Transcript slides for this presentation

CYSHCN in Tennessee and
Department of Health Updates
Michael D. Warren, MD MPH FAAP
Division of Family Health and Wellness
Objectives
• Outline state-level data on the health and
well-being of CYSHCN in TN
• Review public health resources to support
care coordination in the pediatric primary
medical home
• Present pediatric primary care updates
from the Tennessee Department of Health
A little about us…
• Mission: To protect, promote, and improve
the health and prosperity of people in
Tennessee
• Vision: A recognized and trusted leader,
partnering and engaging to make Tennessee
one of the nation’s ten healthiest states.
TDH Divisions/Offices
Community Health
Services
Communicable /
Environmental
Diseases and
Emergency
Preparedness
Family Health and
Wellness
Health Licensure
and Regulation
Laboratory
Services
Policy, Planning
and Assessment
Health Disparities
Patient Care
Advocacy
Health Planning
Chief Medical
Examiner
Communications &
Media Relations
Compliance
General Counsel
Legislative Affairs
Health Policy
Division of Family Health and Wellness
• Maternal and Child Health
• Chronic Disease Initiatives
• Supplemental Nutrition
• State Title V entity
– Funded by the Title V Maternal and Child
Health Block Grant
– Federal-state partnership
Division of Family Health and Wellness
Community
Nutrition
Fetal Infant
Mortality
Review
Breast &
Cervical
Cancer
Screening
Asthma
Early
Childhood
Systems
Children’s
Special
Services
Tobacco
Child
Fatality Review
SIDS/SUID
Prevention
CSFP
Obesity
Prevention
Family
Planning
Injury
Prevention
Newborn
Screening
Obesity
Prevention
WIC
Lead
Poisoning
Prevention
Heart Disease
and Stroke
Diabetes
Rape and
Violence
Prevention
Home Visiting
Targeted Case
Management
Adolescent
Health
Farmer’s
Market
Adolescent
Pregnancy
Prevention
State-level Data on
Children and Youth
with Special Health Care Needs
(CYSHCN)
CYSHCN 101
• CSHCN: Children with Special Healthcare
Needs
• CYSHCN: Children and Youth with Special
Healthcare Needs
• Definition1: “...those who have or are at
increased risk for a chronic physical,
developmental, behavioral, or emotional
condition and who also require health and
related services of a type or amount beyond
that required by children generally.”
1. McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck P, Perrin J, Shonkoff J, Strickland B. A new definition of children with special health
care needs. Pediatrics, 102(1):137–140, 1998
Data Resource
• National Survey of Children with Special
Health Care Needs
• National and state-level data available
through Data Resource Center for Child
and Adolescent Health
– http://www.childhealthdata.org/learn/NSCSHCN
CYSHCN in Tennessee2
• Estimated number of children: 255,692
– 17.2% of all children
• Prevalence by Age
– Age 0-5: 10.7%
– Age 6-11: 20.8%
– Age 12-17: 20.3%
• Prevalence by Sex:
– Male: 20.0%
– Female 14.2%
2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at:
http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.
CYSHCN in Tennessee2
• Prevalence by Poverty Level
– 0-99% FPL: 20.5%
– 100-199% FPL: 17.5%
– 200-399% FPL: 14.5%
– >400% FPL: 16.7%
• Prevalence by Race/Ethnicity:
– White: 16.8%
– Black: 17.9%
– Hispanic: 14.8%
2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at:
http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.
CYSHCN in Tennessee2
• Child Health
– 27.9% report that health conditions affect
activities usually, always, or a great deal
– 14.8% had 11 or more days of school absences
due to illness
• Health Insurance
– 5.1% were without insurance at some point in the
past year
– 25.9% reported that current insurance is
inadequate
2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at:
http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.
CYSHCN in Tennessee2
• Access to Care
– 17.8% had unmet need for specific health care
services
– 13.5% had difficulty getting needed referral
– 11.1% did not have usual source of care
• Family-Centered Care
– 32.5% reported that care was not family centered
2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at:
http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.
CYSHCN in Tennessee2
• Impact on Family
– 21.9% of families paid $1,000 or more out of
pocket for medical expenses per year for child
– 20.1% of families had financial problems because
of child’s medical condition
– 16.4% of families reported spending 11 or more
hours/week providing or coordinating child’s
health care
– 22.9% of families reported that child’s condition
caused family members to cut back or stop
working
2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at:
http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.
