1. The Community Child Health Team Model Child Health Specialty Clinics, University of Iowa Debra Waldron, MD, MPH, FAAP; Director and Chief Medical OfficerVickie Miene, MA, LMHC; Director of Operations Barb Khal, MA; Director of Public HealthMary Larew, MD, FAAP; Medical Director The Community Child Health Team Model (CCHT) is a community utility model that has been successfully implemented in targeted Iowa communities to enhance coordination of care for children and youth with special health care needs (CYSHCN) and in some settings for families and youth with behavioral, emotional, and mental health concerns. The CCHT Model infuses lessons learned from national literature on care coordination, family support, and the science of improvement methodology. In this model, services and supports are wrapped around the child and family while care coordinators and service providers work within the existing community, regional, and state infrastructures. This model was developed by Child Health Specialty Clinics (CHSC) at the University of Iowa, and includes elements from two evidence-based projects: Community Circle of Care (CCC) and the Child and Youth Psychiatric Project of Iowa (CYC-I).  CCC is a community-based Systems of Care program for children and families with behavioral and mental health need in northeast Iowa.  CYC-I was developed to support Primary Care Providers in their treatment of children and youth with behavioral and mental health needs. CHSC serves children and youth, birth through 21 years of age, who live in Iowa and have a chronic condition, are at an increased risk for a chronic condition, and have a need for special services. Chronic conditions may include physical, developmental, behavioral, or emotional issues. As a public health entity, CHSC works to build partnerships and expand available services and supports for local communities. CHSC promotes quality family- centered and community-based services and supports local health homes and best practice protocols. Subspecialists & Mental Health Providers CHSC helps families access specialized care including mental health services. Education Support Services CHSC staff may accompany parents and caregivers to school meetings and if necessary consult on Individualized Education Plans (IEPs). CHSC Regional Centers CHSC operates through a network of 13 regional centers located in communities across the state of Iowa. School-Based Services Teachers, counselors, and other school staff are included in family team meetings and service planning to assure that each child is receiving the best school experience possible. Respite CHSC connects families with options to provide respite services for them and their child. Social Supports Families have the opportunity to participate in traditional family- oriented activities along with additional supports to ensure a positive social experience. Youth Peer to Peer Support The Achieving Maximum Potential (AMP) youth group provides peer support opportunities for youth 13 years and older who have experienced out-of-home placements. Informal Supports CHSC helps families identify available informal supports such as community groups and faith-based organizations. Care Coordination CHSC connects the child and family with the most appropriate services in order to meet individualized treatment goals. Health Home CHSC consults with Primary Care Providers to help children and youth remain in their health home. Diagnosis & Assessment All children and youth receive a comprehensive evaluation, a completed diagnostic assessment, and initial medication management in collaboration with their Primary Care Provider. Family Support CHSC’s team of experienced parents and family caregivers provides families with one-on-one problem solving and emotional support as they care for their child with special health care needs. Child Health Specialty Clinics University of Iowa 100 Hawkins Drive 247 CDD Iowa City, IA 52242 www.chsciowa.org Toll free: 1-866-219-9119 State System Development via Title V CHSC is Iowa’s Title V program for children and youth with special health care needs and has provided services to Iowa families for over 60 years. Iowa CYSHCN Stakeholders CHSC helps coordinate providers and other stakeholders that deliver services to Iowa’s children and youth with special health care needs. Continued Quality Improvement CHSC continues to develop the CCHT Model through evaluation activities designed to measure program effectiveness. Parent Peer to Peer Support CHSC’s Family Navigators have personal experience raising a child with special health care needs.