Please note: Some of the activities below are led by CDPH/MCAH and some are led by the Department of Health Care Services/Integrated Systems of Care Division (DHCS/ISCD). Many of the DHCS/ISCD activities are conducted and funded as part of the California Children’s Services (CCS) program, a statewide program that provides coordinated care for California children and youth with the most highly complex and chronic medical needs. Title V contributes a relatively small portion of funding for the broader program, as well as fully funding several specialized sub-contracts focused on program improvement, quality assurance, and data systems related to the High-Risk Infant Follow-up program.

 

For a full explanation of this domain’s structure and recent changes, please see the Supporting Document titled, ‘Title V Children and Youth with Special Health Care Needs Domain: Year of Learning, Stakeholder Engagement, and Quantitative Needs Assessment Findings.’

 

CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS Priority Need 1: Make systems of care easier to navigate for CYSHCN and their families

 

Surveillance:

The Maternal, Child, and Adolescent Health Division of the California Department of Public Health (CDPH/MCAH) monitored the prevalence of California children and youth with special health care needs (CYSHCN), receipt of services, and county-level planning efforts as part of routine health surveillance efforts. The following indicators and measures listed in the table below are continuously and systematically collected, analyzed, and interpreted to guide program planning, implementation, and evaluation of interventions. These indicators were analyzed at the state and sub-state (where sample size allowed) levels to identify specific improvement opportunities.

 

Select CYSHCN Health Indicators and Measures	Data Source
CYSHCN enrollment in CCS (1-22 years of age and % by health coverage)	CMS Net
Newborn hearing screening	Natus database
NPM 12 (transition), NOM 17.1 (prevalence), NOM 17.2 (systems of care)	National Survey of Children’s Health
Number of local MCAH scope of work activities (CYSYCN Objective 1 and 3)	Local MCAH Scopes of Work

 

As part of California’s Title V State Action Plan, focus areas were identified in each population domain to help guide the work. Each year, the 61 Local Health Jurisdictions (LHJs) in California develop annual Scopes of Work (SOW) that contain activities that align with the State’s Title V Action Plan and these focus areas.

 

The following graph shows the number of LHJs and the related focus areas in the CYSHCN Health Domain that had activities the LHJs planned to implement in their 2021-2022 SOW.

 

 

• 46 LHJs (77%) worked on CYSHCN Focus Area 1: Build capacity at the state and local levels to improve systems that serve CYSHCN and their families, in 2021-2022
• 10 LHJs (17%) worked on CYSHCN Focus Area 2: Increase access to coordinated primary and specialty care for CYSHCN, in 2021-2022
• 18 LHJs (30%) worked on CYSHCN Focus Area 3: Empower and support CYSHCN, families, and family-serving organizations to participate in health program planning and implementation, in 2021-2022

 

 aExcludes one LHJ that did not submit an annual report.

 

The following graph shows the number of activities in each focus area in which the LHJs conducted efforts to address these areas in their 2021-2022 SOW.

 

 

• 56 SOW activities supported CYSHCN Focus Area 1: Build capacity at the state and local levels to improve systems that serve CYSHCN and their families were implemented by 46 LHJs (77%) in 2021-2022
• 14 SOW activities supported CYSHCN Focus Area 2: Increase access to coordinated primary and specialty care for CYSHCN were implemented by 10 LHJs (17%) in 2021-2022
• 21 SOW activities supported CYSHCN Focus Area 3: Empower and support CYSHCN, families, and family-serving organizations to participate in health program planning and implementation were implemented by 18 LHJs (30%) in 2021-2022

 

aExcludes one LHJ that did not submit an annual report.

 

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 percentage (from 0 to x%)[1] of local MCAH programs that implement a Scope of Work objective focused on CYSHCN public health systems and services.

*Note this was the objective when we did our Application Plan in 2021-2022. It has since been updated.

 

Story Behind the Curve:

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.

 

CYSHCN Objective 1: Strategy 1:

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

 

 

 

 

Activity:

CDPH/MCAH will fund innovative local projects that focus on public health strategies for CYSHCN and their families.

