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Systematic Approaches for improving developmental health care

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					Systematic Approaches for
improving developmental
 health care: the Medical
          Home
            Neal Halfon, M.D., M.P.H

 Schools of Public Health, Medicine, Public Policy and
                     Social Research
     UCLA Center for Healthier Children Families &
                       Communities
 National Center for Infancy and Early Childhood Health
                          Policy


   State Early Childhood Comprehensive Systems
                 December 5, 2004
           Goals of this Presentation
   Describe and assess the role of
    developmental health services and the
    Medical Home in ECCS
   Review potential strategies and
    approaches that might be useful
   Consider concrete steps that state can
    employ to advance a progressive health
    development agenda in relationship to
    pediatric and larger child health sector.

Center for Healthier Children,
Families & Communities
         Optimizing Early Childhood
          Health and Development
   Our understanding about early childhood is
    undergoing a fundamental paradigm shift
        Scientific advances, demographic changes, and
         advances in population health trajectories have
         placed greater value on young children
        This evidence suggest that intensive investment in
         the optimal development of young children is
         warranted and necessary in order for a democratic
         society to fulfill its values & achieve its goals
   Optimizing health development requires a
    different approach to organizing, and paying for
    health, education, child development services
    than previous approaches to early intervention

Center for Healthier Children,
Families & Communities
                             Strategies to Improve
                          School Readiness Trajectories
                                                    Family Discord
                                                                                    Social-emotional, Physical
                    Lack of health services                                            Cognitive, Language
                                                                                               function


                    Poverty                                                                 Lower School
Ready to learn




                                                                                            Readiness trajectory:
                                                                           Pre-school       With diminished
                                                                                            function
                                                     Appropriate Discipline

                                       Reading to child

                     Parent education
                     Emotional literacy

                 Birth          Late Infancy                     Late Toddler         Late Preschool
                         6 mo       12 mo   18 mo        24 mo             3 yrs           5 yrs Age
                                                                           Early Preschool
                    Early Infancy
   Center for Healthier Children,
   Families & Communities
                                                    Early Toddler
      Population Strategies for Optimizing
         Child Developmental Health
   Optimize developmental trajectories and
    decrease disparities between high and low
    trajectories
   Utilize curve shifting strategies to achieve
    population outcomes
        Develop and implement community building
         strategies that address nested contexts of
         influence- an ecological approach
        Use system improvement strategies

Center for Healthier Children,
Families & Communities
        State Early Childhood
    Comprehensive Systems Initiative
   Goal:
        Plan for and build a more comprehensive
         and integrated system among the current
         uneven, and often ineffective, mix of
         services for young children.
   States Receive Funding for:
        Two years of strategic planning
        Three years of implementation


Center for Healthier Children,
Families & Communities
        State Early Childhood
    Comprehensive Systems Initiative

   Five Components: Improving and
    Integrating Programs and Services to
    form a System of Care
      Health Care- Medical Home for all children
      Early Care and Education
      Social/Emotional Health
      Parent Education
      Family Support


Center for Healthier Children,
Families & Communities
  Converging Service Sector Strategies to Create an
 Early Childhood Integrated Service Delivery Platform
 Early Care & Education                                   Medical Home
          Deliberate Opportunities for Cognitive,                On-going Assessment of Child
          Physical, Social and Emotional Learning                Development
            Training on Child Health and Development               Elicit & Address Parent Concerns
                 Training on Maintaining a Safe and                   Anticipatory Guidance
                 Healthy Early Care Environment
                                                                        Preventive Health Care
                   Parent Education/Anticipatory Guidance                  Acute and Chronic Health Care
                       Child Observation to identify possible
                                                                              Integration with Community
                       physical/emotional health problems
                                                                              Resources for Referral
                           Linkage to Community Resources

