Priority: Access to Supports

Performance Measures and Annual Objectives

NPM 11: Percent of children with special health care needs, ages 0-17, who have a medical home was 44.0%. The annual objective for reporting year 2022 was 42.0%. The annual objective was met. The annual objective for reporting year 2023 is 44.0%.

ESM 11.1: Percent of children with special health care needs ages 0-17 years who receive family-centered care was 85.4%. The annual objective for reporting year 2022 was 84.0%. The annual objective was met. The annual objective for reporting year 2023 is 86.0%.

The data source for both the NPM and ESM is the National Survey of Children’s Health that is administered annually.

Resource Allocation to Advance this Priority

For this reporting period, MCH Block Grant dollars were braided with state General Funds to support approximately 3.0 FTE on the CYSHCN team and .35 FTE on the Health Informatics and Telehealth and Digital Inclusion teams at CDPHE; implementation of strategies in the state action plan; and contracts with local public health agencies to implement local action plans that support the CYSHCN population. The CYSHCN team leveraged additional MCHB grant funds (the Pediatric Mental Health Care Access Grant) to continue and/or expand several existing partnerships and to support state and local implementation efforts. In partnership with the Pediatric Mental Health Institute, MCH also leveraged the $4.6 million in pandemic relief funds associated with the SB22-147 that was passed during the 2022 Legislative Session to expand the program funded through the Pediatric Mental Health Care Access Grant to more rural areas of the state and extend implementation efforts through 2024. The funded strategies and associated outcomes are summarized below. For a more detailed description, refer to the full state action plan.

Strategy Implementation

The access to supports priority includes, but extends beyond, access to health care services. This is based on the understanding that the health of individuals and families is primarily influenced by non-medical factors such as food, housing, social connectedness and safety, often referred to as social and structural determinants of health (CDPHE Office of Health Equity, 2018). Policy and systems improvements are needed to support whole-person care and make it easier for women, children, youth and families living in Colorado to access the comprehensive services and supports they need. This includes strengthening partnerships, communication, coordination and collaboration across and between organizations and systems that provide support for women, children, youth, and their families.

Most systems are made up of some combination of people (i.e., both those seeking and those providing services and supports), process(es) used by those people (i.e., getting or giving a referral) and technology (i.e., interoperable data systems, a website, or an app on a smartphone). Using this lens, the state action plan for the access to supports priority focuses on the following strategies: 1) increase equitable access to and use of specialty care, with a focus on behavioral health; 2) enhance provider and system capacity to bridge healthcare and other partners (see the Child Health Annual Report for more details on this strategy); and 3) use data to identify, illuminate, and address access, utilization, and outcome inequities.

Strategy One: Increase equitable access to and use of specialty care, with a focus on behavioral health.

MCH continues to serve as an implementation partner with the Pediatric Mental Health Institute and the Department of Psychiatry at the University of Colorado for the Colorado Pediatric Psychiatry Consultation and Access Program (CoPPCAP). The goals of the program are to increase timely detection, assessment, treatment and referral of children and youth with behavioral health disorders in pediatric primary care settings, with a focus on rural and underserved areas. The program offers pediatric primary care providers a phone or email consultation with a child psychiatrist within 45 minutes of a request. Providers can also receive one face-to-face consultation, either in person or through telehealth, to support diagnosis or treatment. Enrolled practices can also receive continuing education opportunities tailored to their community, free screening tools, and educational materials. Since CoPPCAP was launched in September 2019, the project has enrolled 76 pediatric and family practices and 739 practitioners, representing 577,716 covered lives, and provided 2,173 consultations. Specialist consultation topics with primary care providers has included: medication initiation, medication change and/or ongoing medication management; general medical education; therapy referrals; care coordination support; assisting with a diagnosis or interpretation of screening results; requests for community resource assistance; and patient support specific to anxiety, depression, attention deficit hyperactivity disorder, and autism spectrum disorder.

