NPM #11 Medical Home – Ensure coordinated, comprehensive and ongoing health care services for children with and without special health care needs.

 

Please note: for clarity in this domain narrative, “cyshcn” refers to all children and youth who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and require health and related services of a type or amount beyond that required by children generally. “CYSHCN” refers to the Children and Youth with Special Health Care Needs Program.

 

The Bureau of Special Health Care Needs (SHCN) will continue to provide service coordination and conduct comprehensive assessments for participants/families, regardless of financial status. For participants/families who do not report having a medical home, Service Coordinators will provide educational materials to help them obtain coordinated, ongoing, and comprehensive care within a medical home. SHCN staff will receive training regarding the definition, principles, and key components of service coordination. SHCN staff and staff of contracted agencies will continue to discuss emergency planning with participants/families and provide them with materials to prepare for emergency situations to ensure safety and well-being during inclement weather events and other potential situations. To ensure culturally competent services, SHCN will continue to utilize professional interpreters for phone conversations and home visits. Educational materials, forms, and letters will be translated and available in various languages to accommodate the population served. In addition, staff and Service Coordinators of contracted entities will be provided the opportunity to participate in conferences and trainings focused on cultural diversity.

 

SHCN will continue to collaborate with the Department of Social Services (DSS), the Department of Mental Health (DMH), and the Department of Elementary and Secondary Education (DESE), as well as other external partners and agencies to obtain information about children and youth with special health care needs (cyshcn) who transition within the systems of care and to link participants/families with appropriate services and supports. Service Coordinators will continue to discuss life transitions with participants/families to help prepare for changes and navigating systems and supports. For youth who receive in home services and are aging out of the Healthy Children and Youth (HCY) Program, SHCN will begin discussing options for adult services with the participant/family at least one year prior to the participant’s 21st birthday. In addition, SHCN will provide a list of participants who are aging out of the HCY Program with the Department of Health and Senior Service (DHSS) Division of Senior and Disability Services (DSDS)-Long-Term Services and Supports and DMH. SHCN will offer to conduct multi-agency transition meetings for participants who would be eligible for the Medically Fragile Adult Waiver (MFAW) Program after their 21st birthday in an effort to help the participant/family make informed decisions regarding services. SHCN staff and staff of contracted agencies will continue to access the MO HealthNet (Missouri Medicaid) information systems to determine the MO HealthNet status of participants and will refer participants/families who do not have MO HealthNet to DSS. In complex situations, SHCN will assist families by contacting DSS to expedite MO HealthNet applications and assist in resolving MO HealthNet access issues.

 

Service coordination is essential for people with complex conditions and needs. Service Coordinators for the Children and Youth with Special Health Care Needs (CYSHCN) and HCY programs will continue to complete Service Coordination Assessments (SCA) in collaboration with participants and families to address strengths and needs, which drives service plan development and implementation. The assessment tool includes medical home components which address whether a participant has:

1. A usual source of medical care when sick;
2. A usual source of preventive health care;
3. Visited a physician or specialist within the past year;
4. Health care providers that share information with each other and/or with non-medical providers;
5. Medical providers who spend enough time during visits, listening carefully, considering values and customs, providing needed information, and making the participant/family feel like a partner;
6. Knowledge on who to call for services;
7. The ability to get referrals when needed;
8. Received most services in the local community;
9. Adequate insurance to pay for needed services;
10. Access to language or mobility accommodations; and
11. Has been satisfied with general health services (physicians, hospitals, therapist, etc.), in-home provider agency services, and SHCN services.

 

The assessment tool also includes a component to assess if the physician who sees the participant most makes the participant/family feel like a partner and a component to assess if the participant/family feels like a partner with their SHCN Service Coordinator in making decisions regarding their services. In addition, the tool includes components to assess if participants/families are satisfied with general health services (physicians, hospitals, therapist, etc.), in-home provider agency services, and SHCN services. The SCA includes information regarding medical, dental, and vision insurance. SCA components related to adequate health insurance for cyshcn assess if insurance offers benefits and services that meet participants’ needs, if the cost is considered reasonable, if the plan allows participants to see the providers needed, and if there was health insurance coverage all of the last 12 months. The SCA also includes components to assess if services are organized in a way that makes them easy to use by families of cyshcn. For participants who are 13 to 21 years of age, the SCA contains components to assess preparation for youth transitions including: if doctors or other health care providers talked with the participant/family about the changing health needs when the participant becomes an adult, if a plan for addressing changing needs has been developed with a doctor or other health care providers, if doctors or other health care providers have discussed having the participant eventually see a doctor who treats adults, and if the participant has received vocational or career training to help prepare for a job.

