NPM 11 – Medical Home: percent of children with and without special health care needs, ages 0 through 17, who have a medical home.

CSHS Staff and Programming

Children’s Special Health Services (CSHS) addresses NPM 11 by offering gap-filling programs, such as peer support services and resource coordination programs, to all children and their families in Montana. CSHS offers a variety of population health and direct service programs while collaborating with CYSHCN programs across DPHHS. CSHS has 5.0 program staff and opportunity to hire 1.0 Americorps VISTA, supervised by the CYSHCN Director/Section Supervisor. Staff transitions occurred in FFY22. Position turn over included the Title V- CYSHCN Program Specialist, Program Assistant and MAPP-Net Program Specialist.  The MAPP-Net Program Specialist was re-filled after a five month gap and the Program Assistant position was refilled after a three month gap. The Title V-CYSHCN Position remains unfilled.

CSHS manages and funds programs for children and youth with special health needs: Cleft/Craniofacial Clinics; Statewide Genetics Program; Metabolic clinics; Newborn Hearing Screening Program; and the Montana Access for Youth Psychiatry Program. Through Title V funding, CSHS supports initiatives to increase parent leaders and peer-to-peer support through the Parent Partner program and Circle of Parents.  Population-based initiatives are supported through the Transitions Project and the Medical Home Portal.

CSHS also serves as a key collaboration facilitator across state programs, internally and externally. We continue to facilitate training of licensed clinical mental health professionals in Parent Child Interactive Therapy in collaboration with Children’s Family Service Division. CSHS also co-leads the state’s Care Coordination Academy participation with University of Montana’s Rural Institute for Inclusive Communities.

Growth within CSHS

During FFY22, CSHS engaged in developing a section strategic plan and Health Resources & Services Administration (HRSA) technical assistance in order to grow professional capacity and define the direction of programming. CSHS is working towards implementing the HRSA framework to advance NPM 11 by prioritizing family engagement, provider engagement, coordinated care, and systems building. These priority areas are all framed and guided by: a family-centered approach; diversity, equity, and inclusion; and evidence-based practices. These priority areas are the basis of the strategic plan and will continue to guide this section during FFY22 and FFY23. The programs that CSHS funds intersect with multiple priority areas. In this report, programs are organized by priority area based on FFY23 future plans and areas of growth.

The CYSHN Director, with key Title V staff, have been receiving technical assistance with Meredith Pyle through HRSA. The technical assistance has been focused on the national standards of care for CYSHCN, and building staff competency in maternal and child health.

The report following outlines the Title V-funded work through the key strategies of improving access to Medical Homes, as funded by Title V. Narrative details of the most critical work is provided.

1. Coordinated Care

In order to improve access to care coordination across our regional health systems, strategies must be employed to: support systematic improvements of care coordination; advance the Medical Home and National Standards of Care: and ensure that families remain engaged during care coordination. As a part of coordinated care CSHS continues to provide peer support programs through Title V.

During FFY22, the Montana Parent Partner Program and Circle of Parents were employed to provide individual and group peer support.  Below are examples of programs and activities that incorporate care coordination, advance coordinated care and work to decrease siloes within the healthcare system.  Those activities are as follows.

The Montana Parent Partner Program (MPPP) continues to provide individual peer services to families of CYSHCN across Montana. In the first half of FFY22, MPPP has served 145 distinct clients in 512 different encounters; offering valuable support, encouragement, and hope to families. The number of distinct clients this fiscal year is currently trending to be less than last fiscal year. This may be due to a decrease in the number of sites and Parent Partners (PPs). There are currently 6 PPs at five clinic locations in Helena, Billings, Kalispell, Butte, and Great Falls. Services were renewed for FFY22 with significant contract changes to support reduction in administrative costs and increase funding for PPs, in an effort to increase the number of families served.

Circle of Parents (CoP) is a support group program modeled after the national Circle of Parents Train the Trainer model. These support groups aim to decrease isolation, prevent child abuse and neglect and strengthen families through free monthly caregiver support groups. Each parent leader who runs a group is provided a stipend to coordinate a supportive environment with a free meal and free childcare. Groups vary based on location and identified community need. Current groups include: Grandparents raising Grandchildren; Families with CYSHCN or Mental Health Concerns; Parents in Recovery; Foster families, and Postpartum Mental Health. In FFY22, eleven (11) different groups met. Locations of CoP groups include Butte, Missoula, Great Falls, Dillon, Mineral county, and Big Horn. If CoP groups are unable to continue beyond FFY22, due to changes in an upcoming Request for Proposal, staff will assess the opportunity for expansion and sustainability based on available funding for the remainder of FFY22.

