Promoting Families’ Ability to Manage their Health Care through Family Centered Medical Homes

1. Promoting Families’ Ability to Manage their Health Care through Family Centered Medical Homes Pathways to Independence Summit Celeste Putnam, Lynn Marie Firehammer, & Charlotte Curtis September 8th

2. Providing Medical Homes • Department of Children and Families has a partnership with the Department of Health to provide medical homes to eligible children in out-of-home care.

3. Objectives • Overview of Medical Homes • Understanding that Health Care includes physical, developmental and behavioral health • Understanding Early Steps • Understanding of how to integrate Early Steps into the Medical Home

4. Child and Family Well-Being Outcome

5. Many Children in Out-of-Home Care have Special Health Care Needs • “Children and adolescents in foster care are a singularly disadvantaged and vulnerable population known to be a high risk for persistent and chronic physical, emotional, and developmental conditions because of multiple and cumulative adverse events in their lives” (American Academy of Pediatrics, 2005)

6. Many Children in Out-of-Home Care Have Special Health Care Needs Research shows that: • 39.3% of children birth to three meet criteria for early intervention • 41.1% of children three and four required special education services • 60 % of children in foster care have a chronic health care condition • 90 % have a chronic, developmental or social/emotional/behavioral disorder

7. Goals for Health Care Management The goal is to work with the Community Based Care Lead Agencies to provide: • A 72 hour initial medical screen • A comprehensive health care evaluation within 30 days • A developmental screen • A Comprehensive Behavioral Health Care Assessment coordinated with physical health care

8. Goals • Have physical and developmental care coordinated by nurse care coordinators in collaboration with the CBC case manager when feasible • Have children’s immunizations and periodicity schedules monitored • Provide health care assistance in permanency planning

9. Medical Homes • Each child will be have a primary care provider • Medical Homes are distinct from Medical Foster Homes

10. Medical Homes A Medical Home is: • Accessible in the Community • Family Centered • Continuous • Comprehensive • Coordinated • Compassionate • Culturally Competent

11. Developmental Screening and Referral to Early Steps • The Health Plan should address the child’s developmental status • One approach would be for a nurse care coordinator to work with the CBC care manager, family and others to determine if the child requires a developmental assessment • The nurse care coordinator may make the referral to Early Steps

12. What is Early Steps? • Infants and Toddlers with Disabilities Program of the Individuals with Disabilities Education Act (IDEA) Part C • Created in 1986 to: • enhance the development of infants and toddlers with disabilities • minimize potential developmental delay • reduce educational costs to our society by minimizing the need for special education services as children with disabilities reach school age

13. Early Steps • Early Steps is Florida’s Part C system • Program administration and over site is in the Department of Health, Children’s Medical Services • 16 private contractors (hospitals, universities, community agencies, etc.) provide the day-to-day system in 15 Local Early Steps catchment areas that cover all 67 Florida counties

14. Early Steps Goal • The goal of Early Steps is to improve the developmental outcomes of infants and toddlers age birth to 36 months with developmental delays and established conditions • Families and caregivers are provided with services and supports to enable them to enhance their child’s development within their everyday routines, activities, and places

15. Established Condition Eligibility Categories of established conditions are: • Genetic and metabolic disorders • Neurological disorder • Autism Spectrum Disorder • Severe attachment disorder • Significant sensory impairment (vision/hearing) • Infants who weigh less than 1,200 grams at birth

16. Developmental Delay Eligibility Developmental delay must meet or exceed: • 1.5 standard deviations below the mean in two or more developmental domains or • 2.0 standard deviations below the mean in one or more of the domains

17. Developmental Domains • Cognitive • Physical (including hearing and vision) • Communication • Social/emotional • Adaptive

18. Referrals • Local Early Steps (LES) conduct Child Find activities through community health fairs and similar events to identify potentially eligible children • Children are referred to Early Steps from many sources – such as birthing hospitals, CAPTA, pediatricians, child care centers, Early Head Start, Healthy Start and self-referrals • Florida Directory of Early Childhood Services links callers directly to LES 1-800-654-4440

19. Child Abuse Prevention and Treatment Act (CAPTA) • Ensures children under the age of three who are involved in substantiated cases of child abuse or neglect, and are potentially eligible for early intervention services, are referred • Florida has defined “substantiated” as any case with verified findings of child abuse or neglect

20. CAPTA Referral 1 Children who will remain in their parents’ or legal guardian’s home without referral forserviceare referred to Early Steps by the Child Protective Investigator handling the case

21. CAPTA Referral 2 Children who will remain in their parents’ or legal guardian’s home and are referred for services, will be referred to Early Steps by the CBC lead agency child welfare case manager, if certain delays are suspected

22. CAPTA Referrals • Plans are for children who are being placed into out-of-home care to receive an initial screening during comprehensive health assessment process • The decision to make a referral to Early Steps should be made during the health plan development process

23. CAPTA Referrals • Other indications of a developmental delay may also result in a referral • If available, the nurse care coordinator should assist the care giver and the CBC Lead Agency case manager to access Early Steps • Special attention should be given to substance exposed newborns, and low-birth weight infants

24. Individualized Family Support Plan • Early Steps services are based on evaluations/assessments, and family concerns, resources, and goals • Information about the child and family, including authorized services, are captured on the Individualized Family Support Plan (IFSP) which is required under 34 CFR 303.340 • Early Steps uses a Team Based Primary Service Provider approach

25. Individual Family Support Plan • The development of the IFSP should include the nurse care coordinator and the CBC case manager • Recommended services and supports should be integrated within the other services provided to the family • Service delivery schedules should be coordinated, especially home visiting programs

26. Team Based Primary Service Provider • Aims to empower each eligible family by providing a comprehensive team of professionals from the beginning of services through transition at age 3 • Services are provided where families live, learn and play, to enable them to implement developmentally appropriate learning opportunities during everyday activities and routines • Most services will be early intervention home visits

27. Team Based Primary Service Provider • For children in out-of-home care the team should have access to early childhood mental health therapists • Social, emotional and behavioral early intervention services should be coordinated with other mental health services provided

28. Early Intervention Home Visits Goal is for the family to • receive strong support from one person • be provided a comprehensive team of professionals • have fewer appointments and more time to be a “family” • Coordinated with other in home services

29. What does Early Intervention Look Like? Video made available by the Connecticut Birth to Three system and is posted on the Florida Early Steps website for parents to view http://www.birth23.org/videos/HV/B23HVEN.htm

30. Summary • Children should receive coordinated health care • Coordination of care will include physical health care, developmental interventions and mental health services • Early intervention services must be coordinated with the overall health care

31. Integration and Coordination Planning processes and documents such as the IFSP, the health plan and the case plan must be integrated and coordinated to ensure that: • Services are in support of the permanency goals • Services are coordinated and made easily manageable for the care giver • Services address the needs of the immediate care giver and the biological families if appropriate

32. More Information on Early Steps Early Steps Website at http://www.cms-kids.com/families/early_steps/early_steps.html

33. Questions