Children and Youth with Special Healthcare Needs

Plan for the application year: Oct 2020 - Sept 2021

As in prior years, NPM 11, percent of children with and without special health care needs having a medical home, best captures WCFH work to improve access to health care, including continuous, coordinated services that provide both preventive care and specialized treatment for CYSHCN. In addition to access to medical and specialty care, the needs assessment also identified child abuse and neglect as an area of concern for CYSHCN. When children receive care in a medical home, meaningful relationships can be established with health care providers. Through these relationships, medical and social needs of a child can be addressed, thereby increasing a child’s chance of growing up in a safe, stable, and nurturing environment.

The ESM for this domain, number of CYSHCN, their family members, health care and community professionals who complete trainings for the first time on various healthcare topics and report a change in knowledge after the training, aims to improve engagement and consistency in healthcare services for CYSHCN. By increasing knowledge and understanding of healthcare systems, prevention and treatment needs, patients, families, and providers can be better prepared to partner for care. Education can also improve the quality and cultural responsiveness of care and create positive patient, family, and provider relationships. This in turn can improve patient and family healthcare experiences and increase access to care.

NPM Strategy 11.1: Promote a shared resource for families and primary care providers of CYSHCN using the Help Me Grow Alaska centralized system model.

This strategy focuses on offering resources and care coordination services to families through the Help Me Grow Alaska (HMG-AK) centralized system model, to improve access to medical and specialty care. Medical providers are also supported through education that increases their knowledge and access to resources used to assess and treat some pediatric medical, developmental, and behavioral needs. The components of this strategy align with increasing the number of children in a medical home by offering continuous and coordinated support to families as they seek to obtain appropriate health care for their children. This also directly addresses the needs assessment results identifying access to medical and specialty care as an issue. HMG-AK also has the potential to directly impact child abuse and neglect by linking families not only to healthcare services but also to social service resources in their home communities.

HMG-AK is a system that connects children and families with the services they need. HMG-AK originally launched in the Early Childhood Comprehensive Systems (ECCS) place-based communities and now accepts calls and referrals from across the state. They continue to grow and expand their outreach statewide through their call center. The plan is to continue expanding outreach statewide with increased opportunities for supporting communities through tangible support for a network of community contacts, community champions, and HMG Community Liaisons. WCFH will continuing working with the expanded HMG-AK services in an advisory capacity.

HMG-AK has designed and will soon release free online developmental screening training modules for primary care providers, which includes a CYSHCN module. Certificates of Medical Education (CMEs) and an optional Maintenance of Certification Part 4 (MOC-4), a credit needed by physicians who are board certified in general and subspecialty pediatrics, will be offered. Work has also begun to create a new education module for primary care providers focused on infant mental health.

HMG-AK is also a resource for the Partnership Access Line-Pediatric Alaska (PAL-PAK), which is a partnership between Division of Behavioral Health and Seattle Children’s Hospital PAL line. PAL-PAK aims to offer prescribing pediatric care providers in Alaska support when they have questions about child and adolescent mental healthcare. Assistance offered includes diagnostic clarification, medication adjustment and treatment planning. This initiative was in direct response to the lack of psychiatrists available in Alaska to treat pediatric patients with mental health needs. If non-prescribing providers call for assistance, they will be directed to HMG-AK for community resources. HMG-AK also offers provider outreach and education about PAL-PAK through a variety of in-person meetings and educational conferences and webinar opportunities with the PAL-PAK team. The CYSHCN Program Manager is on the advisory committee for PAL-PAK and helps promote PAL-PAK and HMG-AK’s services.

Finally, in response to the COVID-19 pandemic, HMG-AK created a live document accessible to Alaska families, early learning professionals, and health care providers, which offers reliable resources on a variety of topics. Talking to children about COVID-19, managing mental health, supportive resources, and activities for young children are just some of the topics included. This effort will continue, particularly since the pandemic has highlighted the need to focus on strengthening systems and community partnerships to address CYSHCN needs during emergency situations. Emergency preparedness is also part of the WCFH priority area for all domains and given the number of potential natural disasters on offer in Alaska, continuing to develop resources focused on planning for and managing daily needs in an emergency is essential.

NPM Strategy 11.2: Develop resources for adolescent healthcare transition to adult care and increase education for adolescents, their caregivers, educators, and medical providers on this topic.

