Vermont Department of Health
Integrating Community-Based
Services for Children & CYSHCN
within Vermont
Beth Cheng Tolmie, MSW, Ed.D.
May 5 & 6, 2009
Vermont Department of Health
2005/6 CSHCN Survey in Vermont
Six MCHB Performance Outcomes
Outcome 1
59.8% of families partner and satisfied with services
Outcome 2
51.6% CSHCN receive coordinated, ongoing care
within a medical home
Outcome 3
69.4% of families have adequate insurance to pay
for services
Outcome 4
74.4% are screened early and continuously
Outcome 5
89.3% report that services are organized in ways
that families can use them easily
Outcome 6
52.0% youth receive services to transition to adult
health care
2005/2006 CSHCN survey data indicates fewer report none, and more
report four or more functional difficulties in Vermont when compared to the
national non-Hispanic white population
Vermont Department of Health
Key Staff & Partners
 Vermont Department of Health:
• Beth Cheng Tolmie, Grant Coordinator; Carol Hassler, MD, CSHN
Medical Director; Steve Brooks, CSHN Operations Director; Sally
Kerschner, Title V Coordinator; Garry Schaedel, EPSDT; John Burley,
SSDI Coordinator; Office of Local Health Leadership
 Agency of Human Services:
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AHS Secretary’s Office
Department of Aging & Independent Living
Department for Children & Families
Department of Mental Health
Office of Vermont Health Access (Medicaid)
 Vermont Child Health Improvement Program at the University of VT
 Vermont Family Network (merged P2P / parent information
organizations)
 American Academy of Pediatrics – Vermont Chapter; Vermont
Academy of Family Physicians
Vermont Department of Health
Project Goals & Objectives
 Easily Accessible Community-Based Services
• Integrate CSHN programs into the development of Local
Children’s Integrated Services (CIS) Teams in each region
of the state
 Intake and triage function
 Consultation re: CYSHCN considerations and complexities
• CIS is a Vermont Agency of Human Services effort to
combine Healthy Babies, Kids and Families (home visiting),
Family Infant & Toddler (Part C) and Children’s Upstream
Services (mental health) programs
• Connect existing CSHN staff to local public health /
maternal child health coordinator staff, who are part of the
CIS intake and triage team in the community
Vermont Department of Health
Project Goals & Objectives
 Early and Continuous Developmental Screening
• Complete Vermont Child Health Improvement Program practice
improvement project, in partnership with the Agency of Human
Services to:
 Increase the use of standardized developmental screening tools within the
medical home
 Offer financial support to medical homes for the completion of developmental
screens according to Bright Futures © Guidelines
 Measure and improve family-centered care within the medical home using the
Promoting Healthy Development Survey (PHDS)
• Improve Child Development Clinic practice operations and support
of the medical home within the CSHN program at the Vermont
Department of Health
 Vermont Child Health Improvement Program will utilize a practice improvement
model to support scheduling and reporting functions with baseline data from:
– Pediatrician informal inquiry
– Baseline chart review of Burlington clinic operations
Vermont Department of Health
Project Goals & Objectives
 Family-Centered Services
• Improve access to CSHN programs, information and services
 Website development and enhancement
 Database improvements
• Implement Vermont Family Network Family Support Consultant /
Parent Liaison in CSHN operations
 Liaison available to assist families with access to Child Development Clinic
and other CSHN services
 Financing
• Reduce reliance on Title V support for the financing of direct
services for CSHN
 Youth in Transition
• Utilize current opportunities to support health considerations as
CYSHCN transition from youth to adulthood
Vermont Department of Health
Key Activities
Connect and integrate
integration efforts within AHS
Implement practice improvement
efforts to better support the
medical home and families
Redefine role of CSHN and Title
V as payer of last resort /
insurance safety-net
Strengthen medical home for
SHCN youth as they transition to
adulthood
Vermont Department of Health
Proposed Outcomes
 Improve Child Development Clinic capacity to
meet state needs for diagnostic and treatment
planning services
 Reduce reliance on Title V funding to support
financing of direct services for CSHN
 Develop sustainable model for support of family
consultant / parent liaison within CSHN programs
 Improve access for CYSHCN to communitybased services via local Children’s Integrated
Services (CIS) Teams
Vermont Department of Health
Evaluation Efforts
 Complete on-going document review
 Conduct interviews with key informants
• Internal stakeholders
• Pediatricians
 Complete survey and chart review
• Developmental screening practice improvement project
 Use of Promoting Health Development Survey (PHDS)
• Child Development Clinic practice improvement project
 Conduct financial gap analysis