 

Narrative:

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. CDPH/MCAH will distribute grant funding 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.

 

Activity:

CDPH/MCAH will explore mechanisms to expand state-level capacity (positions and funding) for CYSHCN activities.

 

Narrative:

This activity is being reassessed in light of major state funding expansions related to child and family health.

 

Activity:

CDPH/MCAH will 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.

 

 

Narrative:

This activity is paused during this report period and will be reassessed.

 

Activities:

CDPH/MCAH will maintain and expand partnerships with CYSHCN system leaders to increase coordination across sector.

 

CDPH/MCAH will participate on committees, collaboratives, and work groups related to improving systems of care for CYSHCN, including collaboration with the CDPH/MCAH Child Health Domain to guide the efforts of the California Statewide Screening Collaborative.

 

Narrative:

These activities will be combined in future narratives due to their similarity and overlap. In addition, CDPH/MCAH will no longer be funding the California Statewide Screening Collaborative. Details can be found in the Child Health section of the Annual Report. Many partnership activities have been paused due to leadership vacancies and changes through the pandemic; 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.

 

Activity:

CDPH/MCAH will work with the Center for Family Health to support the Children and Youth Behavioral Health Initiative (CYBHI), a multidepartment effort to improve access to care and to destigmatize the need for behavioral health care for children across diverse cultures and communities.

 

Narrative:

CDPH/MCAH participates in several inter-departmental and inter-agency workgroups focused on CYBHI and other mental and behavioral health efforts that are being launched in California to support children and families.

 

CYSHCN 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.

 

Activity:

CDPH/MCAH will hire 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.

 

Narrative:

This activity has evolved in light of the new CYSHCN innovation grants. This position is now a Program Consultant for the innovation grant program. The position was open and posted for recruitment five times beginning in August 2021 and was filled in October 2022.

 

Activities:

CDPH/MCAH will review policies and procedures of state-level MCAH programs to identify areas of need and improvement around serving CYSHCN.

 

The CDPH/MCAH CYSHCN domain team will 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.

 

The CDPH/MCAH CYSHCN domain team will explore mechanisms to support development of screening and resource pathways at the local level.

 

Narrative:

These activities are all paused due to staff vacancies and redirections. Due to changing priorities, these activities are also being reassessed and may be removed from the 2023-2024 Application.

 

CYSHCN Objective 1: Strategy 3:

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

 

Activity:

CDPH/MCAH will fund a California oversample of the National Survey of Children’s Health.

 

Narrative:

This was officially approved by HRSA, in partnership with the Census Bureau, in July 2021. Oversample data collection began in the first half of 2022 and data will be available for analysis in fall 2023. The oversample will provide increased data reliability at the state level, make select data available by county or region and other key demographic characteristics such as race/ethnicity, and will be an incredible asset to child-serving organizations and programs across California. MCAH will use these data to target and inform programs, to share with local agencies via data dashboards, and to better understand health disparities and the needs of children and families across the state.

 

CDPH/MCAH creates indicator-specific dashboards for California, all designed to serve the data needs of our partners and stakeholders. State-, county- and/or regional-level indicator data are shown by various stratifications or subgroups and by year. Each dashboard also includes a link to download the data. The dashboards are organized by the five Title V health domains.

 

Activity:

CDPH/MCAH will consider other data collaborations such as with the Maternal and Infant Health Assessment and with our sister division, the Genetic Diseases Screening Program (GDSP).

 

Narrative:

This activity was paused during this report period and will be reassessed.

 

Activities:

DHCS/ISCD, in partnership with the California Perinatal Quality Care Collaborative (CPQCC), continues to examine existing cardiac datasets to determine whether linkages can be established between CPQCC Neonatal Intensive Care Unit (NICU), High Risk Infant Follow-up (HRIF), and cardiac data to increase identification of neonates requiring HRIF follow-up.

 

DHCS/ISCD will continue to assess referrals and loss to follow-up from the HRIF program to identify and address any disparities.

