CYSHCN Health Domain Annual Report

Please note, many activities were paused or slowed during 2020-2021 as a result of COVID-19 staff redirections and long-term staff vacancies. These activities are noted below by an asterisk (*) next to the activity. Where applicable, additional information is provided.

July 2020 – June 2021

Introduction

In FY 2018-19, the Maternal, Child, and Adolescent Health Division (MCAH) of the California Department of Public Health (CDPH) created a position to direct activities related to Children and Youth with Special Health Care Needs (CYSHCN). The CYSHCN Director designation had previously resided with Department of Health Care Services/Integrated Systems of Care Division (DHCS/ISCD), whose California Children’s Services (CCS) program receives a portion of the state’s Title V CYSHCN funding. CDPH/MCAH’s new CYSHCN Director led a “Year of Learning” during 2018-19, which informed our current 2021-2025 Title V Action Plan and Needs Assessment (NA). Based on findings from the Year of Learning, CDPH/MCAH explored ways to reallocate a portion of the Title V funds from DHCS/ISCD to CDPH/MCAH to build public health systems and services for the broader CYSHCN population.

With this in mind, we acknowledge the continued importance of the CCS program, which provides coordinated care for California’s children and youth with the most highly complex and chronic medical needs. Many of DHCS/ISCD’s CYSHCN activities during fiscal year (FY) 20-21 included program improvement and quality assurance and directly aligned with Title V priorities. Many activities under the CCS umbrella benefit the broader CYSHCN population. For example, CCS provides workforce development for health care providers who serve both children with serious medical complexities and the larger CYSHCN population, and promotes systems, tools, and services accessed by both CCS clients and the broader CYSHCN population such as “Got Transition.”

Title V CYSHCN activities have been deeply affected by the COVID-19 public health emergency. CDPH/MCAH continues to respond to constant staffing shifts and crisis response reassignments, as well as major staffing vacancies. During FY 2020-21, Title V CYSHCN Director Sarah Leff was reassigned to Acting Title V Director from May 2020 until September 2021. To date, there have been long standing vacancies in the CYSHCN program, which CDPH/MCAH is working to fill in early 2022. The MCAH Child Health Medical Officer was also out of the office on extended leave and subsequently retired, leaving this position vacant for the past two years. These factors affected the trajectory of plans and activities during 2020-21.

CYSHCN Focus Area 1: Build capacity at the state and local levels to improve systems that serve CYSHCN and their families.

CYSHCN Objective 1

By 2025, increase the number of local MCAH programs that implement a Scope of Work objective focused on CYSHCN public health systems and services.*

Objective baseline history

Data is not available for this objective for FY 20-21. We anticipate data being available for the FY 22-23 application narrative.

Story behind the baseline

This objective was chosen to capture the progress of local MCAH programs in building their capacity to reach and serve CYSHCN and their families using a public health approach and intervening at the systems level.

CYSHCNs Objective 1: Strategy 1

Lead state and local MCAH capacity-building efforts to improve and expand public health systems and services for CYSHCN.

What did CDPH determine as activities that would work to bring about change?

1. Explore mechanisms to fund, create, and guide local action collaboratives to focus on topics such as emergency preparedness for CYSHCN, transition to adult health care, local family engagement, and other needs.
2. Explore mechanisms to expand state-level capacity (positions and funding) for CYSHCN activities.*
3. Gather information and explore options for training to local MCAH programs on leveraging other sources of funding to expand programs and services available to CYSHCN.*
4. Maintain and expand partnerships with CYSHCN system leaders to increase coordination across sectors.
5. Participate on committees, collaboratives, and workgroups related to improving systems of care for CYSHCN.

Narrative section

1. CDPH/MCAH is utilizing Title V to fund a small number of innovative projects focused on public health strategies to improve support for CYSHCN and their families. The aim of the CYSHCN Innovation Grants is to encourage local health jurisdictions’ local MCAH programs to implement public health strategies that focus on upstream measures to support CYSHCN and their families across the state of California. The Innovation Grants hope to establish best practices and successful approaches that can be adapted by other local MCAH programs throughout California and nationally. CDPH/MCAH released an application for competitive grant awards in June 2021 and finalized the selection of five local MCAH programs to receive funding in October 2021. Grant funding will be allocated annually beginning in 2022 through 2025. The local health departments selected to receive funding are the City of Pasadena and the Counties of Riverside, San Francisco, San Joaquin, and Sutter. Below are brief snapshots of each agency’s original proposal. Actual program activities will likely change and evolve as agencies begin their processes of needs assessment and program implementation.

