Transcript Newport County CATCH

Newport County
Community Access to Child Health
(CATCH)
Creating Medical Homes for
all Children in Newport
County, RI
Newport, Middletown, Portsmouth, Tiverton,
Little Compton, Jamestown
Beginning Ideas
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Newport County CATCH grew out of
the commitment to child well-being*
of the Newport Partnership for
Families (NPFF), an existing
community collaboration representing
over 35 human service agencies,
businesses and other organizations in
Newport
* Child well-being is one of four
priority areas measured by the NPPF
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Initial Steps
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Step 1: Received a planning grant based on
the NPFF’s identification of access barriers
to healthcare for young children.
Step 2: Conducted outreach to the
community to assess the quality of Medical
Homes and training needs required to care
for Children with Special Health Care Needs
(CSHCN)
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Newport County CATCH
Purpose:
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The primary purpose of the Newport
County CATCH/Medical Home Initiative
is to facilitate the creation of medical
homes for all children in Newport
County. Medical homes will posses the
seven common elements as defined by
the American Academy of Pediatrics
(AAP)
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Newport County CATCH
Goals:
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Develop and implement a care
coordination system to support the
medical home
Identify and reduce barriers to medical
homes.
Provide medical home training to
parents, medical and human service
providers
Evaluate the impact of our interventions
Implement systems to sustain and ensure
quality medical homes for all children.
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Newport County CATCH
Funding
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Current funding for Newport County
CATCH is provided by:
– Newport Hospital
– RI DOH, Division of Family Health
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Newport CATCH
Organizational Structure
CATCH
Steering Committee
James Sattel
Newport CATCH Coordinator
Medical Home Training
Work Group
Care Coordination
Work Group
Barriers to Medical Homes
Work Group
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Function Description
Group
Function
Steering
Provides oversight and feedback
to the work group action plans.
Committee
Work Groups Form work group objectives and
strategies and provide medical
home training.
Project
Supports the advisory committee
Coordinator and work groups; produces
reports; and is a single point of
contact for providers and families
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Newport County CATCH
Medical Home Advisory
Committee
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CEDDARs
Covering Kids and Families
Early Intervention
East Bay Community Action Program (EBCAP)
Family Practice Physicians
Head Start
Health Plans
Newport & Middletown Public Schools Family
Center/COZ
Newport Partnership for Families
Newport County Health Advocates
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Newport County CATCH
Medical Home Advisory
Committee
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Newport County Community Mental Health Center’s
Child Intensive Services (CIS) and Child and Adolescent
Services Program (CASP)
Newport Hospital
Parents
Pediatric Practice Enhancement Project (PPEP) Parent
Consultant (PC)
Pediatricians
Rhode Island Department of Health
Rhode Island Health Center Association
Special Education Departments
Visiting Nurse Service of Newport and Bristol Counties 10
Traditional Pediatric Delivery System
Fragmented, Hard to Navigate, Episodic,
Expensive
Recreation
Community Support
Groups/Resources
Health Plans
Pediatrician/
Family Practitioner
Special Education
Mental Health
Family
Transportation
Family Services
Schools
Early Intervention
Child Outreach
Home Care
Rehab Services
Sub-specialists
Emergency Care
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Comprehensive/Coordinated
Family - Centered Medical Home
CEDDAR
NHPRI
Newport Hospital
FRCs/FSCs
Child Outreach
Head Start/Child Care
RIPIN/Family Voices
Medical Home
-Physician
-Family
(PPEP)
Parent Consultant
Aquidneck Medical
Associates
EBCAP
Sub-specialists
Early Intervention
Home Care
Rehab Services
Special Education
Schools
Mental Health Services
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Physician Practice
Training Team
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Objectives: To develop and offer
current, meaningful, and communityfocused medical home trainings for
pediatricians and family practitioners
and their staff
To establish a single point of contact as
a resource for quality improvement
(CATCH Coordinator)
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Physician Practice
Training Team
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Action Step: Developed a curriculum which
includes
– The history of Newport County CATCH
– Community assessment methodology and
findings
– Common elements of a medical home
– Cost benefits of operating a medical home,
particularly for utilizing care coordination
services
– Codes for extended care
– Medical Home indicators (for self-evaluation)
– Strategies for medical home improvement
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Community Agencies
Training Team
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Objective 1: Share care coordination
information with the community
through medical home trainings, single
point of contact and through the
development of a medical home
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Community Agencies
Training Team
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Action Step: Provided medical home
training to approximately forty five health
care coordinators* at agencies throughout
Newport County.
