Workshop E-6 Building Momentum For Family-Centered Medical Homes Moderator: Jeffrey Lobas, MD, FAAP AMCHP Conference 2006

Workshop E-6

Building Momentum For Family-Centered

Medical Homes

Moderator: Jeffrey Lobas, MD, FAAP

AMCHP Conference 2006

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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ECCSPurpose: 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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Religious/ Spiritual Support

Medical Specialists Communit

y Resources

and Agencies

Child and Family

Parent Support Services

Financial Assistance

Mental Health

Services

With a Medical With a Medical

HomeHome


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Religious/ Spiritual Support

Parent Support Services

Financial Assistance

Mental Health

Services

Child and Family

Medical Specialist

s

Without a Medical Without a Medical HomeHome

Community

Resources and

Agencies

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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, MEdLynn B. Wilson, PhD



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


Hawaii State Department of HealthECCS 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




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



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?



Bryan’s Story



Producing Medical HomeFamily Stories

• GOAL: create ‘learner centered’ process- oriented 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



Medical Home Family StoriesEvaluation 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



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



Mahalo & Aloha!

[email protected]@webfishpacific.com


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

– 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:– State Regulation– Skill Mastery– Positive Emotional Tone– Assistance with Negative Affect– Pro-social skills


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Medical Home Workgroup

• 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 Home2. Early Care and Education3. Parent support and education4. Behavioral Health


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Strategic Planning Activities

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

Planning Phase

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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 ComponentsAccess to Health Insurance

and Medical Homes

Early Care and Education and Child Care

Parent Educationand Family Support

Behavioral Health and Social- Emotional Development


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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– Executive– Legislative– Administrative– Private Sector


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Planning Phase Workgroups: Focused on 4 Components

Access to Health Insurance and Medical Homes

Early Care and Education and Child Care

Parent Educationand Family Support

Behavioral Health and Social- Emotional Development


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Documents

Workshop E-6 Building Momentum For Family-Centered Medical Homes Moderator: Jeffrey Lobas, MD, FAAP AMCHP Conference 2006