1. 2015 Pediatric Conference Our Most Difficult Cases

2. At Enrollment Brother & Sister  Girl age 4, Boy age 2 - enrolled in May  Referred to CHIP by Child Protective Services  Immunization status & medical neglect  Abuse  Drug addiction  Abandonment

3. At Enrollment cont. Caregiver (now legal Guardian)  In 30’s, best friends with maternal grandmother. Grandmother also had drug problems and was unable to care for children.  Has no children of her own  Cancer resulting in job loss  Housing & transportation

4. Case Management Following Enrollment Brother & Sister  Medical & dental home  Coordination of health care o Transportation o Tracking of appointments  Monitored developmental milestones  Ineligible for Head Start due to lack of immunization and legal guardianship  Kindergarten readiness  Supplies o Clothes/Shoes o Books/ toys/ safety supplies

5. Case Management Following Enrollment cont. Caregiver (now legal guardian)  Custody  Assisted in navigating health systems o Pediatric & dental appointments o WIC  Provided parent education and support  Caregiver assessments  Housing assistance  Coordinated enrollment into Head Start and Kindergarten

6. Current Case Management Brother & Sister  Health care coordination o Transportation o Play therapy  Support with school system o School assessment o 504 Plan o PAL’s  Referrals o Psychiatrist o Big Brothers / Big Sister  Monitoring developmental milestones

7. Current Case Management cont. Legal Guardian  Financial resources  Continuing health issues  Visitation  Counseling for guardian

8. Future Case Management  Advocate within school systems o Special education information o Head Start collaboration o Assessment with school/treatment planning  Counseling  Financial plan  Connect with support systems  Monitor developmental milestones  Discuss future plan for children if guardian’s health continues to deteriorate

9. Why Case is Still Difficult  Health of guardian uncertain  Children stable and love guardian  Children still working through attachment disorders  Guardian unable to work and become financially independent  Guardian has few support systems