 

SHCN Family Partnership

Family Partners will contact newly enrolled SHCN program participants to inform them of the Family Partnership Program and to increase awareness of the importance of a medical home for children with and without special health care needs. Family Partners will continue to share medical home information through their listservs, as well as at resource fairs and conferences. Additionally, the Family Partners will develop a page on the Family Partnership website focused on medical home resources. Family Partnership newsletters will keep families informed of statewide activities, as well as important information regarding supports available for families. Family Partners will gather input from families to determine the effectiveness of the information shared through the newsletters.

 

Family Partners will continue to be involved in a variety of initiatives. The Southeast Family Partner will continue to serve as the AMCHP Family Delegate for Missouri and will participate in family engagement activities within SHCN and Title V MCH programs. The Southwest Family Partner will continue to serve as a family advocate for the Pediatric Palliative Care (PPC) Task Force through the National Coalition for Hospice and Palliative Care. The Northeast Family Partner will continue to serve on the advisory committee for the Heartland Genetics Service Network and work with the St. Louis Resource and Respite Coalition.

 

SHCN plans to continue to utilize Title V MCH funds to support the printing and dissemination of Missouri Family to Family Information Center Life Course materials and resource folders for families of cyshcn.

 

Family advocacy is critical in building coordinated and comprehensive systems. The Early Childhood Comprehensive Systems Health Integration P-3 grant (ECCS HIP-3) partners with Title V to maintain and support the Missouri Parent Advisory Council (PAC). Over the life of the grant, seven regional PACs will be established and supported and will feed into a larger statewide PAC. The PACs will inform early childhood policy and procedure at local, regional, and state levels. Historically, the PAC also developed opportunities for parent and family involvement in their communities and across the state. The expanded regional model of the PAC will ensure that it is more inclusive and representative of all Missouri families with diverse needs and backgrounds.

 

Dental Home

The Office of Dental Health (ODH) will continue to implement the Preventive Services Program (PSP) in Schools for the Severely Disabled under its ongoing agreement with the DESE. The PSP provides an oral health screening by a dental professional, two doses of fluoride varnish for protection against tooth decay, and a referral to a local dental provider among children identified with a dental need. The referral to a local dental provider is designed to ensure identified needs are addressed and to link children to a Dental Home. Dental visits are recommended for all children at least once or twice annually and are especially important for children with special needs, as they may have behavioral, dietary, or physical complications that affect dental health.

 

Ordinarily, the PSP educates children about good oral hygiene at an educationally appropriate level. For the Schools for the Severely Disabled, the oral health education is directed toward school caregivers and parents of students that have physical and/or intellectual disabilities. Part of this education is an emphasis on connecting children to a Dental Home, regardless of whether a dental issue is identified at the time of the screening. Children also receive toothbrushes and toothpaste, which may be left at school or taken home. The target each year is to reach all 34 schools and serve approximately 300 students. Due to Coronavirus, the number of students reached could be less due to schools possibly restricting visitors or parents who may not give consent for their child to be seen. However, ODH’s Oral Health Consultants will be traveling to the Schools for the Severely Disabled in order to screen and apply varnish as allowed. ODH’s Oral Health Consultants will also be available to advise on any dental issue a student may have. Oral health supplies, education, literature, and fluoride varnish will be available to any child who does not receive a dental screening.

 

ODH is working with the Missouri Coalition for Oral Health, which is coordinating an effort to collaborate with Missouri’s Developmental Disabilities Council, the DMH and the University of Missouri Kansas City Dental School to educate dental professionals, thereby increasing access to care for cyshcn.