 

Narrative:

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 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 objective was to make the EDS option 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, this rollout was postponed 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). After much discussion, the EDS Referral Registration option was announced to NICUs and HRIF clinics during the Data Trainings in October 2021. Sites were able to start using the EDS option effective February 2022. 

 

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.

 

HRIF is developing health equity dashboards in the HRIF Reporting System to assist local HRIF programs in identifying and addressing disparities in their data. Each local HRIF program can examine their data using the following universal filter selections:

 

• Factors: Race/Ethnicity, Language, Insurance
• Birth Years: e.g., 2011-2015, 2016-2020
• Birthweight (BW) or Gestational Age (GA): ≤1500 grams or < 32 weeks, >1500 grams or ≥32 weeks, custom BW, custom GA
• Standard Visits: #1, #2, #3

 

Outcomes that can be examined include Core Visit Follow-up Rate, Early Intervention referrals to the Early Start Program and the Medical Therapy Program, and Service Referrals (medical/special/support). Each HRIF program/clinic data can be compared to all HRIF (statewide) data. These data will assist HRIF programs in identifying social determinants of health factors that affect delivery of services. The dashboards continue to be improved as local HRIF programs provide feedback.

 

In December 2018, CPQCC established the Health Equity Taskforce to “achieve health equity and improve care outcomes for small and sick newborns and their families across California.” In 2020, this taskforce was established as a standing committee of the Perinatal Quality Improvement Panel, CPQCC’s quality improvement (QI) oversight arm. The 31-member task force is a multidisciplinary, multi-stakeholder effort that engages providers and family representatives from across the state and includes leadership from both CPQCC and the California Maternal Quality Care Collaborative (CMQCC). Members convene once a month to identify and define taskforce priorities. Three subgroups were formed to tackle issues of equity within a specific area of focus: disparities in care delivery between NICUs; disparities in care delivery within NICUs; and disparities during transition to home. Select members of the HRIF Executive Committee participate in the subgroup that addresses disparities during transition to home.

 

Research conducted by CPQCC has found differences in care between hospitals, with hospitals that score low on overall quality of care tending to treat more Black and Hispanic infants, and within hospitals, with vulnerable families receiving different and suboptimal care. Considerable disparities in the referral of vulnerable infants to follow-up care post discharge have also been found. The subgroups are working to define QI aims that address equity issues within their domains and to create pilot projects that engage NICUs across the state to test solutions aligned with these aims. The Transition to Home subgroup is completing a project to identify and evaluate sociodemographic, program-level, and regional disparities associated with lack of attendance at the final HRIF visit between 18-36 months.

 

CPQCC is developing a health equity report for each member NICU that will be available through the NICU Reports site. The report will display information on societal factors that may affect the equity of care at each NICU, as well as resources that can help NICU staff to understand these local factors and to refer families to community-based support. Such reports will help support similar efforts in HRIF.

 

CYSHCN 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.

 

Activities:

CDPH/MCAH will participate in Big 5 meetings/conference calls/discussions and collaborate with other Big 5 states on public health approaches to improve systems for CYSHCN.

 

CDPH/MCAH will collaborate to gather information and assess existing tools and resources on a CYSHCN opportunity for improvement that could be applied across all Big 5.

 

CDPH/MCAH will implement activities to launch the focused collaborative work of the Big 5.

 

Narrative:

This strategy and all activities were 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, CDPH/MCAH removed this strategy beginning with the 2022-2023 Application Narrative.

 

CYSHCN Objective 2:

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

 

Story Behind the Curve:

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.

 

CYSHCN 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.

 

Activities:

CDPH/MCAH and DHCS/ISCD will disseminate information to local MCAH and CCS programs on best practices in transition.

 

DHCS/ISCD will support CCS counties to collaborate with Medi-Cal Managed Care Plans on facilitating transition to adult services for CYSHCN.

 

Narrative:

CDPH/MCAH activities related to transition continued to be paused. 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 community-based organizations to identify physicians and services for CCS clients as they transition to adulthood.