                                Integrated Service Delivery Platform
                     Home Visiting                            Anticipatory Guidance
                                                              from Pediatrician                  Positive Parent-
                  Housing Services                                                               Child Interactions
                                                         Anticipatory Guidance
               Adult Education                           from ECE Provider
            Job & Life Skills                         Child Birth Classes                  Infant Mental Health
            Training                                Parenting Classes                      Consulting in ECE
                                                                                           Programs
         Marriage & Family                     Advice from Friends
         Counseling                            and Family                             Part C
    Case Management                         Parenting Information               Mental Health & Socio-
                                            from Media Sources
  Family Support                          Parent Education                      Emotional Development
Center for Healthier Children,
Families & Communities
                 Where Are We Now?
        Uncoordinated, Sector-Specific Services

                      $            $ Childcare   $Socio-     $           $
 State-Level              Health                              Parent      Family
                                     & Early     Emotional
  Agencies                Care                               Education   Support
                                    Education     Health




County-Level
 Agencies                  HC         ECE            SEH         PE          FS




Community
 Programs




  Center for Healthier Children,
  Families & Communities
              Where Are We Going?
     A Community Platform-Based Service System
                        $             Childcare   $Socio-     $             $
State-Level                 Health                              Parent           Family
                                     $ & Early    Emotional
 Agencies                   Care                               Education        Support
                                     Education     Health


                                      Inter-Agency Coordinating Council



                                     HC     ECE       SEH     PE       FS
County-Level

                                          Local Coordinating Council


Community-
   Based
 Platforms
for Services



    Center for Healthier Children,
    Families & Communities
  Converging Service Sector Strategies to Create an
 Early Childhood Integrated Service Delivery Platform
 Early Care & Education                                   Medical Home
          Deliberate Opportunities for Cognitive,                On-going Assessment of Child
          Physical, Social and Emotional Learning                Development
            Training on Child Health and Development               Elicit & Address Parent Concerns
                 Training on Maintaining a Safe and                   Anticipatory Guidance
                 Healthy Early Care Environment
                                                                        Preventive Health Care
                   Parent Education/Anticipatory Guidance                  Acute and Chronic Health Care
                       Child Observation to identify possible
                                                                              Integration with Community
                       physical/emotional health problems
                                                                              Resources for Referral
                           Linkage to Community Resources

                                Integrated Service Delivery System
                     Home Visiting                            Anticipatory Guidance
                                                              from Pediatrician                  Positive Parent-
                  Housing Services                                                               Child Interactions
                                                         Anticipatory Guidance
               Adult Education                           from ECE Provider
            Job & Life Skills                         Child Birth Classes                  Infant Mental Health
            Training                                Parenting Classes                      Consulting in ECE
                                                                                           Programs
         Marriage & Family                     Advice from Friends
         Counseling                            and Family                             Part C
    Case Management                         Parenting Information               Mental Health & Socio-
                                            from Media Sources
  Family Support                          Parent Education                      Emotional Development
Center for Healthier Children,
Families & Communities
                              ECCS Can Improve
                          School Readiness Trajectories
                                                    Parental Mental
                                                        Health                      Optimal Healthy
                    Lack of health services                                         Development and
                                                       Problems
                                                                                    School Readiness


                    Poverty                                                                Lower School
Ready to learn




                                                                                           Readiness trajectory:
                                                                           Pre-school      With diminished
                                                                                           function
                                                        Medical Homes w/
                                                        Developmental Services
                                       Literacy Programs

                     Parent education
                     Parent Support

                 Birth          Late Infancy                     Late Toddler         Late Preschool
                         6 mo       12 mo   18 mo        24 mo             3 yrs           5 yrs Age
                                                                           Early Preschool
                    Early Infancy
   Center for Healthier Children,
   Families & Communities
                                                    Early Toddler
            Young Children at Risk
                                     2-4%
                                    Severe
                                  Disabilities

                                    10-14%
                                 Special Health
                                  Care Needs

                                    30-40%
                                  Behavioral,
                                 Mental Health
                                   Learning
                                   Problems

