Priority Need: Improve Systems of Care for CYSHCN

 

NPM 12: Transition to Adult Care for All Children

 

Children’s Medical Services

In the coming year, the CMS program will continue to work with programs, state agencies, health systems, health plans, families, youth and stakeholders to enhance and expand the system of services for CYSHCN. Monitoring and documenting the implementation of the revised transition policies and procedures for the CMS program including youth and family satisfaction with transition planning is a priority. Documenting lessons learned from the CMS program care coordinators during the transition improvement process will help to offer recommendations and training opportunities to other programs and agencies providing care coordination services to adolescents 12 years of age and older. In the coming year, providing educational opportunities on health care transition preparation and planning for staff coordinating the Individualized Education Plan activities for youth and families within target school district sites will continue in the coming year. Work will continue with school district parent mentors and transition coordinators to provide tools and resources for students and families.

 

The CMS program will continue to support the genetic services telemedicine network offered through seven public health district programs. In addition, continue to work with the Office of Telehealth and Telemedicine to ensure that there is an adequate pool of providers available to support the growing telemedicine clinic activities. Opportunities to work on statewide recruiting and retention efforts of pediatric specialists through presentations and stakeholder meetings in addition to supporting the efforts to develop a streamlined contracting process with medical providers

 

The CMS program will continue developing a strategic plan to provide outreach materials to health care providers, parent mentors and community partners for children and youth without special health care needs focusing on developing and providing educational materials geared towards the adolescent population. The campaign will reach broad audiences in schools and recreation centers. The campaign will provide information highlighting how youth can take charge of their health care as well as provide information about health insurance.

 

 

Priority Need: Promote Oral Health to All Populations

 

NPM 13: Preventive Dental Visits

 

In the coming year, the Oral Health program will continue to educate public health district’s oral health staff on special considerations and treatment needs for special needs patients. Education and training on caring for children and youth with special health care needs will be condition-specific and include evidence informed practices. Education and training for school-based programs that include all children will continue.

 

Priority Need: Improve Systems of Care for CYSHCN

 

SPM 2: Improve Access to Specialty Care for CYSHCN

 

The Department’s robust telehealth and telemedicine program will continue to provide access to comprehensive medical services through a public/private partnership with health departments and health care providers. A key focus for the program includes specialty care services for children and youth with special health care needs.

 

Since 2017, there have been additional telemedicine services pilot projects that have been established to improve access to audiological and therapeutic services for infants and children with special health care needs.

 

Babies Can’t Wait (BCW)
BCW will continue to serve children birth to three with developmental delay and category 1 chronic conditions. BCW will continue to focus on increasing provider capacity and is working on addressing strengths and challenges within the program. BCW is redefining the program infrastructure and identifying areas to target for the upcoming year.

 

BCW will continue to revise and clarify policies and procedures related to consistent implementation of the Part C program across public health districts. As policies are updated, related trainings will be developed and delivered to district staff and contractors to ensure understanding of program requirements and expectations.

 

BCW operates under the Primary Service Provider model. Training was provided across the state in 2005. Since that time, there has been high turnover not only in district staff but also contracted providers. The BCW state team will be working on updating the training materials and redelivering the training to again ensure consistency across the state.

 

Transition between Part C and Part B has been a targeted effort. BCW will continue to work with Part B partners to ensure a consistent understanding of the transition requirements between programs.

 

Child find is a requirement of Part C and BCW hopes to rebrand our program to encourage child find activities and increased referrals. We will be working with the communications department to develop the “Zero to Hero” campaign that highlights the potential of all children with disabilities.

 

We will be implementing a data monitoring plan across the districts that ensure that districts are regularly reviewing their program data so that the APR reporting process will become more streamlined and efficient and accurate.

 

The BCW program will also expand opportunities to include additional pilot tele-therapy programs to address the shortage of therapeutic providers available to many families needing early intervention services, especially in the rural areas of Georgia.

 

Georgia Autism Initiative
In the coming year, the Autism program will improve and increase early identification and screening for Autism Spectrum Disorders in children. Increasing early identification of autism and other developmental disabilities will help to improve outcomes for children by connecting them to early intervention services and supports. By September 2020, the program will implement statewide screening, evaluation and treatment for children and youth with ASD.

 

DPH will continue to provide academic detailing (educational outreach and training) to medical providers to include pediatricians, family physicians, physician’s assistants, nurse practitioners, and nurse managers, utilizing evidence-based practices. Information on topics including the importance of screening, listening to parental concerns, using screening tools during well-child visits, implementing standardized screening practices, billing for reimbursement, as well as referring children for diagnosis, early intervention services, and community supports, will be presented. Outreach will continue to be conducted using a variety of strategies to include webinars, tele-health, and practice visits.

 

DPH will maintain its partnerships with local programs and agencies to meet our goals and objectives. The following is a list of our internal and external partners:

 

• Babies Can’t Wait (Part C Early Intervention Program)

• Children’s Medical Services (State Children with Special Health Care Needs Program)

• Children First (Single point of entry for child health services in public health)

• Georgia Department of Community Health (Medicaid)

• Georgia Department of Behavioral Health and Developmental Disabilities

• Georgia Department of Education

• Georgia Chapter of the American Academy of Pediatrics

• Georgia Academy of Family Physicians

• Centers for Disease Control and Prevention

• Georgia State University

• Marcus Autism Center

• Emory Autism Center

 

The program aims to increase the rate of early detection for Autism Spectrum Disorder through the following objectives and activities:

• Objective 1: Increase developmental screening in primary care practice, at recommended periodic intervals (18, 24,) by 15%;

• Objective 2: Increase the proportion of children with ASD having a first diagnostic evaluation by 30 months of age by 15%

• Objective 3: Increase the proportion of children with ASD enrolled in special services by 36 months of age by 15%

 

DPH will continue to utilize quantitative evaluation methods to examine the achievement of our goals in relation to the medical provider’s pre-knowledge and skills, as well as the effectiveness of the learning outcomes. We will continue to track referrals from participating practices to DPH Child Health programs for children who screen positive for developmental delays. We will also utilize qualitative evaluation methods to examine the process of the educational interventions.