 

The Elk’s Mobile Dental Program provides specialized dental services to individuals with Intellectual and Developmental Disabilities (I/DD). The Program operates in 17 locations around the state, including in many rural areas where access to a dental home for individuals with I/DD is limited. Furthermore, the Elk’s team is specially trained and equipped to serve individuals with I/DD, which increases compliance with regular and urgent dental treatment over time. The mobile unit is wheelchair accessible and sets up in a central location to reduce the burden and disruption of transporting individuals with I/DD. General Revenue has historically supported the Elk’s Mobile Dental Program and pays for about 950 patient visits and 9,000 procedures. The state FY23 proposed state budget includes funding for the Elks program. In addition to General Revenue, the Elk’s Benevolent Trust, a non-profit organization, also provides financial support for the Program. The Trust provides supplemental funding so adults and children with disabilities can receive the dental care they need. It is important to note that the Elk’s Mobile Dental Program also accepts Medicaid, which helps supplement the funding. Due to the shortage of dental professionals that are willing to accept Medicaid as a form of payment and/or the reluctance of many dental teams to treat individuals with certain I/DDs, the program is the dental home for some individuals.

 

Early Childhood Professionals

The Office of Childhood (OOC) Quality Initiatives Section within the DESE provides inclusion referral services, technical assistance, and training throughout the state to help families and caregivers of children with special needs.

 

Inclusion Specialists provide a variety of services for children with special needs. The specialists:

• Assist families with locating appropriate child care that will successfully support the individual needs of their child.
  • This includes providing the families with a list of licensed or regulated child care facilities who have the ability to work with their child. We want parents to make the choice that best fits with their wishes, and by narrowing down who has the ability to accommodate a specific need, the specialist can save the families a lot of time and frustration.
  • When the list does not produce a facility that is able to accommodate a specific need, the specialists reach out to a program to discuss the requirements of the child in need of care. Inclusion Specialists make site visits to the program to strategize on how the facility can make minor adaptations to successfully include a child.
  • They offer follow up technical assistance until the facility is fully equipped to meet the needs of the child.
• Provide training to caregivers to develop the necessary knowledge and skills to appropriately meet the needs of the child in care.
• Connect families with other community resources as appropriate.
• Provide general classroom, as well as child specific, observations. After the observations, the specialists are able to provide technical assistance to child care providers regarding the needs of the group or child. They help develop strategies and offer training as needed to further the knowledge and skills of the caregivers.

 

The OOC Quality Initiatives Section will continue to provide inclusion services to support children with special needs, which includes children with a perceived developmental disability and/or delay, health/mental health, or behavior issue. The Inclusion Specialists will continue to assist families in locating appropriate care by providing resources and assistance so that families are educated to make decisions in the best interests of their family and child. They will continue to offer technical assistance to child care programs so children with special needs are able to maintain placement as the child grows and develops, thereby reducing preschool expulsion. Inclusion Specialists will continue offering training to child care providers as new caregivers enter the workforce and as the needs within their programs change with the children enrolled.

 

While providing inclusion services to families and children, specialists have identified that many of the children with behavior concerns have also experienced some form of trauma. Developing the child care workforce to better identify the signs of trauma in children will help providers better meet the needs of the children in their care. Inclusion Specialists have begun to deliver evidence-based training to child care providers and families to educate them on the effects of trauma in early childhood and to identify how children’s behaviors may be affected by trauma. The training further addresses the stress placed on children in the foster care system and ways caregivers can support children as they transition between homes.

 

In FY21, the Inclusion Services (IS) project listed above was expanded to include the addition of another Inclusion Specialist and a Social-Emotional Learning (SEL) project, which is an additional component of the larger IS project. The IS project provides an element of prevention in the training delivered to teachers, and in the knowledge teachers gain from on-site consultation that can be carried over to new challenges in the future. However, the primary focus of the IS Project is intervention. Inclusion Specialists are asked to help a family or a provider respond appropriately to a challenge occurring at a specific point in time. The intervention focuses on helping the teacher work with a particular child or situation. To most effectively prevent preschool expulsions and the short and long-term dangers they present, a more comprehensive and proactive program is needed. The SEL Project provides this support. A few of the main components of the program are:

• Four, day-long initial training sessions (one day a week for four weeks). The training focuses on understanding how children develop socially and emotionally, and how teachers can facilitate this development in real, practical ways. It is based on the research-based Pyramid and Conscious Discipline models.
• With family permission, the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) is administered to all children enrolled in classrooms participating in the project to identify children at greater risk of social-emotional delay. This could involve coordination with the Missouri Milestones Matter (MMM) project discussed in the Child Health domain.
• Completion of classroom action plans to address environment, relationships, and social emotional teaching strategies. Three specific pro-social skills will be identified and taught to children. The action plan outlines individualized, specific steps to be taken.
• Completion of individual plans for children identified as being at-risk.
• A minimum of four on-site observation/consultation visits from a Project Specialist over a nine-month period to facilitate implementation of plans, and support teachers through challenges that arise. Progress towards goals will be made in between visits with sessions focusing on coaching specific strategies, observation of specific children, etc.
• Two Saturday half-day follow-up meetings to network and problem-solve with other participants.
• Administration of the ASQ:SE at the conclusion of the project to all children who were screened at the beginning of the project and are still enrolled.
• If all training/meeting components are completed, each participant receives 32 approved training clock hours.
• Participants receive a comprehensive training manual and hands-on materials related to curriculum implementation.
• Program administrators attend a half-day session so they can support teachers’ learning.

 

The Child Care Health Consultation (CCHC) Program will provide consultation and training for child care providers at regulated and unregulated child care facilities on topics around health and safety, which include topics relevant to young children with special health care needs, such as autism spectrum disorder, asthma, food allergies, seizure disorders, traumatic brain injury, diabetes, and inclusion. The CCHC Program will continue to provide consultations for child care providers to assist in the development of individualized health care plans (IHPs) with input from other health specialists and parents/guardians, and assist with referrals to outside resources such as MO HealthNet for Kids, developmental screening, and WIC. The Program will also continue to provide developmentally appropriate health promotion for children in child care on health, safety and topics relevant to young children with special health care needs,- including safe interactions with children with food allergies, bullying, positive behavior support, self-esteem, celebrating differences, and empathy. Program services will continue to provide evidence-based and educational materials regarding the physical and emotional care of CSHCN, optimize the physical, social, and emotional health of young children with special health care needs in the child care setting, and promote participation in community-based organizations. CCHC program services will continue to be required to be inclusive of adults and children of all abilities and family participation will be encouraged during all program services.

 

School Health

The School Health Program (SHP) considers school nurses as a component of a medical home; assuring students have insurance, and children with a potential for a life threatening event (such as a seizure, asthma flare, anaphylaxis event, alteration in blood sugar level), or a special health care procedure (such as gastric feeding, catheterization, or dressing change) have written procedures and emergency action plans in place. These plans are developed in collaboration with the parent/guardian and approved by the medical provider. The SHP will continue to promote the School Nurse Chronic Health Assessment Tool (SN-CHAT) to engage school nurses and parents in developing emergency action plans and IHPs.

 

The state school nurse consultant will continue to serve on the faculty for the Autism ECHO (Extension for Community Healthcare Outcomes). This learning opportunity shares autism specialist knowledge in a virtual learning network with a panel of interdisciplinary Missouri providers. Participants learn about best practices and evidence-based care for children with autism and developmental behavioral concerns, including detecting mental health concerns, diagnosing and treating common mental health disorders, making appropriate referrals, and supporting kids and teens in their treatment for mental health disorders. The ECHO meets every other week during the school year and targets school nurses and support staff.

 

The SHP will continue to provide consultation, training, resources, and support to Missouri’s school nurses on health-related topics. The SHP prepares an annual summary report from data collected by school nurses in public, charter, private, and parochial schools, including the nurse to student ratio and the number of students with special health care needs and/or chronic health conditions. This report is shared with stakeholders to inform them about the needs of students and school nurses. The SHP also actively encourages assessment of student insurance status and shares the data in the annual special health care needs/chronic health conditions report. School nurses will continue to receive print materials, video presentations, and virtual conferences about MoHealthNet and other community health resources, including FQHCs to facilitate their role in supporting families to access health care and other health care services and strengthen their role in the medical home model. The SHP will continue to conduct an annual workshop for new health office staff. This three-day workshop provides training on hearing and vision screening, managing children with chronic health conditions in the school setting, guidance for writing emergency management and 504 plans, being a part of the Individual Education Plan (IEP) team, and developing IHPs for students. The SHP also provides guidance and consultation to all school nurses, referencing the Manual for School Health Guidelines that includes a matrix of health care procedures permissible in the school setting. The SHP will continue efforts to ensure that sessions offered at the annual School Nurse Leader Collaborative, Spring School Nurse Association Conference, and the Coordinated School Health Coalition Conference are: applicable to school health services, support nursing best practice and actively promote the school nurse role in care coordination.