                                   60-70%
                                 Good Enough
Center for Healthier Children,
Families & Communities
     Optimizing Early Child Health
          and Development
   Optimizing early childhood health and brain
    development requires
        Integration of clinical, targeted prevention, universal
         and broader social interventions
        Curve shifting strategies that minimize risks and
         maximize protective factors are necessary
        Policies that align levels of government and service
         delivery sectors (silos) within government in a
         common effort
        Place based programs that integrate early childhood
         services and program into a more integrated system
         of care
Center for Healthier Children,
Families & Communities
                                       Universal Curve Shift
                                                                                     Low income

                                                                                       Median

                                                                                            High income
  NUMBER OF CHILDREN




                                  DISABLED      VULNERABLE           Developmental
                                                               Function: School Readiness

                       Targeted         Clinical/Individual
                       Interventions    Interventions

Center for Healthier Children,
Families & Communities
                            Universal Curve Shift          Low income
                                                            Median
                                                               High income
  NUMBER OF CHILDREN




                           VULNERABLE           FUNCTION




Center for Healthier Children,
Families & Communities
                                      Gradients of Population Literacy


            2–


            1–
Literacy




            0–


           -1 –


           -2 –




                   Low income                                   High income

     Center for Healthier Children,
     Families & Communities
            2–


            1–
Literacy




            0–


           -1 –


           -2 –




                   Low income         High income

     Center for Healthier Children,
     Families & Communities
         Optimizing Early Childhood
          Health and Development
   The metaphor of building a bridge from birth to
    school evokes a common vision for how different
    sectors, and levels of government can unite around a
    common goal, can build a a responsive continuum of
    services and can enhance the developmental assets
    available for all young children
   To build a bridge from birth to school for all young
    children we need to have
        Bridging Concepts
        Bridging Strategies
        Bridging Platforms
        Bridging Pathways
        Bridging Tools


Center for Healthier Children,
Families & Communities
                              ECCS Can Improve
                          School Readiness Trajectories
                                                    Parental Mental
                                                        Health                      Optimal Healthy
                    Lack of health services                                         Development and
                                                       Problems
                                                                                    School Readiness


                    Poverty                                                                Lower School
Ready to learn




                                                                                           Readiness trajectory:
                                                                           Pre-school      With diminished
                                                                                           function
                                                        Medical Homes w/
                                                        Developmental Services
                                       Literacy Programs

                     Parent education
                     Parent Support

                 Birth          Late Infancy                     Late Toddler         Late Preschool
                         6 mo       12 mo   18 mo        24 mo             3 yrs           5 yrs Age
                                                                           Early Preschool
                    Early Infancy
   Center for Healthier Children,
   Families & Communities
                                                    Early Toddler
        Towards an Integrated Model of
       Building Early Childhood Systems*

                 FRAMING                          SYSTEMS DESIGN                          IMPROVING

                                              Child Development Outcomes
                Social
               Ecology
                                                    Systems of Change                       Measuring,
                                                                                            Monitoring,
          Life           Community                                                          Analyzing,
         Course                                     Bridging Concepts
                           Building                                                       Interpreting, &
                                                                                             Changing
                                             Bridging Strategies, Tool, Pathways          (PDSA cycles)
              Promoting
               Optimal
             Development                                   Policy


Center for Healthier Children,
Families & Communities           *adapted from A.Best, D.Stokels, L.Green, et al., AJHP, 2003.
       Medical Home Components of an
     Integrated Early Childhood Systems*

                 FRAMING                          SYSTEMS DESIGN                          IMPROVING

                                              Child Development Outcomes
               Medical
               Home
                                                    Systems of Change                       Measuring,
                                                                                            Monitoring,
     Developmental         Community                                                        Analyzing,
       Services                Based                Bridging Concepts
                                                                                          Interpreting, &
                             Services                                                        Changing
                                             Bridging Strategies, Tool, Pathways          (PDSA cycles)
              Promoting
               Optimal
             Development                                   Policy


