NPM 11 – Medical Home: percent of children with and without special health care needs, ages 0 through 17, who have a medical home.

 

Children Special Health Services Section Overview

 

System of Care Improvement, and Addressing NPM 11

 

The Children’s Special Health Services (CSHS) Section addresses NPM 11 by offering gap-filling programs, such as peer support services and resource coordination programs, to all children and their families in Montana. CSHS offers a variety of population health and direct service programs aimed to meet the needs of the Children & Youth with Special Health Care Needs (CYSHCN) in collaboration with numerous DPHHS housed programs.

 

In FFY22, there were significant CSHS staff transitions and changes to the 5.0 program staff and 1.0 Americorps VISTA, supervised by the CYSHCN Director/Section Supervisor. The CYSHCN Director, CSHS Nurse Consultant and Newborn Screening Program Manager remained consistent. A new Montana Access to Pediatric Psychiatry Program (MAPP-Net) Program Specialist began in March 2022 and a new CYSHCN Program Assistant began in June 2022. The Americorps VISTA served the first three months of FFY22 before her term ended in January 2022.

 

CSHS manages critical programs for CYSHCN including: Cleft/Craniofacial Clinics; a Statewide Genetics and Metabolic program; the Newborn Hearing Screening Program; and MAPP-Net. Through Title V funding, CSHS supports initiatives to increase parent leaders and peer-to-peer support through the Parent Partner Program and Circle of Parents. Population-based initiatives are supported through the Transitions Project and the Medical Home Portal.

 

Overview of Programs Directly Funded through Title V

 

The HALI Project: Montana Parent Partner Program - FFY22 Update

 

The Montana Parent Partner Program (MPPP) continued to provide peer services to families of children with special health needs across Montana. The impact of COVID-19 continued into FFY22, resulting in: Parent Partner turnover; a decrease in referrals; and barriers to starting programs in new practices. However, training was ongoing.

 

In FFY22, MPPP served 275 families in 1,859 different encounters; offering valuable support, encouragement, and hope to families. The number of distinct clients for this fiscal year increased from FFY21 (n=154). The FFY 22 increase may have been due to a decrease in the number of host clinical sites and parent partners during the height on the pandemic in FFY21. Parent Partners were spread across Montana in these five locations; Great Falls, Butte, Billings, Kalispell, and Helena.

 

While the COVID-19 pandemic continued to impact the efforts of the MPPP in FFY22, there were significant improvements on the delivery of care and meeting the needs of families in Montana. The MPPP was able to find solutions to issues that arose due to COVID-19 to effectively improve the program. Promotion continued in FFY22 for service delivery via telecommunications, to address both COVID-19 and geographic barriers.

 

CSHS collaborated with the University of Montana Rural Institute (UMRI) to host a Montana team’s participation in the National Care Coordination Academy. The CSHS Supervisor and a UMRI staff co-led an interdisciplinary team that included family leaders, payer representation from Medicaid and Blue Cross Blue Shield, Title V CYSHCN Program Specialist, pediatricians and clinicians, and the MPPP State Director. The Montana team meeting consisted of workshop-structured learning opportunities and regular virtual meetings. The MPPP State Director presented the MPPP model as part of an ongoing series of cross-education on care coordination and care coordination allied programs across the state. There was one presentation per month for a total of 12 presentations throughout the fiscal year done by the MPPP State Director. Other presentations included representatives from Medicaid, the Family to Family Health Information Center, families, and providers.

 

As detailed later in this narrative, CSHS collaborated with the MPPP State Director and the Family to Family Information Center to review applications for the financial assistance program. This collaborative effort resulted in: opportunities to refer new families to the MPPP program;  highlighting opportunities for improved integration between programs for CSHS; and ensured referrals for CSHS programs were not siloed.

 

Circle of Parents

 

CSHS continued to partner with Butte 4-C’s to establish and facilitate Circle of Parents (CoP) groups in Montana. Each group is founded on eight principles: Trust; reciprocity; leadership and personal accountability; respect; parenting in the present; shared leadership; responsibility; and non-violence. These groups aim to decrease isolation, prevent child abuse and neglect, and strengthen families through free monthly caregiver support groups.

 

Through a collaboration with the Children's Trust Fund, CSHS expanded the partnership to support the growth of new CoP groups in different parts of the state and new stipends for respite. Montana Children’s Trust Fund provided $40,000 in state special revenue to supplement CoP expansion and $20,000 for respite scholarships. These scholarships were used in many communities around the state some of which include Butte, Great Falls, St. Regis, Ashland, Polson, Hardin, Missoula, Superior, Ramsay, Whitehall, and others. The $60,000 total had to be expended by September 30, 2022.

