' ' ' for Children Who Fail

1
Medical Homes . . .
. . . for Children Who Fail NB Metabolic
Screening
2
Medical Home History
1967 The text defines a medical home as the
central source of a childs pediatric records,
and emphasizes the importance of centralized
records to children with special needs  
For children with chronic diseases or disabling
conditions, the lack of a complete record and a
medical home is a major deterrent to adequate
health supervision Wherever the child is
cared for, the question should be asked, Where
is the childs medical home? and any pertinent
information should be transmitted to that place.
Standards of Child Health Care, a text published
by the AAP Council on Pediatric Practice
3
Medical Home History

• 1984 Hawaii Healthy Start home visiting
  program for the prevention of child abuse
  and neglect.
• 1985 Dr. Cal Sia in Hawaii designed the
  initial Medical Home Project (SPRANS)
• Adopted by the Hawaii Medical Association and
  the Hawaii Chapter of the American Academy
  of Pediatrics (AAP), to provide child health
  care through a medical home that would
  provide comprehensive services and focus on
  the whole child within the context of the
  family and the community (Sia Breakey, 1985).
• 1986 Zero to Three program for the education
  of the handicapped infant and toddler was
  launched.

4
Medical Home continues

• Early 90s AAP Maternal Child Health
  Bureau (MCHB)
• began discussion and development of
  collaborative projects to implement medical
  homes for all children with special health care
  needs.
• 1998 MCHB Mandated Performance Measures
  for Children with Special Health Care Needs
  (CSHCN) Programs in every state.

5
What is a Medical Home?

• Its an approach for
• providing access to quality health care in in a
  cost-effective manner in a primary health care
  setting.

6
What is a Medical Home?

• Its an approach for
• providing access to quality health care in in a
  cost-effective manner in a primary health care
  setting.
• Its a special relationship that a family has
  with their primary care physician

Proactiveand not Reactive Quality of Health Care
7
Primary Health Care Setting
Preventive Health Care
8
Primary Health Care Setting
Preventive Health Care
Acute Health Care
9
Primary Health Care Setting
Preventive Health Care
Acute Health Care
Chronic Health Care
10
Primary Health Care Setting
Preventive Health Care
Acute Health Care
Chronic Health Care
11
Primary Health Care Setting
Preventive Health Care
Acute Health Care
Chronic Health Care
Every Child Deserves a Medical Home
12
Who Are CSHCN?
90 Survive to adulthood
13
Federal Definition of CSHCN
CSHCN are those who have or are at increased
risk for a chronic physical, developmental,
behavioral, or emotional condition and who also
require health and related services of a type or
amount beyond that required by children
generally.
Children who fail newborn metabolic screening
Defined by the Maternal and Child Health Bureau
(July 1998)
14
80 of Health Care Cost
15
(No Transcript)
16
(No Transcript)
17
Todays Goal
Definition of Medical Home
R
Integrating the principles of the Medical Home
Model into the
primary care management of children
who fail NB metabolic screening.




Parents Perspective
And
Physicians Perspective
18
Medical Home Model
3 Components
19
What do families mean when they say they have a
Medical Home?
1st Component
Medical Home Model
20
My Family 1994
Katelyn Born 1996
21
Working Together
Coming together is a beginning keeping together
is progress working together is
success. Henry Ford
22
7 Principles of Family Professional Collaboration

• The principles are from,
• Family/Professional Collaboration for Children
  with Special Health Needs and Their families
• by Kathleen Bishop

23
7 Principles of Family Professional Collaboration

• Family/professional collaboration

• 1. Promotes a relationship in which family
  members and professionals work together to ensure
  the best services for the child and the family

24
7 Principles of Family Professional Collaboration

• Family/professional collaboration

• 2. Recognizes and respects the knowledge, skills
  and experience that families and professionals
  bring to the relationship

25
7 Principles of Family Professional Collaboration
Family/professional collaboration

• 3. Facilitates open communication so that
  families and professionals feel free to express
  themselves

26
7 Principles of Family Professional Collaboration
Family/professional collaboration

• 4. Creates an atmosphere in which cultural
  traditions, values and diversity of families are
  acknowledged and honored

27
7 Principles of Family Professional Collaboration
Family/professional collaboration

• 5. Recognize that negotiation is essential in a
  collaborative relationship

28
7 Principles of Family Professional Collaboration
Family/professional collaboration

• 6. Brings to the relationship the mutual
  commitment of families, professionals, and
  communities to meet the needs of children and
  their families and

29
7 Principles of Family Professional Collaboration
Family/professional collaboration

• 7. Acknowledges that the development of trust is
  an integral part of the collaborative
  relationship.

30
Family/Professional Collaboration defined
Mathematically
Seth 1988

• (adding) to each others base of knowledge,
• (subtracting) our major differences,
• (dividing) the praise among Family and
  Professional, and
• (multiply) the benefits for the child.

