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

Children’s Special Health Services (CSHS) 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 offered a variety of population health and direct service programs while collaborating with CYSHCN programs across DPHHS. For FFY21, CSHS had 4.75 program staff and 1.0 Americorps VISTA, supervised by the CYSHCN Director/Section Supervisor.

There were significant staff transitions in the first six months of FFY21. The CYSHCN Director began her position at the beginning of the time-period, and then four of the program staff were hired: a Nurse Program Manager in October 2020; the MAPP-net Program Specialist in February 2021; the CYSHN Health Education Specialist in March 2021; and a CSHS Program Assistant in January 2021.  The CYSHCN Director was able to reclassify the CYSHCN Health Education Specialist to a Program Specialist in the last quarter of FFY21, in order to expand the scope and compensation of the position to better serve Title V. The CYSHCN Program Specialist and Program Assistant were new positions in the section.

CSHS manages critical programs for children and youth with special health needs including: Cleft/Craniofacial Clinics; a Statewide Genetics and Metabolic program; the Newborn Hearing Screening Program; and the Montana Access for Youth Psychiatry Program. 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.

CSHS also serves as a collaboration facilitator across state programs. For example, CSHS is leading an inter-division collaboration between Medicaid and Child & Family Services Division to increase the number of Parent Child-Interactive Therapy (PCIT) trained mental health practitioners in the state. Two cohorts, for at total of 23 licensed clinical mental health providers, were trained in July and September of 2021.

Overview of Programs Directly Funded through Title V

The HALI Project: Montana Parent Partner Program - FFY21 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 endured into FFY21, resulting in: Parent Partner turnover; a decrease in referrals; and barriers to starting programs in new practices. However, training was ongoing via telecommunications.

In FFY21, MPPP served 154 distinct clients in 792 different encounters; offering valuable support, encouragement, and hope to families. The number of distinct clients for this fiscal year was less than in the previous. This may have been due to a decrease in the number of host clinical sites and parent partners as the pandemic continued. One new site was added in Helena, at the Shodair's Children Hospital within the statewide Genetics Program which CSHS oversees. This Parent Partner provided services via telecommunications statewide. Parent Partners served in 5 locations; Great Falls, Butte, Billings, Kalispell, Helena.

The COVID-19 pandemic significantly impacted the effort to increase parent partners, and the needs of practices and families. This required them to shift their priorities and adhere to public health protocols and social distancing. CSHS anticipated that with the implementation of vaccines, recruitment and retention of parent partners would increase. However, the impacts of COVID-19 continued, with low vaccination rates and an extended COVID-19 surge in the late summer and Fall of 2021. Promotion continued for service delivery via telecommunications, to address both COVID-19 and geographic barriers.

CSHS remained committed to expanding peer services for families of CYSHCN in Montana. Program staff amended the Parent Partner contract to support reduction in administrative costs and increase in funding for parent partner hours, to maximize impact to CYSHCN.

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 Section Supervisor and a UMRI staff co-led an interdisciplinary team that included family leaders, payer representation (Medicaid and Blue Cross Blue Shield), Title V CYSHCN, pediatricians and clinicians, and the State Director for the MPPP. 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. Other presentations included representatives from Medicaid, the Family to Family Health Information Center and providers.

As detailed later in this narrative, CSHS collaborated with the 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. 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. 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.

Each caregiver leading a group is provided a stipend to coordinate a supportive environment with a free meal and free childcare.  COP facilitators host 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.  As of September 2021, there were ten facilitation sites providing specific groups. Two Groups, Havre and Mission Valley, were on hiatus due to challenges during pandemic. Subspecialities of active sites were as follows:

1. Butte – Families with CYSHCN
2. Butte – Grandparents Raising Grandchildren
3. Dillon – Post-partum
4. Dillon – Families with CYSHCN
5. Mineral County – Postpartum
6. Big Horn County – Autism
7. Big Horn County – Parents in Recovery
8. Great Falls – Families with CYSHCN
9. Great Falls – Foster Families
10. Missoula – Families with CYSHCN

CSHS funded two national COP trainers. They conducted trainings in person in FFY21 to onboard new parent leaders in new communities: Big Horn County, Mineral County, and Dillon.

University of Montana Rural Institute (UMRI): Transitioning Youth into Adulthood

UMRI FFY 21 Update

CSHS continued to partner with UMRI 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.  The CAC facilitated quarterly meetings and work groups, and  participated in an annual Montana Youth Transition conference, in which they exercised their leadership skills.

On an ongoing basis, project staff at UMRI collect and develop new resources and distance learning opportunities for families and medical providers in Montana. 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.

Montana Medical Home Portal (MMHP)

MMHP FFY21 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. CSHS dedicated a partial FTE of an Americorps VISTA to support the maintenance and growth of the resource directory.

CSHS explored several different partnerships and tactics to improve and expand upon community and system resource navigation for families.  The MPPP program was re-trained in the tool in March; and were able to enter, edit and maintain resources specific to CYHSCN and their communities. In January 2021, CSHS and MMHP met with the “211” resource locator, and the CONNECT program staff (a statewide referral system promoted by the Department of Public Health and Human Services). The purpose was to explore sharing resource databases and to help ensure that the MMHP has up-to-date information. Further conversations occurred in the Spring and Summer. Due to potential changes with the CONNECT system under a new administration, those conversations were on pause for the remainder of FFY21.

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. The resource is slated for publication in FFY22. In FFY21 conversations began with F2F on the creation of a MOU between CSHS and F2F to support mutual goals, including resource navigation.

Financial Assistance Program

FAP FFY21 Update

The CSHS Financial Assistance Program (FAP) was in operation through the beginning of FFY 21 and moved to a temporarily closed status in December 2020, due to increased number of applicants, staff transitions and limited budget.  Ten families applied to the program and received financial assistance in FFY21. 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.

In response to increased applications, the program processes in place, and the budget, CSHS made changes to the program, including organizing a committee of: three-parent leaders / Parent Partners (PP); the Parent Partner State Director; two staff from the Family to Family Health Information Resource Center, and, three state staff who reviewed all FFY21 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.

Other CSHS Programs

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

In FFY21 MAPP-net implemented: Project Echo clinics; a behavioral health and psychiatry access line for primary care and behavioral health providers; and the second annual Symposium of Pediatric Mental Health. Monthly meetings with Medicaid were initiated to partner on similar initiatives and discuss options for sustainability. 

In FFY21 Cleft/Craniofacial clinics restarted with COVID regulations in place. Attendance per clinic has decreased, and CSHS is reviewing and assessing data on clients.  Decreases in cleft clinic attendance can partially be explained by clinical spacing requirements to support the safety of providers, clients and families attending the clinics.  CSHS continues to engage with providers and families of CYSHCN to determine the strategy for upcoming fiscal years to ensure that children with cleft and craniofacial anomalies are receiving quality care in their communities.

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.  Further details are available at: http://www.amchp.org/programsandtopics/CYSHCN/.