The Medical Home
“Every Child Deserves
a Medical Home”
Name of Presenter
Medical Home
Outline
• What is a medical home?
• Why is a medical home important?
• The role of:
–
–
–
–
Child care program
Child care health consultant
Medical home
State
• Medical home resources
www.healthychildcare.org
Medical Home
What is a Medical Home?
You may have heard others use:
– “health home”
– “primary care home”
– “advanced primary care”
– “medical home neighborhood”
The AAP will refer to this concept as a
“patient- and family-centered medical home”
www.healthychildcare.org
Medical Home
What is a Medical Home?
Care that is…
Accessible
Continuous
Coordinated
Culturally competent
Family-centered
Comprehensive
Compassionate
A concept rather than a building
www.healthychildcare.org
Medical Home
What is a Medical Home?
• A partnership among children, their families, &
their pediatrician (or other health professional)
• Connections to support systems & services to
meet the needs of the children & their families
• Respect for the cultural & religious beliefs of the
children & their families
• Includes child care providers who feel supported
in their work to provide healthy & safe
environments for the children in their care
www.healthychildcare.org
Medical Home
Medical Subspecialists
Public/
Private
Agencies
Cultural
Supports
Child Care
Family to
Family
Support
Educational
Services
Medical Home
Child/Family
Religious/
Spiritual
Support
Transition
Planning
Financial
Assistance
www.healthychildcare.org
Central
Medical
Record &
Care Plan
Medical Home
Why is a Medical Home Important?
• Enhanced efficiency for children & families
• Family feels supported
at all stages of their
child’s development
• Improved coordination
of care
www.healthychildcare.org
Medical Home
Why is a Medical Home Important?
• Efficient use of limited resources;
connection to information & support
• Opportunities for professionals to gain
expertise & competence
• A forum for problem solving
• Identification of community needs &
strategies for addressing them
www.healthychildcare.org
Medical Home
 Case Scenario 
At 18 months old, Jason started to walk.
Now that Jason is 22-months-old, a child
care provider notices that Jason still seems
unsteady and has not mastered this skill.
What are some actions that can be taken?
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Medical Home
Child Care Program’s Role
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Medical Home
Child Care Program
• Establish a close & open relationship with families
• Document all services the child is receiving
outside the facility
• Include health report in child’s file
Ex:
– Immunizations
– Screening tests
• Assist families in obtaining information about &
eligibility for Children’s Health Insurance Program
or Medicaid
• Help families find a medical home if they don’t
have one
www.healthychildcare.org
Medical Home
Child Care Program
• Ask parents to discuss certain concerns/issues
with their medical home
• Obtain written parental consent to exchange
information with the child’s medical home
• Talk directly with the medical home for clarification
about a child’s care or health needs
– eg, asthma, allergies, diabetes
• If injury or illness occurs, provide the family with
a copy of the symptom/injury record to give to
the medical home
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Medical Home
Child Care Program
• Work with CCR&Rs to maintain a list of community
professionals & agencies
• Work with a child care health consultant
• If services are provided within the child care program,
ensure that this information gets back to the medical
home
– Immunizations
– Developmental screening
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Medical Home
Child Care Health Consultant’s
Role
www.healthychildcare.org
Medical Home
Child Care Health Consultants
• Promote communication among the medical
home, child care program, & family
• Educate families & child care providers about
medical home concepts
• Develop/implement health policies that are
family-centered
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Medical Home
Child Care Health Consultants
• Assist child care programs in compiling
community/health resource files
• Educate pediatricians about early education &
child care issues
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Medical Home
The Medical Home
and Child Care
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Medical Home
Starting the Conversation
Use Bright Futures
1 Month Visit:
• Who watches the baby for you?
• How do you feel about returning to
work/school?
• Have you made arrangements for child care?
2 Month Visit:
• What have you done about locating someone for child care when
you return to work/school?
• Are you comfortable with these arrangements?
9 Month Visit:
• What are your thoughts about discipline? Have you discussed these
issues with your child care provider?
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Medical Home
Starting the Conversation
• Address any concerns the family might have
about the child care setting
• Acknowledge the family’s feelings about
returning to work or school & starting child care
• Remind mothers that they can still continue
breastfeeding
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Medical Home
Communication With Child Care
• Obtain contact information for the child care
program & written parental consent to exchange
information
• Make sure the child is up-to-date on
immunizations & health screenings, & complete
admission forms
• Contact the child care program, introduce
yourself, & provide your contact information
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Medical Home
Acute Conditions
• Acute illness or injury may occur in child care
• Review information on signs/symptoms from the
parent & child care provider
– Symptom Record
– Injury Report
• Simplify treatment recommendations &
medications
– Written instructions, clear language with no jargon
– Consider state laws & policies
– If child is excluded, discuss when child can return
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Medical Home
Children With Special Needs
Develop a written plan of care with the
family & caregiver
– Specific medical information
– Special medication or medical procedures
that may be required on a routine basis
– Modifications needed in daily activities
• Eg, diet, transportation, changes in the physical
environment
– Special emergency response information
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Medical Home
Children With Special Needs
The Care Plan is:
– Completed by the child’s
health care professional
– Reviewed by parents
– Implemented by child care
providers
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Medical Home
Developmental Concerns
• AAP recommends developmental surveillance &
screening activities be performed in the medical
home
• Child care programs may bring developmental
concerns up to parents or actually perform
developmental screening that suggests delays.
