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Michigan Title V CSHCN Strategic Planning Session. “Let’s Get (it) This Party Started”. Diana Denboba April 16, 2008 U.S. Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau - PowerPoint PPT Presentation
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Diana DenbobaApril 16, 2008
U.S. Department of Health and Human Services (DHHS)
Health Resources and Services Administration (HRSA)Maternal and Child Health Bureau
Division of Services for Children with Special Health Needs
“Let’s Get (it) This Party Started”
Michigan Title V CSHCN Strategic Planning Session
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What Kind of Party Is this Anyway?
Core Outcomes
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MCHB :Mission
The mission of (MCHB) is to provide national leadership, in partnership with key stakeholders, to improve the physical and mental health, safety and well-being of the maternal and child health (MCH) population which includes all of the nation’s women, infants, children, adolescents, and their families, including fathers and children with special health care needs.
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Mandates for the System
Amended Legislation for Title V of the Social Security Act (1989):
“Facilitate the development of community-based systems of services”
Healthy People 2010 Objective 16-23 “Increase the proportion of States and territories
that have service systems for children with special health care needs.”
The President’s New Freedom Initiative (2001)
Responsibility given to HRSA for developing and implementing a community-based service system for children and youth with special health care needs and their families.
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“Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”
Who are the Children
and Youth?
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Creating Change
Building on a 20 year history Development Demonstration Partial implementation
History National Agenda for CSHCN Legislative Changes in Title V Healthy People 2000 and 2010 President’s New Freedom Initiative (2001)
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Click image to begin Click here to continue
What Is A Community System?
Source:Champions For Progress National Center/EIRI
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Principles Underlying the
System of Services
Family-Centered Culturally-Competent Coordinated Comprehensive Community Inclusion
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Monitoring Progress
National Survey of CYSHCN Title V Block Grant
Performance Measures/Forms (TVIS)
Discretionary Grant Performance Measures (DGIS)
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Family/Professional Family/Professional Partnerships Partnerships
& Cultural Competence & Cultural Competence OutcomeOutcome
Families will partner in decision making at all levels.
Family-Centered Care assures the health and well-being of children and families through respectful family/professional partnerships. It honors the strengths, cultures, traditions and expertise that everyone brings to this relationship. Family-centered care is the standard of practice that results in high quality services.
Family/Professional Partnerships assures that all are working together collaboratively with a sense of shared ownership, responsibility, success, power and respect for each others’ collective knowledge and expertise.
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Family/Professional Partnerships & Cultural Competence Outcome
.. come together in a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations.
*valuing diversity *cultural self-assessment *adapting to diversity*managing the dynamics of difference
*institutionalization of cultural knowledge
(Modified from Cross, Bazron, Dennis and Isaacs, 1989, by NCCC/Source NCCC)
CulturalCompetence
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Head- Understand that people think, believe, behave, perceive,
understand, react/respond differently than I do.
Heart- Sensitivity to the differences and similarities between and among people; especially those who are different from me.
Hands- Tools, skills and knowledge to work effectively with those who are different from me
Cultural Competence: the 3 H Perspective
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Family/Professional Partnerships & Cultural Competence Outcome
Why Important? National Survey for CSHCN 05-06
Only 57.4% of families with CSHCN report they participate in decision making and are satisfied with services they receive (42.6 not achieved)
35% lacked one or more components of family-centered care
Poor, children with more complex needs, Hispanic, other non-Hispanic and Black
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The Medical Home Outcome
An approach to providing health care services in a high-quality, comprehensive, and cost-effective manner.
Provision of care through a primary care physician and staff through partnerships with families, CYSHCN, allied health care professionals pediatric sub-specialists, education and other community providers.
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The Medical Home Outcome
Care that is:
Accessible Family-centered Comprehensive Continuous Coordinated Compassionate Culturally-effective
*And for which the physician shares responsibility
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The Medical Home Outcome
Why Important? National Survey for CSHCN 05-06
Only 47.1 (52.6%) of families report having all components of a Medical Home.
31.8%did not get one or more aspects of care coordination.
