CASA MEDICAL ADVOCACY TRAINING

1. CASAMEDICAL ADVOCACY TRAINING CASA of New Jersey, Inc.

2. Agenda • Overview of Medical Advocacy & Manual • Training Goals and CASA’s Role • DCF Coordinated Healthcare System • Well-Care for Children in Placement • Health Insurance • Continued Monitoring and Care • Learning Station Activity • Pulling it All Together and Report Writing • Manual Layout

3. CHAPTER 1 Training Goals and the Role of the CASA Volunteer in Medical Advocacy

4. GOAL OF MEDICAL ADVOCACY INITIATIVE To ensure that children in out-of-home placement are receiving any and all healthcare needed for optimal health. This includes regular well-care, dental care, immunizations, and any other necessary healthcare services based on their unique, individual needs.

5. MEDICAL ADVOCACY TRAINING GOALS • Provide the tools, knowledge, and ability to take an active role in ensuring the healthcare needs of children in placement are met • Help you identify informational gaps, areas of concern, and potential areas of risk • Understand the system of healthcare for children in placement, and the importance of regular well-child care, immunizations, and monitoring

6. Why is MEDICAL ADVOCACY Important? Majority of children in placement have some physical, mental health, developmental, and/or psychosocial problems Inconsistent attention to child health in the past Lost records and knowledge, instability in medical home, or inconsistencies in well-care and follow-up care

7. THE CASA VOLUNTEER’S ROLE • Gather information • Monitor healthcare services • Advocate for needed healthcare services • Report to the Court System • It is NOT the role of the CASA volunteer to diagnose the child or render any medical opinions.

8. VOLUNTEER DUTIES - MEDICAL ADVOCACY Communicate and collaborate Gather baseline medical information Ensure routine well-child care and immunizations Monitor the child’s health condition Be mindful and vigilant of unmet health needs Follow up on recommended services Confirm that a Health Plan is in place for the child

9. CHAPTER 2 Department of Children and Families Coordinated Health Care System for Children in Placement

10. DCF COORDINATED HEALTHCARE SYSTEM FOR CHILDREN IN PLACEMENT • Emphasizes continuity of care • Emphasizes each child having a Medical Home • Medical Home = a consistent primary healthcare provider • Implemented Child Health Units (CHUs) to coordinate delivery of healthcare for children in placement and support their Medical Home

11. DCF COORDINATED HEALTHCARE SYSTEM FOR CHILDREN IN PLACEMENT • Child Health Units (CHUs) • Co-located in all 46 local DCP&P offices • Staffed by contracted Child Health Nurses • Establish health baseline & perform PPA • Obtain and review medical records • Schedule Exams • Monitor/provide follow up care • Collaborate with/support Medical Home • Coordinate ongoing healthcare

12. HealthCare Case Management • Health Care Case Management Flowcharts • CHU Flowcharts are for CASA reference only • 3 Sets of flowcharts: • For all children entering care • For youth transitioning to adulthood • For youth aging out of foster care

13. Pre-Placement Assessment • Assessment following removal • Emergency care at hospital ER, or • PPA within 24 hrs of placement • PPA ideally conducted by child’s physician • Purpose of a PPA is to evaluate whether: • The child appears free of contagion, injuries, and acute health issues requiring immediate medical attention • The child has any health issues the caregiver must be aware of at the time of placement

14. Comprehensive Medical Exam (CME) • Performed within 30 days of placement • By contracted CME provider or child’s physician • Includes: • Comprehensive health & developmental history • Comprehensive physical exam • Mental health screening • When done by an RDTC, the CME is a CHEC and includes full medical, mental health, and neurodevelopmental exams • Look for CME or CHEC Report

15. Mental Health Screening • Completed for every child in placement within 30 days of placement, at 180 days, then as needed • Not needed if child: • Already referred for Mental Health Assessment • Already receiving Mental Health services • Presents with an urgent need for Mental Health services • Has had CHEC instead of CME • If MHS indicates the child may have mental health needs, a full Mental Health Assessment should be recommended by the screener • CASA can help ensure appropriate intervention

16. Mental Health Assessment • DCP&P recommends MHA for children: • entering placement with mental health histories (not currently in treatment) • with a history of physical and/or sexual abuse (not currently in treatment) • whose primary caretaker (before removal) has a history of mental illness • with a history of multiple changes in placement • with a history of running away from placements • CASA can recommend MHA

17. Health Passport & Health Records • Health Passport: • Form completed & updated by CHU Nurse • Contains child health information • Shared with parents, caregivers, healthcare providers • Health Care Case Management Record (HCCM) • File organized & maintained by CHU • Contains documentation/information re healthcare case management as well as all health records • CASA volunteers should review child’s HCCM and make sure child’s caregiver has a Health Passport

