CYSHCN in Tennessee andDepartment of Health Updates

Michael D. Warren, MD MPH FAAPDivision of Family Health and Wellness

Objectives

• Outline state-level data on the health and well-being of CYSHCN in TN

• Review public health resources to support care coordination in the pediatric primary medical home

• Present pediatric primary care updates from the Tennessee Department of Health

A little about us…

• Mission: To protect, promote, and improve the health and prosperity of people in Tennessee

• Vision: A recognized and trusted leader, partnering and engaging to make Tennessee one of the nation’s ten healthiest states.

TDH Divisions/OfficesCommunity

Health Services

Communicable / Environmental Diseases and Emergency

Preparedness

Family Health and Wellness

Health Licensure and

Regulation

Laboratory Services

Policy, Planning and Assessment

Health Disparities

Patient Care Advocacy

Health Planning

Chief Medical Examiner

Communications & Media

Relations

Compliance

General Counsel

Legislative Affairs

Health Policy

Division of Family Health and Wellness

• Maternal and Child Health• Chronic Disease Initiatives• Supplemental Nutrition

• State Title V entity– Funded by the Title V Maternal and Child

Health Block Grant– Federal-state partnership

Division of Family Health and Wellness

Community Nutrition

Children’s Special

Services

ObesityPrevention

ObesityPrevention

Fetal Infant Mortality Review

Tobacco

FamilyPlanning

Breast & Cervical Cancer

Screening

ChildFatality Review

Injury Prevention

Asthma

SIDS/SUID Prevention

Newborn Screening

Early Childhood Systems

CSFP

WICLead

Poisoning Prevention

Heart Disease and Stroke

DiabetesRape and Violence

Prevention

Home VisitingTargeted Case Management

AdolescentHealth

Farmer’s Market

Adolescent Pregnancy Prevention

State-level Data onChildren and Youth

with Special Health Care Needs (CYSHCN)

CYSHCN 101

• CSHCN: Children with Special Healthcare Needs• CYSHCN: Children and Youth with Special

Healthcare Needs

• Definition1: “...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.”

1. McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck P, Perrin J, Shonkoff J, Strickland B. A new definition of children with special health care needs. Pediatrics, 102(1):137–140, 1998

Data Resource

• National Survey of Children with Special Health Care Needs

• National and state-level data available through Data Resource Center for Child and Adolescent Health– http://www.childhealthdata.org/learn/NS-CSH

CN

CYSHCN in Tennessee2

• Estimated number of children: 255,692– 17.2% of all children

• Prevalence by Age– Age 0-5: 10.7%– Age 6-11: 20.8%– Age 12-17: 20.3%

• Prevalence by Sex:– Male: 20.0%– Female 14.2%

2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

CYSHCN in Tennessee2

• Prevalence by Poverty Level– 0-99% FPL: 20.5%– 100-199% FPL: 17.5%– 200-399% FPL: 14.5%– >400% FPL: 16.7%

• Prevalence by Race/Ethnicity:– White: 16.8%– Black: 17.9%– Hispanic: 14.8%

2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

CYSHCN in Tennessee2

• Child Health– 27.9% report that health conditions affect activities

usually, always, or a great deal– 14.8% had 11 or more days of school absences due

to illness

• Health Insurance– 5.1% were without insurance at some point in the

past year– 25.9% reported that current insurance is inadequate

2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

CYSHCN in Tennessee2

• Access to Care– 17.8% had unmet need for specific health care

services– 13.5% had difficulty getting needed referral– 11.1% did not have usual source of care

• Family-Centered Care– 32.5% reported that care was not family centered

2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

CYSHCN in Tennessee2

• Impact on Family– 21.9% of families paid $1,000 or more out of

pocket for medical expenses per year for child– 20.1% of families had financial problems because

of child’s medical condition– 16.4% of families reported spending 11 or more

hours/week providing or coordinating child’s health care

– 22.9% of families reported that child’s condition caused family members to cut back or stop working