 

Each caregiver leading a group was provided a stipend to coordinate a supportive environment with a free meal and free childcare.  CoP facilitators hosted seven possible groups depending on their specific communities' needs: Grandparents raising Grandchildren; Families with CYSHCN or Mental Health Concerns; Parents in Recovery; Positive Parenting; and Love and Laundry.  Throughout FFY22, there were 12 facilitation sites providing specific groups. Subspecialities of active sites were as follows:

 

Data was extrapolated from incomplete reports due to turnover in the CoP program and vacancies in the state CSHS program.

 

1. Great Falls- Recovery
   1. On average, 9 individuals attended this group each meeting throughout FFY22.
2. Great Falls- Children with Disabilities
   1. On average, 5 individuals attended this group each meeting throughout FFY22.
3. Havre- Children with Disabilities
   1. On average, 4 individuals attended this group each meeting throughout FFY22.
4. Butte- Children with Disabilities and Mental Health
   1. On average, 10 individuals attended this group each meeting throughout FFY22.
5. Butte- Grandparents Raising Grandchildren
   1. On average, 8 individuals attended this group each meeting throughout FFY22.
6. Dillon- Postpartum Mental Health
   1. On average, 6 individuals attended this group each meeting throughout FFY22.
7. Missoula- Children with Disabilities
   1. On average, 6 individuals attended this group each meeting throughout FFY22.
8. Mineral County- Postpartum Mental Health
   1. On average, 7 individuals attended this group each meeting throughout FFY22.
9. Dillon- Families with Children with Disabilities
   1. An unknown number of individuals attended this group each meeting throughout FFY22.
10. Big Horn- Children with Disabilities
    1. On average, 24 individuals attended this group each meeting throughout FFY22.
11. Big Horn- Recovery
    1. An unknown number of individuals attended this group each meeting throughout FFY22.
12. Mission Valley- Children with Disabilities
    1. An unknown number of individuals attended this group each meeting throughout FFY22.

 

A total of 205 individuals were served through these 12 groups throughout the state in FFY22. There was an option to bring children to the groups as well with childcare provided and a total of 182 children attended meetings with their parent/caregiver.

 

CSHS funded two national CoP trainers. They conducted trainings in FFY22 to continue to grow and develop the CoP programs across the state. These trainings happened bi-monthly with parent leads allowing 14 individuals to be trained. These all happened virtually due to the nature of the COVID-19 pandemic and the population being served. A quote from one of the individuals trained is as follows, “Thank you for the opportunity to be trained in the Circle of Parents. I feel very blessed to be able to help other fathers, especially native Dads.”

 

University of Montana Rural Institute for Inclusive Communities (UMRIIC): Transitioning Youth into Adulthood

 

UMRI FFY22 Update

 

CSHS continued to partner with UMRIIC to provide evidence-based transition resources to Montana’s youth and families.  This program works to: maintain and expand the 15 member Consumer Advisory Council (CAC); maintain and disseminate a health care transition (HCT) guide; disperse mini-grants, develop evidence-based/informed HCT training and resource materials; conduct distance learning opportunities; maintain a transition website; and provide technical assistance to other initiatives related to HCT.

 

The CAC continued to recruit new members and provide member orientation.  This team facilitated ongoing leadership development and mentoring of all members, with a focus on youth engagement and self-advocacy. Mentoring of this group covers many topic areas, but the largest is through encouragement to join committees and attend trainings. For example, members have the opportunity to join committees such as: the Rural Institute Strategic Planning Committee; the Montana Independent Living Youth Employment Taskforce; and the Montana Youth Transitions Conference Planning Committee.

 

A training that members found beneficial was a Developmental Disabilities Lecture Series titled, “Disability Inclusion: Building Capacity of Partners” and “Supporting Self-Determination Across the Life Course”. The CAC facilitated quarterly meetings and work groups, and  participated in an annual Montana Youth Transition conference, in which they exercised their leadership skills.

 

CAC quarterly meetings are 90-minutes long and are well attended. In quarter one, there were 12 CAC members, project staff, and four guests that participated in the meeting on November 29, 2021. In quarter two, there were 15 CAC members, project staff, and the Rural Institute Executive Director that participated in the meeting on February 22, 2022. In quarter three, there were ten CAC members, project staff, and the Rural Institute Executive Director that participated in the meeting on May 12, 2022. Lastly, quarter four had nine CAC members, project staff, two CSHS staff, the Rural Institute Interim Executive Director, the MonTECH director, and one guest that participated in the meeting held on August 16, 2022.

 

The Community Investment Fund Workgroup holds meetings based on applications they receive for funding. This Workgroup met once in quarter one on September 27, 2021 to review five applications. They did not meet in quarter two, but corresponded over email in preparation for that 2022 application process. This group also did not meet in quarter three or quarter four. They were able to launch the Community Investment Fund application in quarter four with no meeting necessary.

