1. Workshop E-6 Building Momentum For Family-Centered Medical Homes Moderator: Jeffrey Lobas, MD, FAAP AMCHP Conference 2006

2. Session Objectives 1) Increase understanding of Medical Home concept 2) Examine how the Medical Home applies to ECCS components 3) Identify steps for integrating Medical Home and ECCS activities Workshop E-6 AMCHP Conference 2006

3. Session Objectives 3) Assess how use of Medical Home Family Story Videos can build capacity in implementing Medical Homes in communities 4) Discuss ways that health professionals and families can support improved outcomes for young children Workshop E-6 AMCHP Conference 2006

4. ECCS Purpose: To support State Maternal and Child Health Agencies and their partner organizations in collaborative efforts to strengthen the State's early childhood systems of services for young children and their families. –Access to medical homes for all children –Mental health and social-emotional development –Early care and education services –Parent education –Family support services Workshop E-6 AMCHP Conference 2006

5. Medical Home...“a headquarters for care” that includes –a person as the usual source of care as well as –a place AND a process for the anticipation, coordination, and provision of care that is: accessible family-centered continuous comprehensive coordinated compassionate and culturally-effective Cooley, et al. The Medical Home Index: Development and Validation of a New Practice-level Measure of Implementation of the Medical Home Model. Ambulatory Pads 2003;3:173-180. Workshop E-6 AMCHP Conference 2006

6. Religious/ Spiritual Support Medical Specialists Community Resources and Agencies Child and Family Parent Support Services Financial Assistance Mental Health Services With a Medical Home AMCHP Conference 2006 Workshop E-6

7. Religious/ Spiritual Support Parent Support Services Financial Assistance Mental Health Services Child and Family Medical Specialists Without a Medical Home Community Resources and Agencies Workshop E-6 AMCHP Conference 2006

8. Workshop E-6

9. Medical Home Works! Hawaii Medical Home Family Stories Hawaii Medical Home Implementation Project Sharon C. Taba, MEd Lynn B. Wilson, PhD AMCHP Conference 2006

10. Medical Home Works! Hawaii Genesis of Medical Home Family Stories Identified need for family-centered Medical Home curriculum Offered community-based ‘picture’ of Medical Home partnerships: families, physicians, and community agencies working together Interviewed physicians & families of children who are medically fragile for 3 video stories Created 15 minute template AMCHP Conference 2006

11. Hawaii State Department of Health ECCS Goals for Medical Home Promote Medical Home Promote timely developmental screening Strengthen parent/family support to keep “keiki” safe Apply Medical Home in piloting transitional housing AMCHP Conference 2006 Medical Home Works! Hawaii

12. Introduction to DVD Videos & Bryan’s Story DVD contents: videos, 3 inserts, evaluation, additional materials accessed by computer Insert contents: MH partners, Dr’s notes, learning points Bryan’s Story: child & family, physician, Head Start, inter-professional team AMCHP Conference 2006

13. Medical Home Works! Hawaii Questions for Viewing What worked well, what didn’t work well in the Medical Home? What are issues and barriers to making Medical Home partnerships work? How can we advocate for Medical Home within our state programs, e.g., MCH, ECCS? AMCHP Conference 2006

14. Medical Home Works! Hawaii Bryan’s Story AMCHP Conference 2006

15. Medical Home Works! Hawaii Producing Medical Home Family Stories GOAL: create ‘learner centered’ process- oriented curriculum GOAL: create videos to focus on what Medical Home partnerships look like Criteria for selecting families and physicians Criteria for selecting Medical Home issues in each video AMCHP Conference 2006

16. Medical Home Works! Hawaii Medical Home Family Stories Evaluation Results Focus groups & written evaluation strategies- local, national, international Very positive responses from families and trainers Luke-warm responses from community pediatricians and pediatric training faculty Need for broader family-centered stories focused on the Medical Home concept AMCHP Conference 2006