Center for Healthier Children,
Families & Communities           *adapted from A.Best, D.Stokels, L.Green, et al., AJHP, 2003.
                             Strategies to Improve
                          School Readiness Trajectories
                                                    Family Discord
                                                                                    Social-emotional, Physical
                    Lack of health services                                            Cognitive, Language
                                                                                               function


                    Poverty                                                                 Lower trajectory:
Ready to learn




                                                                                            With diminished
                                                                           Pre-school       function

                                                     Appropriate Discipline

                                       Reading to child

                     Parent education
                     Emotional literacy

                 Birth          Late Infancy                     Late Toddler         Late Preschool
                         6 mo       12 mo   18 mo        24 mo             3 yrs           5 yrs Age
                                                                           Early Preschool
                    Early Infancy
   Center for Healthier Children,
   Families & Communities
                                                    Early Toddler
                              ECCS Can Improve
                          School Readiness Trajectories
                                                    Parental Mental
                                                        Health                      Optimal Healthy
                    Lack of health services                                         Development and
                                                       Problems
                                                                                    School Readiness


                    Poverty                                                                Lower School
Ready to learn




                                                                                           Readiness trajectory:
                                                                           Pre-school      With diminished
                                                                                           function
                                                        Medical Homes w/
                                                        Developmental Services
                                       Literacy Programs

                     Parent education
                     Parent Support

                 Birth          Late Infancy                     Late Toddler         Late Preschool
                         6 mo       12 mo   18 mo        24 mo             3 yrs           5 yrs Age
                                                                           Early Preschool
                    Early Infancy
   Center for Healthier Children,
   Families & Communities
                                                    Early Toddler
                           Building Bridges
   Bridging Concepts: School Readiness, Health
    Development
   Bridging Policies: State Early Childhood Comprehensive
    Systems Initiative
   Bridging Strategies: Creating integrated &
    comprehensive medical homes, functionally integrated in
    to school readiness pathways
   Bridging Platforms: School-linked school readiness
    centers, Pediatric Medical Homes,
   Bridging Tools:
        Promoting Healthy Development Surveys
        Healthy Steps and NICHQ Improvement Methods
   Bridging Pathways: School Readiness Pathways
Center for Healthier Children,
Families & Communities
Bridging Concepts
  Healthy Development and
     School Readiness
       Medical Home Components of an
     Integrated Early Childhood Systems*

                 FRAMING                          SYSTEMS DESIGN                          IMPROVING

                                              Child Development Outcomes
               Medical
               Home
                                                    Systems of Change                       Measuring,
                                                                                            Monitoring,
     Developmental Community                                                                Analyzing,
       Services       Based                         Bridging Concepts
                                                                                          Interpreting, &
                             Services                                                        Changing
                                             Bridging Strategies, Tool, Pathways          (PDSA cycles)
              Promoting
               Optimal
             Development                                   Policy


Center for Healthier Children,
Families & Communities           *adapted from A.Best, D.Stokels, L.Green, et al., AJHP, 2003.
                       School Readiness
         National Goals Panel – School Readiness
     i.     Schools ready for children
     ii.    Children ready for Schools
     iii.   Families and Communities support

         NAEYC –children ready for schools
           Cognition and general knowledge
           Social Emotional Development
           Physical Well Being & Motor Development
           Language Development

Center for Healthier Children,
Families & Communities
                              ECCS Can Improve
                          School Readiness Trajectories
                                                    Parental Mental
                                                        Health                      Optimal Healthy
                    Lack of health services                                         Development and
                                                       Problems
                                                                                    School Readiness


                    Poverty                                                                Lower School
Ready to learn




                                                                                           Readiness trajectory:
                                                                           Pre-school      With diminished
                                                                                           function
                                                        Medical Homes w/
                                                        Developmental Services
                                       Literacy Programs

                     Parent education
                     Parent Support

                 Birth          Late Infancy                     Late Toddler         Late Preschool
                         6 mo       12 mo   18 mo        24 mo             3 yrs           5 yrs Age
                                                                           Early Preschool
                    Early Infancy
   Center for Healthier Children,
   Families & Communities
                                                    Early Toddler
 School Readiness and Pediatric
             Care
   School Readiness is an important framing and
    bridging concept
   School Readiness as defined by NEGP is
    equivalent to a Health Related Quality of Life
    (HRQL) measure for young children
   Pediatricians have always been in the school
    readiness business
   Pediatricians need to consider how to take
    advantage of national focus on school readiness
    and connect practice and quality improvement
    efforts to this important new policy frame.