 

The SHP will continue to partner with school board associations, principals’ associations, Missouri’s Family and Community Trust, and the MO HealthNet Division to promote access to care via Medicaid enrollment and awareness of FQHCs. The SHP will continue to support professional development opportunities for school health services staff by way of trainings, workshops, webinars and regional conferences to address Medicaid enrollment, Medicaid managed care, and management of cyshcn and chronic conditions.

 

The Missouri School Boards’ Association (MSBA) leads an initiative to routinely include special services representatives and nurses on schools’ emergency planning teams and for schools to consider the nature of disabilities and medical conditions presented by students and staff when creating, reviewing, and practicing emergency response plans. The SHP will continue to engage and partner with MSBA on the emergency planning process for students with special needs. The SHP will encourage the utilization of MSBA’s Emergency Planning for Students with Special Needs Task Force file of resources to inform and support districts in improving their emergency planning process by considering the unique needs of each person within the school community.

 

Newborn Screening

Since April of 2017, information about the importance of a medical home for children with and without special health care needs has been included in the Newborn Screening booklet and will continue to be distributed to new and expectant parents. The Newborn Screening booklet is distributed upon request to birthing hospitals, pediatric hospitals, LPHAs, WIC clinics, health care providers, high schools, home birthing centers, midwives, prenatal classes, pediatric clinics, obstetrician and gynecological clinics, businesses, and neonatal intensive care units. On average, approximately 4,000 booklets are requested by these entities per month. In addition, the Newborn Screening Program will implement a revised parent survey using a new electronic format. The revised survey will continue to include questions about the medical home in order to provide insight into parents’ definitions of their child’s medical home. In addition, the survey will be distributed to a larger sample of parents with the hope of receiving an improved response rate.

 

The Missouri Newborn Hearing Screening Program (MNHSP) will continue to collaborate with the Family Partnership to engage families in the Missouri Early Hearing Detection and Intervention (EHDI) system. Family Partners who are parents of children who are deaf or hard-of-hearing will contact parents of newborns who failed the newborn hearing screening to provide parent-to-parent support, review resources, and encourage appropriate follow-up with the medical home.  Additionally, Family Partners will continue to emphasize the role of the medical home in management of the unique needs of an infant with hearing loss through distribution of the “EHDI Parent Resource Toolkit for Western Missouri.”

 

Local Public Health Agencies (LPHA)

The MCH Services Program will continue contracts with the LPHAs to support a leadership role for LPHAs at the local level to:

• Build community-based systems and expand the resources those systems can use to respond to priority MCH issues;
• Provide and assure mothers and children (in particular those with low income or limited access to health services access to quality MCH services;
• Reduce health disparities for women, infants, and children, including those with special health care needs;
• Promote the health of mothers and infants by assuring prenatal, delivery, and postpartum care for low income, at-risk pregnant women; and
• Promote the health of children by providing preventive and primary care services for low-income children.

 

LPHAs efforts to fulfill the purpose of the MCH Services contract will include activities and services that address the needs of cyshcn. One LPHA has selected to work on the priority health issue of children with and without special health care needs to ensure coordinated, comprehensive, and on-going health care services for children, provide education about special health care needs, and promote the medical home approach. In coordination with the WIC Program, the Tri-County Health Department will assess the medical home status of children ages 0-5 years. The health department has implemented an electronic health record to maintain accessible, comprehensive, and complete health records that can be shared with other providers. They plan to train providers and those in the community on the medical home approach and increase the number of children and families that have a “care notebook” to assist families and caregivers in maintaining a record of their child’s care, services, and providers, which can be taken to all medical appointments, therapies, conferences, and vacations.