 

The Montana Youth Transitions conference was held November 15-17, 2021 in Missoula, MT. Four CAC members and the CSHS liaison disseminated transition information and resources to approximately 135 in-person attendees at the vendor fair. There was a virtual “Special Education Transition and Alternatives to Guardianship” workshop put on by project staff to 17 participants and a “Financial Literacy- A Panel Discussion” workshop put on by CAC members to 13 attendees.

 

On an ongoing basis, project staff at UMRIIC collect and develop new resources and distance learning opportunities for families and medical providers in Montana. Determining the need for new resources was done in a variety of ways by project staff, such as: exhibiting at the Montana Chapter of the American Academy of Pediatrics Conference; participating in the Montana Care Coordination Academy; and meeting with various providers around the state such as a Pediatric Practice Medical Social Worker. They are also able to distribute resources to medical providers through these same means. Updates were provided to CSHS once quarterly on the status of these resource distributions and progress associated. Project staff continued to disseminate this information via the Transition and Employment Projects website (http://transition.ruralinstitute.umt.edu/), which is reviewed and updated quarterly by UMRI staff.

 

Montana Medical Home Portal (MMHP)

 

MMHP FFY22 Update

 

CSHS continued to contract for a Montana-specific services directory on the Montana Medical Home Portal (MMHP) https://mt.medicalhomeportal.org/, a website developed by the University of Utah. The key goal of this program is to improve access to community resources and provider inventories for families of CYSHCN to enable them to navigate the system of care with ease. MMHP is a one-stop-shop which provides diagnosis information, treatment options and state and local resources to families, providers and agencies. The MHP includes vetted, up-to-date clinical information, materials on accessing care, and a statewide services directory specific to Montana.

 

In order to increase usability, some updates were made for FFY22.  These included: keywords added in the metadata to help searchers find portal pages; checks run weekly to ensure links on the portal site were not broken; and images and other page elements were “optimized” so the page load time was faster. As for specific content updates, clinical content such as Hearing Loss and Deafness and Maple Syrup Urine Disease were restructured with up-to-date information and family content. Apps to help kids and teens with anxiety, and transition tools and checklists, were updated for the most recent and useful information.

 

CSHS dedicated a partial FTE of an Americorps VISTA to support the maintenance and growth of the resource directory. Due to unforeseen staffing changes, the most recent and relevant data on the MMHP is quarter 1 of FFY22. During this time period, on average, 7,475 individuals used the Medical Home Portal in Montana. Their were 15,191 pageviews with 8,543 sessions. The page views went up 3.77% from the last quarter of FFY21 to the first quarter of FFY22 while the sessions went down by 9.44%. The cause of this trend is unknown.

 

CSHS explored several different partnerships and tactics to improve and expand upon community and system resource navigation for families. The MPPP program was able to continue to enter, edit and maintain resources specific to CYHSCN and their communities.

 

CSHS worked in collaboration with the Family to Family Health Information Resource Center (F2F) to create a high level resource guide on the system of care and critical information for families of CYSHCN that were new to the state. Due to staffing vacancies this publication was put on hold until FFY23. Children’s Special Health Services will work with the F2F in FFY23 to reinstate this project and provide funding for this work.

 

Financial Assistance Program

 

FAP FFY22 Update

 

The CSHS Financial Assistance Program (FAP) reopened in January 2022 after temporary closure. This program was not being used to the extent it was intended, so a committee was established to make better use of the funds and more closely monitor the program’s spending. Through the FAP, qualifying families can apply to cover out-of-pocket expenses for medical and enabling services, such as therapeutic services, occupational therapy items, adaptive equipment, and respite care. Qualifying families are eligible to receive up to $2000 per federal fiscal year, per child.  

 

From January 2022 through the end of September 2022, 22 families applied for financial assistance. Of those 22, 14 were approved, seven were denied, and one pulled their application due to finding funding elsewhere. The total amount paid through the FAP in FFY22 was $10,314.56. This funding covered, for example: Occupational, Speech, Physical, and Applied Behavioral Analysis Therapy co-pays; an adaptive backpack for a child to participate in family outdoor activities; weighted blankets for children with mental health diagnoses; a foldable therapy bench; a therapy seat; a mobility harness; and travel to medical appointments out of state. Families applied from all across the state in FFY22 from communities such as: Glendive, Havre, Billings, Great Falls, Lamedeer, and Kalispell.