The CoPPCAP Advisory Committee guides program implementation and expansion and includes the Colorado Chapter of the American Academy of Pediatricians, the Colorado Child Health Access Program, Children’s Hospital Colorado, the state’s Medicaid program, Parent to Parent of Colorado and many other organizations working statewide to improve access to behavioral health services. During this reporting period, the Advisory Committee had two significant policy impacts. CoPPCAP promotes the consistent use of screening tools by primary care providers to identify behavioral health needs in children as early as possible. Through consultation with pediatric providers, the Advisory Committee learned that the Pediatric Symptom Checklist tool, used to identify behavioral health conditions in school age children, was not reimbursable by Medicaid. Representatives from the Advisory Committee met with the Medicaid program to highlight the importance of this tool being added to the list of reimbursable screening tools and, as a result, Medicaid approved the tool for reimbursement in November 2021. A second policy impact was made in October 2021, when the CYSHCN team, in partnership with the CoPPCAP Advisory Committee, developed a recommendation for funds made available through the American Rescue Plan Act to be allocated to enhance and expand the program. Based on that recommendation, legislation was passed during the 2022 session that provided $4.6 million to CoPPCAP over two years.

Strategy Three: Use data to identify, illuminate, and address access, utilization, and outcome inequities.

This strategy reflects the intentionality of using data to identify future objectives and activities that explicitly reduce racial inequities between different population groups. The data from the National Survey of Children’s Health (NSCH) indicates that there are disparities among children of different races/ethnicities across the United States related to access to care and a medical home. Based on Colorado data from the 2020-2021 NSCH, about half (47.9%) of all children living in Colorado do not have a medical home (56.0% of children with special health care needs and 45.9% of children without special health care needs). Disparities in access to a medical home are apparent by race/ethnicity and household income among children. In Colorado, only 42.8% of children who are Hispanic have a medical home compared to 57.3% of white non-Hispanic children. 42.5% of children with a household income between 0 and 199% Federal Poverty Level (FPL) have a medical home, compared to 61.7% of children at 400% FPL or greater (NSCH, 2020-2021). These data may not be reliable for other races and ethnicities due to wide confidence intervals. More information about Colorado’s oversample of the NSCH to address this issue is described in the MCH Data Capacity section.

In addition to the strategies being implemented through the state action plan, eight of the 15 largest local public health agencies selected the access to supports priority. Nine of the 15 agencies have expanded their CYSHCN work into other priority areas, such as economic mobility and built environments. Twelve of the 15 agencies continue implementing MCH-funded care coordination. Four partner agencies (Boulder, Denver, Eagle and Jefferson) are leveraging other local and state resources to offer the Family Connects Colorado program to all families within their community. These agencies are building upon their MCH-funded CYSHCN care coordination expertise and infrastructure. For example, Boulder’s Family Connects program is intentionally integrated with their agency’s MCH-funded care coordination program. Integration with Family Connects is intended to increase NICU referrals to the care coordination program and to improve the system of referrals to other Boulder County support programs. Family Connects leveraged over 300 resources from the existing care coordination community resource guide for their database.

The CYSHCN decision tool was created, in partnership with families and local public health agencies, to guide data-driven and community-informed decision making when selecting strategies to support children and youth with special needs, either in addition to or in place of care coordination for CYSHCN. During this reporting period, five local public health agencies completed the tool and two additional agencies are currently exploring its use. After completing this tool, two local public health agencies (El Paso and Jefferson) decided to discontinue MCH-funded care coordination services for CYSHCN.  These agencies identified other options for clients through community based organizations and/or other care coordination programs/providers, such as the Medicaid program’s Regional Accountability Entity. These agencies will continue to provide information and referral services for families with CYSHCN, as per core Colorado public health service requirements. El Paso and Jefferson Counties are now engaging their community to identify their new CYSHCN strategies.

Two Counties (Denver and Mesa) decided the best path forward was to continue providing care coordination for CYSHCN. They also identified changes like reduced staffing for the program and/or rescoping their services to focus on a specific subpopulation or those with higher acuity of needs, such as children and youth with a dual diagnosis (specifically autism and a mental/behavioral health diagnosis).

Tri-County Health Department also completed the tool prior to the dissolution of the agency in December 2022. As part of the transition to three separate agencies for Douglas, Adams and Arapahoe counties, Tri-County shared their findings and recommendations with staff from each agency to inform their future strategies to support the CYSHCN population. Weld County will move from exploration to implementation of the decision tool and is currently exploring contractors to provide support with their community engagement and data efforts.