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What can we do for the Maltreated Child or child at-risk?

Learn how the Medical Home Initiative in Southwest CT provides high-quality, comprehensive care for children at risk. Discover the role of coordinators, services offered, and how to support families in need.

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What can we do for the Maltreated Child or child at-risk?

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  1. What can we do for the Maltreated Child or child at-risk? • Can we Try to prevent this? • Who can help? • How do they help?

  2. Who are Children with Special Healthcare Needs? Children and Youth with Special Health care Needs (CYSHCN) those who have or are at increased risk for a chronic physical, development, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally

  3. Medical Home Initiative Southwest CT Medical home is an approach to providing health care services in a high quality, comprehensive, coordinated, continuous, compassionate and cost-effective manner.

  4. CYSHCN are about 16% of the population and account for 80% of pediatric health care expenditure

  5. How does Medical Home (MH) help? MH has trained coordinators who understand the child and family’s needs Coordinators are aware of the existing services in the community They know how to procure resources

  6. Who decides what is required? Plan of care is developed by the Physician/Advocate, Youth and the family. It is shared by the other providers involved in the care of the patient. Care among multiple providers is coordinated Families are linked to support services and advocacy groups. Transition of care is planned

  7. How does a Coordinator help? • Coordinator will attempt to: • Recognize such situations • Try to prevent it from happening • Seek professional help • Seek solutions for the family • Reach family support networks

  8. Potential problems I encounter? • Potential stressful scenarios: • Family with a CYSHCN • Family with financial/other stress • Abusive relationship

  9. How will the coordinator relieve stress? Seek solutions for the family’s stresses • Find an after school program/mentor • Find camps • Work with connecting with DVCC • Help mother out of a stressful situation if possible • Parenting classes • Introduce to support group

  10. What else can we do? • Refer child and family to therapy Crisis Management Services Child Advocacy Mental Health Counseling Social Skills/Mentoring/Recreation Parent Education Program Parent Support Groups Camps

  11. How else can a coordinator help? • Help with insurance • Connect children to specialists • Help connect patients with Child Guidance, Birth to three, School personnel • Contact Social Service agencies • Apply for Respite/Extended care funds • Educate families about their rights • Transition of youth

  12. Who is part of the Medical Home? Medical Home Team Primary care provider Family Child/Youth Pediatric office staff Pediatric specialists Allied health care professionals Community organizations/Schools

  13. Tools of Medical Home • Release • Screener – 5 questions address the need for additional services or treatment (Title V) • Complexity Index – how much assistance does the child need regardless of the diagnosis • Portable Health Care Plan • Directions Manual

  14. Case Study -Physician needs help • Autism • 10 year old boy demands excessive attention • Dad walks out • Physically hurts 8 years sister who breaks her arm • A year later child dies with viral cardiomyopathy • Mom and sister deeply distressed left alone

  15. Case Study -Physician needs help • KIDS in Crisis • Obese-raised by GM • GM obese, hypertensive, diabetic with arthritis • Child craves approval • Mom does jail time for drug usage • Mother disgusted with obesity, inactive child- slob • Dad: Pizza/coke/movie

  16. PreventionHow?

  17. Prevention-Medical HomeChildhood Blueprint 0-8 years Organized delivery of care to help those at-risk rather than wait for them to be diabetic or school failures CYSHCN Childhood obesity Asthma Mental Health Reading Dental care

  18. Obesity effort in Stamford

  19. The YSCHN is growing up? What now? • Barriers and challenges abound • Frustration mounts • Parents worry • Adults providers clueless of past and challenges • Youth need services to help cross this bridge to adulthood

  20. What do we strive for? • Financial independence • Positive peer group and relationships • Independent living • Transition helps youth achieve a meaningful productive life

  21. Medical Home InitiativeSouthwest Region 1351 Washington Boulevard 4th Floor Stamford, CT 203-276-7552

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