While medical clinics and Public Health are at the core of a systemic child health and development solution there is a lot slipping through the cracks. Early learning centers, Head Start, Help Me Grow (HMG) and other organizations are needed to meet the systemic goals of early detection, effective follow up and 100% reach. Building out an effective community health network works best when managed by a central organization but more importantly, the work, costs and data needs to be distributed in self-sustaining sites within the network. Connection between all these disparate groups is required and easily managed using Pediatric Tools. The network simply shares information across its connections with permissions. It sounds complicated but it is actually easy to implement and maintain.
Implement a Community Model
Connect Screening Sites
Connect with Services and Resource Sites
Connect to Data and Program Mgmt
Distribute Work and Cost
Build Network Connections
Build a consensus and expectation about how screening is going to be implemented in the community. Typically each screening site is responsible for follow up and management of any flags that are generated. This may be as simple as sharing flags with a connected medical clinic, public health resource or equivalent community resource but an expectation of how to manage flags needs to be established and met. Additionally, expectation needs to be set about the schedule for screenings and what is measured when, to best enable early detection.
Medical clinics, WIC clinics, home visitation programs, early learning centers, Head Start, personal apps and even health fairs are all sites where screenings can be initiated and managed. Remote screening via secure links in SMS texts or emails are excellent alternatives to screening in person, dramatically increasing the potential reach of a screening site.
Expectations about how to manage flags needs to be tailored to services and resources available in the community. Connection to Early Intervention services, special education services, a HMG central access point, food banks and other community specific resources and services need to be mapped out and made available to the screening site flag management procedures.
While the work and costs need to be pushed off into self-sustaining sites, a group in the community needs to setup and maintain the screening program. Setup involves recruiting the network of sites, working out the rules of engagement and potentially providing technical assistance as sites in the network get implemented. Maintenance involves ongoing feedback of performance data (typically quarterly), providing transparency and guidance highlighting what is and is not working.
It is important to understand that medical clinics have the best access to children and typically can get reimbursed for screening and providing services. This makes them an ideal screening site because they are self-sustaining with good reach to the families that they serve. However medical clinics have strict HIPAA regulations and need to manage their patients using their EMR, pretty much excluding centralized screening solutions. Pediatric Tools implements a standard Data Exchange solution that enables each site to operate independently, centralizing data and securely sharing information as needed and with permissions.
Using embedded Data Exchange functions, Pediatric Tools builds a Community Health Network from a few simple apps, making profile and data connections. You can start with a single app and easily build a county, state or national network.
Connections Make It Work
Similar to social media apps, use an email address and user name to create a profile for each child in the family. Parents grant permission for a clinic or agency to connect to their child’s profile. Once connected, screening results, flags, referrals, notes and dispositions can be shared to manage care coordination between disparate groups.
Once permission has been granted to the Program Management site, aggregate data from connected screening sites and services and resources sites can be compiled to track and manage how the program is performing. Screening rates, flag rates and flag disposition rates are key indicators and can be used to focus program direction. Typically reports get shared quarterly keeping the program on track.
Permission and consent
Typically there are not issues around sharing aggregate data. Under HIPAA regulations, medical clinics can share information with other medical clinics but not non-medical sites. The easiest way to proceed it to create a Community Business Associates Agreement (CBAA) and have all involved sites in the Community Health Network sign off. To help manage expectations, having parents electronically consent to participating in the program is helpful but not required.
The first Community Health Network was developed and implemented for the Meeting Milestones Initiative (MMI) program in Grand County, Colorado as part of the Grand County 2010 community initiatives. It developed a roadmap with input from all stakeholders in the community and includes all the screening sites in the county. Grand County is home to Winter Park and Mary Jane Ski Resorts so the population is fairly transient but the reach is estimated at an impressive 90% of all children in the county.
Profile connections enable individual results, flags and referrals to be shared and managed between any Screening or Services Site in the county. The primary profile connections are between Early Learning Centers and the Primary Care Provider at the Patient Centered Medical Home. The program is marketed to the general public engaging parents directly and adding value for screening sites to participate, using data connections to show performance.
Early Childhood Education
The National Association for the Education of Young Children (NAEYC) guidelines for developmentally appropriate assessment practice recommend screening of all young children to identify those who have special learning or developmental needs, as well as to plan appropriate curriculum and instruction.
Pediatric Tools simplified implementation makes it easy for centers to screen children at enrollment, as well as room change, automating most of the process. You simply pick up PDF reports via secure email. Data connection into the community program management is seamless enabling out-of-the-box connection into the Community Health Network.
Help Me Grow Affiliates
Help Me Grow (HMG) affiliates face the same problem that the MMI program, as well as state initiatives, have of the only option being to use a centralized screening site. Unfortunately a centralized screening site for security, access, breadth of information and patient management reasons, is unacceptable to healthcare organizations. Additionally centralized screening requires manual access creating more work and cost for the screening sites. These additional costs, along with excluding healthcare, dramatically affect the efficacy and sustainability of a centralized implementation.
Using a Community Health Network, as shown in the MMI program, is all inclusive and distributes the work and cost. This enables screening, services and resource sites to operate the way that works best for them and simply share information with permissions as required. It’s a more effective and sustainable solution.
Implementing a Community Health Network in a Help Me Grow Affiliate comes down to:
• Creating a roadmap with stakeholder buy in
• Recruiting screening, services and resource sites
• Marketing the program to engage parents and providers
• Managing aggregate data to drive performance
It’s the same work that affiliates are already doing, it’s just easier because they are now bringing greater value to parents and providers.
Central Access Point (CAP)
Configure the Community Health Network primary Services and Resource Site to be the HMG CAP. During the screening interview when parents are identified as potentially benefiting from HMG referral, additional information can be gathered and the parent recruited into utilizing HMG. This saves providers time whether prefilling a form for manual referrals or automatically interfacing to an electronic referral system being used by the community.
Family & Community Outreach
Use a comprehensive screening interview combined with better follow up actions like parent reports, recruitment into the CAP and links to educational opportunities. This provides better value to parents and engages parents and family into the community network. Simply seeing HMG recruitment in the screening interview provides valuable outreach.
Providers simply do not have the time to gather the breadth of information required, much less recruit parents into the HMG CAP. Embedding this work into the screening interview saves valuable time engaging the provider viewing HMG as a valued partner.
Data Collection and Analysis
Sharing de-identified aggregate data automatically through the Community Health Network makes it easy for HMG to manage the program. If the issue arises, under HIPAA regulations sharing of de-identified aggregate data is allowed, however creating a Community Business Associates Agreement (CBAA) and have all involved sites in the Community Health Network sign off is an effective workaround. Also to help manage expectations, having parents electronically consent to participating in the program is helpful but not required.
Give the Comprehensive Pediatric Screening Interview (CPSI) a try!