 

State Agencies and Partners

The overall goal of the Missouri Disability and Health Collaborative is to support individuals with intellectual disabilities to be included and have access to the full range of evidence-based physical activity and nutrition programs provided through public health programs. Through the Missouri Disability and Health Collaborative, the DHSS-Bureau of Community Health and Wellness will continue to contract with University of Missouri Kansas City Institute for Human Development (UMKC-IHD) to assist with reviewing and adapting existing nutrition and physical activity strategies to assure inclusivity of people of all abilities. Missouri has developed several strategies to increase access to healthy foods and safe places to be physically active. However, few of these strategies have been designed to be accessible to people with intellectual disabilities or with the specific health needs of people with intellectual disabilities in mind.

 

In addition to the programs at the DHSS, there are several initiatives that contribute to Missourians receiving coordinated, comprehensive, and ongoing health care services throughout the state. In October 2011, the Centers for Medicare and Medicaid Services (CMS) approved Missouri’s State Plan Amendment (SPA) establishing Medicaid reimbursement for health homes, making Missouri the first state in the nation to have an approved SPA for health home services. This first SPA established Community Mental Health Center (CMHC) Healthcare Homes serving individuals with serious mental illness. A companion SPA establishing Primary Care Health Homes (PCHH) in Missouri was approved in December 2011. Both SPAs were effective January 1, 2012. MO HealthNet, the DMH, and the community mental health systems collaborated to establish ‘health homes’ throughout the state’s 29 CMHCs. Missouri’s CMHC Healthcare Home Program was selected to receive the American Psychiatric Association’s 2015 Gold Achievement Award in the category of community-based programs. The PCHH initiative provides intensive care coordination and care management as well as addresses social determinants of health for medically complex individuals. One aspect of PCHH includes the implementation and evaluation of the Patient Centered Medical Home (PCMH) model. PCHH emphasizes the integration of primary and behavioral health care in order to improve health outcomes. In addition, MO HealthNet employs Registered Nurse Case Managers in the Evidence-Based Decision Support Unit. The Unit established a pilot case management project made up of a multidisciplinary team that includes clinicians. The purpose of the pilot is to build infrastructure to support participants. Participants are selected for the pilot by utilizing an algorithm that determines participants with high needs and expenditures. The initiative builds a collaborative resource network to identify available resources. Care plans are developed for each of the participants in the case management program. Missouri’s pediatric hospitals also provide services that support comprehensive, coordinated, and ongoing healthcare. The Journey’s Program at the University of Missouri’s Children’s Hospital helps coordinate care provided by a child’s health care professionals, community, and family to meet the physical, emotional, and spiritual needs of the child and family as they cope with complex medical conditions. Children’s Mercy Hospital in Kansas City and St. Louis Children’s Hospital provide similar services, such as Family Centered Care Coordinators, The Beacon Program and Clinic, and the Pediatric Advanced Care Team.

 

Childhood Lead Poisoning Prevention Program (CLPPP) staff will continue to work with LPHAs and Mo HealthNet lead case managers to coordinate clinical and environmental services for families of children with elevated blood lead (EBL) levels in order to strengthen the role of primary care providers within the public health domain. Supporting public health relationships involving professionals with a variety of clinical and environmental expertise results in (elevated) children’s blood lead levels declining more rapidly, therefore preventing further undesirable health effects. These supportive activities will include:

• Leading education to health care providers, LPHAs, WIC programs, and many community activities;
• Documenting case managers, physicians, and other clinicians names and phone numbers in the records of children with EBL;
• Including Family Partners and representatives of various clinical and environmental disciplines when designing and planning new program strategies;
• Strategies to share and document pertinent case management information and actions across the disciplines and with family/caregiver input to result in coordination of care and more effective, efficient care; and
• Working with Family Partners to review program materials and planned activities.

