CYSHCN Action Plan (October 1, 2021-September 30, 2022)

Transition: NPM 12 Transition to Adult Care: Children with special health care needs, ages 12 to 17 years will be realigned this reporting period. The newly developed Transition Services policy and transition toolbox is now in a revision phase after initial implementation. Plans are being developed to increase provider awareness related to transition services. In addition to training, a key performance indicator around transition has been established. CYSHCN has now been reporting quarterly transition data as an agency key performance measure for the last 12 months in addition to choosing this NPM 12 to report on as an indicator. 

Family Engagement: CYSHCN will develop an ESM related to family engagement during this grant cycle. Implementation of the CYSHCN, as well as the MCH Bureau Family Engagement policies were delayed due to COVID but plans to implement will be reinstituted before the of this rating period. Once these policies are implemented our staff can further understand the needs of the families we serve and aligning those needs with our resources is the core of CYSHCN’s foundation. We will continue to partner with our Family organization, Family Connection of SC (FCSC), to train and mentor our workforce in providing family engagement skills to address the needs of our families. Our expanded family engagement effort, our strong relationship with our family-to-family partner organization, and continued strategies will help us cultivate the relationship with patient/families to help improve our program services for the CYSHCN population. 

Care Coordination/Children’s Rehabilitative Services (CRS)/Orthodontia/Hearing Programs: CYSHCN will continue to look at opportunities to promote growth in our Care Coordination, CRS, Orthodontia and hearing programs.  In the next year as we return to post COVID delivery of services we have already noted challenges in access to services. We have identified a need to partner with telehealth services to offer additional options to our families. We are identifying other technology methods to assist staff with meeting our population in safe venues as well as updating our policies to reflect these alternative delivery methods. We believe this expanded use of Technology will allow CYSCHN to continue all services programs and experience growth in all programs.  

Hemophilia: Active discussion with partner agencies to expand CYSHCN Hemophilia capacity have begun and due to COVID-19 has been deferred until later in the year. This expansion may allow the program to provide future funding for other needed services for other vulnerable populations. The Hemophilia Premium Assistance Program (HPAP) which serves uninsured individuals with hemophilia will remain in place and has the capacity to grow. Partnerships with the SC Hemophilia Association and SC physicians serve as the referral source for this program. 

Camp Burnt Gin: The MCH Bureau recognizes the value Camp Burnt Gin provides for children, youth and young adults with special health care needs in South Carolina. While we had to slow the start of our strategic plan we will move ahead with several major renovation projects and move forward with the a more detailed five-year plan for sustainability. With the addition of a new Assistant Camp Director position, plans are in place for a deferred 75 Years Plus celebration during our 2022 camp season. We plan to use technology to look at additional opportunities to increase camper enrollment, improve the recruitment of staff, and streamline the camper application process. This new model for CBG will focus on a new style of leadership while building greater community partnerships.     

Medical Home: NPM 11: The percent of children with and without special health care needs having a medical home. This NPM will remain an emphasis for CYSHCN. According to the 2018-2019 NSCH, the percentage of CYSHCN in SC receiving care in a coordinated medical home is at 44.6%, which is above the national average.  While our CYSHCN families receive medical home education upon enrollment and annually, we recognize that additional strategies need to be developed to improve this measure. This includes a change in policy to direct a more detailed annual record update to incorporate a medical home assessment. The program will investigate upcoming collaborative cohorts that focus on improving medical home outcomes during this grant cycle.  

Sickle Cell: Helping to ensure that any infant born with Sickle Cell Disease (SCD) can access care early in life is the ultimate goal. Consistent care coordination and support is essential to positive health outcomes. While SCD tracking and care coordination is no longer an official SPM the program still believes this to be a worthy measure. Regional staff have struggled to improve our performance on this measure over the last several rating periods. We revised our internal processes and could not see the full impact of our changes due to COVID restrictions during the second half of the rating period, however the CYSHCN program saw slight improvement over the last rating period. When challenged with COVID restrictions we had to defer one of our steps and hope to reinstitute home visiting in this next rating period to help us reach those patients that have not be successful through other strategies. Monthly review of our tracking and surveillance tool has identified gaps earlier. The early identification of issues with regional care coordination and missing notifications have been resolved leading to more timely encounter attempts.   

CYSHCN will continue to coordinate and partner with our Sickle Cell CBOs and stakeholder group to maintain the level of awareness and engagement to make progress with our SCD State plan. As the plan enters the 3rd year of implementation consistent challenges with participation by all stakeholders has been identified as well as leadership roles for the plan. SC DHEC will remain integrally involved and will assure that these group remains solvent.   

Our Premium Assistance Program has allowed the program to provide valuable services to those living with SCD who are unable to afford health insurance through other means. This program allows accessibility to stable healthcare. During the last year we were able to support 11 eligible clients and moving forward in this next year we would like to look at ways to increase the number of eligible clients receiving Premium Assistance and set up a plan for sustainability.  

Workforce Development:  Building and maintaining a competent workforce will be a continued focus, as well as a challenge. Staff turnover through attrition and retirement has demanded that, as a program, we provide opportunities in a variety of learning venues. Regional trainings on program initiatives will continue, as well as our Annual Policy and Procedure meeting. We have become familiar with many new learning platforms and will utilize all as needed to achieve this. The CYSHCN program staff has created a Share Point site to increase communication, serve as a repository for program trainings, and share upcoming events, webinars, bulletins etc. This platform allows staff to engage at any opportunity. The value of continued educational training is a vital to maintaining an efficient workforce.  We will continue to look for creative ways to provide relevant training opportunities both internally and externally for our staff to engage in. CYSHCN is excited about plans to expand and serve the special need patients and families of South Carolina.