2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

(Relatively) Good News:CYSHCN Core Outcomes2

Families partner in shared decision-making for child's optimal health

Children receive coordinated, ongoing, comprehensive care within a medical home

Families have adequate private and/or public insurance to pay for the services

CYSHCN are screened early and continuously for special health care needs

CYSHCN can easily access community based services

CYSHCN receive services necessary to make appropriate transition to adulthood

0 10 20 30 40 50 60 70 80 90

72.3

45.9

70.4

79.1

71.5

41.8

NationalState

Percent

2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

Public Health Resourcesto Support Care Coordination

in the Primary CareMedical Home

Children’s Special Services

• Available in all 95 counties– Access through local health department

• Eligibility:– Income <200% FPL– Diagnosis of chronic physical condition

• Two components:– Care coordination– Payor of last resort

• Payment for hospitalizations, outpatient visits, medications, therapies, DME, supplies, co-pays/co-insurance

CYSHCN Section

• New effort by TDH• Look at broad issues and opportunities

related to CYSHCN• Includes federal D70 Systems Integration

Grant (HRSA)– Medical Home Summits– Practice based support for care coordination– Partnership with TNAAP and Family Voices

Newborn Screening Follow-Up

• State law requires every newborn receive blood spot screening, hearing screening, and pulse oximetry screening for critical congenital heart disease– ~80K births/year– Each blood spot screened for 51 conditions

• Follow-up nurses perform case management– Presumptive positive screens– Follow-up testing/screens– Confirmation of follow-up data

Childhood Lead Poisoning Case Management

• All blood lead resultsreportable to TDH

• New CDC threshold foraction: 5 mcg/dL

• Ordering providerresponsible for follow-up

• Follow-up nurse assists with case management– Fax PCP reminder if BLL 5-9 (then case closed)– Follow-up for cases >10 or persistently elevated– Arrange environmental investigation upon request

Home Visiting Programs

• Evidence-based programs in most at-risk counties

• Home visiting professionals meet with family with varying frequency (based on need and program criteria)– Assess and support child development– Provide education on health topics and

positive parenting– Facilitate referral to community resources

Targeted Case Management—HUGS

• HUGS: Help Us Grow Successfully• Available in all 95 counties

– Accessed through local health departments– For TennCare eligible families

• Case manager visits family once/month– Assess development (Ages & Stages)– Connect with medical home– Refer to community resources

Pediatric Primary Care Updates

Welcome Baby• Universal outreach program

to all new parents• All packets contain safe sleep

information

• Low risk receive packet by mail

• Medium risk receive phone call

• High risk receive a home visit with education and promotional items such as a onesie with a safe sleep message

Safe Sleep Campaign

Hospital Safe Sleep Project

• Free “Sleep Baby, Safe and Snug” board book for each birth in your facility

• Free TDH “ABC’s of Safe Sleep” materials

• Free Recognition on TDH website (http://safesleep.tn.gov)

• Signed certificate from TDH Commissioner

• Press release template

TN Breastfeeding Hotline

• 24/7 access to certified lactation consultant

• Available to anyone—mothers, other family members, health care providers

TN Tobacco QuitLine• Free service

– Toll free #– Online program

• Confidential• Callers can:

– Receive freeinformation

– Work with Quit Coach

• More information available at: http://health.state.tn.us/tobaccoquitline.htm

Newborn Screening Results ONLINE

• Access patient results 24/7 through secure online portal

• Search via several mechanisms

• Online directory of state services• Information on child health, development, and

education• Create profile to review milestones as your child

develops and bookmark important articles• Mobile app

– Access profile and resourcesfrom anywhere

– “Refrigerator Magnet” withimportant information andemergency contacts

Contact Information

• Website: http://health.tn.gov

• Michael D. Warren, MD MPH FAAP• Email: michael.d.warren@tn.gov• Phone: 615-741-7353

Finding YourLocal Health Department

http://health.tn.gov/localdepartments.htm

Click on map to get county contact information

Click on county name in list to get information

OR