Better Health Outcomes Reductions in disparities in health between
socially disadvantaged subpopulations and more socially advantaged populations. *
Increased wellness resulting from comprehensive care .*
* Starfield B, Shi L. The Medical Home, Access to Care, and Insurance: A Review of Evidence.Pediatrics. 2004:113(suppl):1493-1498
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Early & Continuous Screening Outcome
Early and periodic/on-going developmental screening and monitoring for all children and youth in conjunction with the medical home.
Develop and monitor the efficacy of statewide newborn and infant hearing screening, evaluation and follow-up programs
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Early & Continuous Screening Outcome
Why Important? National Survey for CSHCN
Only 63.8% of CSHCN were screened early and continuously for special needs.
Only 48% of CSHCN below the poverty level were.
40-50% of infants needing some follow-up are lost (UNHS)
Early identification and continuous screening is critical: Provision of appropriate services and ongoing
assessments Reduce long term, secondary consequences Support families
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Access to Adequate Public or Private Insurance to Pay for Needed Services Outcome
Expand Insurance for Uninsured CYSHCN
Assure Comprehensive Coverage for CYSHCN with Insurance
Strengthen the Financing System Uninsured and underinsured Improve identification of CYSHCN Increase outreach & enrollment Raise income eligibility levels, expand buy-in
options Improve affordability (e.g. premium
subsidies) Buy in options, especially for small business
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Access to Adequate Public or Private Insurance to Pay for Needed Services Outcome
Why Important? National Survey of CSHCN
Only 62.0% feel adequately insured for services they need.
18.1% experience financial problems.
Impact on family 1/2+ of families spend $250 or more out
of pocket, 20% of families spent more than $1,000 Medicaid & SCHIP limit co-pays, don’t have data on unpaid bills.
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Integrated Community Systems Outcome
To support states and community development activities that enhance capacity to address service integration issues of CYSHCN and their families so that services are organized in ways that families can use them easily and be satisfied with services they receive.
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Integrated Community Systems Outcome
Why Important? National Survey for CSHCN
Only 89.1% families report services are easy to use.
19.5% Spanish language homes report outcome not achieved.
22% of those with emotional, behavioral or developmental issues report outcome not achieved
More difficult for complex medical needs, minority populations.
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OUTCOME Community-based service systems organized for easy useMichigan
Cshcndata.org
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Transition to Adult Life Outcome
“The optimal goal of health care transition is to provide health care
that is family-centered, continuous, comprehensive, coordinated, compassionate, & culturally competent in a health care system that is as developmentally appropriate as it is technically sophisticated.”
SOURCE: PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1304-1306. A Consensus Statement on Health Care Transitions
for Young Adults with Special Health Care Needs
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Transition to Adult Life Outcome
Why Important National Survey of CSHCN
Only 41.2 % (6%) of youth receive guidance and support in the transition to adult health care and have vocational/career training to prepare for adult job
Only 67.1% of mother only households achieve outcome
Trends 90% of CYSHCN are living to adulthood Employment rate for adults with disabilities
hovers around 30%. (U.S. Disability Statistics) Natural progression in a lifespan approach
to systems of care for CYSHCN.
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Transition to Adult Life
Race & Ethnicity in Michigan
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What Does This Mean What Does This Mean For You?For You?
Grants, family leaders, other agencies
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Watch for Signs AlongYour Journey!!
Hazardous Driving Conditions – Identify ChallengesWatch for Pedestrians & Cyclists – Look for the “Champions”Slow Speed – Evaluate: Participatory Action Research (PAR)Toll Ahead – Budgets Reflect Priorities
Adapted from: T.D. GoodeNational Center for Cultural Competence,
2005
Detour- More Than One Method/Communities Differ
Stop Light - Competing Priorities
Hidden Entrance – Unforeseen Opportunities, Work Zone – Many Partners/Non-Traditional
Divided Highway – Integrate
New Traffic Pattern – New Paradigm
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Strategic Planning! Oh No!!
Michigan’s way- Everyone has a role, so be a “Champion!”
The Non-Inclusive Way
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Contact Diana Denboba, Family-Centered
Care/Cultural Competence and Community Integrated Systems Programs Director 301-443-9332;
[email protected] Handouts
Michigan State Profile