 

As part of the California Advancing and Innovating Medi-Cal Initiative (Cal AIM) launched in January 2022, DHCS/ISCD is providing input on quality metrics, to include transition measures, for the Population Health Management (PHM) program, which is designed to proactively assess and address the care needs of Medi-Cal beneficiaries with tailored interventions. Establishing a unified, statewide approach to PHM ensures that all members - children, their parents, pregnant persons, elderly and other adults, and people with disabilities - have access to a whole-system, person-centered program that leads to longer and healthier lives, improved clinical outcomes, and a reduction in disparities. The launch of PHM is part of a broader arc of change to improve health outcomes across the state that began with CalAIM. Transition measure recommendations will help streamline and standardize processes implemented by CCS counties to continue to assist youth transitioning to adulthood.

 

Activities:

DHCS/ISCD will ensure CCS counties continue regular meetings with health plans and other community-based organizations to ensure the CCS program incorporates recommendations from the Transition to Adulthood Workgroup-based organizations.

 

DHCS/ISCD will keep the CCS website updated on transition materials and pertinent links to resources.

 

Narrative:

These activities have been completed and were removed beginning with the 2022-2023 Application Narrative.

 

CYSHCN 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.

Activities:

DHCS/ISCD will ensure that CCS counties educate families about CCS benefits to assist them in navigating services.

 

DHCS/ISCD will support CCS counties to collaborate with Medi-Cal Managed Care Plans to facilitate care coordination and case management.

 

DHCS/ISCD will ensure that CCS shares best practices with Medi-Cal so that these may be broadly applied to the CYSHCN population.

 

Narrative:

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.

 

CYSHCN Objective 2: Strategy 3:

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

 

Activities:

DHCS/ISCD will continue Interagency Agreements with the University of California, Davis and the University of California, San Francisco to ensure that specialty/subspecialty medical expertise are provided to fill critical gaps.

 

DHCS/ICSD will continue to improve/streamline CCS review processes to ensure that comprehensive desk reviews and facility site visits are conducted in a timely manner.

 

Narrative:

DHCS/ISCD collaborated 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. While onsite facility review visits were on hold, comprehensive desk reviews continued to be processed appropriately. Due to the effects of the pandemic, virtual site visits became the norm until Spring 2022 when in-person site visits were resumed.

 

Activity:

DHCS/ISCD will continue to process provider applications for CCS paneling in a timely manner.

 

Narrative:

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. Other flexibilities, which will continue until the official end of the federal COVID-19 Public Health Emergency, 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.

 

Activity:

DHCS/ISCD will continue to implement processes to improve the timeliness of eligibility determinations and service authorization requests and DHCS/ISCD ensures that CCS counties collaborate with Medi-Cal Managed Care Plans to address barriers to utilizing the Medi-Cal transportation benefit.

 

Narrative:

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 (MCPs) and to collaborate with MCPs to ensure the availability of services for beneficiaries.

 

Challenge(s):

• 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 Priority Need 2: Increase engagement and build resilience among CYSHCN and their families. (2020-25 plan)

 

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 SOW objective focused on family engagement, social/community inclusion, and/or family strengthening for CYSHCN. [2]

*Note this was the objective when we did our Application Plan in 2021-2022. It has since been updated.

 

Story Behind the Curve:

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 youth 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.

 

Activity:

CDPH/MCAH will explore mechanisms to support expansion of the Family Voices of California Project Leadership training.

 

Narrative:

This activity was paused because the Project Leadership training has not resumed since the start of the pandemic. Family Voices of CA is currently working on updating and revising the training for a virtual format. The California Title V CYSHCN Director has been in contact with Family Voices of California about plans to support the new version of the training when it becomes available.

 

Activity:

CDPH/MCAH will explore mechanisms for compensation of family members and self-advocates who participate in state and local level program planning.

 

Narrative:

This activity was paused due to lack of state mechanisms for compensation of non-employees. The only mechanism identified is to set up a new external contract via a competitive funding process, which takes up to 18 months and was not an option during this reporting period due to staff vacancies in both the program and contracts teams.

