• ​Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems
  This American Academy of Pediatrics policy statement provides a definition and framework for implementing care coordination.

• ​Pediatric Care Coordination Curriculum
  Created by Boston Children's Hospital with support from the Maternal and Child Health Bureau, the curriculum demonstrates the principles, key concepts and activities that are necessary to successfully provide care coordination to patients and families.

• The Pediatric Care Coordination Curriculum (PCCC) was developed in collaboration with Family Voices and colleagues from nursing, social work, medicine, Title V and health care trainees.
• The 4-module curriculum focuses the following topics:
• Building Patient/Family-Centered Care Coordination through Ongoing Delivery System Design
• Care Coordination as a Continuous Partnership
• Integrating Care Coordination into our Everyday Work
  
• Health-Related Social Service Needs: Strategies to Assess and Address in the Family-Centered Medical Home
• Target audiences include all individuals, programs, and organizations that provide care coordination services, including the following:
• Families and caregivers
• Nurses
• Social workers
• Care managers
• Case managers
• Patient navigators
• Physicians
• Community health workers
• Title V programs
  
• The PCCC is applicable broadly to a range of different entities, however specific content such as information about local and regional resources can be added to the curriculum to support learning. 

• Health Care Coordination in Schools: An Instructional Curriculum for School Nurses
  The National Center for Medical Home Implementation partnered with the California State University, Sacramento, to edit the Pediatric Care Coordination Curriculum specifically for school nurses. The full curriculum is now available for download below.
  • Module 1: How School Nurses Can Implement Care Coordination
    
  • Overview and presentation documents
    
  • In-session handouts
  • Pre-session readings
  • Download all documents in Module 1 (Zip file)
  • Module 2: How School Nurses and Care Coordination Support Students with ADHD
  • Overview and presentation documents
  • In-session handouts
  • Download all documents in Module 2 (Zip file)
  • Module 3: Health-Related Social Service Needs: Strategies to Assess and Address Shared Planning in the Family-centered Health Care Home
  • Overview and presentation documents
    
  • Download all documents in the Instructional Curriculum for School Nurses (Zip file)
  
  

• Webinar: Coordinating Care for Kids—School Nurses Linking with the Medical Home
  Care coordination is not a new concept—it is a function that school nurses are part of every day. However, care coordination is more effective when communication between school health and medical communities is established and implemented in a structured manner. This webinar will provide practical examples and resources on how school nurses, community-based clinicians and other providers can implement care coordination successfully. Speakers will share experiences and approaches to care coordination, focusing on collaboration with community-based pediatric clinicians, other pediatric providers and families in their communities.
  • Speakers:
  • Dian Baker, PhD, APRN-BC, PNP
    
  • Jody Johnson, MS, RN
    
  • Mark Satterfield, MD
  • Harold Magalnick, MD, FAAP
    
  • View Recording Here
  • View PowerPoint Slides Here
  • Resources
  • Audience Questions and Answers
  
  

• Care Coordination Measurement Tool
  Created by Boston Children's Hospital with support from the Maternal and Child Health Bureau, this value capture tool tracks care coordination activities and outcomes that are currently being done but are not being tracked or reimbursed
  • Data collected by the tool assesses the amount and type of resources needed to adequately provide care coordination services to a patient population and the outcomes that both occur and that are prevented from performing these care coordination activities
  • The tool reflects the true cost and value of care coordination activities.  It allows care coordination staff to quantitatively demonstrate how successful care coordination leads to cost-savings and better outcomes for patients and their families.
  • The tool can be used by any individual, program, and/or organization providing care coordination services.
    
  •  The core tool can be adapted to fit the needs of various entities including the following:
  • Pediatric primary and specialty care
  • Adult primary and specialty care
  • Research facilities and projects
  • Title V programs
    
  • Family advocacy and leadership programs

• Additional tools and resources to assist with care coordination implementation include the following:
  

  • Care Coordinator Job Description
  • Parent Consultant Job Description

  •  Special Needs Consultation and Care Coordination Program Job Description

  •  Care Coordination Webinar Series
  • Enhancing Care Coordination through Patient- and Family- Initiated Telephone Encounters: A Quality Improvement Project
  •  Building Your Medical Home: Coordinated Care
  • Care Coordination Resources for Practices
  • The Care Coordination Conundrum and Children and Youth with Special Health Care Needs

• National Center for Care Coordination Technical Assistance
  The National Center for Care Coordination Technical Assistance (NCCCTA) is a partnership between the National Center for Medical Home Implementation and Boston Children's Hospital Integrated Care Program. The mission of the NCCCTA is to support the promotion, implementation and evaluation of care coordination activities and measures in child health across the United States.
• The following technical assistance and support is available to individuals interested in implementing care coordination:
• One hour of introductory technical assistance regarding the Pediatric Care Coordination Curriculum, Care Coordination Measurement Tool and the Pediatric Integrated Care Survey.
  
• Two additional hours of technical assistance in the adaptation, implementation and evaluation of the aforementioned tools.
• Assistance and support through email, as necessary.
  
• Contact us for technical assistance and support.
• View a graphical summary of a recent environmental scan, performed by the NCCCTA, that looked at care coordination activities across the United States. If you would like to receive a more comprehensive report, contact Hannah Rosenberg.
  
• View a comprehensive poster describing the National Center for Care Coordination Technical Assistance.
  
• To learn more about these care coordination tools, please visit the Boston Children's Hospital Coordinated Care Web site.
  

• Overview
  Part of the mission of the National Center for Care Coordination Technical Assistance (NCCCTA) is to share examples of care coordination capacity building and measurement across the United States. The NCCCTA will be highlighting these examples on this web page over the coming months.
• The purpose of sharing these examples is to foster a community of multidisciplinary professionals and further advance the field of care coordination and integrated care.
  
• If you are interested in having your project or initiative published on this Web page (the project or initiative does not need to be fully implemented in order to be published on this Web page) please email Hannah Rosenberg. 
• For more information about the NCCCTA, view the "Technical Assistance and Support" section of this Web page.
•  Examples of Care Coordination in the Community
  
• Tennessee Chapter of the American Academy of Pediatrics
• Help Me Grow
• Keeping Families Healthy
  

• The National Center for Care Coordination Technical Assistance is developing an interactive listserv that will foster a virtual community of those interested in and focused on care coordination activities and measures. If you are interested in joining the listerv, please email Hannah Rosenberg at Hannah.Rosenberg@childrens.harvard.edu.