18. Ongoing Healthcare for Kids in Care • Children in placement entitled to ongoing healthcare coordinated through CHUs • Routine preventive medical care (well-child visits) • Semi-annual Dental Exams and any needed dental care • Up-to-date immunizations • Maintenance/update of Health Passport • Appropriate follow-up care to address health needs • Every child in placement should have a Health Plan • outlines routine healthcare services to be provided, special healthcare needs, and how needs will be met • Found in the Pediatric Nursing Report in the HCCM

19. CASA Advocacy (Ch2) • Gather information • Facilitate communication (including with CHU) • Review HCCM record to ensure exams were done and get important child health information • PPA - ensure caregivers made aware of any ongoing issues and that any needed follow-up was done • CME - making sure necessary follow-up is being done • MHS – ensure initial and ongoing MHS completed and that MHA is done if needed; ensure child is receiving recommended services • Ensure that youth are proactive about healthcare and understand their Health Passports

20. CHAPTER 3 Well-Care for Children in Placement

21. Well Care for Children in Placement All children in placement are entitled to adequate well-care and timely immunizations • Early & Periodic Screening, Diagnosis & Treatment (EPSDT) program • Comprehensive, preventive health program • Medicaid requirement in every state (NJ Family Care) • Done at each well-child visit; follows regular schedule • Include history, physical exam, immunizations, needed diagnostic testing • EPSDT visits should be made when the child is NOT sick

22. Child Growth & Growth Charts Growth is tracked on Growth Charts • Track length/height and weight • Track head circumference for children under 2 and BMI children/youth between 2 and 21 • Help doctors determine if child growth is normal, track development, and detect potential health problems • Used at each well-child or EPSDT visit • Professionals look at the child’s pattern of growth to ensure there are no significant increases or decreases that would require further evaluation

23. Child Immunizations • CASA should help ensure that immunizations are up to date and accurate records kept, especially through transitions • Challenges and Risks: • Lapses in immunization before & during placement • Over-immunization due to lack of coordination/record-keeping • Sources of immunization information • NJIIS – State vaccination registry • School records • CHUs

24. Child Immunizations (cont’d) • Immunization Schedules developed by the CDC, AAP, and AAFP: • frequency & type based on age • updated annually • Children entering Preschool/Public School must comply with NJ Preschool/NJ Public School Immunization Requirements • Providers & caregivers must report any adverse events

25. CASA Advocacy (Ch3) • Ensure children have their well-child & EPSDT visits • Ensure children are getting immunizations and that their records are up to date • Make sure that vaccine and all medical records follow the child through placement to permanency or emancipation • Review growth charts and request evaluation in the event of any large fluctuations in weight, length/stature, and BMI • Advise caregivers to report any adverse reactions to immunizations

26. CHAPTER 4 Health Insurance for Children in Placement

27. Health Insurance for Children in Care • Payment NEVER an obstacle to care or treatment • DCP&P provides Medicaid to all children upon removal regardless of previous insurance • Resource Parents must be provided a Medicaid number for any child placed with them • Medicaid is to cover all necessary treatment

28. Health Insurance for Children in Care • Care provided through 1 of 5 Medicaid HMOs • PCP provides routine care and makes referrals for specialty care • Caregiver must select HMO upon placement • HMO Care Manager works with CHU nurse to coordinate care & ensure continuity of services • Youth aging out keep Medicaid until age 26 if they stay under Division care until 18th birthday • See manual for Medicaid Guide for Resource Parents

29. CASA Advocacy (Ch4) • Remember that payment should never be an obstacle • Ensure the child is enrolled in one of the 5 Medicaid Managed Care HMOs and has a PCP • Ensure caregivers have the child’s Medicaid number and have selected an HMO • If child not getting full coverage, alert supervisor, reach out to DCP&P, and utilize Medicaid Guide • Communicate with DCP&P if there are any issues regarding coverage or payment

30. CHAPTER 5 Continued Monitoring and Care for Children in Placement

31. Continued Monitoring and Care • Children in placement have biological factors, medical histories, or trauma issues that often give rise to health issues • Volunteer role is NOT to diagnose • Volunteers should monitor for any signs of a health issue • If diagnosis exists, volunteers can help ensure appropriate treatment /medication • Communication is essential - Volunteers can help facilitate this communication

32. Pediatric Health & Red Flags Tool • Used by CHU and DCP&P for assessment • Provides baseline for child development • What to expect in different domains at different ages • Questions to ask youth and caregivers • Red flags to watch out for • Pediatric, Medical and Mental Health covered • Not the CASA role to use the Tool to assess the child • Tool is a reference • Baseline developmental information • Identification of red flags • Basis for further discussion

33. Medications • When child changes placement, CASA should be aware of any daily medications and ensure all medications and equipment follow the child • Medications may be for medical or mental health issues • CASA should help ensure no lapses in medications • Common Medical issues and medications: • Asthma - Asthma Action Plan and medications • Anaphylactic Allergies/Reactions -- EpiPen and MedicAlert Bracelet • Caregivers must have the child’s Medicaid number and a list of all current medications