 

Objective 1 Annual Activities:

Activity 1: Training

Increase the number of professionals trained to provide MCHAT-R Screening within the 18 public health districts.

Activity 2: Screening Protocol

Implement screenings and track data collected on children screened at recommended periodic intervals (18 and 24 months).

 

Objective 2 Annual Activities:

Activity 1: Provider Capacity

Ensure at least one psychologist per Public Health District will be trained to conduct an autism evaluation/diagnostic test using a standardized tool (ADOS-2).

Activity 2: Referral

Children who receive a negative or “fail” result on the MCHAT-R assessment will be referred for a diagnostic assessment.

Activity 3: Evaluation

Children will receive an ASD diagnostic evaluation within thirty days of referral.

 

Objective 3 Annual Activities:

Activity 1: Provider Network

the Georgia Autism Initiative will develop a network of providers through the DPH contractual process for the provision of direct behavioral services.

Activity 2: Service Implementation

children who receive an ASD diagnosis will be referred for and receive behavioral intervention services.

 

In January 2019, Coordinators will begin to complete MCHAT-R/F screening with children at the recommended 18- and 24-month intervals. Coordinators include BCW Service Coordinators, Intake Coordinators (IC) and C1st Coordinators or Developmental Specialist.

 

Children zero – three enrolled in BCW will have access to comprehensive services that address ASD such as screening, diagnostic referral, behavioral evaluations and intervention. DPH is committed to ongoing professional development and capacity building, therefore, will continue contracting with certified behavioral analyst to offer a quality standard of care.

 

Collaboration with internal and external partners has been vital to the Autism Initiative. DPH will maintain and establish partnerships with key stakeholders to leverage resources and expand access to care. In June 2019, DPH will reestablish the Autism Advisory Board, to address priorities published in the Georgia Autism State Plan.

 

Early Hearing Detection Intervention (EHDI)

In the coming year, EHDI will continue the work that was enhanced by Legislative Act 462 bringing into focus the academic landscape for children who are deaf or hard of hearing. EHDI and Part C programs will continue to work more collaboratively with DECAL and the DOE to monitor and strengthen the systems that support early identification, intervention, language development academic achievement for D/HH children across the continuum of service they receive from birth to third grade. DPH, DECAL and DOE will jointly publish an annual report on D/HH children’s language and literacy outcomes. This first annual report will review the existing D/HH system using qualitative and quantitative means to describe the current landscape and identify areas of future work. The report will open with an environmental scan describing the resources and services available to support the cognitive, behavioral and social-emotional development of D/HH children, resources for language acquisition and family support. Available baseline data regarding early identification, intervention and school performance will be described and measured against national benchmarks. The report will also emphasize the collaborative nature of the stakeholders engaged in this work and other areas in the existing ecosystem where Georgia excels. This report will serve as a baseline report from which future progress on this legislation will be measured.

 

EHDI will continue to collaborate with key stakeholders to enhance the quality and timeliness of the EHDI system and continue to promote activities that result in access to needed resources and interventions to promote language acquisition and optimal social, emotional and cognitive development for children who are deaf or hard of hearing. To that end, EHDI will continue to engage two family support programs through Georgia Hands and Voices; Guide By Your Side and Advocacy Support and Training. Parent guides are assigned to each of the 18 public health districts and work closely with district EHDI coordinators to identify families who may benefit from peer support. The EHDI program will also continue to support Georgia PINES Deaf Mentor program. The Deaf Mentor program provides families who have children with hearing loss with family-centered, home-based, and curriculum-led early education, focusing on visual communication, American Sign Language, and Deaf Culture.

 

The EHDI program will establish a second learning community in a new district in the coming year. Membership will include parents of children with hearing loss and diverse health care providers and interventionists. The group will develop new objectives and the program will consult this group for projects around best practices for early intervention and service coordination to increase participation and encourage engagement.

 

The EHDI program will expand tele-audiology to a second rural region of the state. Through a video consultation, tele-audiology can increase access to specialty services by linking an audiologist to the patients several hours away, decreasing travel time for the patient. The tele-audiology initiative is a partnership with the state EHDI program, the audiology department at Children’s Healthcare of Atlanta (CHOA), and the local health district.  EHDI program staff will travel to the local health district to train the local EHDI follow-up coordinator on using the audiology equipment and interfacing with the audiologist at CHOA through the virtual platform.

 

In the coming year, the EHDI program will work with the Valdosta Health District to provide tele-audiology services. Valdosta has only one pediatric audiologist that can perform a diagnostic evaluation on infants. A tele audiology clinic in Valdosta will supplement the local resource by virtually bringing in a second provider to perform diagnostic evaluations. Furthermore, Valdosta borders the Waycross Health District and families within Waycross can be scheduled either in to the Waycross or Valdosta tele audiology clinic as appointments become available.