Medical Home Portal

CSHS continues to contract for a Montana-specific services directory on the Montana Medical Home Portal (MMHP) https://mt.medicalhomeportal.org/, a website developed by the University of Utah through July 2022. This easy to navigate, one-stop-shop provides diagnosis information, treatment options and state and local resources to families, providers and agencies. The MHP includes clinical information, materials on accessing care, and a statewide services directory. CSHS continues to explore several different partnerships to advance resource navigation in the state at the population level.

FFY23 Peer Support

CSHS remains committed to expanding peer services for families of CYSHCN in Montana. The Montana Parent Partner Program, Circle of Parents, and Medical Home Portal are being consolicated into one RFP process for FFY23. The purpose of this RFP is to provide funding for family-centered peer support services that improve access to the Medical Home and support CYSHCN families in navigating the system of care. This RFP will allow for applicants to address different levels of peer support to include population, group, and individual peer support. This RFP will allow versatility in approach to peer support and may identify new partners and collaborations within the state. One or more applicants could be awarded funding. CSHS is exploring potential partnerships within DPHHS to further expand family peer services through braided funding with the Mental Health Block Grant.

2. Provider Engagement

Provider engagement is a continued area where CSHS sees value in creating bi-directional relationships with providers statewide. Through alignment with contracts and relationship building across the state, this will be a continued priority for CSHS to impact the medical home of CYSHCN.

University of Montana Rural Institute for Inclusive Communities: Care Coordination Academy & Transitions 

CSHS is collaborating with the University of Montana Rural Institute (UMRI) to host a Montana team’s participation in the National Care Coordination Academy. The CSHS Section Supervisor and a UMRI staffer co-lead an interdisciplinary team that includes family leaders, payer representation (Medicaid and Blue Cross Blue Shield), Title V CYSHCN, pediatricians, and clinicians. This collaboration led to a partnership with the Family to Family Health Information Center (F2F) and Linda Starnes, a Title V staffer from Florida. Through these partnerships, a Friday Medical Conference Parent Grand Round Panel was presented through the University of Montana. Three Montanan parents of CYSHCN, facilitated by Linda Starnes, shared with medical providers their stories of working with the medical system. The panel highlighted how providers can be more family-centered by sharing personal stories of impact regarding positive and negative provider interactions. UMRI and CSHS are collaborating on a toolkit for other states to implement similar grand round panels. The Care Coordination Academy ends in May 2023, however CSHS and UMRI will continue to coordinate with the Montana Team on a regular basis.  The goal is to maintain the network of stakeholders, and partner with agencies such as  Montana Pediatrics, on identified care coordination initiatives. CSHS is currently working on recruiting a VISTA, and new staff, to build back capacity for providing more parent panels in FY22 and FY23.

CSHS continues to partner with UMRI to provide evidence-based transition resources to Montana’s youth and families.  This program works to: maintain and expand the 15-member Consumer Advisory Council (CAC); maintain and disseminate a health care transition (HCT) guide; develop evidence-based/informed HCT training and resource materials; conduct distance learning opportunities; maintain a transition website; and provide technical assistance to other initiatives related to HCT. UMRI staff and contractors are assessing next steps in expanding HCT work across the state with an emphasis of engaging providers. CSHS is currently working with UMRI on a scope of work for FFY23.  This will expand on all the current work to include provider focus groups engaged in mapping the system of care, to inform future pilot projects that address system gaps.

Project staff continue to disseminate this information via the Transition and Employment Projects website (http://transition.ruralinstitute.umt.edu/), which is reviewed and updated quarterly.

3. Family Engagement

CSHS has prioritized family engagement this fiscal year through the creation of formal agreements with the F2F center and finding opportunities to elevate family voices in their work with stakeholders and providers.

Family to Family Health Information Center

In March 2022, a MOU between the F2F center and CSHS was signed. The MOU highlights and formalizes the collaboration between F2F center and CSHS. F2F center and CSHS continue to work together on a contract for the HRSA Family Delegate position, which will be housed within the F2F center. Anticipated contract execution date is July 1, 2022. This contract will be the first time in known CSHS history that the family delegate position is compensated for their work and has clear job responsibilities. The position will be integrated into the F2F center and will advise on CSHS policy, and support resource navigation and program alignment.

The Family Delegate position will be able to support other CSHS programs through participating in work groups, advising on policies and programs, and supporting outreach to families. CSHS is making an effort to have more accessible programs and will be inviting a parent to be part of the Pediatric Mental Health Symposium Planning Committee this year, for FFY23. CSHS will also attempt to use APHA accessibility guidance for conferences, to ensure that the conference is accessible to all.