Pasadena:

• Hire a Peer Family Navigator to provide system navigation support and linkages to services, mentoring, and other peer-to-peer support for families of CYSHCN.
• Improve transition of youth into the adult health care system.
• Conduct a comprehensive environmental scan to understand needs, strengths, barriers, and opportunities for CYSHCN and their families.

Riverside:  

• Strengthen the partnership between MCAH and the California Children’s Services (CCS) program while establishing a pipeline for cross-referrals and increasing utilization of MCAH home visitation programs.
• Build resilience among clients and their families by creating a program to identify needs, facilitate peer relationships, and build connections between families and community resources.

San Francisco:

• Develop a formal, community-based, family centered interagency collaborative to improve systems that serve CYSHCN and families with a focus on collaborative impact and giving power to the community voice, simplifying processes across agencies, improving the transition to adult health care, and training family members to advocate for systems-level improvement.

San Joaquin:

• Improve and expand MCAH home visiting services for CYSHCN with focus on empowering families to successfully navigate systems of care.
• Create a virtual peer support group for families and work with community partners on collective impact approaches to address social determinants of health.

Sutter:

• Expand and enhance identification and intervention services to young children experiencing developmental and mental health challenges.
• Work with providers and community partners to strengthen “Help Me Grow” outreach.
• Provide case management for families with unmet needs and expand availability of mental health interventions for families of CYSHCN in home visiting programs.

2. Activity Paused

3. Activity Paused

Activities 4 & 5 will be combined in future narratives due to their similarity and overlap. Most partnership activities were paused during FY 20-21 due to the CYSHCN Director also serving as the Acting Title V Director during this time, in addition to the redirection of resources to the COVID-19 pandemic response. However, the relationships built over previous years with key partners were continued, including Family Voices of California, the Lucile Packard Foundation for Children’s Health, and the UC Davis University Center for Excellence in Developmental Disabilities, among others.

CYSHCNs Objective 1: Strategy 2

Lead program outreach and assessment within state MCAH to ensure best practices for serving CYSHCN are integrated into all MCAH programs.*

What did CDPH determine as activities that would work to bring about change?

1. Dedicate a staff position to lead integration of best practices for serving CYSHCN into state-level MCAH programs, track and organize CYSHCN resources, create technical assistance materials, and support the work of the CYSHCN Director in building state and local MCAH capacity and engagement.*
2. Review policies and procedures of state-level MCAH programs to identify areas of need and improvement around serving CYSHCN.*
3. Partner with the CDPH/MCAH Child Health domain team to integrate best practices around developmental screening, referrals, and linkages to care in local case management and public health nursing programs.*
4. Explore mechanisms to support development of screening and resource pathways at the local level.*

 Narrative section

All activities paused.

CYSHCNs Objective 1: Strategy 3

Partner to build data capacity to understand needs and health disparities in the CYSHCN population.

What did CDPH determine as activities that would work to bring about change?

1. Explore mechanisms to fund a California oversample of the National Survey of Children’s Health (NSCH).
2. Examine existing cardiac datasets to determine whether linkages can be established between California Perinatal Quality Care Collaborative (CPQCC) Neonatal Intensive Care Unit (NICU), High Risk Infant Follow-up (HRIF), and cardiac data to increase identification of neonates requiring HRIF follow-up.
3. Assess referrals and loss to follow-up from the HRIF program to identify and address any disparities.

Narrative section

1. CDPH/MCAH accomplished Activity 1. In 2021, California successfully partnered with HRSA and the U.S. Census Bureau to utilize California’s Title V Block Grant funds to purchase a state oversample of the NSCH. In addition to the 3,300 addresses typically invited to participate in the survey, nearly 30,000 addresses will also be invited to participate. Information about the planned oversample is available here: California's Title V Program Investing in Better Child Health Data

2-3.

The CPQCC at Stanford University is the DHCS HRIF contractor and handles the data from CCS-approved NICUs in collaboration with DHCS/ISCD. CPQCC NICU data are linked to the HRIF Quality Care Initiative (QCI) data. More recently, HRIF data efforts have focused on examining existing cardiac datasets to determine whether linkage can be established between CPQCC, HRIF, and cardiac data. Significant opportunities to improve HRIF referral and follow-up exist for infants with Congenital Heart Disease (CHD) requiring neonatal surgery and/or minimally invasive intervention.