* Agency care coordinators include family
service coordinators, mental health workers,
nurse/educators, health advocates, case
managers, social workers, physicians and
practice staff (any provider that links
families to community services)
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Community Agencies
Training Team
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Objective 2: Identify and document all
sources of care coordination support
Such as PPEP, CEDARR , East Bay Community Action
Program, Child and Family Services, Newport County
Mental Health Center, NHPRI Case Management,
Housing Authority, Family Service Coordinators, COZ
Centers, Visiting Nurse Service of Newport and Bristol
Counties, Head Start, Early Intervention, Newport
and Regional Special Education, Dr. Martin Luther
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King Jr. Center, CODAC
Community Agencies
Training Team
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Action Step: Developed a comprehensive
list of agencies that provide care
coordination by disseminating a care
coordination services survey .
– Based on returned surveys, developed a
Pediatric Care Coordination Directory that
defines the scope of care coordination
provided by each agency (40 Agencies
Represented)
– Distributed over 120 Directories to
agencies and physician practices as part
of Medical Home Trainings
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Community Agencies
Training Team
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Objective 3: Assist in orienting PC’s
to community care coordination
services and through the PPEP
provides Newport County CATCH with
feedback about gaps or delays in
service delivery
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Family Training Team
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Action Step 1: Developed a family
questionnaire to capture current and
specific problems regarding barriers to
medical homes and to define the
educational needs of the families.
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Family Training Team
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Action Step 2: Provided medical home
education for families through focus groups.
– Educated over 400 parents on medical home
concepts during focus groups.
– The 400 parents represented parents served by
support groups, Head Start, Even Start, the
Newport Hospital Birthing Center, mental health
parent groups, and the Newport County Regional
Special Education Advisory Committee, etc.
– Families are instructed on how to advocate for
their child and how to make maximum benefit of
the visit to the medical home
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Barriers Workgroup
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Objective:
Identify and
address barriers
to use of
medical homes,
including:
Transportation
Language
Health Insurance
Jim's Email.lnk
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Barriers Workgroup
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Survey findings on transportation:
– No bus service on Memorial Blvd. which is
the location of the largest pediatric
practice in Newport County
– Confusion over RIte Care transportation
benefits.
– Bus routes are unclear.
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Barriers Workgroup
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Transportation Actions Taken:
– Partnered with RIPTA to create a medical
home bus route map to be distributed at
the birthing center, physicians offices, and
to parents in medical trainings.
– DHS provided CATCH with an explanation
of transportation benefits which will be
distributed to parents and providers.
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Barriers Workgroup
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Survey findings on language &
culture:
– Parents don’t understand medical jargon.
– Lack of written bilingual information.
– Parents find it difficult to tell the doctor
they don’t understand their instructions.
– Cultural sensitivity is lost if a different
doctor is seen at each visit.
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Barriers Workgroup
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Language recommendations made:
– Raise awareness of RIte Care interpretation/
translation benefits.
– Create flyers in multiple languages describing
the above benefit to distribute to parents at
medical home trainings.
– Encourage physicians to assess their practice’s
need for interpreters.
– Ask physicians what bi-lingual information would
be useful for the practice and help them get it.
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Barriers Work Group
Health Insurance
 Identify locations where families present
without insurance i.e. Newport Department
of Labor and Training, Housing Authority
Intake Offices, Urgent Care Facilities, E.R.
etc.
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Collaborate with Covering Kids to provide
community education concerning RIte
Care/RIte Share benefits, eligibility
guidelines and enrollment procedures
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Newport County CATCH
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Overall Lessons Learned:
Simplify medical home jargon. Make it Relevant
One-on-one visits with organizations work best.
Use visits to learn of services that are or are not
available in the community
Plug into existing community organization
networks, develop collaborations
Help stakeholders understand how they benefit
from medical homes.
Tailor medical home trainings to your audience ie
families, human service agencies, PCP’s
Family input is critical in the development of
curriculums and training strategies
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Future Initiatives
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Collaborate with the PPEP to define access barriers
and capacity issues & continue collaborative
problem solving with providers and families
Collaborate with the RI Lung Association, Hasbro
Children's Hospital and Newport Hospital to
implement community needs assessment and
training for asthma
Develop Neighborhood Training Teams in
collaboration with the Newport Housing Authority
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Future Initiatives
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Provide medical home training to school educators,
FSC(s) and health advocates as part of the Train
the Trainer Initiative
Collaborate with mental health and special
education services to integrate care into the
medical Home
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Develop a Newport County Medical Home web-site
for families and providers
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Maintain and build upon established medical home
services and products
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Obtain funding to sustain Newport County
CATCH/Medical Home Initiative
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Newport County CATCH
For more information contact:
James Sattel
Newport County CATCH /Medical Home
Initiative Coordinator
435 Broadway
Newport, RI. 02840
(401) 847-2100; ext 223
[email protected]
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Newport County CATCH
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Question and Answer Time
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