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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 MeetingFebruary 11, 2002

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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”

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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).

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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

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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.

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HRSA’s 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.

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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.

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What is a Medical Home?

The medical home is: accessible family-centered continuous comprehensive coordinated compassionate culturally effective

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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.

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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,

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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.

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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).

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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.

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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.

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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.

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MCHB Medical Home Program

Statewide Implementation Grants: Massachusetts New Hampshire New Mexico Oregon Pennsylvania Utah Washington

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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.

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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)