This strategy focuses on adolescent coordination of care and developing skills to manage healthcare needs and navigate healthcare systems. As adolescents prepare to leave pediatric and enter adult care, it is necessary for them to understand how this process works, and what tools are needed to access care and make healthy life choices. This strategy aligns with increasing the number of children in medical homes, because by establishing a medical home for care, adolescents have more opportunity to receive transition services, ongoing education and ask questions of their primary healthcare providers on a regular basis. In addition, the process of learning about and planning for healthcare is also an important component of emergency preparedness. The transition worksheets and checklists offered as learning tools to plan for care in the future, can also be used to plan for care in the event of an emergency.

Adolescent healthcare transition work has been ongoing since 2018, when the CYSHCN Program Manager began working at WCFH. This work is funded by Title V. In the coming year, plans are being made to begin offering healthcare transition classes to foster adolescents who receive independent life skill services through the State of Alaska. Currently the independent life skills curriculum does not include healthcare information. Presentations will also to be given in coordination with the Alaska Center for Resource Families, an agency that focuses on enhancing the health and safety of children, families, and their communities. The presentations will offer foster, adoptive, relative caretaker, and guardianship families information and resources for adolescent healthcare transition.

The CYSHCN Program Manager has begun partnering with the Adolescent Health Project Coordinators in WCFH who work on The Fourth R curriculum for Healthy Relationships and developing adolescent friendly clinics in Alaska. The Adolescent Health Coordinators are developing health curriculums for schools and healthcare providers on a variety of adolescent health topics and want to incorporate adolescent healthcare transition into these curriculums. This will greatly increase access to information and resources for adolescent healthcare transition, for all youth with and without special healthcare needs, and providers caring for them.

NPM Strategy 11.3: Partner with Tribal health and the University of Alaska Anchorage Center for Human Development (UAA CHD) to implement Project ECHOs to increase caregiver and provider knowledge and skills.

Project ECHO is a learning model that uses real time videoconferencing technology to connect a team of interdisciplinary specialists with health and community service professionals, educators, and community members. Using a hub and spoke model, ECHOs provide access to expert information from professionals across the state and country, building capacity to implement best practices and improve outcomes. Specialists serve as mentors and colleagues and create ongoing learning communities, breaking down walls between primary care, specialty care, community partners and families. ECHOS give providers the tools and resources they need to deliver better medical-home model patient-centered care, which incorporates a team approach and comprehensive, coordinated personalized care. The Family focused ECHO gives families the tools they need to be fully engaged partners in healthcare, also falling within the scope of the medical home model. The University of Alaska Anchorage (UAA) Center for Human Development (CHD) is Alaska’s University Center of Excellence for Developmental Disabilities (UCEDD) and is now (through funding from WCFH) certified as an ECHO Super Hub, and is the facilitator for an increasing number of Title V sponsored ECHO projects, which will carry forward into FY21. WCFH has a key role in leadership and funding for ECHO projects, a model which is a good fit for Alaska and has proven successful. The Title V MCH Director and the Acting Section Chief for Rural and Community Health Systems continue to lead the statewide ECHO workgroup.

The Neurodevelopmental Disabilities ECHO will continue to take the principles of ECHO and add the components of interdisciplinary expertise, including the integration of parent expertise, to focus on enhancing statewide primary care knowledge, screening and management of Autism Spectrum Disorder (ASD) and related disabilities. The interdisciplinary team includes a developmental pediatrician, child neuropsychologist, advanced nurse practitioner, licensed clinical social worker, and a parent advocate. In FY 21, due to COVID 19 challenges, there may be a need, and an opportunity, to expand the Neurodevelopmental ECHO to include a specialized session on best practices for diagnosing and treating ASDs using telehealth.

The Family ECHO: Challenging Behaviors will continue as a virtual learning network for family members and those supporting individuals with disabilities who need higher support, care, and skills for challenging behaviors. This ECHO incorporates experts including family members, social workers, behavior analysts and family navigators to provide case-based learning and didactics on complex behavior and transition challenges.

The Behavioral Interventions for Early Childhood ECHO, launched in 2020, will also continue with a focus on providing learning for early childhood professionals supporting children birth through five, who have challenging behaviors and need additional supports. Providers participating in this ECHO include childcare, preschool, and early intervention professionals. Also continuing into FY21, is the COVID Perinatal ECHO. This ECHO launched almost overnight, due in part because of the experience from past WCFH sponsored ECHOs, to increase provider knowledge of perinatal topics and increase confidence in managing COVID-19 positive or suspected cases, strengthening the network of providers in Alaska. WCFH also leads the Dental COVID-19 ECHO for Alaska.