Center for Healthier Children,
Families & Communities
       Medical Home Components of an
     Integrated Early Childhood Systems*

                 FRAMING                          SYSTEMS DESIGN                          IMPROVING

                                              Child Development Outcomes
               Medical
               Home
                                                    Systems of Change                       Measuring,
                                                                                            Monitoring,
     Developmental Community                                                                Analyzing,
       Services       Based                         Bridging Concepts
                                                                                          Interpreting, &
                             Services                                                        Changing
                                             Bridging Strategies, Tool, Pathways          (PDSA cycles)
              Promoting
               Optimal
             Development                                   Policy


Center for Healthier Children,
Families & Communities           *adapted from A.Best, D.Stokels, L.Green, et al., AJHP, 2003.
Bridging Strategies
  School Readiness Delivery
          Pathways
                            Critical Pathway
                          to School Readiness
  Family support &
intervention services
                                                                            Family
                                                                          functioning
                                    Families reading
Parent education                       together

                                                                          Early literacy    School
 Access to books                    Quality child care
   and libraries                   and early education
                                                                                           Readiness
                                        programs
                                                                          Child health &
Medical Home as                                                           Development
Regular Source of                   Developmental
  Primary Care                      Health Services

                                                                         Maternal
Health insurance                      Prenatal care
                                                                          health

                                                         Breastfeeding
  Center for Healthier Children,
  Families & Communities
Center for Healthier Children,
Families & Communities
Bridging Strategies
  School Readiness Delivery
          Platforms
                Readiness to Learn Trajectory
Service sectors and Programs that influence school readiness
                                                                                                      Compliance to simple requests
                                                                                                    Emotional control
                                                                                                Functional use of language
                                                         Nascent awareness of standards       Exploration of object world
                                                       Nascent emotional regulation        Effective peer interactions
                                                     Nascent selfhood/identity
                      Social relationships         Language Development
                    Physiological regulation
                Entry into verbal milieu
             Attentional/motoric “control” of object world


             Birth      6 mo          12 mo          18 mo       24 mo                    3 ys                 4 ys                   5ys


Health                 Ongoing well child care, acute, developmental and preventive care
 Pre/perinatal care


Education:        Early Intervention Programs (including Head Start and Early Head Start)
                                                                                                        Pre-school

Social &                                            Parenting and Family Literacy Programs
Family                                     Center and Home Based Family Resource Programs
Services:
                                                               Child Care Programs
                            Service Organization
            for Early Brain and Child Development

                         Programs influencing Early Brain,
                       Child Development & School Readiness
                                                            Kindergarten
   Pre/perinatal
                                 Child care       Nursery                  Parenting and Family
     support
                                  centers         Schools                   Literacy Programs
      Family
     Child Care              Family                 Pediatric
                        Resource Programs           services        Child Care
                                                                Resource Programs

                                          Recreation &
                                          Arts Programs
                 E.I.                                              Children’s Library
               programs                                                Programs



Center for Healthier Children,
Families & Communities
                    Service Organization for
             Early Child Development and Parenting

        Home-visiting                                                              Specialized
        network                                       Parent                       services
                                                     Support
                                     Pre/Postnatal             Pediatric
                                      Health                       Care
                                     Care
                                                                    Early
Home-based                Information                                Headstart
satellites                 & referral
                             services
                                                                     & Headstart        Family
                                                                      Family            Day Care
                              Toy and                                Events
                              resource
                                 libraries
                                                               Play-based
                                               WIC        problem solving
    Libraries
                                             Programs                              Recreation
                                                                                   Programs


