Children and Youth with Special Healthcare Needs
Children and youth with special health care needs (CYSHCN) are those at “increased risk for chronic physical, developmental, behavioral, or emotional conditions that require health and related services of a type or amount beyond that required of children generally.” More than 12 million U.S. children meet this definition. Comprising 15 percent to 18 percent of the childhood population, CYSHCN use 80 percent of the health care dollars spent annually for all children.
New Evidence Supports the Pediatric Medical Home
A team of child health researchers developed a brief regarding evidence about the pediatric medical home entitled "Medical Home for Children with Special Healthcare Needs -A Review of the Evidence." This report shows how medical home implementation leads to improvements in important outcomes for children and youth with special healthcare needs (CYSHCN) and their families. This work was carried out for the Maternal and Child Health Bureau and represents a collaboration among the MGH Center for Child and Adolescent Health Policy, NICHQ, and the Child and Adolescent Health Measurement Initiative.
New Title V Index and Wisdom of QI Resources Now Available
Over the past five years, NICHQ has worked with the federal Maternal and Child Health Bureau (MCHB) and state programs for Children with Special Health Care Needs (known as “Title V” programs, after the section of the Social Security Act through which they receive federal funds) to bring the science of quality improvement to state systems of care for children and families.
The two most recent state collaboratives looked at QI opportunities in services for children with hearing loss and epilepsy, with a focus on quality within Title V programs themselves. They posed the questions:
· How does a Title V program go about systematically improving its effectiveness;
· What are the domains in which such programs operate; and
· What are the benchmarks by which we can measure progress across those domains.
In response to these questions, NICHQ has worked with Title V programs participating in the two recent collaboratives and federal project officers to develop an index that identifies both domains and benchmarks for Title V improvement. The Title V Index is designed to help states apply the cumulative wisdom of quality improvement at the policy level. The list attached, developed for a presentation to states working on systems improvements outside the framework of a learning collaborative, suggests how the techniques of QI can be applied in a Title V setting, helping programs define and solve problems that have seemed entrenched or inevitable in the past.
Summary from Fall 2009 Learning Sessions:
By: Hillary Anderson
Senior Project Coordinator, NICHQ
NICHQ and the New York State Department of Health Convene 35 School-Based Health Centers to Improve Primary Care Access for Underserved Children
Working in partnership with the New York State Department of Health (NYSDOH), last month NICHQ facilitated, as part of its School-Based Health Center (SBHC) Quality Improvement Initiative, two, full-day learning sessions in Syracuse and New York City. A diverse range of health teams from 35 different school-based health care centers comprised of healthcare providers, educators, and collaborating physicians, as well as sponsors from 26 hospitals and health networks, participated in the two meetings. These teams will be instrumental in developing and testing system changes. NICHQ’s ultimate goal is to share these systems changes program-wide in order to improve the processes for delivery of primary care in School-based Health Centers; and thereby effect better health outcomes for the children they serve.
The sessions were led by Improvement Advisors, Patricia Simino-Boyce, RN, PhD of NICHQ, and Patricia Waniewski, RN, MS of the NYSDOH. Teams both learned and applied models and frameworks for improvement around the Comprehensive Physical Exam (CPE), asthma, and obesity in school based health centers. Teams also had the opportunity to participate in small breakout sessions with NICHQ expert faculty, Steven Cook, MD and Mamta Reddy, MD.
The learning sessions were particularly successful in the development of collaborative learning and problem-solving. The attendance of leaders from sponsoring organizations is expected to play a key role in the sustainability of the project work; collaborating physicians were instrumental in supporting their respective health teams. Overall, the energy, commitment and passion of the SBHC teams should prove to be a powerful force in improving access to comprehensive primary care for underserved children and youth.