NPM Strategy 11.4: Collaborate with state, private and non-profit programs to remove barriers to data sharing and centralized data collection to create an integrated early childhood data system.

Increasing the number of children receiving care in medical homes aims to improve children’s access to both preventive care and treatment. The development of integrated early childhood data systems is a strategy that would enhance the care received in the medical home. By creating systems that offer coordinated and comprehensive medical information, medical providers, and other early childhood providers, will have the opportunity to enhance childhood screenings aimed at improving health and development in young children. Integrating data can also reduce the risk of child abuse and neglect, by targeting children at risk for maltreatment with programs and services aimed at improving social and health outcomes.

WCFH provides leadership on several initiatives aimed at removing barriers to data sharing and centralized data collection to create early childhood data systems. The Early Childhood Comprehensive Systems (ECCS) grant program, funded through HRSA MCHB, is one such initiative. The ECCS program is focused on the development of two-generational early childhood systems at the state and community levels. The goal was to enhance early childhood systems building and demonstrate improved outcomes in population-based children’s developmental health and family well-being indicators. Beginning in 2018 and continuing into 2019, the ECCS program began tracking the increased use of standardized developmental screening tools and child level outcomes. The was achieved by the Alaska ECCS program working with community coalitions, medical providers, Early Intervention and other partners, to coordinate data sharing agreements to track the developmental health of 0-3 year olds in three place-based communities. To build on these successes, the plan is for the ECCS program, along with the Maternal Child Health Epidemiology Unit and a contractor, to explore the development of an early childhood shared data resource to collect comprehensive health information for young children in child protective services.

Another initiative aimed at building comprehensive early childhood systems is the Alaska Early Childhood Coordinating Council (AECCC). The purpose of the AECCC is to promote positive development, improve health outcomes and school readiness for children prenatal through age eight. This will be achieved by creating a unified, sustainable system of early care, health, data, education, and family support for young children and their families. The Council is co-chaired by the Department of Education and Early Development (DEED) and the Department of Health and Social Services (DHSS), and has a wide variety of members spanning the early childhood sector, including public, Tribal, private, and non-profit representatives. WCFH is represented on this council and provides leadership and organizational support. The AECCC serves as the advisory board for Alaska’s Head Start, Child Care Assistance and the Maternal Infant Early Childhood Home Visiting (MIECHV) grants. The Title V MCH Director has been the lead DHSS staff to this Council for the past and is now transitioning that role to the ECCS Program Manager.

The Child Care Assistance Office received a Federal Impact Project grant from the federal Child Care State Capacity Building Center, to help create a unified framework around early childhood programs and initiatives. In collaboration with the Mental Health Trust, the Child Care Assistance Office decided to create a Task Force, to help coordinate needs assessments and data from early intervention and education, childcare and labor. The data collected will provide guidance on how Alaska will define quality programs, as well as understand service availability, and location of services, especially in rural areas. To the extent practicable, there will also be an effort to document the number of unduplicated young children and families of young children being served in existing programs. The Task Force also acts as the Advisory Board for the Preschool Development Grant (PDG) needs assessment and the Tribal Project LAUNCH grant. WCFH is an active member of the Task Force and is involved in the additional projects.

The Alaska Birth Defect Registry (ABDR) has some common data interests with both the Early Hearing Detection and Intervention (EHDI) and the Newborn Bloodspot Screening (NBS) programs. This overlap presents an opportunity for collaboration and quality assurance for certain conditions because each program relies on distinct reporting systems. These three programs have developed data sharing protocols that allow for insight into missing reports, which is one of the most difficult aspects for any screening, or surveillance program to measure. This process has already produced valuable information to the EHDI program and allowed EHDI to better focus its resources. During the upcoming year, these programs will develop regularly scheduled data sharing intervals to solidify this mutually beneficial opportunity and use the information gleaned to identify and eliminate gaps in reporting.

NPM Strategy 11.5: Partner with statewide agencies to provide Family Navigation services for families of CYSHCN.

Alaska is one of two remaining states where medical care is paid through a fee-for-service model. Often this means that care coordination, an important component of a medical home, is not offered because these services are not currently reimbursable. Peer to peer Family Navigation services fills this component of a medical home specific to CYSHCN populations, by offering family-centered, coordinated assistance to access and advocate for needed medical and specialty care.

