Implementation Resources from the National Resource Center for Patient/Family-Centered Medical Home Connecticut Children's Medical Center, Center for Care Coordination Promising Practice ProfileDeveloped as part of the National Resource Center for Patient/Family-Centered Medical Home Promising Practices in Pediatric Medical Home Initiative, this profile describes how one pediatric medical center implemented care coordination at the state level. State Maternal and Child Health Title V / Children and Youth with Special Health Care Needs (CYSHCN) programs, pediatricians, families, and other pediatric stakeholders can learn practical, replicable strategies about statewide care coordination implementation from this profile. Implementation strategies to enhance the system of services for CYSHCN are also discussed. States At-a-Glance TableCreated by the former National Center for Medical Home Implementation and in partnership with the National Academy for State Health Policy, this states "at-a-glance" table provides an overview of pediatric medical home initiatives occurring through Medicaid and the Children's Health Insurance Program. By learning about ongoing pediatric medical home initiatives in your state, pediatricians, state Maternal and Child Health Title V / Children and Youth with Special Needs programs, American Academy of Pediatrics chapters, and others can gain insights on how to integrate their work and coordinate efforts across multiple systems. Family Engagement via Quality Improvement: A "How-To" Implementation Guide The former National Center for Medical Home Implementation conducted a nationwide family engagement quality improvement project to enhance family engagement in the pediatric medical home. As a result of this project, a Web-based implementation guide was developed. The guide provides tools and resources needed for implementing family engagement quality improvement projects in clinical practice or through multi-site learning collaboratives. Examples of resources included within the implementation guide include the following: sample Institutional Review Board application quality improvement change package data collection instruments Lessons learned from the project are shared throughout the guide and support those interested in implementing a similar project. Supporting documentation is available for individuals, organizations, or practices interested in applying for Maintenance of Certification Part 4 for a project on family engagement. All resources are customizable, modifiable, and free to download. State Title V and Medicaid Collaboration to Support Pediatric Medical Home ImplementationPublished in collaboration with the National Academy for State Health Policy, this fact sheet presents main ideas from the 2017 webinar, Supporting Title V and Medicaid Collaboration in Pediatric Medical Home Implementation. The fact sheet and webinar provide strategies and promising practices to enhance collaboration on pediatric medical home initiatives between state Maternal and Child Health Title V / Children and Youth with Special Health Care Needs programs and Medicaid agencies. Examples of Medicaid-Title V collaborative efforts from Colorado, Connecticut, and Texas are highlighted. Additional Implementation Resources AAP, AAFP, and ACP Calling on Clinicians to Develop Structured Health Care Transition Processes The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) recently released an updated clinical report on transitioning youth and young adults from pediatric to adult health care. The clinical report includes an evidence review, and practical guidance and customizable tools for clinicians related to key elements of transition: planning, transfer, and integration into adult health care. In addition, the needs of special populations, such as youth with medical complexity, intellectual and developmental disabilities, behavioral health conditions, and social complexity are addressed. To increase the number of youth and young adults who receive structured transition assistance nationwide, recommendations related to infrastructure, education/training, payment, and research are provided. American Academy of Pediatrics Reaffirms Care Coordination Policy Statement and Offers Implementation Resource for Pediatric CliniciansThe American Academy of Pediatrics (AAP) recently reaffirmed its policy statement on care coordination. Care coordination is an important component of the medical home model and has been shown to improve family and provider satisfaction, facilitate a child's access to services, and improve health care outcomes.The "Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems" (AAP Policy Statement) has laid the foundation for various care coordination tools and resources developed collaboratively by the National Center for Care Coordination Technical Assistance (NCCCTA) and the former National Center for Medical Home Implementation. These free resources include: Pediatric Care Coordination Curriculum which demonstrates the principles, key concepts and activities that are necessary to successfully provide care coordination to patients and families Care coordination webinar series that showcases real-world experiences from diverse health care providers with the common goal of capturing the value of care coordination using the Care Coordination Measurement Tool and Adaptation and Implementation Guide Promising Practices that demonstrate the practical application of care coordination to enhance the care provided to patients/families. Additional care coordination tools and resources can be found on the NCCCTA Web site. Bright Futures Tool & Resource Kit, Second EditionThe Bright Futures Tool and Resource Kit, 2nd Edition is now available. The completely updated and revised kit is designed to accompany and support Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition, the national standard for health supervision care. Bright Futures guidelines provide guidance to pediatric clinicians about preventive care as it should be administered within the patient/family-centered medical home. This second edition provides pediatric and other clinicians with an organized and integrated compilation of current forms and materials that relate to preventive health supervision and health screening for