Transcript Slide 1
Pathways to Independence Summit
Promoting Families’ Ability to Manage their Health Care
through
Family Centered Medical Homes
Celeste Putnam, Lynn Marie Firehammer, & Charlotte Curtis
September 8th
Providing Medical Homes
Department of Children
and Families has a
partnership with the
Department of Health to
provide medical homes
to eligible children in
out-of-home care.
Objectives
Overview of Medical Homes
Understanding that Health Care includes physical,
developmental and behavioral health
Understanding Early Steps
Understanding of how to integrate Early Steps into
the Medical Home
Child and Family Well-Being Outcome
Many Children in Out-of-Home Care have
Special Health Care Needs
“Children and adolescents in
foster care are a singularly
disadvantaged and vulnerable
population known to be a high
risk for persistent and chronic
physical, emotional, and
developmental conditions
because of multiple and
cumulative adverse events in
their lives” (American Academy
of Pediatrics, 2005)
Many Children in Out-of-Home Care Have
Special Health Care Needs
Research shows that:
39.3% of children birth to three meet
criteria for early intervention
41.1% of children three and four required
special education services
60 % of children in foster care have a
chronic health care condition
90 % have a chronic, developmental or
social/emotional/behavioral disorder
Goals for Health Care Management
The goal is to work with the Community Based Care
Lead Agencies to provide:
A 72 hour initial medical screen
A comprehensive health care evaluation
within 30 days
A developmental screen
A Comprehensive Behavioral Health Care
Assessment coordinated with physical health care
Goals
Have physical and developmental care coordinated
by nurse care coordinators in collaboration with
the CBC case manager when feasible
Have children’s immunizations
and periodicity schedules
monitored
Provide health care assistance
in permanency planning
Medical Homes
Each child will be have a primary
care provider
Medical Homes are distinct from
Medical Foster Homes
Medical Homes
A Medical Home is:
Accessible in the Community
Family Centered
Continuous
Comprehensive
Coordinated
Compassionate
Culturally Competent
Developmental Screening and
Referral to Early Steps
The Health Plan should address the child’s
developmental status
One approach would be for a nurse care
coordinator to work with
the CBC care manager, family and others to
determine if the child requires a
developmental assessment
The nurse care coordinator may make the referral
to Early Steps
What is Early Steps?
Infants and Toddlers with Disabilities Program of the
Individuals with Disabilities Education Act
(IDEA) Part C
Created in 1986 to:
enhance the development of infants and
toddlers with disabilities
minimize potential developmental delay
reduce educational costs to our society
by minimizing the need for special
education services as children with
disabilities reach school age
Early Steps
Early Steps is Florida’s Part C system
Program administration and over site is in the
Department of Health,
Children’s Medical Services
16 private contractors (hospitals, universities,
community agencies, etc.) provide the day-today system in 15 Local Early Steps catchment
areas that cover all 67 Florida counties
Early Steps Goal
The goal of Early Steps is to improve the
developmental outcomes of infants and toddlers
age birth to 36 months with developmental delays
and established conditions
Families and caregivers are provided with services
and supports
to enable them to
enhance their child’s
development within
their everyday routines,
activities, and places
Established Condition Eligibility
Categories of established conditions are:
Genetic and metabolic disorders
Neurological disorder
Autism Spectrum Disorder
Severe attachment disorder
Significant sensory impairment (vision/hearing)
Infants who weigh less than 1,200 grams at birth
Developmental Delay Eligibility
Developmental delay must meet or exceed:
1.5 standard deviations below the mean in two or
more developmental domains or
2.0 standard deviations below the mean in one or
more of the domains
Developmental Domains
Cognitive
Physical (including hearing and vision)
Communication
Social/emotional
Adaptive
Referrals
Local Early Steps (LES) conduct Child Find activities
through community health fairs and similar events to
identify potentially eligible children
Children are referred to Early Steps from many sources –
such as birthing hospitals, CAPTA, pediatricians, child care
centers, Early Head Start, Healthy Start and self-referrals
Florida Directory of Early Childhood Services links callers
directly to LES
1-800-654-4440
Child Abuse Prevention and Treatment Act
(CAPTA)
Ensures children under the age
of three who are involved in
substantiated cases of child
abuse or neglect, and are
potentially eligible for early
intervention services,
are referred
Florida has defined
“substantiated” as any case
with verified findings of child
abuse or neglect
CAPTA Referral 1
Children who will remain
in their parents’ or legal
guardian’s home
without referral for
service are referred to
Early Steps by the Child
Protective Investigator
handling the case
CAPTA Referral 2
Children who will remain in their parents’ or
legal guardian’s home and are referred for
services, will be referred to Early Steps by the
CBC lead agency child welfare case manager,
if certain delays are suspected
CAPTA Referrals
Plans are for children who are being placed into
out-of-home care to receive an initial
screening during comprehensive health
assessment process
The decision to make a referral to Early Steps
should be made during the health plan
development process
CAPTA Referrals
Other indications of a developmental delay may
also result in a referral
If available, the nurse care coordinator should
assist the care giver and the CBC Lead Agency case
manager
to access Early Steps
Special attention should be given to substance
exposed newborns, and low-birth weight infants
Individualized Family Support Plan
Early Steps services are based on
evaluations/assessments, and family concerns,
resources, and goals
Information about the child and family, including
authorized services, are captured on the
Individualized Family Support Plan (IFSP) which
is required under 34 CFR 303.340
Early Steps uses a Team Based Primary Service
Provider approach
Individual Family Support Plan
The development of the IFSP should include the
nurse care coordinator and the CBC case manager
Recommended services and supports should be
integrated within the other services provided to
the family
Service delivery schedules should be coordinated,
especially home visiting programs
Team Based Primary Service Provider
Aims to empower each eligible family by
providing a comprehensive team of professionals
from the beginning of services through
transition at age 3
Services are provided where families live,
learn and play, to enable them to implement
developmentally appropriate learning
opportunities during everyday activities
and routines
Most services will be early intervention
home visits
Team Based Primary Service Provider
For children in out-of-home
care the team should have
access to early childhood
mental health therapists
Social, emotional and
behavioral early
intervention services should
be coordinated with other
mental health services
provided
Early Intervention Home Visits
Goal is for the family to
receive strong support
from one person
be provided a
comprehensive team of
professionals
have fewer
appointments and more
time to be a “family”
Coordinated with other
in home services
What does Early Intervention Look Like?
Video made available by the
Connecticut Birth to Three system and
is posted on the Florida Early Steps
website for parents to view
http://www.birth23.org/videos/HV/B23HVEN.htm
Summary
Children should receive
coordinated health care
Coordination of care will
include physical health
care, developmental
interventions and mental
health services
Early intervention services
must be coordinated with the overall health care
Integration and Coordination
Planning processes and documents such as the
IFSP, the health plan and the case plan must be
integrated and coordinated to ensure that:
Services are in support of the permanency goals
Services are coordinated and made easily manageable
for the care giver
Services address the needs of the immediate care giver
and the biological families if appropriate
More Information on Early Steps
Early Steps Website at
http://www.cms-kids.com/families/early_steps/early_steps.html
Questions