The EHDI program partners with Stone Soup Group (SSG) to provide Family Navigation to families with a child diagnosed with a hearing loss, or at-risk of hearing loss after failing their newborn hearing screening. Stone Soup Group (SSG) is a non-profit that has been providing support for families raising children with special needs since 1992 and is Alaska’s HRSA funded Family-to-Family Health Information Center (F2F). The EHDI Parent Committee reviews all SSG resources and scripts to assure the materials are up to date and accurate. In the coming year, an EHDI Guide/Mentor program is being launched in partnership with SSG, to help pair experienced parents of Deaf/Hard of Hearing children with parents who have received a recent diagnosis for their newborn.

SSG also provides Family Navigation services at the Cleft, Lip, and Palate clinic offered at Southcentral Foundation, and the State-sponsored Neurodevelopmental Outreach Clinics. The contracts for navigation services are funded in part with Title V funds. There are quarterly meetings between WCFH and SSG to discuss Family Navigation services and assess for additional needs.

WCFH also partners with the CHD to provide Family Navigation training for providers and their staff. To better meet the needs of pediatric providers and families, this training integrates the principles of pediatric care coordination, with the more family systems approach of navigation. In an effort to fill an important gap and build capacity, in FY20 this work will also include a web-based portal where Family Navigators can share information and resources, and providers can request training for their staff.

NPM Strategy 11.6: Develop and implement Family Engagement training.

This strategy to improve family and professional partnership, is part of the strong commitment WCFH has to family engagement and leadership. A critical part of family centered care is ensuring parents are engaged and supported, and this training provides parents with the skills and resources they need to be involved in healthcare planning, development and implementation at multiple levels; individual, community and policy.

This strategy has developed out of the last few years of partnering with statewide agencies to increase Family Navigation services for CYSHCN families. Improving family and professional partnership, is part of the strong commitment WCFH has to family engagement and leadership, and a critical part of family centered care. Offering family engagement training aims to develop the parent and family skills needed to participate in healthcare planning, development, and implementation at multiple levels; individual, community and policy. Supporting parent leaders invested in care for CYSHCN can also help improve access to medical and specialty care in Alaska, through shared knowledge and capacity building in local communities.

In 2019, with first year funding from Alaska’s Preschool Development Grant (PDG) the Department of Early Education and Development (DEED) partnered with WCFH to develop a Family Engagement training. Parents and caregivers of young children were recruited from large and small communities across the state, from Anchorage and Juneau to Eek and Kongiganak. The training has two components, and both contain evaluation tools. One is an asynchronous training consisting of 20 online learning modules that families can complete at their own pace. This part of the training has been developed and will launch in the fall of 2020. The second aspect of this training is a Family Engagement ECHO and serves as the “practicum” for this parent as professional skill building. This ECHO began in 2020, and has proven so successful, that even though Alaska did not receive second year PDG funding, the project will continue as this ECHO will now become part of the UAA LEND (Leadership Education in Neurodevelopmental and related Disabilities) program’s Family Echo.

NPM Strategy 11.7: Partner with audiologists and Early Intervention to increase referrals and enrollment by 6 months of age for children diagnosed with a hearing loss.

This strategy is a continuation and seeks to improve access to medical and specialty care for CYSHCN, by improving the timeliness of referrals for hearing loss services. Referring infants and families for services earlier, makes for timelier interventions and better coordinated care. There is potential to reduce child abuse and neglect when therapeutic services can be accessed before more significant developmental and communication deficits develop.

Prior to 2020-2021, the Early Hearing Detection and Intervention (EHDI) Family Navigator and Alaska’s Early Intervention (EI) program only received referrals for infants when a hearing loss was diagnosed. This referral process has now expanded to include children identified as at-risk for a hearing loss, not just those with a diagnosis. Earlier referrals for at-risk children will ensure families have assistance in navigating systems involved in determining an audiology diagnosis. Access to earlier diagnosis means children with hearing loss can also be enrolled in EI sooner. The EHDI program is also seeking improvements in the referral process by developing an automated reminder system with OZ, the EHDI database contactor, to automatically collect hearing screening results. The goal is for OZ to send automatic weekly reminders to providers when a child with a documented hearing loss does not have documented EI enrollment. It is hoped that the development of the provider-family relationship through the referral and reminder process will improve utilization of the medical home for children with hearing loss.