The HRIF-Cardiovascular Intensive Care Unit (CVICU) Expansion Project started during the FY 18-19 with a pilot project of five participating cardiac centers. The data linkage initiative, which has since expanded to include the CVICUs, NICUs, and HRIF clinics of the eight hospitals that conduct the majority of neonatal cardiovascular surgeries in the state, addresses the issue of more completely identifying all neonates requiring intensive care support and follow-up after hospital discharge. The project aims to connect with CVICUs and help them identify and refer neonates with complex CHD who are eligible for care in a CCS HRIF clinic upon hospital discharge. CHD infants requiring neonatal surgery and/or minimally invasive intervention may be directly admitted to CVICUs without passing through the NICU. Such infants are thus not referred to HRIF and not captured in the HRIF database. Establishing linkages with cardiac datasets improves our ability to examine the complete picture of outcomes for high-risk infants discharged from intensive care settings.

As part of the expansion project, CPQCC examined ways to streamline the HRIF Reporting System to facilitate the referral and registration process for CVICUs. In October 2019, CPQCC introduced two new features to the HRIF Reporting System: a cardiac referral tracking feature, which includes summary reports, and an electronic data submission (EDS) option. While the focus of the project is CVICUs, the EDS option will ultimately be available to CVICUs, NICUs, and HRIF clinics in all CCS-approved hospitals to streamline referral and registration of eligible high-risk infants. Beginning in summer 2020, CPQCC planned to make the EDS option, which allows automatic submission of records, available to all NICUs and HRIF clinics. This option saves facilities time and effort since they currently register patients individually in the HRIF Reporting System. However, due to system changes to address data entry during the COVID-19 pandemic and the rapid development and deployment of solutions around virtual visits/telehealth (i.e., CPQCC COVID webinars and data finalization modifications), this rollout was postponed.

We continue to work on gaining a better understanding of local and regional practice variations and learning from hospitals that excel at coordination and communication between the NICU, the CVICU, and the HRIF clinic. In addition, we continue to increase awareness of HRIF eligibility criteria and CCS expectations for referral among local HRIF programs, recognizing that different approaches may be necessary in different parts of the state.

Identifying disparities in HRIF data enables HRIF programs to address barriers to referral and follow-up. The CPQCC Health Equity Task Force Transition to Home Subgroup consists of HRIF Coordinators, CCS HRIF staff, and CPQCC staff collaborating with NICU staff to work on solutions to increase referral and follow-up rates.

CYSHCNs Objective 1: Strategy 4

Lead the establishment of a state-level learning collaborative to improve systems for CYSHCN through a national collaboration with the five largest states (CA, FL, IL, NY, TX), known collectively as the Big 5.*

What did CDPH determine as activities that would work to bring about change?

1. Participate in Big 5 meetings/conference calls/discussions and collaborate with other Big 5 states on public health approaches to improve systems for CYSHCN.*
2. Collaborate to gather information and assess existing tools and resources on a CYSHCN opportunity for improvement that could be applied across all big five states.*
3. Implement activities to launch the focused collaborative work of the Big 5.*

Narrative section

This strategy is indefinitely delayed due to the impact of the COVID-19 pandemic on all states involved. Because it is unknown when or if the Big 5 states will reconvene around this topic area again, we will remove this strategy beginning with the FY 22-23 application narrative. CYSHCN Objective 2

By 2025, increase the percentage of adolescents (ages 12 to 17) with special health care needs who received services necessary to make transitions to adult health care from 12.6% to 13.9% (NSCH 2017-18).

Objective baseline history

 

Story behind the baseline

This objective was chosen because it mirrors the National Performance Measure (NPM) for this domain. Of the three NPM options for CYSHCN, all are focused on the health care delivery system (Adequate Insurance, Medical Home, and Transition to Adult Health Care). As such, it made sense to align the required NPM with the objective for the CYSHCN Focus Area that relates to the health care delivery system. The other two domain Focus Areas are more geared toward public health approaches. Because this objective is related to the health care delivery system, the Title V program is unlikely to directly impact statewide data for this measure. However, the planned activities for this area do include Title V funding to help support the California Children’s Services (CCS) program at the Department of Health Care Services (DHCS) and has a more direct connection to the process of transition to adult health care. CDPH/MCAH is also in the process of funding innovation grants located in five public health departments in the state, several of which may incorporate a broader focus on supporting CYSHCN as they transition to adult health services beyond just the health care system.