 

CSHS continues to utilize the financial assistance committee including two staff from the F2F, the AMCHP Family Delegate, and three state staff who reviewed all FFY22 applications. In instances where funding was not possible, the committee compiled resources and reached out to partners like Medicaid and Part C to redirect the applicants to other available resources. Some cases in FFY22 where funding was not possible included: families or providers not responding to CSHS staff; belieiving that an item or service should be covered by Medicaid (in which case we would help the family get in contact with Medicaid to be sure they were taken care of); and families being outside of income limits. If referred to Medicaid or Part C, the application was not closed out until it was known the family had been in close contact with the respective program and their needs were being met. In all cases of denial from the program, the FAP committee endevoured to help families get the assistance they needed elsewhere.

 

Other CSHS Programs

 

The CYSHCN Title V Director/CSHS Section Supervisor managed these programs:  Newborn Hearing Screening; a statewide genetics program; metabolic clinics; Cleft/Craniofacial clinics; and the Montana Access to Pediatric Psychiatry Network (MAPP-net).

 

In FFY22 MAPP-net continued to implement Project Echo clinics; a behavioral health and psychiatry access line for primary care and behavioral health providers. It also held the third annual Symposium of Pediatric Mental Health on April 28-29th, 2022 at Fairmont Hot Springs. Topics covered included: COVID-19 Loss and Grief (Mary-Ann Bowman, Ph.D.); Suicide Safe Care for Patients (Karl Rosston, LCSW); Rediscovering the Beauty Within (Sasha Joseph Neulinger); Youth Homelessness (Nikki Hannon and Irene Augere); Health and Well Being of LGBTIQ+ Youth (Bryan Cochran, Ph.D.); Provider Resiliency and Self-Compassion (Molly Molloy, MSW, LCSW); Supporting American Indian Clients (Ann Douglas, Ph.D.); Youth Mental Health Awareness (Kathy Shea); Treatment and Referral for Clinicians (Heather Zaluski, M.D., M.A.); and Parental Engagement (John Sommers-Flanagan, Ph.D.). There were 165 complete registrations. Evaluations showed a content relevance and presentation quality exceeding 80%. This Symposium was accredited for CME and Nursing Continuing Education Credits.

 

In FFY22, MAPP-Net promoted and facilitated: mental and behavioral health screening and follow-up through trainings; product development; outreach and education information and  dissemination; and telehealth. The MAPP-Net Access Line received 20 calls over the course of FFY22. Furthermore, 181 inter-disciplinary providers were trained through MAPP-Net programming, with 61 unique providers reached via Project ECHOs.

 

Many partnerships were created and/or redefined in FFY22 by the MAPP-Net Program Specialist including Montana Pediatrics, the Montana Chapter of the American Academy of Pediatrics, and professional and community-based organizations. Due to several iterations of grant management staff turnover, relationships that were initially intended to be incorporated into programming from year 1 atrophied and were not meaningful partnerships until this reporting period.

 

New grant management staff re-engaged with the Montana American Academy of Pediatrics Chapter. Part of this renewed collaboration included bringing the REACH Institute’s Patient-Centered Mental Health in Pediatric Primary Care (PPP) training to Montana primary care providers, in conjunction with Blue Cross Blue Shield Montana. This training is for primary care providers treating children and adolescents with mental health conditions seen in every day practice, and increases provider capacity to manage common issues - reducing referrals for complex cases.

Furthermore, MAPP-Net is partnering with three Montana-Based nonprofit organizations (Rural Behavioral Health Institute, Catalyst for Change, and Montana Pediatrics) to support care coordination support services and integrated behavioral health initiatives with a focus on rural and underserved areas and school systems.  This funding was the result of the Bipartisan Safer Communities Act (BSCA) (P.L. 117-159), and project activities span through the FFY23. Relationships with the three partner organizations were formalized through expansion funding activities.

 

In FFY22 Cleft/Craniofacial clinics continued with COVID-19 safety regulations in place. These clinics were conducted in Billings, Missoula, Bozeman, and Great Falls. While clinics were being conducted and contracts were ending, CSHS contracted with Yarrow, a Public Health Consulting company, to conduct a Needs Assessment to determine the future of the specialty clinics. This needs assessment was completed FFY23, and more information is detailed in the NPM 11 narrative for that timeframe. Needs Assessment results will guide future decision-making and be used to distinguish if CSHS is the best place for the cleft clinics to be housed, or if they would be better suited elsewhere. CSHS continued to engage with providers and families of CYSHCN to determine the best ,strategy for upcoming fiscal years to ensure that children with cleft and craniofacial anomalies are receiving quality care in their communities. This was done through close monitoring of reports received from clinic coordinators.

 

These CSHS Programs support the advancement of medical homes for CYSHCN and their families and align with National Standards for Systems of Care for CYSHCN. These programs include the Montana Parent Partner Program, Circle of Parents, Transition Resources, the Montana Medical Home Portal, Financial Assistance, and other programs in the CSHS section such as MAPP-Net and Specialty Clinics. Further details are available at: http://www.amchp.org/programsandtopics/CYSHCN/.