 

The CLPPP will partner with other Title V MCH programs, health care providers, and the DESE to establish well-coordinated efforts to provide early evaluation and referrals for services as well as ongoing monitoring and services for children with lead poisoning. Schools should have an early and ongoing role in the appropriate and timely follow-up of children with a history of EBL. Schools can request, collect, and record EBL information for all children in their district. Therefore, increasing timely referrals to the DESE allows children with a history of EBL to access a variety of expanded and ongoing evaluation, monitoring, and intervention services such as school nurses, Parents as Teachers (PAT), First Steps Early Intervention Programs, Head Start Programs, and other special services to develop IEPs. DESE program staff can provide lead awareness education for all families/children in their districts, from birth to high school graduation, regarding the potential adverse effects of lead on the developing infant and child. They can also share information on services available to families and children to decrease the potential ongoing exposure and detrimental effects of lead. They can work with children’s medical providers to assure that initial and ongoing health, developmental, behavioral, and cognitive assessments/evaluations are performed. They can perform or refer for various types of child health and developmental evaluations and intervention services needed due to lead exposures that occur prior to and during their school years.

 

CLPPP staff will focus on lead hazard reduction in dwellings linked to a child with EBL, including contracting with a licensed lead abatement firm, in compliance with procurement processes. The Program will assist low-income homeowners and landlords of subsidized housing to perform lead hazard reduction in dwellings linked to a child with EBL. Funding will be used to supplement training costs to encourage contractors to become licensed in lead abatement in areas lacking capacity. A recent national study shows that every dollar spent on lead hazard reduction has a $17 - $250 return on investment over the life of a child.

 

The Missouri WIC program will continue to offer training and support to local agencies and community partners interested in implementing the WIC Developmental Milestones Program. Participating agencies will use a set of age-appropriate developmental checklists, based on the LTSAE campaign, to increase parents’ awareness of developmental milestones and to promote the early identification of potential developmental delays. Local agencies will refer participants for screening and early intervention services to primary care physicians or Individuals with Disabilities Education Act (IDEA) diagnostics programs, known in Missouri as First Steps (0-3 years of age) and Early Childhood Special Education (3-5 years). Local agencies may also refer their participants to ParentLink, an affiliate of Help Me Grow National Center, for validated screening and connection to intervention programs. Data reports from the Missouri WIC Management Information Systems (MIS) on referrals and follow-ups will be available for FFY 2023. These reports will be used to assess the program’s effectiveness in providing referrals and access to early intervention programs. Technical assistance from DHSS will be available to all current participating agencies to improve program effectiveness.

 

The DHSS will support participating entities by providing education and promotional items, including printed materials such as the developmental checklists and the Amazing Me books developed by the CDC. The Missouri WIC program will consider promotional materials that will assist parents in assessing their child’s development such as feeding utensils. These resources will be available for WIC agencies as well as internal and external stakeholders as part of providing educational support and promotion of early identification of potential developmental delays. Monthly updates on various child development topics will be posted on the Missouri WIC webpage to provide education and support to local agencies.

 

Efforts by the Missouri WIC program to recruit non-participating local agencies and external partners to implement the WIC Developmental Milestones Program will continue. Training and support will be provided to local agencies interested in implementing the program, including the language component, Talking is Teaching: Talk, Read, Sing. Implementation training developed by the CDC will be used to onboard new local agencies enrolling in the program. Agencies will also be required to complete the Association of Public Health Nutritionist (ASPHN) “Introduction to Child Development” training for WIC staff. The Missouri WIC Facebook page will host monthly posts to promote the program to local agencies and the public. Results from a FY21 local agency survey will be used to determine current program participation rates, clinic activities, and training needs from participating agencies as well as gather data on program interest from agencies not currently enrolled. Feedback from agencies not currently enrolled will be used to design future promotional activities. DHSS will continue to collaborate with local and nationwide partners to promote developmental milestones and identification of educational resources for parents and health care providers. Collaborations with CDC, ASPHN, ParentLink, and Wichealth will continue.