CYSHCNs Objective 2: Strategy 1

Partner on identifying and incorporating best practices to ensure that CYSHCN and their families receive support for a successful transition to adult health care.

What did CDPH determine as activities that would work to turn the curve of the baseline?

1. Disseminate information to local MCAH* and CCS programs on best practices in transition.
2. Collaborate with Medi-Cal Managed Care Plans on facilitating transition to adult services for CYSHCN
3. Ensure CCS counties continue regular meetings with health plans and other community-based organizations (CBOs) to ensure the CCS program incorporates recommendations from the Transition to Adulthood Workgroup -based organizations.
4. Keep the CCS website updated on transition materials and pertinent links to resources.

Narrative section

The response below covers all activities related to this strategy:

DHCS/ISCD collaborates with local counties on transition best practices.

DHCS/ISCD continues to collaborate with Medi-Cal Managed Care Quality and Monitoring Division (MCQMD) on facilitating transition to adult services for CYSHCN. County CCS programs with robust transition programs provided input to DHCS/ISCD on transition planning and communications with Managed Care Plans (MCPs). DHCS/ISCD discussed transition planning with county directors of the Medical Therapy Program, which serves clients with cerebral palsy and other movement disorders.

CCS counties engaged in a variety of practices pertaining to transition services, including transition fairs and using county CCS parent liaisons and navigators who worked with families to identify pertinent community resources.

Counties implemented transition planning, readiness assessment, and guidance on conservatorship. They had regular meetings with health plans and CBOs to identify physicians and services for CCS clients as they transition to adulthood.

The proposed Transition Performance Measures developed by the DHCS/ISCD 2019-2020 Transition to Adulthood Workgroup are under review at the state level. These recommendations will help streamline and standardize processes implemented by CCS counties to continue to assist youth transitioning to adulthood.

CYSHCNs Objective 2: Strategy 2

Fund DHCS/ISCD to assist CCS counties in providing necessary care coordination and case management to CCS clients to facilitate timely and effective access to care and appropriate community resources.

What did CDPH determine as activities that would work to turn the curve of the baseline?

1. Ensure that CCS counties educate families about CCS benefits to assist them in navigating services.
2. Support CCS counties to collaborate with Medi-Cal Managed Care Plans to facilitate care coordination and case management.
3. Ensure that CCS shares best practices with Medi-Cal so that these may be broadly applied to the CYSHCN population.

Narrative section

The response below covers all activities related to this strategy.

CCS counties continue to work closely with families on educating them about CCS benefits. Family Advisory Committees in Whole Child Model counties ensure that families are well informed regarding navigation of services.

CCS counties communicate with MCPs regularly to facilitate care coordination and case management. DHCS/ISCD collaborates with MCQMD to address MCP issues.

CYSHCNs Objective 2: Strategy 3

Fund DHCS/ISCD to increase timely access to qualified providers for CCS clients to facilitate coordinated care.

What did CDPH determine as activities that would work to turn the curve of the baseline?

1. Secure Interagency Agreements with the University of California, Davis and the University of California, San Francisco to ensure that specialty/subspecialty medical expertise and audiology expertise are provided to fill critical gaps.
2. Continue to process provider applications for CCS paneling in a timely manner.
3. Continue to improve/streamline CCS review processes to ensure that comprehensive desk reviews and facility site visits are conducted in a timely manner.
4. Continue to implement processes to improve the timeliness of eligibility determinations and service authorization requests.
5. Ensure that CCS counties collaborate with Medi-Cal Managed Care Plans to address barriers to utilizing the Medi-Cal transportation benefit.

Narrative section

The response below covers all activities related to this strategy.

DHCS/ISCD collaborates with the University of California, Davis (UCD) and the University of California, San Francisco (UCSF) to provide appropriate specialty/subspecialty expertise for facility review site visits and input on CCS policy as needed. The COVID-19 pandemic necessitated a shift from onsite facility review visits to virtual visits. DHCS/ISCD developed a protocol for virtual facility review site visits, which resumed in January 2021 after a hold for several months with the onset of the pandemic and its associated lockdowns. There were some glitches at initial implementation of the virtual site visit protocol, but things have gone smoothly since then. Due the effects of the pandemic, virtual site visits have become the norm. While onsite facility review visits were on hold, comprehensive desk reviews continued to be processed appropriately.

