Vermont Department of Health Maternal and Child Health

Vermont Department of Health Maternal and Child Health Division Children with Special Health Needs Co. P Call October 2, 2013

New Definition for CSHN Eligibility Effective January 1, 2013 “CSHN serves those Vermont children and youth aged birth to 21, who have a chronic physical or developmental condition and who also require health and related services of a type or amount beyond that required by children generally. ”

Re-envisioning CSHN: Moving down the MCHB pyramid – a sustainability model child development clinic craniofacial team nutrition network Physiatry Direct care services Enabling services newborn screening system-wide educational materials on CSHN: transition, immunizations, environmental health community-based integration liaison to specialty care birth information network care coordination resource & referral respite financial technical assistance supplemental financial assistance (POLR) Vermont Family Network family support programming pediatric palliative care children’s personal care hitech nursing Population-based services Infrastructure building services medical home capacity performance-based contracting CSHN specialty care certification children’s health and support services autism SIG university autism center pilot Medicaid advisory panel systems integration w/ other state services (CIS &

Children with Special Health Needs-Overview l l l Child Development Clinic Care coordination Medical Home pilot Pediatric Hi-Tech Personal Care (ADL Assistance) Children’s Palliative Care Cleft Palate Clinic Rehabilitation Clinic Respite Financial Technical Assistance Community Nutrition Birth to age 21

Care Coordination: Integrating with a Statewide System of Care Support and resource to families with CYSHN Co-located in Health Dept District offices Member of regional CIS team Care Coordinators: SWs & RNs Liaison to Blueprint Medical Home initiative Member of CSHN-hosted CDC team Connected to (co-located in) PCP offices Children’s Integrated Services (CIS) is a statewide resource for pregnant or postpartum women and families with children from birth to age six and Includes: Early Intervention, Nursing & Family Support, and Children’s Mental Health Liaison to health system Specialty Clinic teams The Vermont Blueprint for Health (Medical Home initiative) is a vision, a plan, and a statewide partnership to improve health and the health care system for Vermonters. The goals are: 1) To implement a statewide system of care that enables Vermonters with, and at risk of, chronic disease to lead healthier lives; 2) To develop a system of care that is financially sustainable; and 3) To forge a public-private partnership to develop and sustain the new system of care.

Pediatric Collaborations in Chittenden County 6

Pediatric Hi-Tech Nursing l l l Previously overseen by the Department of Aging and Independent Living (DAIL) Integrated into CSHN in January 2012, recognizing that most children were also enrolled with CSHN Public-private partnership providing skilled nursing, durable medical equipment, and care coordination

Children’s Personal Care Services (CPCS) l l l Previously overseen by the Department of Aging and Independent Living (DAIL) Provides direct assistance with Activities of Daily Living to Medicaid eligible children, under the age of 21 Serves approximately 2, 000 children, statewide Survey of participants found that 50% were also enrolled with CSHN Integrated into CSHN in January, 2012

Pediatric Palliative Care Program l l Part of the Chronic Care Initiative (DVHA) Close partnership with CSHN Nursing and Social Work Program eligibility: l Under age 21 l Medicaid eligible l Diagnosed with life-limiting illness and not expected to live into adulthood Services include: l Care coordination l Family training l Expressive therapy l Skilled in-home respite l Grief/bereavement counseling

Contact us: l Steve Brooks – 802 -865 -1312 l l Carol Hassler – 802 -865 -1324 l l Carol. hassler@state. vt. us Janet Kilburn – 802 -865 -1323 l l Steve. a. brooks@state. vt. us Janet. kilburn@state. vt. us CSHN – P. O. Box 70, Burlington, VT 05402