    Center for Healthier Children,
    Families & Communities
Center for Healthier Children,
Families & Communities
                   Service Organization for
            Early Child Development and Parenting
                                           Parenting Support

          Early                                                            Early Child
    Intervention                                                           Mental Health
                                                                           Services

                              Preventive                         Acute
                                 Care                             Care
Home-visiting
network                                                                         Early
                                                                                HeadStart
                                                                                & HeadStart
                            Developmental                        Chronic
                               Services                           Care


                                                                             Child Care
                                                                             Resource &
   Developmental
                                                                             Referral
         Services
                                                                             Agency
    Center for Healthier Children,
                                             Lactation Support
    Families & Communities
       Medical Home Components of an
     Integrated Early Childhood Systems*

                 FRAMING                          SYSTEMS DESIGN                          IMPROVING

                                              Child Development Outcomes
               Medical
               Home
                                                    Systems of Change                       Measuring,
                                                                                            Monitoring,
     Developmental Community                                                                Analyzing,
       Services       Based                         Bridging Concepts
                                                                                          Interpreting, &
                             Services                                                        Changing
                                            Bridging Strategies, Tool, Pathways           (PDSA cycles)
              Promoting
               Optimal
             Development                                   Policy


Center for Healthier Children,
Families & Communities           *adapted from A.Best, D.Stokels, L.Green, et al., AJHP, 2003.
                                   POLICY                       Includes:
                                                                Doctors
                                                                Schools
                                                               Child Care
                                  COMMUNITY


                                 NEIGHBORHOOD
                                    SERVICES


                                    FAMILY




                                    CHILD




                                                Child Health




Center for Healthier Children,
Families & Communities
A 2020 Vision of Pediatric Care:
        Strategic Goals
         Automatic and affordable health
          insurance for all children and parents
         Comprehensive benefits--preventive
          care, medical care, dental care, mental
          health care, developmental services
         Medical home with a designated
          physician or pediatric nurse
          practitioner responsible for every child



Center for Healthier Children,
Families & Communities
        2020 Vision of Pediatric Care:
    Strategic Goals for the Medical Home

   Information and resources for parents and
    childcare providers
   Hubs of health development connectivity--
    automatic linkage to developmental services,
    early interventions, child care, and school-
    based services
   Use of information technology--reminders for
    visits, e-mail with pediatric clinician, parent
    information
   Commitment to quality improvement with
    measurable accountability

Center for Healthier Children,
Families & Communities
          Developmental Services
   Assessment Services
        Surveillance – community wide approaches
        Screening- targeted or universal
        Assessments- focused on those who need it
   Anticipatory Guidance and Education
   Developmental Interventions
   Care Coordination

Center for Healthier Children,
Families & Communities
   Effective Medical Home: Improving
 Provision of Developmental Services in
           Pediatric Practices

         Innovative thinking/re-engineering
         Provider, practice and system change
         Leverage existing health care dollars
         Evaluating what works




Center for Healthier Children,
Families & Communities
New National Surveys for Assessing
 Content of Health Supervision for
 U.S. Children under 3 Years of Age




Center for Healthier Children,
Families & Communities
Center for Healthier Children,
Families & Communities
      Specialty of Providers of Well Child
        Visits in 1999, by Patient Age
                              Pediatricians                Other

100%

80%

60%

40%

20%

  0%
                  Infants                  Age 2-6               Age 7-12
 Center for Healthier Children,   Source: AAP Analysis of 1999 NAMCS
 Families & Communities
  Health Supervision Topics That Parents
Discuss, and Don’t Discuss, But Would Find
                  Helpful
 Disc ussed           Not disc ussed      Not disc ussed, would have been helpful


  100%            14%             18%      17%
                                                              25%       23%

                 33%
                                 46%                          28%       30%
                                          55%
   50%