 

Activity:

CDPH/MCAH will 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:

This activity was mainly paused during this reporting period. This activity resumed during the summer with a networking session to connect CYSHCN innovation grantees (who are all also Local MCAH agencies) with their specific Family Resource Center Network location. The California Title V CYSHCN Director has also been discussing future plans for partnering on technical assistance and training with Family Voices of California.

 

CYSHCN 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.

 

Activity:

DHCS/ISCD will 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.

 

Narrative:

CDPH/MCAH and DHCS/ISCD aimed 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.

 

Activity:

DHCS/ISCD will continue to promote participation in the family advisory committees of the Whole Child Model health plans.

 

Narrative:

Whole Child Model 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. Whole Child Model counties find that input from family members is valuable in improving service delivery and communication with beneficiaries.

 

Activity:

DHCS/ISCD will continue to encourage family representation in the CCS Advisory Group and other pertinent stakeholder groups.

 

Narrative:

The CCS Advisory Group (AG) includes members of county/health plan family advisory committees and parent liaisons. They are active participants in addressing issues encountered by beneficiaries at CCS counties and provide valuable input. The number of family representatives in the CCS AG has gradually increased over the past several years. Currently, there are four family representatives and a Family Voices of California representative in the 34-member CCS AG.

 

CYSHCN Objective 3: Strategy 3:

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

 

Activity:

CDPH/MCAH will expand local MCAH SOW options to include community/social inclusion and community-building activities for families of CYSHCN.

 

Narrative:

This activity has been accomplished and will be removed in future reports. The following optional activities are now included in the Local MCAHSOW:

 

• 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.

 

Activity:

The CDPH/MCAH CYSHCN domain team in partnership with the CDPH/MCAH Child Health Domain team will support local MCAH programs to promote trauma-informed practices in case management and public health nursing programs.

 

Narrative:

This activity was paused during this report period due to long term staff vacancies.

 

Activities:

DHCS/ICSD will support Medi-Cal providers and CCS counties in the promotion of trauma-informed practices in case management.

 

DHCS/ICSD CCS Local County programs will provide outreach materials informing families of the benefits/services available for CYSHCN, including CCS, and educating them in the navigation of such services.

 

DHCS/ICSD will ensure that CCS counties collaborate with county Departments of Behavioral Health to facilitate referrals to appropriate mental health services for CYSHCN.

 

Narrative:

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 approximately 518,000 unique Medi-Cal beneficiaries between January 1, 2020, and March 30, 2021. One-third (33%) of the approximately 518,000 unique ACE screenings were conducted with children under five years old through their caregivers, and more than three-quarters (80%) of all unique ACE screenings were with the pediatric population under age 18. Additionally, nearly 105,000 adults were screened for ACEs (20%). Six percent of unique Medi-Cal beneficiaries screened had an ACE score of four or higher (indicating high-risk for toxic stress); 94% had an ACE score of three or less (indicating lower risk for toxic stress). High-risk ACE scores were most prevalent among females ages 45 through 64 (15%), followed by females ages 18 through 44 (13%). The prevalence of high-risk ACE scores generally increased with age for each sex.

 

American Indian/ Alaskan Native beneficiaries had the greatest prevalence of high-risk ACE scores (20%), followed by White beneficiaries (13%), Black/African American beneficiaries (10%), beneficiaries who did not report their race or ethnicity (6%), Hispanic beneficiaries (5%), and Asian/Pacific Islander beneficiaries (4%).

 

DHCS/ISCD continued to support Medi-Cal providers and CCS counties in the promotion of trauma-informed practices. CCS counties continued 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 collaborated with county behavioral health staff to facilitate referrals to mental health services.

 

Activity:

CDPH/MCAH and DHCS/ISCD will continue to participate in the Statewide Screening Collaborative to promote developmental screening efforts across the State.

 

Narrative:

This activity is no longer applicable and has been removed beginning with the 2022-2023 Application. This is reported on in more detail in the Child Health Annual Report (Objective 1, Strategy 2, Activity 2).

[1] This measure was finalized and submitted with the 2022-2023 Application Narrative.

[2] This measure was finalized and submitted with the 2022-2023 Application Narrative.