Application Year Plan (FFY21): This section presents strategies/activities for 2021-2025 MCH priorities related to Children with Special Health Care Needs (CSHCN).  All MCH programs (Women and Infant Health, Child Health, Youth and Young Adult Health (YAYAHP), and Children’s Special Health (CSH)) support the efforts within this domain. See Five-Year State Action Plan Table for more information.

The National Survey of Children’s Health (NSCH, 2017-18) estimates there are 26,977 (19.4%) children with special health care needs (CSHCN) ages 0-17 in Wyoming. In Wyoming, only 9.7% of CSHCN receive care in a well-functioning health care system compared to 13.9% nationally (NSCH, 2017-18). Components of a well-functioning system are the following: family partnership, medical home, early screening, adequate insurance, easy access to services, and preparation for adult transition.

Twenty-eight percent of July 2020 public input survey respondents indicated that they believe the health care system in their community works well or very well for children with special health care needs.  

The Maternal and Child Health Unit (WY MCH) seeks to leverage diverse partnerships, including those with families and family-serving organizations, to understand and improve systems of care for CSHCN. In FY21, CSH will implement the following strategies to improve systems of care for CSHCN and address NPM 11:

1. Conduct a comprehensive gap analysis of Wyoming CSH program and services to understand where gaps exist internally for meeting the National Standards for Systems of care for CYSHCN. This will include developing an outreach plan to reach more families for gap-filling assistance and linking them to needed services.

2. Train internal staff on National Standards for Systems of Care for CYSHCN so they can serve as subject matter experts. Internal staff will support and facilitate the training and education of family members of CYSHCN and providers through Wyoming.

3. Compile a comprehensive Wyoming CSH systems map incorporating the National Standards for Systems of Care for CYSHCN Systems Improvement Alignment Tool.

4. Develop and convene a family-centered CSH Advisory Council to include caregivers with lived experience in compiling a comprehensive Wyoming CSH systems map incorporating the National Standards for Systems of Care for CYSHCN Systems Improvement Alignment Tool. This will also include development of a resource guide and glossary of standard terms and definitions, and continued recruitment of new members to facilitate the goal of more statewide collaboration, including family involvement.

5. Increase collaboration and coordination between State agencies, community-based organizations, families, service providers, and the University of Wyoming supporting the creation of a systems map that will inform the development of the comprehensive CSH resource guide.

6. Increase understanding of certification requirements for a Patient-Centered Medical Home (PCMH) by attending annual PCMH trainings hosted by the Wyoming Primary Care Association and/or partners.

Based on these goals CSH will actively engage CYSHCN and families with lived experience to drive CSH forward.

In FFY21, CSH, YAYAHP, and MCH Epidemiology Program staff will continue to implement the following strategies to address SPM 7 within the Improve Systems of Care for CYSHCN priority: 

1. Continue Public Health Nursing (PHN) use of the transition toolkit previously developed as part of the health care transition initiative, which includes a flow chart outlining suggested visit structure and duration; assessment forms to include a plan of care document to be shared between provider and client; talking points for clients and families; a comprehensive resource list; and other supplemental documents contained in the Bright Futures Virtual Toolkit.

2. Continue sending reminders to enrolled clients to attend their annual well visit and complete the transition readiness assessment. The FAQ document, The Adolescent and Young Adult Well-Visit: A Guide for Families, is also included with the appointment letters for clients ages 11-18.

3. Collaborate with other WY MCH staff to develop a tool to assess parent and youth impressions of the health care transition tools provided by PHN. CSH staff will receive technical assistance, as necessary, from organizations such as Got Transition on the applicability of their evidence-based and evidence-informed resources to Wyoming populations and the development of a transition policy. 

Seventy-three percent of July 2020 public input survey respondents indicated that they believe CSH’s planned work for 2021-2025 fits the needs of their community well or very well, and 87% indicated that they believe it fits at least somewhat well. One July respondent stated, “Families feel completely overwhelmed with follow-through on medical concerns. [The planned work conveyed to survey respondents] fits the needs of our community and […] families’ medical needs.” Another respondent indicated that the planned CSH work “could increase access to doctors and resources. For example, there are nearly no local resources for children with type 1 diabetes in Wyoming. Low-income families really struggle to get the resources they need for [type 1 Diabetes].”

Other Programmatic Activities

Genetics

WY MCH continues to run genetics clinics in partnership with Public Health Nursing. In FFY21 the Wyoming Genetic Program will work to better understand provider referrals to this program and continue to work on quality improvement projects through a partnership with the Wyoming Institute for Disabilities.