17. Medical Home Works! Hawaii Recommendations for Use of Videos from Evaluations Train new professionals Increase families’ understanding of the possibilities of Medical Home at the service level Build capacity among community professionals Provide inter-professional training environments AMCHP Conference 2006

18. Medical Home Works! Hawaii Mahalo & Aloha! sharontab@kapiolani.org lynn@webfishpacific.com AMCHP Conference 2006

19. Virginia Early Childhood Comprehensive Systems Grant Colleen Kraft, M.D., FAAP Workshop E-6 AMCHP Conference 2006

20. Learning Objectives Functional explanation of Medical Home to our state collaborative partners Promotion of Medical Home principals, values, and components within a state plan Integration of child health with other child values and responsibilities within our state Workshop E-6 AMCHP Conference 2006

21. Early Childhood Success Nationally it has been estimated that 25-40% of children are not ready to be successful in kindergarten Workshop E-6 AMCHP Conference 2006

22. Challenges for Parents/Families in Virginia  31% percent of births are to single mothers  17 of 1000 births are to a 15-17 year old mother  13% of children live in poverty Workshop E-6 AMCHP Conference 2006

23. Challenges for Families 62% with both parents working 68% women and 85% men working Workshop E-6 AMCHP Conference 2006

24. Factors Predicting Child Success Family psycho-social factors (depression, domestic violence) Quality of early education experiences Parent-child attachment Workshop E-6 AMCHP Conference 2006

25. Factors Predicting Child Success Prenatal-Postnatal health Parents promoting early learning Family economic security Workshop E-6 AMCHP Conference 2006

26. Research and scientific evidence supports the following six points: Learning begins at birth Children need to be healthy in order to be ready to learn School readiness is multidimensional AMCHP Conference 2006 Workshop E-6

27. Research Failure to start school healthy and ready to learn is expensive Quality out of home care matters Investment in early years pays off AMCHP Conference 2006 Workshop E-6

28. Virginia’s Response to the Issues Five year planning and implementation initiative from the federal Maternal and Child Health Bureau Goal: Build a comprehensive state early childhood system AMCHP Conference 2006 Workshop E-6

29. Virginia’s Goal Coordinate Integrate Improve access and quality –Health –Early Education and Child Care –Parent Support and Education –Behavioral Health AMCHP Conference 2006 Workshop E-6

30. Medical Home Structure and Process of Care Headquarters for care –Primary prevention/immunizations/well care –Care for routine and chronic illness –Coordination Families feel welcomed and engaged Link to community resources AMCHP Conference 2006 Workshop E-6

31. Medical Home Access Family-Centered Continuous Comprehensive AMCHP Conference 2006 Workshop E-6

32. Medical Home Coordinated Compassionate Culturally Effective AMCHP Conference 2006 Workshop E-6

33. Medical Home Continuity as children move from Early Intervention to School, between schools Promotion of: –State Regulation –Skill Mastery –Positive Emotional Tone –Assistance with Negative Affect –Pro-social skills AMCHP Conference 2006 Workshop E-6

34. Medical Home Workgroup American Academy of Pediatrics as lead Title V Early Childhood, VDH Voices for Virginia’s Children Children’s Hospital Community non-profit organizations AMCHP Conference 2006 Workshop E-6

35. Medical Home Workplan Access to primary care –Insurance –Medicaid –Many areas of the state without care for children Access to subspecialty care Coordination of care with non-clinical needs Inclusion of behavioral health AMCHP Conference 2006 Workshop E-6

36. Approach to the issue Build a system of support –State and Local levels –Strategic Fiscal Planning –Reduce Risks –Early Intervention for problems –Integrate services AMCHP Conference 2006 Workshop E-6

37. Approach to the issues Integrate issues as they relate –Economic security as a health risk –Poor health as an education risk AMCHP Conference 2006 Workshop E-6

