HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING
PUBLIC HEALTH ACROSS THE LIFESPAN
Financing Early Childhood Health Systems
PHYLLIS STUBBS-WYNN: Thank you Kay, that was an excellent review of what works as well as, I think, laying down the gauntlet and challenging us in terms of thinking strategically in financing early childhood systems. We do have a couple minutes for questions. And if there are any, there are four mikes in the room and we can take them now.
ADRIENNE AKERS: My name is Adrienne Akers. I’m from the state of Utah and I just wanted to acknowledge Utah ’s recent adoption of what’s called “UtahCLICKS” which is an inter-agency method for families to go on and apply for Medicaid, WIC, Early Intervention, Part C as well as CSHCN and presumptive eligibility into Medicaid, which is our well-known program, Baby Your Baby. And again, thinking of the partnerships that were developed through this grant that was provided by the Division of Services for Children with Special Health Care Needs, it’s been really remarkable because now 60 percent of the families in our pilot applied from home, meaning having the 24/7 availability of the internet is really something that, in the long run is going to pay off. So, it was just rolled out last week and there’s a number of other states that have been working with us. Oregon is going to allow us to help them develop OregonCLICKS and so that’s a wonderful way to create partnerships across agencies and bring services to families more quickly.
KAY JOHNSON: Adrienne, that’s just one of the many good things that are going on in Utah and while I didn’t mention you here, you’re certainly mentioned in our report. Thank you for bringing that one out. That’s great.
PHYLLIS STUBBS-WYNN: Thank you. Yes.
HARVEY KINGMAN: I’m Harvey Kingman from South Carolina. We’ve done some focus groups with clinicians and talked to them about doing developmental screens, which they aren’t doing, but getting paid for with EPSDT. They just don’t have the time. They’re trying to get through the day and trying to make it financially. It seems that if we could offload that from the physician’s shoulders and maybe put it into kiosks or some sort of Web-based system, or perhaps on the telephone with interactive voice response units where you could call the family if they had a phone and ask the questions with a computer, not with a human, and have that recorded. But we can’t develop that in South Carolina, we barely have the resources to continue each day. I wonder if at the national level you could develop questionnaires for--you know, take developmental questionnaires and put them into that kind of format: telephone, computers, computers in the office or Web-based systems?
KAY JOHNSON: I think this is an area that a lot of people have been working--is Chris Degraw still in the room? No, yes, yes. Chris you’re right behind the light. I’m sorry. You may want to come up and say more about this Chris, particularly as we’ve been thinking about this in ABCD II, but I think there are several answers to that. I think that it would be marvelous to have parents have the ability to do some checking and thinking themselves. I don’t know that it’s a substitute, particularly I would guess that the Academy of Pediatrics would think there are some good, quick tools even, you know, as having parents do the check list in the office and have that opportunity for dialogue with the provider there whether you’ve got a worried/well situation or a family that has needs where you’ve got that opportunity to trigger, I think there is a special opportunity there and if the parent can do the check list in the office. We also know from Healthy Steps ABCD I, and other pilot projects around the country where people were really thinking about, "How can we use other kinds of workers in the pediatric and primary care settings?" Chris, you think about this?
CHRIS DEGRAW: I think the comment would be one of the good questions is making sure there’s a good connection between the primary care physician and any information that’s generated. I think the idea, particularly of using things that families fill out, serves a couple of purposes. It gives you information, but it’s also an educational thing for families and they become better observers, so I think some of those ideas are things that we’re thinking about. The one other thing that I’d throw in here is that we’re really thinking about the concept of developmental monitoring and surveillance where developmental screening is one part of it, but there’s other information that needs to come in and there’s real advantage to seeing the same person over time, so that’s where the medical home is. So, I think trying to put those ideas together and making it more efficient, involving families and educating them about their child development and making them observers are good ideas. And I think the idea of waiting rooms or times like that to use those questionnaires are certainly one of the tools. The Ages and Stages Questionnaire is one that physicians have experimented with, and have worked with, and in some places have been helpful.
KAY JOHNSON: So reducing that physician’s time from five minutes to one?
HARVEY KINGMAN: We have to get away from paper and go to something that we can track better. Certainly the connection, if you did this sort of thing beforehand, and the clinician had it in their hands, it would give the families a chance to think about it, but to go back to paper, is to go back to the 19th century.
PHYLLIS STUBBS-WYNN: Thank you. Question?
AMY FINE: Hi, Kay, thank you for a wonderful presentation. I just wanted to follow up on this idea of how you can do developmental screening and how states can help with this. I’m just completing a study for the Commonwealth Fund on pediatric health care linkages to—
KAY JOHNSON: This is Amy Fine. This is the celebrated Amy Fine.
AMY FINE: I’m sorry. Not celebrated, happy to be here. Anyway, pediatric linkages for developmental behavioral and mental health issues linking kids to community services and we’ve seen a couple of really wonderful examples where people have, in fact, used Web sites. Kaiser of northern California Web site, if you look, you can look up their physicians. Scott Gee a pediatrician there, has a series of developmental questions that his patients fill out before they even get to the office. Now, of course, they have to have the Internet, but that’s changing and my guess is over the next 10 years, it’s going to be very much more available to people. Connecticut ’s Help Me Grow program that Paul Dworkin has put together has done a really wonderful job of connecting kids who are at risk; those ones that--number 10, “monitor those kids who are at risk”--to services that are not the high-end services, but the family support services and other pieces that can help intervene early on. They are also experimenting now with not just working with the physicians to be doing the developmental screening, but also using other sites to screen and then refer into their one phone number that helps with follow-up assessment. So there are, I think, ways that this is happening across the country. The other thing I would highly recommend is partnering with your local chapter of the Academy of Pediatrics because the small practices can’t do what the Kaisers can do, but those folks really do want to do developmental screening and they’re looking for tools that maybe you could put together with a state chapter.
KAY JOHNSON: Another question, Ralph do you want us to talk about this, what you’re doing in Illinois? No, okay.
PHYLLIS STUBBS-WYNN: We’ll take our final question, in the back.
SAM EUGENE: My name is Sam Eugene and I’m with Arkansas and in our grant we’re trying to look at linking parents and daycare centers and medical homes together in a way, perhaps, to pick up on Chris’ words about making better observers because often the daycare center may observe things about a child that maybe the family hasn’t picked up on and perhaps that would be a useful thing to address in some kind of a conference that would bring these groups together.
KAY JOHNSON: It certainly is a promising practice so thank you for raising that one. It’s one that did not catch on in its early incarnations. Back in the 80s when I was working in managing childcare centers, we had from the University of North Carolina, the pediatric residents coming through our high quality childcare center to look at normal child development in action and an array of things like that, but I think it’s an idea, perhaps, whose time has come, is figuring out ways to make those linkages.
PHYLLIS STUBBS-WYNN: I’d like to ask you to join me in again thanking Kay for an excellent presentation.