In 2019, EDHI developed a Shared Plan of Care that was offered by the Family Navigator to families identified as having a child at-risk for hearing loss. This tool, which is available in both paper and electronic formats, aims to help families centralize information about their child’s medical and other needs to improve access to services. A quality improvement project was developed to refine the tool as it was rolled out, and tests will continue to determine the usefulness of the tool. Two hospitals and two EI providers currently offer this tool to families of children at-risk for hearing loss and are part of the quality improvement activities.

EHDI program staff and parent leaders will continue to offer presentations twice a year to Alaska EI grantees through in-person or webinar meetings. The EHDI Advisory Committee, which includes the EHDI Family Navigator, EI staff, audiologists, self-advocates, and parents, will continue to collaborate on improving pediatric audiology services in Alaska. The focus will remain on quality improvement initiatives to increase referrals and enrollment by 6 months of age for children with diagnosed hearing loss.

NPM Strategy 11.8: Conduct or support special studies related to access to care (i.e. GIS mapping of access to care; comparative study of military and Tribal Health systems and non-military/non-tribal health systems; CCHD study).

Since the 2015 Title V Block Grant needs assessment, access to medical and specialty care for CYSCHN in Alaska, has been identified as an area of great need. Many factors affect access to care including difficulties recruiting medical specialists to Alaska, the rate of reimbursement for specialist services, patient’s health insurance coverage, and the practical challenges of travelling from rural Alaska for medical care to a larger community or out of state. To appropriately address access to care needs and understand the burden associated with specific health conditions, it is necessary to conduct or support special studies that describe these issues. Gathering data that quantifies the problem is necessary to understand where and how gaps in care exist and offer a road map to effective design strategies to improve systems of care.

The Alaska Birth Defects Registry (ABDR) and Newborn Bloodspot Screening (NBS) programs are currently participating in a project that aims to better understand the burden of Critical Congenital Heart Disease (CCHD) in Alaska, the efficacy of screening and the healthcare received. This two-year project utilizes a pediatric cardiology specialist and medical record review of all CCHD cases reported to ABDR to more accurately measure the prevalence rate of CCHD in Alaska and to track the care received in the first two years of life.

The COVID-19 pandemic is a public health emergency that has greatly affected access to care not only in Alaska, but across the nation and the world. As routine medical services were reduced in an effort to curb the spread of the virus, alternative ways of providing healthcare are evolving. Almost overnight, Medicare, Medicaid and private health insurance companies began changing reimbursement policies and, at least in the short term, waiving barriers for telehealth services to facilitate ongoing healthcare access for patients. As a result, the emergency yielded an opportunity to explore how medical, behavioral, and therapeutic telehealth services are delivered, and how such approaches could be continued and expanded in the future to reduce gaps and barriers to specialty care for CYSHCN across Alaska.

NPM Strategy 11.9: Participate in workgroups related to workforce capacity, systems integration, and healthcare infrastructure for primary and specialty care (i.e. healthcare transformation workgroup, FASD ad hoc committee, Autism ad hoc committee).

Alaska needs the healthcare workforce capacity to offer care to all children to realize progress on the national performance measure related to children receiving care in a medical home. Strategies need to be developed that increase healthcare workforce capacity and help retain providers providing care in Alaska. WCFH is a key member of several statewide initiatives that seek to improve Alaska’s healthcare infrastructure and support healthcare providers.

The Alaska Healthcare Transformation Project consists of several focus groups of policy makers, state and healthcare leaders and administrators, patient advocates and private payers who are working to collectively improve Alaska’s healthcare system. The vision of this group ‘is to improve Alaskans’ health while enhancing patient and health professionals’ experience of care while lowering the per capita healthcare cost growth rate.’ Being able to access affordable care that improves health, is really the driving focus behind the creation of this project. The aim is to collect data from focus groups around how current care is provided and what the strengths and weaknesses are within these systems. Data from studies completed on Alaska’s healthcare system over the last 10 years is also being collected, along with different systems of care offered in Alaska and from around the United States, in an effort to create a blue print of an innovative healthcare delivery system that would meet the needs of Alaska’s and would contain costs. The CYSHCN Program Manager has been attending the meetings and offers insight into how and where CYSHCN access care, to ensure any redesign of the healthcare system would support this population. One of the goals that will measure success for this project is to increase by 15% over the next five years, the number of Alaskans with a usual source of primary care. This goal aligns with the CYSHCN priority of increasing medical home use. Currently this project has paused due to the COVID-19 pandemic. However, it is hoped that once resumed, a plan will be created that seeks to positively improve the current Alaskan healthcare system.