38. How This Guided the VECCS Process AMCHP Conference 2006 Workshop E-6

39. VECCS Grant Goals Support State Maternal and Child Health Agencies and their partner organizations in collaborative efforts to strengthen the State’s early childhood system of services for young children and their families. AMCHP Conference 2006 Workshop E-6

40. VECCS goals Develop and implement a state strategic plan that includes four grant component areas: 1. Medical Home 2. Early Care and Education 3. Parent support and education 4. Behavioral Health AMCHP Conference 2006 Workshop E-6

41. Strategic Planning Activities May 2004 State planning meeting to create a vision, governance structure, identify critical issues Environmental Scan 2004-2005 Work groups Develop plans around 5 components October 2005 State Meeting: Discuss Overall Plan, Integrate 5 work group plans into a single plan Fall 2005: Completed State Plan Planning Phase Workshop E-6

42. Vision: Virginia’s Early Childhood Investment: Creating a system for healthy, successful children. Mission: Implement a comprehensive early childhood system that promotes the health and well-being of young children, enabling them to enter school ready and able to learn. AMCHP Conference 2006 Workshop E-6

43. Environmental Scan: What We Have Learned  Support more family and parent involvement within systems development efforts AMCHP Conference 2006 Workshop E-6

44. What We Have Learned Public information and engagement in process Community-based systems of care –Integration looks different in different communities AMCHP Conference 2006 Workshop E-6

45. What We Have Learned System Oversight –Maintain momentum toward an integrated system Data and Evaluation –Accountability for public investment –Sustainability of system AMCHP Conference 2006 Workshop E-6

46. What have we learned? Early Childhood Education –Quality –Access –Affordability Funding –Child Health/Medicaid –Early Education AMCHP Conference 2006 Workshop E-6

47. Overall Plan: Integrating the Four Work Plans Consider how individual plans fit together to create and overall plan AMCHP Conference 2006 Workshop E-6

48. Planning Phase Workgroups: Focused on 4 Components Access to Health Insurance and Medical Homes Early Care and Education and Child Care Parent Education and Family Support Behavioral Health and Social- Emotional Development AMCHP Conference 2006 Workshop E-6

49. Integration Review of common themes Areas of collaboration between plans Areas not addressed within plans AMCHP Conference 2006 Workshop E-6

50. Integration Commitments from individuals and agencies Inclusive process AMCHP Conference 2006 Workshop E-6

51. Final Structure of the Plan Infrastructure Integrated systems of care Family and public engagement Evaluation and finance AMCHP Conference 2006 Workshop E-6

52. VECCS Goals GOAL 1: Virginia has the capacity to provide a comprehensive, consumer oriented system of information, support, prevention, and intervention services to families and children birth to age five. AMCHP Conference 2006 Workshop E-6

53. VECCS Goals GOAL 2: A coordinated method of delivering a full spectrum of easily accessible services needed by children and families is developed in all communities and supported by state agencies. AMCHP Conference 2006 Workshop E-6

54. VECCS Goals GOAL 3: Families and the public have knowledge, understanding and the opportunity for direct involvement in all levels of the early childhood system. AMCHP Conference 2006 Workshop E-6

55. VECCS Goals GOAL 4: The early childhood system is sustainable, has flexible financing and resources, is standards driven, and uses quality indicators to measure progress. AMCHP Conference 2006 Workshop E-6

56. Planning for Implementation: Leadership/ oversight of the plan Priorities for the plan Performance measures and Data Community and family engagement AMCHP Conference 2006 Workshop E-6

57. Next Steps Integration with other state planning activities and initiatives Identifying feasible strategies based on existing resources AMCHP Conference 2006 Workshop E-6

58. Next Steps Generate Public and Political Will Implement Action Plan –Executive –Legislative –Administrative –Private Sector AMCHP Conference 2006 Workshop E-6

59. Planning Phase Workgroups: Focused on 4 Components Access to Health Insurance and Medical Homes Early Care and Education and Child Care Parent Education and Family Support Behavioral Health and Social- Emotional Development AMCHP Conference 2006 Workshop E-6