These concerns should be relayed to the child’s
medical home to pursue a formal assessment.
www.healthychildcare.org
Medical Home
Developmental Concerns
• Be willing to follow up on developmental
concerns that child care providers may have
• Remember that the child care provider is a key
partner in the care of the child
– Opportunities to observe the child over an
extended period!
– Training in early childhood development
www.healthychildcare.org
Medical Home
Developmental Concerns
• Ask the family about contributing factors at home
& child care
• Offer to speak with the child care provider
• Consider doing an on-site observation at the
child care program
• Develop a written care plan for the child
www.healthychildcare.org
Medical Home
Don’t Forget About CCHCs!
• A child care health consultant (CCHC) is a health
care professional who has interest in and experience
with children, has knowledge of resources and
regulations and is comfortable linking health resources
with facilities that provide primarily education and
social services.
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Needs assessment
Training
Telephone advice
Referrals to community services
CCHCs can be a liaison between the child care
program & medical home!
www.healthychildcare.org
Medical Home
The State’s Role
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Medical Home
The State’s Role
• Help link child care programs with community
resources
• Encourage social service organizations to reach
out to child care programs
• Partner with the Division for Children with Special
Health Care Needs to identify children with
developmental delays (Part B & Part C of IDEA)
• Promote the use of trained child care health
consultants
www.healthychildcare.org
Medical Home
The State’s Role
• Work with CCHCs & child care programs to
enhance the identification & referral of children at
risk for social, emotional, or behavior disorders
• Enforce pre-employment physical requirement for
child care providers & advocate for health
promotion activities
• Design/implement parent education initiatives to
promote positive home environments & overall
child outcomes
www.healthychildcare.org
Medical Home
The State’s Role
• ECCS includes “access to health care and
medical homes” as one of their 5 components
• State plan goal examples:
– CO: Increased number of children who receive a
medical home approach; Increased number of
children who are fully immunized
– OK: Increase in numbers of children covered by
insurance and enrolled in primary health care
– NC: Enhance the commitment to medical homes
across agencies and communities through social
marketing strategies.
www.healthychildcare.org
Medical Home
Back to Our Case Scenario…
www.healthychildcare.org
Medical Home
 Case Scenario 
At 18 months old, Jason started to walk.
Now that Jason is 22-months-old, a child
care provider notices that Jason still seems
unsteady and has not mastered this skill.
What are some actions that can be taken?
www.healthychildcare.org
Medical Home
 Case Scenario 
At 18 months old, Jason started to walk. Now that Jason is
22-months-old, a child care provider notices that Jason still
seems unsteady and has not mastered this skill. The child
care provider discusses this concern with Jason's mom, and
asks if the center's CCHC can perform a developmental
screening test on her son. With the mother's consent, the
CCHC performs the test and finds that Jason my have a
developmental delay and should see his pediatrician. The
CCHC faxes the results to Jason's pediatrician and speaks to
the pediatrician on the phone (with mother's consent). The
pediatrician refers the child for a neurodevelopmental
assessment and follows up to make sure the intervention
includes the child care program.
www.healthychildcare.org
Medical Home
Resources
www.healthychildcare.org
www.MedicalHomeInfo.org
Marketing Materials
• AAP/National
Center materials
• Fact sheets
• Brochures for
families
• Brochures for
physicians
• Posters
• Media
www.medicalhomeinfo.org/quick_links/ma
rketing_materials.aspx
Medical Home
Pediatric Care Plan Template
www.healthychildcare.org
Medical Home
Other Care Plans
www.ucsfchildcarehealth.org/pdfs/forms/SpecialHealthCare.pdf
www.state.nj.us/health/forms/ch-15.pdf
www.healthychildcare.org
Medical Home
The Pediatrician’s Role in Promoting
Health and Safety in Child Care
• Valuable resource for
pediatricians
• Describes 3 levels of
involvement:
– Providing guidance to families
– Providing health consultation to
child care programs
– Advocating for quality child care
http://tinyurl.aap.org/pub38947
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Medical Home
Caring for Our Children
National Health and Safety Performance Standards: Guidelines for
Out-of-Home Child Care Programs, 2nd Ed
• Primary reference for health & safety in child care!
