1. Health Resources and Services Administration Maternal and Child Health Bureau Health Resources and Services Administration Maternal and Child Health Bureau CONNECTING EHDI WITH THE MEDICAL HOME Bonnie Strickland, Ph.D. National Early Hearing Detection and Intervention Meeting February 11, 2002

2. Health Resources and Services Administration Maternal and Child Health Bureau MCHB Mission To provide national leadership and to work, in partnership with states, communities, public-private partners, and families to strengthen the MCH infrastructure, assure the availability and use of medical homes, and build the knowledge and human resources, in order to assure continued improvement in the health, safety and well-being of the MCH population

3. Health Resources and Services Administration Maternal and Child Health Bureau Healthy People 2010 Increase the number of: newborns screened for hearing loss by 1 month of age, audiologic evaluation by 3 months, and appropriate intervention by 6 months (#28-11) persons who are referred by the primary care physician for hearing evaluation and treatment (#28-15).

4. Health Resources and Services Administration Maternal and Child Health Bureau Healthy People 2010 Increase the proportion of: children with special health care needs with access to a medical home (#16-22) States and territories with service systems for children with special health care needs (#16-23

5. Health Resources and Services Administration Maternal and Child Health Bureau HRSA: Focus on Access The HRSA EHDI Program assures access to: physiological screening prior to hospital discharge, proper diagnosis, and audiologic intervention, an ongoing system of services within the community to insure continuity and coordination of intervention from birth to school entry.

6. Health Resources and Services Administration Maternal and Child Health Bureau HRSAs EHDI Program Once screened, infants and their families are systematically linked to: an ongoing source of health care through a medical home, information and advocacy through family-to- family support, and appropriate intervention through Part C of IDEA.

7. Health Resources and Services Administration Maternal and Child Health Bureau What is a Medical Home? The medical home is an ongoing source of routine health care that: provides preventive, primary, and acute care, is coordinated with other aspects of health and medical care such as subspecialty care, is coordinated with other community services such as audiology and early intervention, and supports inclusion and full participation for the child and family in the community.

8. Health Resources and Services Administration Maternal and Child Health Bureau What is a Medical Home? The medical home is: accessible family-centered continuous comprehensive coordinated compassionate culturally effective

9. Health Resources and Services Administration Maternal and Child Health Bureau Why Medical Home? More than 300 inherited syndromes involve hearing loss, Otitis media accounts for 24.5 million visits to doctor offices, and is the most frequent reason cited for taking children to the emergency room, The most intensive period for development of language either spoken or signed is during the first 3 years of life, yet the current age of identification ranges from 14 months - 3 years.

10. Health Resources and Services Administration Maternal and Child Health Bureau Why Medical Home? The medical home is an essential player: Screening itself does not result in improved outcomes for infants and children, Not every infant will be screened in a hospital, and many are still lost to follow-up, Many infants neither require nor meet the eligibility requirements for early intervention programs,

11. Health Resources and Services Administration Maternal and Child Health Bureau Why Medical Home? Many infants will require ongoing preventive medical assessment and management, Many children will acquire hearing loss during early childhood, Primary care is an essential, but often missing partner in assuring that infants with hearing loss receive early and timely intervention.

12. Health Resources and Services Administration Maternal and Child Health Bureau Why Medical Home? Research supports the concept: access to an ongoing source of routine health care significantly improves health status (Starfield, 1992), continuity of care reduces hospitalizations, ER visits, length of hospital stays, missed school days (Christakis,et.al, 2001), coordinated, comprehensive, accessible, family-centered care is associated with family perceptions of better access to care (Sandler,1999).

13. Health Resources and Services Administration Maternal and Child Health Bureau Why Now? Attention has increased significantly: National Healthy People 2010 Objectives, Newborn Screening Task Force Report Serving the Family from Birth to the Medical Home (2002) American Academy of Pediatrics Position Statements on Medical Home and Hearing Screening, State Title V Programs Reporting Requirements.

14. Health Resources and Services Administration Maternal and Child Health Bureau MCHB Medical Home Program Purpose: Establish statewide models of medical home implementation, work with primary care providers to expand medical home in practice settings, develop strategies for better coordination between primary and specialty care, establish mechanisms for coordination between the medical home and other community services.

15. Health Resources and Services Administration Maternal and Child Health Bureau MCHB Medical Home Program Resources: Seven statewide implementation grants in 2001, ( five additional in 2002), National Medical Home Mentorship Network National Resource Center at the AAP, CATCH planning grants to implement medical home at the practice level.

16. Health Resources and Services Administration Maternal and Child Health Bureau MCHB Medical Home Program Statewide Implementation Grants: Massachusetts New Hampshire New Mexico Oregon Pennsylvania Utah Washington

17. Health Resources and Services Administration Maternal and Child Health Bureau Challenges? Ensuring the availability of an adequate network of medical home providers, Establishing adequate reimbursement strategies, Integrating principles of the medical home into pediatric training and continuing education programs. Sustaining continuity in the system that gets a child from birth to school entry.

18. Health Resources and Services Administration Maternal and Child Health Bureau MCHB Medical Home Program The challenge is to provide a true medical home for all….children, including those with special health care needs, in their communities, to supply an ongoing source for continuous, comprehensive, health care (Brewer, 1989)