Transcript Vision for the Future

Medical Homes and Young Children:
State of the Field
(Opportunities for Synergy with
Early Childhood Systems Building)
Medical Homes Conference
Detroit, MI
Charles Bruner, Director
Research and Evaluation for the BUILD Initiative
Child and Family Policy Center
May 21, 2012
The science of early childhood
and school readiness
1.
2.
3.
Learning begins at birth.
The early years are critical to healthy development and
educational success.
School readiness is multidimensional.
•
•
•
•
•
4.
Language and literacy
Physical health and motor development
General cognition
Social and emotional development
Approach to learning
Healthy child development is multidimensional.
•
•
•
•
Genetic
Bio-medical
Social
Environmental
The elements of an early childhood system
(through the eyes of early childhood systems builders)
15-25%
Comprehensive health services
that meet children’s vision,
hearing, nutrition, behavioral,
and oral health as well as
medical health needs.
Early
Learning
Family
Support
Health, Mental
Health and
Nutrition
5-10%
Early identification,
assessment and appropriate
services for children with
special health care needs,
disabilities, or developmental
delays
20-30%
Early care and education
opportunities in nurturing
environments where children
can learn what they need to
succeed in school and life.
Special Needs/
Early
Intervention
40-60%
Economic and
parenting supports to
ensure children have
nurturing and stable
relationships with
caring adults.
What federal programs exist today to
contribute to that system
Medicaid
CHIP
Title V MCH Block Grant
Community Health Centers
WIC
ACA/CHIPRA
Demonstrations
Early
Learning
Health, Mental Health
and Nutrition
IDEA Part C
Title IV Part B and Part E
EPSDT under Medicaid
Community Mental Health
Services Block Grant
Head Start
IDEA Part B Preschool
CCDBG
TANF
RTT-ELC Grants
Family Support
Special
Needs/
Early
Intervention
Early Head Start
Even Start
Title IV Part B, TANF, CAPTA,
SSBG, Community Services
Block Grant
ACA Home Visiting
Different literatures:
Similar foci
• Medical Terms
• Early Childhood Terms
– life-course model
– ecological, whole child
– patient-centered care
– family-centered services
– anticipatory guidance
– family engagement
– social determinants
– risk/protective factors
– developmental
screening/surveillance
– Early identification and response
– child health outcomes
– domains of school readiness
Unpacking the medical home’s role in
early childhood systems building
Coverage
Clinical Care
Coordination
Consulting
Community Health
From the conceptual to real world
• A mother brings her one-year-old in for a check-up and
it’s clear that the mom is stressed, if not depressed, and
shows little sign of responding to the child’s cues for
attention. While the child isn’t “diagnosable” today, if
things proceed as the medical home practitioner
expects, in two years there will be significant indicators
of development delay and likely social and emotional
problems, including a DSM-IV diagnosis. The medical
home does not want to wait two years to take action
and the mom seems receptive to receiving help. At the
same time, pointing out problems without offering help
could be considered malpractice.
Medical homes:
the what of coverage
• Medical home definition: “Practitioner/office
who takes a partnership approach with families
to provide care that is accessible, familycentered, coordinated, comprehensive,
continuous, compassionate, and culturally
effective”
• Goal for coverage – every child has a medical
home providing continuous health care over
time
Medical homes:
the what of clinical care
• Clinical care definition: Primary, preventive,
developmental health services (Bright Futures)
as well as responses to illness, injury, and
chronic health conditions
• Goal for clinical care – medical homes will
ensure that all young children are assessed and
treated to achieve child health outcome goals
Medical home responsibilities for
young child health outcomes
Physical health and development
• No undetected hearing or vision problem
• No chronic health problems without a treatment plan
• Immunizations complete for age
• No undetected congenital anomalies
Emotional, social and cognitive development
• No unrecognized or untreated delays
Family’s capacity and functioning
• Parents knowledgeable about child’s physical health status and needs
• No unrecognized maternal depression, family violence, or family
substance use
• No undetected early warning signs of child abuse or neglect
Medical homes: the what of
coordination with other services
• Coordination definition: Care coordination and
clinical referrals to subspecialty care and
transmedical services
• Goal for coordination – children and their
families will be referred to needed services,
appointments scheduled and kept, and results
reported back to the medical home
Representation of coordination aspects
to medical and community services
1.
2.
Medical Home Screening &
Surveillance
“Do you have questions about how
your child is learning, behaving, or
developing?”
Engaging family
Securing professional services
Securing community supports
Providing practitioner with feedback
Developmental screening tools
3.
Community
Resource Connections
Identifying and updating resources in
community
Developing networks across
providers and community
resources
Building community capacity for
response
Child
Mental
Health
Clinician
Part C
Peer
Support
Group for
Grandparents
Care Coordination
Immunologist
Church
Family
Night
Program
Home
Visiting
Parent of
Children
with
ADHD
Group
Domestic
Violence
Shelter
Head
Start
Hispanic
Resource
Center
Parents
Anonymous
Medical homes: the what of consulting
and follow-up with other providers
• Consulting definition: Integrated plans across
service systems that respond to clinical
treatments for the child and draw upon the
clinician’s expertise
• Goal for consulting – clinical expertise will
guide responses to children and their families
which involve clinical care and treatment
Medical homes: the what of
contributing to community health
• Community health definition: Identifying and
responding to population health concerns and
advocating for community actions
• Goal for community health – medical homes will
contribute to community understanding of child
health needs and participate in promoting
community health
From conception to practice: Achieving
medical home goals in an ECE system
• Resources, Resources, Resources
– Financing medical homes and their responsibilities
– Financing the care coordination that leads to effective
referrals and consulting
• Diffusing exemplary practices
– Creating impetus for change and its diffusion,
adoption
• Developing pillars of success
– Closing the gap in child health outcomes in
communities
Effective medical homes in an ECE
system: the results of the work
• The mother comes in with her child for the 36-month
well-child visit. Her daughter is looking forward to
coming, knowing she will receive a free book and
excited to tell the nurse she will be going to Head Start
next month with her best friend from the Hispanic
family center. The mother has an ASQ form, completed
at her family day-care home, and a set of questions for
the practitioner about her daughter, who’s already
starting to read but mixing up letters, and is wondering
if there might be dyslexia. The mother is in a mutual
assistance group with other parents and wants help
from the practitioner in getting more dentists who will
serve children in their community.
Making it happen back home
Collective Impact: The Margaret Meade Approach
Practitioner
Champions
Policy
Champions
HEALTHY
KIDS
Financing
Champions
Systems
Building
Champions
for more information …
Charles Bruner, Director
[email protected]
Publications:
The Healthy Child Storybook
Clinical Care and Community-Building
(with Ed Schor)
Medical Homes and Early Childhood
Systems Building
Improving Young Child Health:
Addressing Social Determinants
505 5th Street,
Suite 404
Des Moines, IA
50309
(515) 280-9027