31

• The primary care physician (PCP) and other
  health care providers
•    Know the childs health history
•    Listen to the parents and childs concerns
  and involves them in decision-making
•    Share a trusting, collaborative relationship
  with the family and
•    Treat the child with compassion and
  understanding
• Parents and child
• Are comfortable sharing concerns and questions
  with the childs primary care physician
  and other health providers.
•  Routinely communicate their child's needs and
  family priorities to the primary care
  physician, who facilitates communication between
  the family and other health care providers
  when necessary.
•  

32
What do physicians mean when they say they
provide a Medical Home?
2nd Component
Medical Home Model
33
Critical Supporting ElementsMedical Home Model
Standards of Pediatric Care
Standards Developed by Recognized Professional
Organizations
G U I D E L I N E S
P O L I C I E S
Basic Knowledge
34
Critical Supporting ElementsMedical Home Model
Standards of Pediatric Care
G U I D E L I N E S

• POLICIES
• Newborn Metabolic Screening
• Newborn Hearing Screening
• Immunizations
• Developmental Screening
• Obesity
• Clinical Conditions Asthma, ADHD, etc
• http//www.aap.org/policy/pprgtoc.cfmS

P O L I C I E S
Basic Knowledge
35
Critical Supporting ElementsMedical Home Model
Standards of Pediatric Care
G U I D E L I N E S

• PRACTICE GUIDELINES
• Management
• ADHD
• Febrile Seizures
• Minor Closed Head Injury
• Sinusitis
• Acute Gastroenteritis
• National Guideline Clearing House
• www.guideline.gov

P O L I C I E S
Basic Knowledge
36
Bright Futures

• Guidelines for Health Supervision of Infants,
  Children, and Adolescents
• Immunizations
• Routine Health Screening
• Anticipatory Guidance
• Oral Health
• Nutrition
• Physical Activity
• Mental Health

http//brightfutures.aap.org
37
Primary Care Physician

• Accessible
• Family-Centered
• Comprehensive
• Continuous
• Coordinated
• Compassionate
• Culturally-competent

• Chronic Care Management that is

and for which the PCP
Shares Responsibility
38
Applying the . . .
3rd Component
Medical Home Model
39
Brain Storming

• Ideas
• Thoughts
• ?????

40
Creating a Medical Home while . . .
41
Brain Storming

• Ideas
• Thoughts
• ?????

42
(No Transcript)
43
Illinois Provider Directory

• The directory includes
• general pediatricians
• family physicians
• pediatric specialists
• occupational therapists
• physical therapists
• speech pathologists
• audiologists
• mental health specialists
• pediatric dentists
• and other health care providers who serve
  Illinois children with special health care needs.
  
• A RESOURCE FOR BOTH FAMILIES AND PROVIDERS

http//www.illinoisaap.org
44
(No Transcript)
45
Illinois Community Resource CD
46
Medical Homes in Action

• Web-based
• Chronic Care Conditions NB Metabolic Disorder
• Information for Physicians GIS Map
• Information for Parents
• Community Resources
• National Resources

47
http//66.99.103.134/medhome/mdprimer/conditions/c
onditions.asp
48
Format for Metabolic Conditions
49
Medical Homes in Action

• http//66.99.103.134/medhome/mdprimer/conditions/c
  onditions.asp
• GIS mapping of resources for region
• ArcReader http//www.esri.com/software/arcgis/arc
  reader/download.html

50
The Essential Element for both families and
professionals
51
Additional Resources

• The National Center of Medical Home Initiatives
  for Children with Special Needs
• www.medicalhomeinfo.org

• State Resources
• Training Programs Materials
• Screening Initiatives

52
Center for Medical Home Improvement

• Building a Medical Home Improvement Strategies
  in Primary Care for Children with Special Health
  Care Needs
• Improvement kit keyed to Medical Home Index
• Web site www.medicalhomeimprovement.org
• Download kit and measurement tools
• Links to other resources
• News
• Interactive self-assessment (future)

53
Bright Futures

• Bright Futures Guidelines for Health Supervision
  of Infants, Children, and Adolescents was
  developed to provide comprehensive health
  supervision guidelines, including recommendations
  on immunizations, routine health screening, and
  anticipatory guidance

http//brightfutures.aap.org/
54
National Center for Cultural Competence (NCCC)

• http//gucchd.georgetown.edu/nccc/index.html

55
For More Information Contact
Division of Specialized Care for
Children(DSCC) 2815 W. Washington, Suite
300 P.O. Box 19481 Springfield, IL 62794-9481
1-800-322-3722 Illinois CSHCN
DirectorCharles N. Onufer, MD
cnonufer_at_uic.edu Family Liaison Specialist
Robert J. Cook at rjcook_at_uic.edu
www.uic.edu/hsc/dscc