth to adulthood

Vermont Department of Health

Key Activities

Connect and integrate integration efforts within AHSImplement practice improvement efforts to better support the medical home and familiesRedefine role of CSHN and Title V as payer of last resort / insurance safety-netStrengthen medical home for SHCN youth as they transition to adulthood

Vermont Department of Health

Proposed Outcomes Improve Child Development Clinic capacity to

meet state needs for diagnostic and treatment planning services

Reduce reliance on Title V funding to support financing of direct services for CSHN

Develop sustainable model for support of family consultant / parent liaison within CSHN programs

Improve access for CYSHCN to community-based services via local Children’s Integrated Services (CIS) Teams

Vermont Department of Health

Evaluation Efforts Complete on-going document review Conduct interviews with key informants• Internal stakeholders• Pediatricians

Complete survey and chart review• Developmental screening practice improvement project

Use of Promoting Health Development Survey (PHDS)

• Child Development Clinic practice improvement project

Conduct financial gap analysis