• 707 standards & recommendations
• Developed by AAP/APHA
• Promoting the Medical Home
- a smaller document with only standards related
to the medical home
nrckids.org/SPINOFF/MEDHOME/MedHome.htm
• Full text is available at:
nrckids.org/CFOC/index.html
• Print copies from AAP, APHA, NAEYC:
http://tinyurl.aap.org/pub38873
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Medical Home
Managing Chronic Health Needs in
Child Care and Schools
Includes more than 35 quick-access fact
sheets that describes specific
conditions, like:
– Allergies
– Asthma
– Autism
– Diabetes
– Heart conditions & Defects
– Seizures
Also includes:
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Care plans
Emergency planning recommendations
Ready-to-use sample letters & forms
Info on medication administration issues
http://tinyurl.aap.org/pub92742 (Available as an AAP eBook)
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Medical Home
www.healthychildcare.org
For additional resources, visit the Healthy Child Care America
Web site (a program of the American Academy of Pediatrics),
which includes:
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The Pediatrician’s Role
Child care health consultation
E-News
Searchable Resource Library
AAP Chapter Child Care Contacts
E-Mail:
[email protected]
Web site: www.healthychildcare.org
Phone:
888/227-5409
www.healthychildcare.org
Medical Home
References
•
American Academy of Pediatrics, American Public Health Association, and
National Resource Center for Health and Safety in Child Care and Early
Education. Caring for Our Children: National Health and Safety Performance
Standards: Guidelines for Out-of-Home Child Care Programs, 2nd edition. Elk
Grove Village, IL: American Academy of Pediatrics and Washington, DC:
American Public Health Association; 2002
•
American Academy of Pediatrics; Council on Children With Disabilities, Section
on Developmental Behavioral Pediatrics, Bright Futures Steering Committee
and Medical Home Initiatives for Children With Special Needs Project Advisory
Committee. Identifying infants and young children with developmental disorders
in the medical home: an algorithm for developmental surveillance and
screening. Pediatrics. 2006;118(1):405-420
•
American Academy of Pediatrics, Medical Home Initiatives for Children With
Special Needs Project Advisory Committee. The medical home. Pediatrics.
2002;110:184-186
•
American Academy of Pediatrics. The Pediatrician's Role in Promoting Health
and Safety in Child Care. Elk Grove Village, IL: American Academy of
Pediatrics; 2001
www.healthychildcare.org
Medical Home
References
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Aronson SS, Shope TR. Managing Infectious Diseases in Child Care and
Schools: A Quick Reference Guide. 2nd ed. Elk Grove Village, IL: American
Academy of Pediatrics; 2009
Boller K, Kirby G, Moodie S, et al. Compendium of Quality Rating Systems and
Evaluations. Washington, DC: Child Trends and Mathematica Policy Research;
2010. Available at
www.acf.hhs.gov/programs/opre/cc/childcare_quality/compendium_qrs/qrs_com
pendium_final.pdf
Donoghue EA, Kraft CA. Managing Chronic Health Needs in Child Care and
Schools: A Quick Reference Guide. Elk Grove Village, IL: American Academy of
Pediatrics; 2010
Early Childhood Colorado Framework. 2008. Available at
http://eccs.hrsa.gov/PlansModels/docs/COstateplan.pdf
Early Childhood Comprehensive Systems Web site. Available at
http://eccs.hrsa.gov/Resources/component-areas.htm. Accessed September 7,
2010
Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health
Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove
Village, IL: American Academy of Pediatrics; 2008
www.healthychildcare.org
Medical Home
References
•
National Center for Medical Home Implementation Web site. Available at
www.medicalhomeinfo.org/about/faqs.aspx. Accessed August 12, 2010
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National Child Care Information and Technical Assistance Center, National
Association for Regulatory Administration. The 2008 Child Care Licensing
Study. Lexington, KY: National Association for Regulatory Administration; 2010.
Available at
www.naralicensing.org/displaycommon.cfm?an=1&subarticlenbr=205
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National Child Care Information and Technical Assistance Center Web site.
CCDF Quality Activities for FY 2010–2011: Early Childhood Health Consultants
and Health Activities. Available at
http://nccic.acf.hhs.gov/poptopics/consultants.html. Accessed September 7,
2010
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North Carolina’s Plan for a Comprehensive Early Childhood System. Available at
http://eccs.hrsa.gov/PlansModels/stateplans/docs/northcarolinastateplan.pdf
Resource: NC Medical Home Campaign www.nchealthystart.org/outreach/medicalhome
•
Oklahoma State Department of Health. Progress Report. Available at
http://eccs.hrsa.gov/PlansModels/stateplans/docs/oklahoma-implement-plan.pdf
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Medical Home
Questions?
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The Medical Home - Healthy Child Care America