Transcript Medical Home Works! - AAP Early Education and Child Care

Workshop E-6
Building Momentum
For Family-Centered
Medical Homes
Moderator: Jeffrey Lobas, MD, FAAP
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Session Objectives
1) Increase understanding of
Medical Home concept
2) Examine how the Medical Home
applies to ECCS components
3) Identify steps for integrating
Medical Home and ECCS
activities
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Session Objectives
3) Assess how use of Medical
Home Family Story Videos can
build capacity in implementing
Medical Homes in communities
4) Discuss ways that health
professionals and families can
support improved outcomes for
young children
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ECCS
Purpose: To support State Maternal and
Child Health Agencies and their partner
organizations in collaborative efforts to
strengthen the State's early childhood
systems of services for young children
and their families.
– Access to medical homes for all children
– Mental health and social-emotional
development
– Early care and education services
– Parent education
– Family support services
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Medical Home
...“a headquarters for care” that includes
– a person as the usual source of care as well as
– a place AND a process for the anticipation,
coordination, and provision of care that is:
• accessible
• family-centered
• continuous
• comprehensive
• coordinated
• compassionate and
• culturally-effective
Cooley, et al. The Medical Home Index: Development and
Validation of a New Practice-level Measure of Implementation of
the Medical Home Model. Ambulatory Pads 2003;3:173-180.
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With a Medical Home
Medical Specialists
Religious/
Spiritual
Support
Community
Resources
and Agencies
Child and
Family
Parent
Support
Services
Financial
Assistance
Mental
Health
Services
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Without a Medical Home
Medical
Specialists
Community
Resources
and Agencies
Religious/
Spiritual
Support
Child and
Family
Parent
Support
Services
Mental Health
Services
Financial
Assistance
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Looking in on Iowa
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Medical Home Works! Hawaii
Medical Home
Family Stories
Hawaii Medical Home
Implementation Project
Sharon C. Taba, MEd
Lynn B. Wilson, PhD
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Medical Home Works! Hawaii
Genesis of Medical Home
Family Stories
• Identified need for family-centered Medical
Home curriculum
• Offered community-based ‘picture’ of Medical
Home partnerships: families, physicians, and
community agencies working together
• Interviewed physicians & families of children
who are medically fragile for 3 video stories
• Created 15 minute template
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Medical Home Works! Hawaii
Hawaii State Department of Health
ECCS Goals for Medical Home
• Promote Medical Home
• Promote timely developmental
screening
• Strengthen parent/family support to
keep “keiki” safe
• Apply Medical Home in piloting
transitional housing
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Medical Home Works! Hawaii
Introduction to DVD Videos
& Bryan’s Story
• DVD contents: videos, 3 inserts,
evaluation, additional materials
accessed by computer
• Insert contents: MH partners, Dr’s
notes, learning points
• Bryan’s Story: child & family, physician,
Head Start, inter-professional team
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Medical Home Works! Hawaii
Questions for Viewing
• What worked well, what didn’t work well
in the Medical Home?
• What are issues and barriers to making
Medical Home partnerships work?
• How can we advocate for Medical Home
within our state programs, e.g., MCH,
ECCS?
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Medical Home Works! Hawaii
Bryan’s Story
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Medical Home Works! Hawaii
Producing Medical Home
Family Stories
• GOAL: create ‘learner centered’ processoriented curriculum
• GOAL: create videos to focus on what
Medical Home partnerships look like
• Criteria for selecting families and
physicians
• Criteria for selecting Medical Home issues
in each video
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Medical Home Works! Hawaii
Medical Home Family Stories
Evaluation Results
• Focus groups & written evaluation
strategies- local, national, international
• Very positive responses from families and
trainers
• Luke-warm responses from community
pediatricians and pediatric training
faculty
• Need for broader family-centered stories
focused on the Medical Home concept
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Medical Home Works! Hawaii
Recommendations for Use of
Videos from Evaluations
• Train new professionals
• Increase families’ understanding of the
possibilities of Medical Home at the
service level
• Build capacity among community
professionals
• Provide inter-professional training
environments
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Medical Home Works! Hawaii
Mahalo & Aloha!