(Relatively) Good News:
CYSHCN Core Outcomes2
CYSHCN receive services necessary to
make appropriate transition to adulthood
41.8
CYSHCN can easily access community
based services
71.5
CYSHCN are screened early and
continuously for special health care needs
79.1
National
Families have adequate private and/or
public insurance to pay for the services
70.4
Children receive coordinated, ongoing,
comprehensive care within a medical home
State
45.9
Families partner in shared decision-making
for child's optimal health
72.3
0
10
20
30
40 50
Percent
2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at:
http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.
60
70
80
90
Public Health Resources
to Support Care Coordination
in the Primary Care
Medical Home
Children’s Special Services
• Available in all 95 counties
– Access through local health department
• Eligibility:
– Income <200% FPL
– Diagnosis of chronic physical condition
• Two components:
– Care coordination
– Payor of last resort
• Payment for hospitalizations, outpatient visits,
medications, therapies, DME, supplies, co-pays/coinsurance
CYSHCN Section
• New effort by TDH
• Look at broad issues and opportunities
related to CYSHCN
• Includes federal D70 Systems Integration
Grant (HRSA)
– Medical Home Summits
– Practice based support for care coordination
– Partnership with TNAAP and Family Voices
Newborn Screening Follow-Up
• State law requires every newborn receive
blood spot screening, hearing screening, and
pulse oximetry screening for critical
congenital heart disease
– ~80K births/year
– Each blood spot screened for 51 conditions
• Follow-up nurses perform case management
– Presumptive positive screens
– Follow-up testing/screens
– Confirmation of follow-up data
Childhood Lead Poisoning
Case Management
• All blood lead results
reportable to TDH
• New CDC threshold for
action: 5 mcg/dL
• Ordering provider
responsible for follow-up
• Follow-up nurse assists with case
management
– Fax PCP reminder if BLL 5-9 (then case closed)
– Follow-up for cases >10 or persistently elevated
– Arrange environmental investigation upon request
Home Visiting Programs
• Evidence-based programs in most at-risk
counties
• Home visiting professionals meet with
family with varying frequency (based on
need and program criteria)
– Assess and support child development
– Provide education on health topics and
positive parenting
– Facilitate referral to community resources
Targeted Case Management—HUGS
• HUGS: Help Us Grow Successfully
• Available in all 95 counties
– Accessed through local health departments
– For TennCare eligible families
• Case manager visits family once/month
– Assess development (Ages & Stages)
– Connect with medical home
– Refer to community resources
Pediatric Primary Care
Updates
Welcome Baby
• Universal outreach program
to all new parents
• All packets contain safe sleep
information
• Low risk receive packet by
mail
• Medium risk receive phone
call
• High risk receive a home visit
with education and promotional
items such as a onesie with a
safe sleep message
Safe Sleep Campaign
Hospital Safe Sleep Project
• Free “Sleep Baby, Safe
and Snug” board book for
each birth in your facility
• Free TDH “ABC’s of Safe
Sleep” materials
• Free Recognition on TDH
website
(http://safesleep.tn.gov)
• Signed certificate from TDH
Commissioner
• Press release template
TN Breastfeeding Hotline
• 24/7 access to
certified lactation
consultant
• Available to
anyone—mothers,
other family
members, health
care providers
TN Tobacco QuitLine
• Free service
– Toll free #
– Online program
• Confidential
• Callers can:
– Receive free
information
– Work with Quit Coach
• More information available at:
http://health.state.tn.us/tobaccoquitline.htm
Newborn Screening Results ONLINE
• Access patient results 24/7 through secure
online portal
• Search via several mechanisms
• Online directory of state services
• Information on child health, development, and
education
• Create profile to review milestones as your child
develops and bookmark important articles
• Mobile app
– Access profile and resources
from anywhere
– “Refrigerator Magnet” with
important information and
emergency contacts
Contact Information
• Website: http://health.tn.gov
• Michael D. Warren, MD MPH FAAP
• Email: [email protected]
• Phone: 615-741-7353
Finding Your
Local Health Department
http://health.tn.gov/localdepartments.htm
Click on map to get
county contact
information
OR
Click on county
name in list to get
information