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CYSHCN in Tennessee andDepartment of Health Updates
Michael D. Warren, MD MPH FAAPDivision of Family Health and Wellness
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
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.
TDH Divisions/OfficesCommunity
Health Services
Communicable / Environmental Diseases and Emergency
Preparedness
Family Health and Wellness
Health Licensure and
Regulation
Laboratory Services
Policy, Planning and Assessment
Health Disparities
Patient Care Advocacy
Health Planning
Chief Medical Examiner
Communications & Media
Relations
Compliance
General Counsel
Legislative Affairs
Health Policy
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
Division of Family Health and Wellness
Community Nutrition
Children’s Special
Services
ObesityPrevention
ObesityPrevention
Fetal Infant Mortality Review
Tobacco
FamilyPlanning
Breast & Cervical Cancer
Screening
ChildFatality Review
Injury Prevention
Asthma
SIDS/SUID Prevention
Newborn Screening
Early Childhood Systems
CSFP
WICLead
Poisoning Prevention
Heart Disease and Stroke
DiabetesRape and Violence
Prevention
Home VisitingTargeted Case Management
AdolescentHealth
Farmer’s Market
Adolescent Pregnancy Prevention
State-level Data onChildren and Youth
with Special Health Care Needs (CYSHCN)
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
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-CSH
CN
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.
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.
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.
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.
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.
(Relatively) Good News:CYSHCN Core Outcomes2
Families partner in shared decision-making for child's optimal health
Children receive coordinated, ongoing, comprehensive care within a medical home
Families have adequate private and/or public insurance to pay for the services
CYSHCN are screened early and continuously for special health care needs
CYSHCN can easily access community based services
CYSHCN receive services necessary to make appropriate transition to adulthood
0 10 20 30 40 50 60 70 80 90
72.3
45.9
70.4
79.1
71.5
41.8
NationalState
Percent
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.
Public Health Resourcesto Support Care Coordination
in the Primary CareMedical Home
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
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
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
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
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
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
Pediatric Primary Care Updates
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
Safe Sleep Campaign
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
TN Breastfeeding Hotline
• 24/7 access to certified lactation consultant
• Available to anyone—mothers, other family members, health care providers
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
Newborn Screening Results ONLINE
• Access patient results 24/7 through secure online portal
• Search via several mechanisms
• 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
Contact Information
• Website: http://health.tn.gov
• Michael D. Warren, MD MPH FAAP• Email: [email protected]• Phone: 615-741-7353
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