[email protected]
[email protected]
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Virginia Early Childhood
Comprehensive Systems
Grant
Colleen Kraft, M.D., FAAP
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Learning Objectives
• Functional explanation of Medical Home
to our state collaborative partners
• Promotion of Medical Home principals,
values, and components within a state
plan
• Integration of child health with other
child values and responsibilities within
our state
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Early Childhood Success
• Nationally it has
been estimated that
25-40% of children
are not ready to be
successful in
kindergarten
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Challenges for Parents/Families in
Virginia
31% percent of births are to
single mothers
17 of 1000 births are to a 15-17
year old mother
13% of children live in poverty
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Challenges for Families
• 62% with both parents working
• 68% women and 85% men working
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Factors Predicting Child Success
• Family psycho-social factors
(depression, domestic violence)
• Quality of early education experiences
• Parent-child attachment
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Factors Predicting Child Success
• Prenatal-Postnatal health
• Parents promoting early learning
• Family economic security
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Research and scientific evidence
supports the following six points:
• Learning begins at birth
• Children need to be healthy in order
to be ready to learn
• School readiness is multidimensional
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Research
• Failure to start school healthy and
ready to learn is expensive
• Quality out of home care matters
• Investment in early years pays off
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Virginia’s Response to the Issues
• Five year planning and implementation
initiative from the federal Maternal and
Child Health Bureau
• Goal: Build a comprehensive state
early childhood system
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Virginia’s Goal
• Coordinate
• Integrate
• Improve access and quality
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Health
Early Education and Child Care
Parent Support and Education
Behavioral Health
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Medical Home
• Structure and Process of Care
• Headquarters for care
– Primary prevention/immunizations/well care
– Care for routine and chronic illness
– Coordination
• Families feel welcomed and engaged
• Link to community resources
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Medical Home
• Access
• Family-Centered
• Continuous
• Comprehensive
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Medical Home
• Coordinated
• Compassionate
• Culturally Effective
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Medical Home
• Continuity as children move from Early
Intervention to School, between schools
• Promotion of:
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State Regulation
Skill Mastery
Positive Emotional Tone
Assistance with Negative Affect
Pro-social skills
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Medical Home Workgroup
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American Academy of Pediatrics as lead
Title V
Early Childhood, VDH
Voices for Virginia’s Children
Children’s Hospital
Community non-profit organizations
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Medical Home Workplan
• Access to primary care
– Insurance
– Medicaid
– Many areas of the state without care for children
• Access to subspecialty care
• Coordination of care with non-clinical
needs
• Inclusion of behavioral health
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Approach to the issue
• Build a system of support
– State and Local levels
– Strategic Fiscal Planning
– Reduce Risks
– Early Intervention for problems
– Integrate services
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Approach to the issues
• Integrate issues as they relate
– Economic security as a health risk
– Poor health as an education risk
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How This Guided
the VECCS Process
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VECCS Grant Goals
Support State Maternal and Child
Health Agencies and their partner
organizations in collaborative
efforts to strengthen the State’s
early childhood system of services
for young children and their
families.
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VECCS goals
Develop and implement a state
strategic plan that includes four
grant component areas:
1. Medical Home
2. Early Care and Education
3. Parent support and education
4. Behavioral Health
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Strategic Planning Activities
Planning Phase
May 2004 State planning meeting to create a vision,
governance structure, identify critical issues
Environmental Scan
2004-2005 Work groups
Develop plans around 5 components
October 2005 State Meeting: Discuss Overall Plan,
Integrate 5 work group plans into a single plan
Fall 2005:
Completed State Plan
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Vision: Virginia’s Early Childhood Investment:
Creating a system for healthy, successful
children.
Mission: Implement a comprehensive early
childhood system that promotes the health and
well-being of young children, enabling them to
enter school ready and able to learn.
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Environmental Scan:
What We Have Learned
 Support more family and parent
involvement within systems
development efforts
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What We Have Learned
• Public information and engagement
in process
• Community-based systems of care
– Integration looks different in different
communities
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What We Have Learned
• System Oversight
– Maintain momentum toward an
integrated system
• Data and Evaluation
– Accountability for public investment
– Sustainability of system
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What have we learned?
• Early Childhood Education
– Quality
– Access
– Affordability
• Funding
– Child Health/Medicaid
– Early Education
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Overall Plan: Integrating the
Four Work Plans
Consider how individual plans fit
together to create and overall plan
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Planning Phase Workgroups:
Focused on 4 Components
Access to Health Insurance
and Medical Homes
Behavioral Health and SocialEmotional Development
Early Care and Education
and Child Care
Parent Education
and Family Support
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Integration
• Review of common themes
• Areas of collaboration between
plans
• Areas not addressed within plans
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Integration
• Commitments from individuals and
agencies
• Inclusive process
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Final Structure of the Plan
• Infrastructure
• Integrated systems
of care
• Family and public
engagement
• Evaluation and
finance
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VECCS Goals
• GOAL 1: Virginia has the capacity to
provide a comprehensive, consumer
oriented system of information,
support, prevention, and
intervention services to families and
children birth to age five.
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VECCS Goals
• GOAL 2: A coordinated method of
delivering a full spectrum of easily
accessible services needed by
children and families is developed in
all communities and supported by
state agencies.
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VECCS Goals
• GOAL 3: Families and the public
have knowledge, understanding and
the opportunity for direct
involvement in all levels of the early
childhood system.
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VECCS Goals
• GOAL 4: The early childhood system
is sustainable, has flexible financing
and resources, is standards driven,
and uses quality indicators to
measure progress.
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Planning for Implementation:
• Leadership/
oversight of the plan
• Priorities for the plan
• Performance
measures and Data
• Community and
family engagement
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Next Steps
• Integration with other state planning
activities and initiatives
• Identifying feasible strategies based
on existing resources
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Next Steps
• Generate Public and Political Will
• Implement Action Plan
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Executive
Legislative
Administrative
Private Sector
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Planning Phase Workgroups:
Focused on 4 Components
Access to Health Insurance
and Medical Homes
Behavioral Health and SocialEmotional Development
Early Care and Education
and Child Care
Parent Education
and Family Support
AMCHP Conference 2006