The All Alaska Pediatric Partnership (AAPP), is a public/private partnership that links healthcare and community-based services with government, healthcare entities, social services, and payers for children and family healthcare. The goal is to improve the health of all children in Alaska. The Title V Director is a member of the AAPP Board and many working in WCFH attend monthly AAPP meetings.

WCFH is also involved with two ad-hoc committees convened by the Governor’s Council on Disabilities and Special Education, Alaska’s Developmental Disability (DD) Council (The Council). Both the Autism Ad-Hoc Committee and the FASD Ad-Hoc Committee, bring together stakeholder groups focused on improving health outcomes and access to healthcare for children affected. The work of these committees aligns with the CYSHCN focus in WCFH, to seek ways of improving the systems of healthcare that most impact CYSHCN.

NPM Strategy 11.11: Continue to provide limited gap-filling pediatric specialty clinics as needed and as resources allow.

This strategy addresses concerns raised in the 2020 Title V Block Grant Needs Assessment about access to specialty care. Much of the work done at WCFH focuses on identifying needs and creating partnerships to improve access to care for CYSHCN seeking healthcare. This is both an effective approach to finding sustainable ways to meet needs and to overcoming the problem of limited resources within WCFH for extensive specialty care. Currently, the Title V Block Grant funds the administration of one gap-filling clinic for Alaska.

The State of Alaska Metabolic Clinic is offered three times a year in February, June, and October. Pediatric and adult patients are served in the Metabolic Clinic, while infants are referred for care when an abnormal result from their newborn bloodspot screen results in a metabolic diagnosis. Title V funding pays for the metabolic clinic physician, dietician, and other supporting costs such as transcription and the clinic manager, who works in WCFH. During the rest of the year, metabolic consultation services are offered remotely to patients, families, and medical providers, by the same physician consultant and dietician. This includes covering metabolic consultation for abnormal results found by Alaska’s Newborn Bloodspot Screening Program in conjunction with the Iowa State Hygienic Lab who are contracted to analyze all of Alaska’s newborn bloodspot screenings.

Clinics are normally in person and held for two days in Anchorage and one day in Fairbanks. However, due to the COVID 19 pandemic, the June 2020 clinic is being offered for the first time via telehealth. This response to the worldwide health emergency presents the opportunity to re-evaluate how the Metabolic Clinic is offered and accessed by patients across Alaska. The feasibility of offering at least one clinic per year as a telehealth clinic, will be explored in the coming year.

A Program Manager and Office Assistant in WCFH are the main points of contact for physician and dietician services and help coordinate prescriptions refills and medical foods orders. They also contact health insurance companies to discuss coverage and eligibility for specific treatments and obtain prior approval for clinic visit, as needed.

There are three pediatric autism diagnostic centers in Alaska, and all are in the Anchorage and Mat-Su area. One center only serves Alaska Native Tribal beneficiaries. In the past, when rural Alaskan patients needed pediatric autism diagnostic services, they had to travel to receive services in either Anchorage or outside of Alaska. To address this challenge, WCFH contracts with the Seattle Children’s Hospital and Medical Center and the University of Virginia Children’s Hospital for Pediatric Neurodevelopmental Specialists (PNDs) to travel with the Neurodevelopmental Outreach Clinics to rural areas of Alaska. This work is funded using State of Alaska general fund, mental health dollars. The PDNs work alongside a clinic coordinator who is a licensed clinical social worker, and a Title V Block Grant funded Parent (Family) Navigator. Children from 12 months to 12 years old, and their families, are served in these clinics. Services include screenings, evaluations, and diagnoses, follow up referrals, and recommendations for treatment, care, early intervention, and education. In addition, the PNDs and a Neurodevelopment Partners Group, facilitated by UAA CHD and WCFH, are using a Multi-tiered Autism Diagnostic Process to streamline how to determine where and how children with an unambiguous neurodevelopmental diagnosis should be treated. Outreach clinics are scheduled during times of the year that are convenient to family traditions such as fish camp, hunting, and school schedules.

In the coming year, the PNDs, CHD, and the State of Alaska are collaborating on a strategy for telehealth platform delivery for future Neurodevelopmental Outreach Clinics. This in turn could expand the outreach clinic services into other remote communities and the opportunity to offer appointment times that better align with patient schedules.