With the pandemic, DHCS established an Emergency Medi-Cal Provider Enrollment process, effective March 23, 2020, with a retroactive date to March 1, 2020. This includes the temporary enrollment (good for 60 days) of providers enrolled in Medicare or as Medicaid Providers in other states. CCS paneling is expedited to conform with the Emergency Medi-Cal Provider Enrollment process. This has helped to ensure the timely processing of provider applications for CCS paneling.

DHCS/ISCD uses a divisional team approach and collaborates with CCS counties to work on streamlining processes to improve the timeliness of eligibility determinations and service authorization requests (SARs). DHCS/ISCD continues to work closely with CCS counties on addressing issues pertaining to Medi-Cal Managed Care Plans. Flexibilities that have been implemented with the pandemic include the following:

• Temporary suspension of previously required authorizations for Medi-Cal covered benefit categories
• Temporary suspension of previously required authorizations for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) in instances where the DMEPOS is lost, destroyed, irreparably damaged, rendered unusable, or unavailable
• Extension of age-out limits for High-Risk Infant Follow-up clinics
• Increasing previous caps to a 100-day supply for the dispensing of any covered drug, medical supplies, or prescription formulas and covered enteral supplements, including mail and home delivery by Medi-Cal enrolled pharmacies

CCS counties continue to collaborate with MCPS to ensure the availability of services for beneficiaries.

CHALLENGES

Due to the COVID-19 pandemic, onsite facility reviews of CCS facilities were suspended until the implementation of a virtual site visit protocol. DHCS/ISCD staff worked with facility staff to facilitate the review process, but facilities faced numerous challenges with the pandemic, including staff attrition and redirection. It took several months for the virtual site visit protocol to be fully implemented.

CYSHCN Focus Area 2: Empower and support CYSHCN, families, and family-serving organizations to participate in health program planning and implementation.

CYSHCN Objective 3

By 2025, x of 61 local MCAH programs will select a Scope of Work objective focused on family engagement, social/community inclusion, and/or family strengthening for CYSHCN.*

Objective baseline history

Data is not available for this objective for FY 20-21. We anticipate data being available for the FY 22-23 application narrative.

Story behind the baseline

This objective was chosen to capture Local MCAH activities related to building family resilience for families with CYSHCN, engaging families and caregivers, and promoting social and community inclusion for children and young people with special health care needs and disabilities.

CYSHCN Objective 3: Strategy 1

Partner to train and engage CYSHCN and families to improve CYSHCN-serving systems through input and involvement in state and local MCAH program design, implementation, and evaluation.*

What did CDPH determine as activities that would work to turn the curve of the baseline.

1. Explore mechanisms to fund expansion of the Family Voices of California Project Leadership training.*

2. Explore mechanisms for compensation of family members and self-advocates who participate in state- and local- level program planning.*

3. Provide technical assistance on family engagement to local MCAH programs, including connections to family-serving organizations and trained local family advocates, in collaboration with Family Voices of California.*

Narrative section

All activities paused.

 

CYSHCNs Objective 3: Strategy 2

Fund DHCS/ISCD to support continued family engagement in CCS program improvement, including the Whole Child Model, to assist families of CYSHCN in navigating services.

What did CDPH determine as activities that would work to turn the curve of the baseline?

1. Ensure that CCS counties continue to obtain family input by encouraging family participation in transition planning and/or Special Care Center (SCC) team meetings, advisory committees, and task forces by providing feedback regarding satisfaction with services.
2. Continue to promote participation in the family advisory committees of the Whole Child Model (WCM) health plans.
3. Continue to encourage family representation in the CCS Advisory Group and other pertinent stakeholder groups.

Narrative section

The response below covers all activities related to this strategy.

CDPH/MCAH and DHCS/ISCD seek to align with the goals of the federal Title V funding to provide family-centered community-based systems of coordinated care for CYSHCN, with family-centered services defined as the partnership

between families and professionals at all levels working together for the best interest of the child and the family.

Input from CCS family members may be obtained through the following:

• Family members are offered an opportunity to provide feedback regarding their satisfaction with the services received through the CCS program by participation in such areas as surveys, group discussions, or individual consultation.
• Family members participate in advisory committees or task forces and are offered training, mentoring and reimbursement when appropriate.
• Family members are participants of the CCS Special Care Center (SCC) services provided to their child through family participation in SCC team meetings and/or transition planning.
• Family advocates, either as private individuals or as part of an agency advocating family-centered care that has experience with CYSHCN, may serve as consultants to CCS counties.