                 52%                                          43%       44%
                                 35%
                                          27%
     0%
                4-9               10-18    19-35              10-18     19-35
               months            months   months             months    months
                             Child care                      Guidance/Discipline
Center for Healthier Children,
Families & Communities
Health Supervision Topics That Parents Discuss,
   and Don’t Discuss But Would Find Helpful
      Discussed               Not discussed        Not discussed, but would have been helpf ul



   100%           6%              4%          7%                                        10%
                 2%               4%                             16%         16%
                                           19%
                                                                 20%         19%        27%


     50%          91%             92%
                                           73%                               63%
                                                                 62%                    61%



       0%
                4-9           10-18       19-35                 4-9        10-18       19-35
               months         months      months               months      months      months
                       Food and feeding                                  Reading

 Center for Healthier Children,
 Families & Communities
Recall of Developmental Assessment
   Ever Being Done (Children 4-35 Months)
                                  DA
                                 56%


   No DA
   44%




Center for Healthier Children,
Families & Communities
Parent Recall of Developmental Assessment Varies Little by
    Type of Health Insurance (Children 12-35 Months)


                                  Recall being told of DA


     100%




                      42%         44%              43%
                                                                37%




       0%
                     Private      Public        Private and   Uninsured
                                                   public

 Center for Healthier Children,
 Families & Communities
      Factors Associated with provision of
              Developmental Services
Physician/staff capacity
     Lack of non-physician to do DA
     •


     Lack of training
     •


     Unfamiliarity with DA instruments
     •


Office resources
     Time limitations
     •


     Inadequate reimbursement
     •


     Inability to bill and be reimbursed separately
     •


     Unfamiliarity with CPT codes for DA
     •


Community resources
     Lack of developmental diagnostic/treatment
     •

     services
     Lack of programs to refer to
     •




Center for Healthier Children,
Families & Communities
Targeted Initiatives:
Improving Pediatric
   Developmental
Services to Optimize
 the Medical Home
  Innovations to Improve Delivery of
    Developmental Services and to
       Create Medical Homes
     Practice redesign - Healthy Steps
     Improve Connectivity - Child Serve
     Create Pathways- Denver System
     Improve Accountability - CAHMI PHD
     Improve Quality – NICHQ
     Improve Systems- Orange County

Center for Healthier Children,
Families & Communities
            HS Specialist & 7 Services
    Enhanced WC Care
    Home Visits
    Telephone Line
    Child Development &
    Family Check-Ups
    Written Materials
    Parent Groups
    Linkages to Resources        2 HS Specialists/site
                                 (1 per 100 families)


  A Physician-Developmental Specialist Partnership

Center for Healthier Children,
Families & Communities
         Innovations to Improve Delivery of
            Developmental Services and
             to Create Medical Homes

   Practice redesign - Healthy Steps
   Improve Connectivity – Help Me Grow
   Create Pathways- Denver System
   Improve Accountability - CAHMI PHD
   Improve Quality – NICHQ
   Improve Systems- Orange County, Ca

Center for Healthier Children,
Families & Communities
   Help Me Grow- The Process

                                 Child Health Provider

              Language/Behavior/Parenting Concerns

                                 1-800-Help Me Grow

 Referrals: Language Eval; Play and Support Groups

              Two Week Follow-Up Contact: Enrolled

                    Feedback to Child Health Provider

Center for Healthier Children,
Families & Communities
          Innovations to Improve Delivery of
             Developmental Services and
                       to Create Medical Homes

   Practice redesign - Healthy Steps
   Improve Connectivity - Child Serve
   Create Pathways- Denver System
   Improve Accountability - CAHMI PHD
   Improve Quality – NICHQ & NCCCHQI
   Improve Systems- Orange County, Ca

Center for Healthier Children,
Families & Communities
  Denver Health General Pediatrics Model
 Multi Step Surveillance, Assessment and Referral Model