 

Other Title V MCH Activities Related to cyshcn

 

SHCN coordinates programs and initiatives focused on developing, promoting, and supporting community‐based systems that enable the best possible health and greatest degree of independence for Missourians with special health care needs. SHCN accomplishes its mission in collaboration with families, health care providers, and other community, state, and national partners. SHCN values family partnerships in decision-making and satisfaction with the services they receive. SHCN programs and initiatives include the ABI Program, Brain Injury Waiver (BIW) Program, CYSHCN Program, HCY Program, Family Partnership Initiative, and MFAW Program. Bureau programs and initiatives that serve cyshcn include the CYSHCN Program, the HCY Program, and the Family Partnership Initiative. In addition to these programs and initiatives, SHCN provides funding to Missouri Assistive Technology for the Kids Assistive Technology (KAT) project, which improves access and reduces barriers for cyshcn. SHCN also facilitates the Missouri Brain Injury Advisory Council and administers the Federal Traumatic Brain Injury State Partnership Grant.

 

The CYSHCN Program provides statewide assistance for individuals from birth to age 21 who have or are at increased risk for a medical condition that may hinder their normal physical growth and development and who require more medical services than children and youth generally. The program focuses on early identification and service coordination for individuals who meet medical eligibility guidelines. As payer of last resort, the CYSHCN Program provides limited funding for medically necessary diagnostic and treatment services for individuals whose families also meet financial eligibility guidelines. To be eligible for the CYSHCN Program, participants must: be a Missouri resident, be between birth to 21, have an eligible special health care need (conditions such as cerebral palsy, cystic fibrosis, cleft lip and palate, hearing disorders, hemophilia, paraplegia, quadriplegia, seizures, spina bifida, and traumatic brain injury), and meet financial eligibility guidelines for funded services (family income at or below 185% of the Federal Poverty Guidelines). The CYSHCN Program provides two primary services: Service Coordination and Funded Services. Service coordination is provided to all participants, regardless of financial status, including: outreach/identification and referral/application, eligibility determination, assessment of needs, resource identification, referral and access, family support, service plan development and implementation, monitoring, and evaluation, and transition/closure. SHCN maintains contracts with multiple LPHAs to provide service coordination for the CYSHCN Program. CYSHCN Service Coordinators complete comprehensive individual assessments during annual home visits to identify each participant’s/family’s unique needs and assist the family with resource identification and referral to ensure their needs are met. In addition to service coordination, limited funding (up to $25,000 annually per participant) is available for medically necessary diagnostic and treatment services for participants whose families meet financial eligibility guidelines. Funded services may include but are not limited to: doctor visits, emergency care, inpatient hospitalization, outpatient surgery, prescription medication, diagnostic testing, orthodontia and prosthodontia (cleft lip/palate only), therapy (physical, occupational, speech, and respiratory), durable medical equipment, orthotics, hearing aids, specialized formula, and incontinence supplies. Service Coordinators assist participants/families with resource identification and referral. All third party liability is  exhausted prior to accessing CYSHCN program funds. Direct care diagnostic and treatment services are supported through state funds. Service coordination is supported through state funds, Medicaid, and MCH Title V Block Grant.

 

SHCN administers the HCY Program through a cooperative agreement with MO HealthNet. To be eligible for the HCY Program, participants must be a Missouri resident, be between birth and 21 years, need medically necessary services, and be enrolled in the MO HealthNet fee for service system (not the MO HealthNet Managed Care Plans). The HCY Program provides service coordination that involves: evaluation and needs assessment, identifying and accessing service providers, service plan development and implementation, coordination of services through resource identification and referral, family support, assisting in establishing a medical home, transition planning, and prior authorization of medically necessary services (private duty nursing, advanced personal care, personal care aide, skilled nursing visits, authorized registered nurse visits, and administrative case management). SHCN Nurse Service Coordinators monitor services through assessments, regular home visits, medical records, and care plan review. The HCY Program is primarily supported through Medicaid funds with secondary support through state and Title V MCH Block Grant funding.

 

The SHCN Family Partnership enhances the lives of individuals and families impacted by special heath care needs by providing resources and information to empower families to live a good life. The Family Partnership hosts events to benefit families through development of leadership skills, networking among peers, and staying current with trends and issues regarding special health care needs. Each Family Partner is a parent of a child or youth with special health care needs and is well equipped to help families explore options and solutions. The SHCN Family Partnership is funded primarily through the Title V MCH Block Grant and secondarily through the HRSA Universal Newborn Hearing Screening and Intervention Program Grant. Additional information about the SHCN Family Partnership can be found in the Family Partnership section of the grant application.