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CYSHCN in Tennessee and Department of Health Updates

CYSHCN in Tennessee and Department of Health Updates. Michael D. Warren, MD MPH FAAP Division of Family Health and Wellness. Objectives. Outline state-level data on the health and well-being of CYSHCN in TN

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CYSHCN in Tennessee and Department of Health Updates

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  1. CYSHCN in Tennessee andDepartment of Health Updates Michael D. Warren, MD MPH FAAP Division of Family Health and Wellness

  2. Objectives • Outline state-level data on the health and well-being of CYSHCN in TN • Review public health resources to support care coordination in the pediatric primary medical home • Present pediatric primary care updates from the Tennessee Department of Health

  3. A little about us… • Mission: To protect, promote, and improve the health and prosperity of people in Tennessee • Vision: A recognized and trusted leader, partnering and engaging to make Tennessee one of the nation’s ten healthiest states.

  4. TDH Divisions/Offices

  5. Division of Family Health and Wellness • Maternal and Child Health • Chronic Disease Initiatives • Supplemental Nutrition • State Title V entity • Funded by the Title V Maternal and Child Health Block Grant • Federal-state partnership

  6. Division of Family Health and Wellness Community Nutrition Fetal Infant Mortality Review Breast & Cervical Cancer Screening Asthma Early Childhood Systems CSFP Children’s Special Services Tobacco ChildFatality Review SIDS/SUID Prevention Obesity Prevention FamilyPlanning Injury Prevention Newborn Screening Obesity Prevention WIC Lead Poisoning Prevention Heart Disease and Stroke Diabetes Rape and Violence Prevention Home Visiting Targeted Case Management AdolescentHealth Farmer’s Market Adolescent Pregnancy Prevention

  7. State-level Data onChildren and Youthwith Special Health Care Needs (CYSHCN)

  8. CYSHCN 101 • CSHCN: Children with Special Healthcare Needs • CYSHCN: Children and Youth with Special Healthcare Needs • Definition1: “...those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” 1. McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck P, Perrin J, Shonkoff J, Strickland B. A new definition of children with special health care needs. Pediatrics, 102(1):137–140, 1998

  9. Data Resource • National Survey of Children with Special Health Care Needs • National and state-level data available through Data Resource Center for Child and Adolescent Health • http://www.childhealthdata.org/learn/NS-CSHCN

  10. CYSHCN in Tennessee2 • Estimated number of children: 255,692 • 17.2% of all children • Prevalence by Age • Age 0-5: 10.7% • Age 6-11: 20.8% • Age 12-17: 20.3% • Prevalence by Sex: • Male: 20.0% • Female 14.2% 2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

  11. CYSHCN in Tennessee2 • Prevalence by Poverty Level • 0-99% FPL: 20.5% • 100-199% FPL: 17.5% • 200-399% FPL: 14.5% • >400% FPL: 16.7% • Prevalence by Race/Ethnicity: • White: 16.8% • Black: 17.9% • Hispanic: 14.8% 2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

  12. CYSHCN in Tennessee2 • Child Health • 27.9% report that health conditions affect activities usually, always, or a great deal • 14.8% had 11 or more days of school absences due to illness • Health Insurance • 5.1% were without insurance at some point in the past year • 25.9% reported that current insurance is inadequate 2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

  13. CYSHCN in Tennessee2 • Access to Care • 17.8% had unmet need for specific health care services • 13.5% had difficulty getting needed referral • 11.1% did not have usual source of care • Family-Centered Care • 32.5% reported that care was not family centered 2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

  14. CYSHCN in Tennessee2 • Impact on Family • 21.9% of families paid $1,000 or more out of pocket for medical expenses per year for child • 20.1% of families had financial problems because of child’s medical condition • 16.4% of families reported spending 11 or more hours/week providing or coordinating child’s health care • 22.9% of families reported that child’s condition caused family members to cut back or stop working 2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

  15. (Relatively) Good News:CYSHCN Core Outcomes2 2. 2009/10 National Survey of Children with Special Health Care Needs. Tennessee State Profile. Available at: http://www.childhealthdata.org/browse/snapshots/cshcn-profiles?rpt=9&geo=44. Accessed 03/15/2014.

  16. Public Health Resourcesto Support Care Coordinationin the Primary CareMedical Home

  17. Children’s Special Services • Available in all 95 counties • Access through local health department • Eligibility: • Income <200% FPL • Diagnosis of chronic physical condition • Two components: • Care coordination • Payor of last resort • Payment for hospitalizations, outpatient visits, medications, therapies, DME, supplies, co-pays/co-insurance

  18. CYSHCN Section • New effort by TDH • Look at broad issues and opportunities related to CYSHCN • Includes federal D70 Systems Integration Grant (HRSA) • Medical Home Summits • Practice based support for care coordination • Partnership with TNAAP and Family Voices

  19. Newborn Screening Follow-Up • State law requires every newborn receive blood spot screening, hearing screening, and pulse oximetry screening for critical congenital heart disease • ~80K births/year • Each blood spot screened for 51 conditions • Follow-up nurses perform case management • Presumptive positive screens • Follow-up testing/screens • Confirmation of follow-up data

  20. Childhood Lead Poisoning Case Management • All blood lead resultsreportable to TDH • New CDC threshold foraction: 5 mcg/dL • Ordering providerresponsible for follow-up • Follow-up nurse assists with case management • Fax PCP reminder if BLL 5-9 (then case closed) • Follow-up for cases >10 or persistently elevated • Arrange environmental investigation upon request

  21. Home Visiting Programs • Evidence-based programs in most at-risk counties • Home visiting professionals meet with family with varying frequency (based on need and program criteria) • Assess and support child development • Provide education on health topics and positive parenting • Facilitate referral to community resources

  22. Targeted Case Management—HUGS • HUGS: Help Us Grow Successfully • Available in all 95 counties • Accessed through local health departments • For TennCare eligible families • Case manager visits family once/month • Assess development (Ages & Stages) • Connect with medical home • Refer to community resources

  23. Pediatric Primary Care Updates

  24. Welcome Baby • Universal outreach program to all new parents • All packets contain safe sleep information • Low risk receive packet by mail • Medium risk receive phone call • High risk receive a home visit with education and promotional items such as a onesie with a safe sleep message

  25. Safe Sleep Campaign

  26. Hospital Safe Sleep Project • Free“Sleep Baby, Safe and Snug” board book for each birth in your facility • Free TDH “ABC’s of Safe Sleep” materials • Free Recognition on TDH website (http://safesleep.tn.gov) • Signed certificate from TDH Commissioner • Press release template

  27. TN Breastfeeding Hotline • 24/7 access to certified lactation consultant • Available to anyone—mothers, other family members, health care providers

  28. TN Tobacco QuitLine • Free service • Toll free # • Online program • Confidential • Callers can: • Receive freeinformation • Work with Quit Coach • More information available at:http://health.state.tn.us/tobaccoquitline.htm

  29. Newborn Screening Results ONLINE • Access patient results 24/7 through secure online portal • Search via several mechanisms

  30. Online directory of state services • Information on child health, development, and education • Create profile to review milestones as your child develops and bookmark important articles • Mobile app • Access profile and resourcesfrom anywhere • “Refrigerator Magnet” withimportant information andemergency contacts

  31. Contact Information • Website: http://health.tn.gov • Michael D. Warren, MD MPH FAAP • Email: michael.d.warren@tn.gov • Phone: 615-741-7353

  32. Finding YourLocal Health Department http://health.tn.gov/localdepartments.htm Click on map to get county contact information Click on county name in list to get information OR

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