Financial Assistance Program: Direct assistance to CYSHCN

The CSHS Financial Assistance Program (FAP) resumed operation in January 2022, after being temporarily closed in December 2021. Through the FAP, qualifying families can apply for the FAP to cover out-of-pocket expenses for medical and enabling services, such as therapeutic services, occupational therapy items, adaptive equipment, and respite care. Qualifying families are eligible to receive up to $2000 per federal fiscal year, per child. CSHS made changes to the program, including organizing a committee of: three-parent leaders (PP); the Parent Partner State Director; two staff from the Family Information Center, and, three state staff who are reviewing FFY22 applications. In instances where funding is not possible, the committee compiles resources, and reaches out to partners like Medicaid and Part C to redirect the applicants to other available resources.  Future FAP plans for FFY23 include continuing to utilize the review committee with a focus on referral and resource navigation.  CSHS continued to operate the genetics financial assistance program in FFY22. This program provides financial assistance to CYSHCN who are seeking genetic testing, as the price of genetic tests can be a barrier to access.  CSHS will also partner with MonTECH, within UMRI, to support their assistive equipment and adaptive technology library with items specifically needed for families of CYSHCN. Discussions on additional areas for collaboration are planned for later this year.

4. Systems-Building

CSHS attempts to improve relationships and build collaborative partnerships to strengthen systems in all programs. Some examples of this work include:

• Partnering with Medicaid and EPSDT staff through the financial assistance program. Through collaboration with payers, CHSH had been able to educate providers and families on Medicaid policies and bring attention to gaps in the plan of benefits.
• Establishing a quarterly inter-departmental meeting across DPHHS middle management over children’s systems of care. This informal quarterly meeting includes various representatives from Medicaid regarding: developmental disabilities and mental health; behavioral health prevention programs; Part C; and, with the Head Start Collaboration Director. The meetings are an opportunity to share information and identify area's of collaboration. Information from these meetings can then be shared with our respective stakeholders.
• A needs assessment for specialty clinics and care will be conducted in SFY23 and SFY24 that will result in increased engagement with the regional system of care, and result in a new system of providing cleft/craniofacial clinics for SFY24.
• Montana was recently awarded funding to build data linkages between children’s systems data and PRAMS, including: Medicaid data; Part C data; Newborn Screening data; and Child Care data. Through this process, surveillance data for CYSHCN can be collected to assist in more comprehensive identification of the CYSHCN population.

Other CSHS Programs

The CYSHCN Title V Director/CSHS Section Supervisor oversees other programs including:  Newborn Hearing Screening; a statewide genetics program; metabolic clinics; and the Montana Access to Pediatric Psychiatry Network (MAPP-Net).

In FFY22, MAPP-Net implemented: Project Echo clinics; an access line for providers; and the third annual Symposium of Pediatric Mental Health. Monthly meetings with Medicaid were initiated to partner on similar initiatives and discuss options for sustainability.  In FFY23 MAPP-Net will continue these activities and focus on sustainability. The advisory council will expand to include more primary care representation. MAPP-net will continue to partner with Medicaid; and build upon the Bright App, a behavioral health telehealth provider directory. This work will align with other section programs with the goal of improving service navigation for families. MAPP-Net is also undertaking two needs assessment projects in FFY22, to inform FFY23 and beyond activities. One needs assessment focuses on understanding the service gaps and care needs for Montana youth who identify as LGBTQI, who experience homelessness or who are Native American. The second needs assessment project is a analysis of the utilization of the access line, with recommendations on how to increase adoption of the tool.

In FFY21 Cleft/Craniofacial clinics restarted with COVID regulations in place. In FFY22 clinics were regularly scheduled however COVID regulations remained in place which resulted in fewer clients being seen per clinic.  Attendance per clinic has decreased, and CSHS is reviewing and assessing data on clients. The remaining portion of  FFY22 and FFY23 will focus on supporting consistency and continuity of care at the cleft clinics and an assessment on the outcomes of care. CSHS is in the process of securing a contractor to conduct a needs assessment of specialty care with a focus on the sustainability of the cleft-craniofacial clinics. The results of the needs assessment will likely publish in FFY23 and will inform the future of the clinics in FFY24.

In the 2021 Montana Legislature session, House Bill 423 was passed which required the creation of a Newborn Screening Advisory Committee. CSHS, in coordination with the metabolic newborn screening program through the state public health laboratory, will manage the committee. The first meeting was April 19, 2022 and contained representatives from providers, payers, families, advocacy agencies and tribal health.  

These CSHS Programs support the advancement of medical homes for CYSHCN and their families and align with National Standards for Systems of Care for CYSHCN.  Further details are available at: http://www.amchp.org/programsandtopics/CYSHCN/.