WCM counties’ health plans are required to create and maintain a family advisory council. Positive feedback on this requirement has been received from family advocates and counties. WCM counties find that input from family members is valuable in improving service delivery and communication with beneficiaries.

 

The CCS Advisory Group (AG) includes members of county/health plan family advisory committees and parent liaisons. They are active participants in the discussion addressing issues encountered by beneficiaries at CCS counties. The number of family representative in the CCS AG has gradually increased over the past several years.

 

CYSHCN Objective 3: Strategy 3

Support statewide and local efforts to increase resilience among CYSHCN and their families.

What did CDPH determine as activities that would work to turn the curve of the baseline?

1. Expand local MCAH Scope of Work options to include community/social inclusion and community-building activities for families of CYSHCN.

2. Support local MCAH programs to promote trauma-informed practices in case management and public health nursing programs.*

3. Support Medi-Cal providers and CCS counties in the promotion of trauma-informed practices in case management.

4. Continue to participate in the Statewide Screening Collaborative to promote developmental screening efforts across the State.

5. Provide outreach materials informing families of the benefits/services available for CYSHCN, including CCS, and educating them in the navigation of such services.

6. Ensure that CCS counties collaborate with county Departments of Behavioral Health to facilitate referrals to appropriate mental health services for CYSHCN.

Narrative section

1. CDPH/MCAH accomplished activity 1. The following optional activities are now included in the Local MCAH Scope of Work: 

• Attend a Family Voices of California Project Leadership Training-of-Trainers and implement local Project Leadership Trainings.
• Within your county or region, create and deliver a training on family engagement for LHJ staff and partners.
• Design and implement a project focused on social and community inclusion for CYSHCN and their families.
• Promote trauma-informed practices specific to CYSHCN and families to ensure local MCAH programs such as home visiting and public health nursing have a trauma-informed approach that is inclusive of CYSHCN.

Local MCAH agencies also have the option of designing and implementing their own activity under the Priority Need, “Increase engagement and build resilience among CYSHCN and their families.”

The response below covers all DHCS activities related to this strategy.

DHCS, in partnership with the California Office of the Surgeon General, has created a first-in-the-nation statewide effort to screen patients for Adverse Childhood Experiences (ACEs) that lead to trauma and the increased likelihood of ACEs-associated health conditions due to toxic stress. By screening for ACEs, providers can better determine the likelihood that a patient is at increased health risk due to a toxic stress response, which can inform patient treatment and encourage the use of trauma-informed care. Detecting ACEs early and connecting patients to interventions, resources, and other supports can improve the health and well-being of individuals and families. The bold goal of this initiative is to reduce ACEs and toxic stress by half in one generation.
​The ACEs Aware Initiative launched in California in December 2019. Between December 2019 and December 2021, more than 21,500 individuals completed the ACEs Aware training. About 11,300 of those who completed the training are Medi-Cal providers who became ACEs Aware-certified to receive payment to screen for ACEs. Medi-Cal providers screened nearly 518,000 unique Medi-Cal beneficiaries between January 1, 2020 and March 30, 2021. DHCS/ISCD continues to support Medi-Cal providers and CCS counties in the promotion of trauma-informed practices.

CCS counties continue to provide support to families in outreach and education to assist them in navigating beneficiary services. In addition to ensuring access to appropriate medical services, CCS counties collaborate with county behavioral health staff to facilitate referrals to mental health services.

Please note, Activity 4 is reported on as part of the Child Health Action Plan (Objective 1, Strategy 2). This will be removed from the CYSHCN application narrative beginning with the 2022-23 application to avoid unnecessary duplication.

Challenges

For both Strategy 2 and 3, due to the COVID-19 pandemic, county staff have been redirected to pandemic efforts. This redirection has resulted in lack of adequate staff to perform the routine functions that ensure access to services.

 

CYSHCN Domain Partners

Who are our key partners?

Key Partners: Department of Health Care Services, Integrated Systems of Care Division    Family Voices of California   Local MCAH Programs   Lucile Packard Foundation for Children’s Health  California Perinatal Quality Care Collaborative (CPQCC) California Maternal Quality Care Collaborative (CMQCC) University of California, San Francisco  University of California, Davis       For a full list of partnerships, please refer to the Interagency Partnerships and Collaborations appendix