1. Vermont Department of Health Integrating Community-Based Services for Children & CYSHCN within Vermont Beth Cheng Tolmie, MSW, Ed.D. May 5 & 6, 2009

2. Vermont Department of Health 2005/6 CSHCN Survey in Vermont Six MCHB Performance Outcomes Outcome 159.8% of families partner and satisfied with services Outcome 2 51.6% CSHCN receive coordinated, ongoing care within a medical home Outcome 369.4% of families have adequate insurance to pay for services Outcome 474.4% are screened early and continuously Outcome 5 89.3% report that services are organized in ways that families can use them easily Outcome 652.0% youth receive services to transition to adult health care 2005/2006 CSHCN survey data indicates fewer report none, and more report four or more functional difficulties in Vermont when compared to the national non-Hispanic white population

3. Vermont Department of Health Key Staff & Partners  Vermont Department of Health: Beth Cheng Tolmie, Grant Coordinator; Carol Hassler, MD, CSHN Medical Director; Steve Brooks, CSHN Operations Director; Sally Kerschner, Title V Coordinator; Garry Schaedel, EPSDT; John Burley, SSDI Coordinator; Office of Local Health Leadership  Agency of Human Services: AHS Secretary’s Office Department of Aging & Independent Living Department for Children & Families Department of Mental Health Office of Vermont Health Access (Medicaid)  Vermont Child Health Improvement Program at the University of VT  Vermont Family Network (merged P2P / parent information organizations)  American Academy of Pediatrics – Vermont Chapter; Vermont Academy of Family Physicians

4. Vermont Department of Health Project Goals & Objectives  Easily Accessible Community-Based Services Integrate CSHN programs into the development of Local Children’s Integrated Services (CIS) Teams in each region of the state  Intake and triage function  Consultation re: CYSHCN considerations and complexities CIS is a Vermont Agency of Human Services effort to combine Healthy Babies, Kids and Families (home visiting), Family Infant & Toddler (Part C) and Children’s Upstream Services (mental health) programs Connect existing CSHN staff to local public health / maternal child health coordinator staff, who are part of the CIS intake and triage team in the community

5. Vermont Department of Health Project Goals & Objectives  Early and Continuous Developmental Screening Complete Vermont Child Health Improvement Program practice improvement project, in partnership with the Agency of Human Services to:  Increase the use of standardized developmental screening tools within the medical home  Offer financial support to medical homes for the completion of developmental screens according to Bright Futures © Guidelines  Measure and improve family-centered care within the medical home using the Promoting Healthy Development Survey (PHDS) Improve Child Development Clinic practice operations and support of the medical home within the CSHN program at the Vermont Department of Health  Vermont Child Health Improvement Program will utilize a practice improvement model to support scheduling and reporting functions with baseline data from: –Pediatrician informal inquiry –Baseline chart review of Burlington clinic operations

6. Vermont Department of Health Project Goals & Objectives  Family-Centered Services Improve access to CSHN programs, information and services  Website development and enhancement  Database improvements Implement Vermont Family Network Family Support Consultant / Parent Liaison in CSHN operations  Liaison available to assist families with access to Child Development Clinic and other CSHN services  Financing Reduce reliance on Title V support for the financing of direct services for CSHN  Youth in Transition Utilize current opportunities to support health considerations as CYSHCN transition from youth to adulthood

7. Vermont Department of Health Key Activities  Connect and integrate integration efforts within AHS  Implement practice improvement efforts to better support the medical home and families  Redefine role of CSHN and Title V as payer of last resort / insurance safety-net  Strengthen medical home for SHCN youth as they transition to adulthood

8. Vermont Department of Health Proposed Outcomes  Improve Child Development Clinic capacity to meet state needs for diagnostic and treatment planning services  Reduce reliance on Title V funding to support financing of direct services for CSHN  Develop sustainable model for support of family consultant / parent liaison within CSHN programs  Improve access for CYSHCN to community- based services via local Children’s Integrated Services (CIS) Teams

9. Vermont Department of Health Evaluation Efforts  Complete on-going document review  Conduct interviews with key informants Internal stakeholders Pediatricians  Complete survey and chart review Developmental screening practice improvement project  Use of Promoting Health Development Survey (PHDS) Child Development Clinic practice improvement project  Conduct financial gap analysis