                                                                    Individual
                                             Special Assessment       Family
                                                                                     Part C
                                               & Coordination         Service        IDEA
                                                                       Plan
   9-18 mo.
                          Abnormal               2 Yr.                           3 Yr.
  Pediatric
                                               Pediatric                     Pediatric
Developmental                                Developmental                 Developmental
 Surveillance              Normal             Surveillance                  Surveillance




                             Monitoring                       Monitoring

                                     Continuous Quality Improvement


 Center for Healthier Children,
 Families & Communities
     Innovations to Improve Delivery of
    Developmental Services and to Create
              Medical Homes

   Practice redesign - Healthy Steps
   Improve Connectivity - Child Serve
   Create Pathways- Denver System
   Improve Accountability - FACCT PHD
   Improve Quality – NICHQ & NCCCHQI
   Improve Systems- Orange County, Ca

Center for Healthier Children,
Families & Communities
                   Improving Accountability:
                     Developmental Care
               for Young Children: CAHMI PHD
               Seven Core Measures in the PHDS
     Anticipatory Guidance (Bright Futures and AAP Criteria)
     Getting Health Information
     Follow-Up for Children At Risk for Developmental/
      Behavioral Delays
     Assessment of Smoking, Alcohol or Other Substance
      Abuse
     Assessment of Well-Being and Safety in the Family
     Family Centered Care
     Helpfulness and Effect of Care Provided
    Center for Healthier Children,
    Families & Communities
                Performance in
         12 Managed Care Organizations
             WA State, CA and Ohio
                                        Range
    Anticipatory Guidance             60.5-76.9
    Health Information                60.9-83.6
    Follow-Up for Children at Risk    35.5-65.7
    Assessment of Well-Being/Safety   15.2-34.6
    Assessment of Smoking, Drugs      43.1-65.9
    Family Centered Care              59.5-74.5



Center for Healthier Children,
Families & Communities
         Innovations to Improve Delivery of
            Developmental Services and
             to Create Medical Homes

   Practice redesign - Healthy Steps
   Improve Connectivity – Help Me Grow
   Create Pathways- Denver System
   Improve Accountability - CAHMI PHD
   Improve Quality – NICHQ
   Improve Systems- Orange County

Center for Healthier Children,
Families & Communities
                                                                   Regional Center
                                                Assessment        Severe Disabilities
                                                   Phase
                             Screening
                               Phase
                                                   Midlevel
                                              Assessment Center


                                                                   Coordination &
  Surveillance                                                    Case Management
     Phase                 Pediatric office




    Child Care
      WIC                        Community Pathways for Early
        SR                       Identification, Assessment, Treatment,
                                 Rehabilitation and Coordination

Center for Healthier Children,
Families & Communities
Improving Early Childhood Health Care &
      Medical Home Development
   Vision for what the early childhood health
    system will look like
   Communication Strategy re:
       Development Health and School Readiness
       Medical Home
       Developmental Services
       Re-engineering current systems
            Connecting medical home and child care
              Improving capacity of medical home to provide
               developmental services
Center for Healthier Children,
Families & Communities
Improving Early Childhood Health Care &
      Medical Home Development
   Consider State Wide Agenda Setting
    Conference to:
        Bring the various players in the health sector
         together
        Create a common vision about the importance
         of improving developmental services, service
         delivery pathways, and systems change
         strategies
        Consider a child sector level strategy focused
         on improving the development and function of
         medical homes
Center for Healthier Children,
Families & Communities
Improving Early Childhood Health Care &
      Medical Home Development
   Develop policy strategies that overcome
    barriers for fully functional medical homes
        Reimbursement and contracting changes to
         create incentives for the provision of
         developmental services
               Coding and reimbursement strategies
               Medicaid Contract language
        Quality measurement and monitoring
         strategies focused on provision of
         developmental services
Center for Healthier Children,
Families & Communities
Center for Healthier Children,
Families & Communities
     UCLA Center for Healthier Children,
          Families and Communities
                       &
     National Center for Infancy and Early
           Childhood Health Policy




                            Http.//healthychild.ucla.edu


Center for Healthier Children,
Families & Communities

				
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