Celeste Putnam, Lynn Marie Firehammer, & Celeste Putnam, Lynn Marie Firehammer, & Charlotte CurtisCharlotte Curtis

September 8thSeptember 8th

Promoting Families’ Ability to Manage their Promoting Families’ Ability to Manage their Health Care through Health Care through

Family Centered Medical Homes Family Centered Medical Homes

Pathways to Independence Summit

Providing Medical Homes

Department of Children and Families has a partnership with the Department of Health to provide medical homes to eligible children in out-of-home care.

Objectives

Overview of Medical Homes Understanding that Health Care includes

physical, developmental and behavioral health

Understanding Early StepsUnderstanding of how to integrate Early

Steps into the Medical Home

Child and Family Well-Being Outcome

Many Children in Out-of-Home Care have Special Health Care Needs

“Children and adolescents in foster care are a singularly disadvantaged and vulnerable population known to be a high risk for persistent and chronic physical, emotional, and developmental conditions because of multiple and cumulative adverse events in their lives” (American Academy of Pediatrics, 2005)

Many Children in Out-of-Home Care Have Special Health Care Needs

Research shows that:39.3% of children birth to three meet

criteria for early intervention41.1% of children three and four required

special education services60 % of children in foster care have a

chronic health care condition90 % have a chronic, developmental or

social/emotional/behavioral disorder

Goals for Health Care Management

The goal is to work with the Community Based Care Lead Agencies to provide:

A 72 hour initial medical screenA comprehensive health care evaluation

within 30 daysA developmental screen A Comprehensive Behavioral Health Care

Assessment coordinated with physical health care

GoalsHave physical and developmental care

coordinated by nurse care coordinators in collaboration with the CBC case manager when feasible

Have children’s immunizations and periodicity schedules monitored

Provide health care assistance in permanency planning

Medical Homes Each child will be have a

primary care provider Medical Homes are distinct

from Medical Foster Homes

Medical Homes

A Medical Home is: Accessible in the CommunityFamily CenteredContinuousComprehensiveCoordinatedCompassionateCulturally Competent

Developmental Screening and Referral to Early Steps

The Health Plan should address the child’s developmental status

One approach would be for a nurse care coordinator to work with the CBC care manager, family and others to determine if the child requires a developmental assessment

The nurse care coordinator may make the referral to Early Steps

What is Early Steps?Infants and Toddlers with Disabilities Program of the Individuals

with Disabilities Education Act (IDEA) Part C

Created in 1986 to: enhance the development of infants and

toddlers with disabilitiesminimize potential developmental delayreduce educational costs to our society

by minimizing the need for special education services as children with disabilities reach school age

Early Steps

Early Steps is Florida’s Part C system Program administration and over site is

in the Department of Health, Children’s Medical Services

16 private contractors (hospitals, universities, community agencies, etc.) provide the day-to-day system in 15 Local Early Steps catchment areas that cover all 67 Florida counties

Early Steps Goal

The goal of Early Steps is to improve the developmental outcomes of infants and toddlers age birth to 36 months with developmental delays and established conditions

Families and caregivers are provided with services and supports to enable them to enhance their child’s development within their everyday routines, activities, and places

Established Condition Eligibility

Categories of established conditions are:Genetic and metabolic disordersNeurological disorderAutism Spectrum DisorderSevere attachment disorder Significant sensory impairment (vision/hearing)Infants who weigh less than 1,200 grams at

birth

Developmental Delay Eligibility

Developmental delay must meet or exceed: 1.5 standard deviations below the mean in

two or more developmental domains or2.0 standard deviations below the mean in

one or more of the domains

Developmental Domains

CognitivePhysical (including hearing and vision)

CommunicationSocial/emotionalAdaptive

ReferralsLocal Early Steps (LES) conduct Child Find

activities through community health fairs and similar events to identify potentially eligible children

Children are referred to Early Steps from many sources – such as birthing hospitals, CAPTA, pediatricians, child care centers, Early Head Start, Healthy Start and self-referrals

Florida Directory of Early Childhood Services links callers directly to LES

1-800-654-4440

Child Abuse Prevention and Treatment Act (CAPTA)

Ensures children under the age of three who are involved in substantiated cases of child abuse or neglect, and are potentially eligible for early intervention services, are referred

Florida has defined “substantiated” as any case with verified findings of child abuse or neglect

CAPTA Referral 1

Children who will remain in their parents’ or legal guardian’s home without referral for service are referred to Early Steps by the Child Protective Investigator handling the case

CAPTA Referral 2

Children who will remain in their parents’ or legal guardian’s home and are referred for services, will be referred to Early Steps by the CBC lead agency child welfare case manager, if certain delays are suspected

CAPTA Referrals

Plans are for children who are being placed into out-of-home care to receive an initial screening during comprehensive health assessment process

The decision to make a referral to Early Steps should be made during the health plan development process

CAPTA Referrals

Other indications of a developmental delay may also result in a referral

If available, the nurse care coordinator should assist the care giver and the CBC Lead Agency case manager to access Early Steps

Special attention should be given to substance exposed newborns, and low-birth weight infants

Individualized Family Support PlanEarly Steps services are based on

evaluations/assessments, and family concerns, resources, and goals

Information about the child and family, including authorized services, are captured on the Individualized Family Support Plan (IFSP) which is required under 34 CFR 303.340

Early Steps uses a Team Based Primary Service Provider approach

Individual Family Support Plan The development of the IFSP should

include the nurse care coordinator and the CBC case manager

Recommended services and supports should be integrated within the other services provided to the family

Service delivery schedules should be coordinated, especially home visiting programs

Team Based Primary Service Provider

Aims to empower each eligible family by providing a comprehensive team of professionals from the beginning of services through transition at age 3

Services are provided where families live, learn and play, to enable them to implement developmentally appropriate learning opportunities during everyday activities and routines

Most services will be early intervention home visits

Team Based Primary Service Provider For children in out-of-

home care the team should have access to early childhood mental health therapists

Social, emotional and behavioral early intervention services should be coordinated with other mental health services provided

Early Intervention Home Visits

Goal is for the family to receive strong support

from one personbe provided a

comprehensive team of professionals

have fewer appointments and more time to be a “family”

Coordinated with other in home services

What does Early Intervention Look Like?

Video made available by the Connecticut Birth to Three system and is posted on the Florida Early Steps website for parents to view

http://www.birth23.org/videos/HV/B23HVEN.htm

Summary Children should receive

coordinated health careCoordination of care will

include physical health care, developmental interventions and mental health services

Early intervention services must be coordinated with the overall health care

Integration and Coordination

Planning processes and documents such as the IFSP, the health plan and the case plan must be integrated and coordinated to ensure that:Services are in support of the permanency

goalsServices are coordinated and made easily

manageable for the care giverServices address the needs of the immediate

care giver and the biological families if appropriate

More Information on Early Steps

Early Steps Website athttp://www.cms-kids.com/families/early_steps/early_steps.html

Questions