Alameda County Medical Home Project Resources for Children with Special Health Care Needs and their Families June, 2007
Definition of Medical Home Ideally, pediatric health care professionals and parents act as partners in the medical home to • identify • access and • coordinate all medical and non-medical services needed to achieve maximum potential for the child.
Definition of CSHCN Children with special health care needs (CSHCN) include all children who have or are at increased risk for: 1) chronic physical, developmental, behavioral or emotional conditions and 2) who also require health and related services of a type or amount beyond that required by children generally.
CaliforniaChildren’s Services (CCS) Eligibility: • Children and youth 0-21 years with physical injuries, illness, or disabilities (list of diagnoses to follow). Income Requirements: • For diagnostics, PT & OT or if adopted with eligible condition: no income requirements. • For coverage of CCS condition, income less than $40,000. • If out-of-pocket medical expenses greater than 20% family income.
CCS Services • Diagnostic services • All services which apply to condition: doctors, hospital, surgery, PT, OT, lab tests, x-rays, orthopedic & medical equipment, case management including transportation and maintenance
CCS Diagnoses • Heart conditions • Neoplasms • Blood disorders (hemophilia, sickle cell anemia) • Respiratory system disorders (cystic fibrosis, chronic lung disease) • Endocrine, nutritional & metabolic disorders (PKU, thyroid problems or diabetes) • Genito-urinary system disorders (serious kidney problems) • Gastrointestinal system disorders (biliary artesia)
CCS Diagnoses (con’t) • Serious birth defects (cleft lip/palate, spina bifida) • Sense organ disorders (hearing loss, loss of vision due to glaucoma or cataracts) • Nervous system disorders (cerebral palsy, uncontrolled epilepsy) • Musculoskeletal & connective tissue disorders (muscular dystrophy, JRA) • Severe disorders of the immune system (HIV)
CCS Diagnoses (con’t) • Disabling injuries & poisonings requiring intensive care or rehabilitation (severe brain, spinal cord injuries & burns) • Complications of premature birth requiring an intensive level of care • Skin & subcutaneous tissue disorders (severe hemangioma) • Medically handicapping malocclusion
COUNTY MENTAL HEALTH Eligibility: • Children and youth, 0-18 years old, with full scope Medi-Cal • Special education referrals from schools Income Requirements: • No income limits if referred by school system
COUNTY MENTAL HEALTH Services: • Outpatient assessment or psychological evaluation & referral to community practitioners • All services required of an IEP including day & residential treatment as necessary • Psychological emergency services (for a fee if not covered by insurance)
SPECIAL EDUCATION Eligibility: • Children and youth, 0-22 years old, eligible for Regional Center and/or Mental Health services • Children with other health or sensory impairments, and/or learning disabilities • Early Start eligible Income Requirements: • No income limits
SPECIAL EDUCATION Services: • Assistive devices/services • Audiology services • Family training, counseling, home visits (Early Start only) • Some health services • Diagnostic services • Nursing assessments
SPECIAL EDUCATIONServices (con’t) • PT & OT • Respite (Early Start only) • Special instruction • Speech & language services • Transportation • Psychological services • Vision services
Regional Center of the East Bay (RCEB) Eligibility: • Persons of all ages with developmental disabilities including retardation, cerebral palsy, epilepsy, autism • Early Start eligible (see future slide) Income Requirements: • No income limits
RCEBServices: • Early Intervention services (see next slide) • Non-medical services, primarily case management • Family support, respite, crisis intervention, special living arrangements, community integration • Interpreter or translator, advocacy, transportation vouchers • Assessment, rehabilitation and training, treatment, therapy, prevention, special equipment (usually as a payer of “last resort”)
RCEB Early InterventionEARLY START EARLY START ELIGIBILITY • Ages 0-3 years • Are at risk for developing developmental disabilities • Developmentally delayed • Have a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay
RCEB / EARLY START Services: • Assistive devices/services • Audiology services • Case management • Family training, counseling, home visits • Some health services • Diagnostic services
RCEB / EARLY START Services (con’t) • Nursing • Nutritional counseling • Oral Feeding specialist • OT & PT • Psychological services • Respite
RCEB / EARLY START Services (con’t) • Social work services • Special instruction • Speech & language services • Transportation • Vision services • Others as needed
FAMILY RESOURCE NETWORK Eligibility: • All families and/or caregivers of special needs children, 0-22 years old, residing in Alameda County Income Requirements: • No income limits
FAMILY RESOURCE NETWORKServices • Parent to parent support for families of children with special health and developmental needs • Free information and referral services • Quarterly newsletter • Resource library • Training & Advocacy • Multi-lingual services
Accomplishments • Visited 1/3 of the pediatric practices and all major clinics in Alameda County (approx. 40) • Reached providers serving over half of the CCS children in the county (approx. 2300) • Created resource materials for providers and office staff to improve referral pathways • Distributed comprehensive child health records to families