infants, children, and adolescents. Infographic: Care Coordination for Children and Youth with Special Health Care NeedsDeveloped by the Catalyst Center, this one-page infographic discusses the importance of care coordination for children and youth with special health care needs (CYSHCN).This infographic includes an overview of care coordination in practice and discusses its importance for CYSHCN. This infographic can support state Maternal and Child Health Title V / Children and Youth with Special Health Care Needs programs, pediatricians, families, and other pediatric stakeholders in learning how to support and implement care coordination activities for CYSHCN. Training, Events, and Conferences Medicaid Managed Long-term Services and Supports Programs for Children and Youth with Special Health Care NeedsDecember 4, 2018 at 2 to 3pm CentralRegister HerePresented by the National Academy of State Health Policy, this webinar will provide an overview of a recent analysis of how state managed long-term services and supports (MLTSS) programs serve children and youth with special health care needs (CYSHCN). The webinar will also feature presentations from Texas and Iowa to discuss approaches to providing long-term services and supports for CYSHCN through managed care. This webinar is for state Maternal and Child Health Title V / CYSHCN programs, pediatricians, families, and others who care for CYSHCN. Family Partners for Better CareDecember 18, 2018 at 1:30 to 3pm CentralRegister HereThe Coordinating All Resources Effectively (CARE) Award, a national project to transform care delivery and payment models for children with medical complexity (CMC), presents the final webinar in a four-part series on improving care for CMC. Faculty will discuss development of a parent navigator model and telehealth for virtual home visits as strategies to enhance family partnership. These practical tools and strategies can support state Maternal and Child Health Title V / CYSHCN programs, pediatricians, and families in enhancing care for children with medical complexity. Archived recordings of the webinar series are also available. State Strategies for Using Shared Plans of Care to Improve Care Coordination for Children and Youth with Special Health Care NeedsPresented by the National Academy of State Health Policy, this recorded webinar provides an overview of shared plans of care (SPoC) and their importance for children and youth with special health care needs (CYSHCN). A national overview of SPoC for CYSHCN is discussed followed by presentations from Oregon and Iowa, which provide strategies for successful implementation of SPoC for CYSHCN at the state level. This webinar can support state Maternal and Child Health Title V / CYSHCN programs, pediatricians, and families in implementing care coordination for CYSHCN at the state level. A Conversation on Ethical Considerations for a Fair and Effective Health Care SystemThis recorded webinar from the Lucile Packard Foundation for Children's Health is the seventh webinar in a series on the Pediatrics supplement, "Building Systems that Work for Children with Complex Health Care Needs." This webinar discusses recommendations and strategies that ensure programs for children with medical complexity (CMC) avoid potentially ethically problematic situations and practices. This webinar is for state Maternal and Child Health Title V / Children and Youth with Special Health Care Needs (CYSHCN) programs, pediatricians, families, and other pediatric stakeholders implementing programs for CYSHCN and CMC. Faculty include lead authors of the article, "Ethical Framework for Risk Stratification and Mitigation Programs for Children with Medical Complexity." Partners and National Initiatives New Release: Interactive Family Navigator Story WallPresented by the Association of Maternal and Child Health Programs, this interactive story wall features a half dozen family navigators' stories on their experience supporting families access comprehensive systems of care for children and youth with special health care needs (CYSHCN). The Family Navigator Story Wall can support state Maternal and Child Health Title V / CYSHCN programs, pediatricians, families, and other pediatric stakeholders in supporting and partnering with families of CYSHCN. Strategies to Pay for Transition ServicesFailure to make the critical handoffs between pediatric and adult care providers often can result in poorer health outcomes, consumer dissatisfaction and worry, and increased emergency room and hospital costs. A major barrier to providing transition services is lack of payment incentives for either pediatric or adult providers. To address this, the National Alliance to Advance Adolescent Health, with funding from the Lucile Packard Foundation for Children's Health, convened stakeholders to develop recommendations for pediatric-to-adult transition value-based payment strategies and quality measures. Their findings are outlined in a new report, "Recommendations for Value-Based Transition Payment for Pediatric and Adult Health Care Systems." Express Your Views on TransitionGot Transition, which aims to improve transition from pediatric to adult health care through the use of innovative strategies, is in the process of updating its Six Core Elements of Health Care Transition packages and sample tools and is seeking feedback from pediatric clinicians. The Six Core Elements are intended for use by pediatric, family medicine, med-peds, and internal medicine practices to assist youth and young adults as they transition to adult-centered care. Complete the Six Core Elements of Health Care Transition survey to provide feedback. Article on the Role of Pediatricians in Special EducationPresented by the American Academy of Pediatrics, the article "My child is receiving special education in school. What role should his pediatrician play?" discusses the role of pediatricians in advocating for children's developmental and behavioral needs in schools. The article provides an overview of the Individuals with Disabilities Education Act and a list of additional resources for families. Resources from this article can support families and caregivers of children and youth with special health care needs in understanding and navigating the special education system.