34. Psychotropic Medications • Psychotropic Medications may be prescribed for children with psychiatric illness • Must be in accordance with the DCF Psychotropic Medication Policy. • Governs treatment of children with psychiatric illness • Outlines basic principles and expectations, including requirement for a Treatment Plan • Both Biological Parent and DCP&P must approve meds • CASAs should pay careful, accurate attention to medications and dosages to help avoid safety issues

35. Issues Particular to Teens/Adolescents • Teens must have access to Medical Home where they are comfortable and where staff is trained in providing care to teens with difficult histories • Teens should understand their Medicaid/HMO benefits, including any SSI benefits if disabled • CASA can support good teen decisions about preventive and ongoing healthcare • CASA should collaborate with DCP&P to ensure guidance/counseling on high-risk behaviors • Substance use/abuse (cigarettes, alcohol, drugs) • Unsafe sex

36. CASA Advocacy (Ch5) • Remember the CASA role – we do NOT diagnose or assess. Instead, CASA volunteers: • Communicate – be a hub for information • Help ensure a Medical Home and up-to-date records • Monitor healthcare, including medications, well-care, and necessary follow-up • Ensure that Psychotropic Medication Treatment Plan exists and is followed • Ensure appropriate care for Asthma & Anaphylactic allergies • Encourage teens to actively participate & make good decisions

37. Learning Station Activity

38. Learning Station Instructions • Individually, read the case study provided: • For 5 minutes, it will be like a library in here • As a group, briefly discuss for five minutes: • For a volunteer, specifically what medical issues in this case deserve attention? • Be ready to take these insights into this activity

39. Learning Stations • Working as a group, answer the Learning Station questions regarding your particular child • Review the manual and agree on a group answer to each question • Focus on the yellow pages in the manual, and particularly the shaded Points of Advocacy • Assign a scribe and write your answers on the provided handout

40. LEARNING STATION QUESTIONS DEBRIEF • Lets go over some of the questions and discuss what your responses were • Each group should report out on their child • Remember that when you have a real case, you will have this CASA program’s resources at your disposal in dealing with questions of this nature

41. CHAPTER 6 Pulling it All Together

42. Pulling It All Together • Primary Goal: Ensure that children in placement receive all needed healthcare • Use your investigative skills to: • Gather information and fill in gaps on child health status, immunizations, assessments, and care provided • Help ensure that specific healthcare needs are met (including well-care, dental care, immunizations) • Provide Court with timely, objective, and unbiased information, allowing the Court to make well-informed decisions on the child’s behalf

43. Information Gathering & Record Review • Request and review both DCP&P and HCCM Files • Explain CASA role & purpose of visit to CHU Nurse • Reference and bring Order of Appointment • Review all medical files • Consider using the Advocate Questionnaire for Medical Information to track information • Use Health Information Gathering Guide and Healthcare Information Sources to identify other sources of medical information such as: • School nurse • Medical Home • Biological Parents, relatives, and other caregivers

44. Ensuring Appropriate Healthcare • Work closely with child’s caseworker, nurse, caregiver, and parents to ensure timely, appropriate healthcare is provided and that medical/mental health needs are met • DCP&P policy requires that, unless parental rights are terminated, parents must: • Be kept informed of routine care • Must provide consent to non-routine medical interventions (such as surgery, special testing, or medication) • If parent unable to consent or cooperate, DCP&P must seek Court intervention – DCP&P cannot consent • CASA can facilitate communication and consents for special medical interventions

45. Court Reports • Court Reports should include a Medical Section • Report should include factual update on child health: • Well-care, dental care, and immunizations • Specific medical or mental health needs • Whether needs are being addressed appropriately • Be sure you advocate for items before calling them out in a Court Report • Recommendations should cover: • Any needed assessments or testing • Any special interventions/services needed • Ongoing well-care

46. Court Report Activity

47. Draft a Court Report Section • Work in your child’s group and use Chapter 6 of your manual • Assign a scribe to write on your flipchart • Draft a short “medical advocacy” section of a CASA Court Report for your particular child • Include a summary of the child’s medical status • Include any recommendations (assume for the purpose of the exercise that you have already discussed these recommendations with the caseworker) • Timing: 15 minutes

48. Court Report Debrief • Each child-specific group will summarize their report as written on their flipchart • The whole training class will provide feedback: • Is there anything else you would add? • Is there anything that you would not have included?

49. CASAs Play an Important Role You are critical in facilitating communication and ensuring that a child’s healthcare needs are met You gather important information, monitor the provision of medical services, and advocate for the child’s healthcare needs With your new skills and tools, you can make a bigger difference than ever!

50. Thank you for your participation in this training today!