Transcript California Children’s Services

Developmental Screening
April 4, 2009
Baseball, Child Advocacy,
and the Role of CCS
Paul Russell, MD
Children’s Medical Services
Department of Public Health
St. Mary’s Industrial School
Foster Care Baseball Team
1914
St. Mary’s Industrial School
Foster Care, Pitcher, 1914
World Series, 1918
Babe Ruth
Hospital Visit
Circa 1926
Child Advocacy in America
1927: “Crippled Children’s Services” Program
started in California
1930: American Academy of Pediatrics founded to
respond to the special developmental
and health needs of children.
1935: Title V, Social Security Act passed to
promote and improve maternal and child
health nationwide. Seventy-four years
later, Title V remains the longest lasting
public health legislation in our Nation’s
history.
California Children’s Services
CCS
Medical Treatment Program
Medical Therapy Program
CCS Program Eligibility
Medical Eligibility: Diagnosis Based
- CCS eligible condition as per Title 22, Division 2, Part 2,
Subdivision 7, CCS, Chapter 4, Section 41832
Residential
- Resident of the county
- Or enrolled in public schools
Financial
- M/C, HF, or Annual income under $40K
- Medical cost > 20 % of annual income
CCS Referral Process
* Initial referral by hospital, physician, family.
* Medical records are required by CCS; review
for support of requested services.
* The family completes and submits
application.
* Nurse, MD and/or therapy manager
determine medical eligibility.
Referral Confusion and
MTP Eligibility
Title 22, Section 41517.5
“(a) CCS applicants with at least one of the following
conditions shall be medically eligible for
participation in the CCS Medical Therapy Program:
(1) Cerebral palsy as specified in Section 41517.3(a)(2).
(2) Neuromuscular conditions that produce muscle
weakness and atrophy, such as poliomyelitis,
myasthenias, and muscular dystrophies.
(3) Chronic musculoskeletal and connective tissue diseases
or deformities such as osteogenesis imperfecta,
arthrogryposis, rheumatoid arthritis, amputations, and
contractures resulting from burns.
(4) Other conditions manifesting the findings listed in
section 41517.3(a) above, such as ataxias, degenerative
neurological disease, or other intracranial processes. ”
“(b) CCS applicants under three years of age shall be
eligible when two or more of the following
neurological findings are present:
(1) Exaggerations of or persistence of primitive
reflexes beyond the normal age (corrected for
prematurity);
(2) Increased Deep Tendon Reflexes (DTRs) that are 3+
or greater;
(3) Abnormal posturing as characterized by the arms,
legs, head, or trunk turned or twisted into an
abnormal position;
(4) Hypotonicity, with normal or increased DTRs, in
infants below one year of age. (Infants above one
year must meet criteria described in (a)(1)); or
Title 22 Sect. 41517.3.a.2
“Cerebral palsy, a motor disorder with onset in
early childhood resulting from a nonprogressive lesion in the brain manifested by
the presence of one or more of the following:
(A) Rigidity or spasticity
(B) Hypotonia, with normal or increased DTR’s, and
exaggeration of or persistence of primitive
reflexes beyond the normal age range
(C) Involuntary movements that are described as
athetoid, choreoid or dystonic
(D) Ataxia manifested by incoordination of voluntary
movement, dysdiadochokinesia, intention tremor,
reeling or shaking of trunk and head, staggering
or stumbling, and broad based gait.”
Diagnostic Confusion:
The Hypotonic Infant
* Hypotonic cerebral palsy
* Developmental delay with
hypotonia
* Myopathy
Referral Confusion:
The Hypotonic Infant
Less than one year:
* hypotonia with increased DTRs….refer to
CCS
* hypotonia, developmental delay….refer to
Regional Center/Early Start
* hypotonia with isolated gross motor
delay…refer to CCS for diagnostic
evaluation
Hypotonia with exaggerated primitive reflexes
at any age…refer to CCS
Clonus
Types of CCS Cases



CCS only – medical case management
only; no MTP services
MTP only – receive PT/OT at MTU,
limited medical case management
CCS and MTP – therapy and medical
case management
Medical Therapy Program
MTP



Physical Therapy
Occupational Therapy
Medical Therapy Conference
Medical Therapy
Conference (MTC)


Specialty team - It is the function of
the MTC to bring together the
expertise of combined professional
services in order to bring maximum
benefit to the child and his/her family
Role - Medical Direction versus
Consultation
Medical Therapy
Conference
Pediatric Orthopedist
Pediatrician
Physical Therapist
Occupational Therapist
Orthotist
Social Worker
Nutritionist
CCS Case Manager
Misconception
Therapy is good, more is better.
Medically Necessary
Therapy


Once eligible, a therapy assessment is done
to determine if there is a need for medically
necessary therapy (as opposed to
educationally necessary)
Services are provided under medical direction
(paneled provider)
– Prescriptions
– Medical reports documenting functional gains

Therapy is for habilitation and rehabilitation
caused by the MTP eligible condition
Primary Care Physician
Role



Perform formal developmental
screening
Refer to appropriate agency
Be an active member of the team