Electronic Information Exchange:Elements that Matter for Children in Foster Care "

Beth Morrow Director, Health IT Initiatives The Children’s Partnership

SPARC Webinar, January 31, 2013

Children in foster care face unique challenges that require additional care coordination."

n  Childhood trauma."

n  Frequent movement among placements, caregivers, and schools."

n  Higher rates of special education needs, psychotropic medications, and chronic health conditions."

n  Enter adulthood without family support system."

www.childrenspartnership.org

Unique challenges face states/localities too"

n  The average cost of Medicaid per child in foster care is over 3 times the average cost for nondisabled children."

n  Children in foster care account for 28% of all Medicaid expenditures on inpatient psychiatric services (or, 46% of such expenditures on nondisabled children)."

n  During their early adult years, these youth are much more likely than their peers to forego higher education, describe their general health as fair or poor, become homeless, and rely on public supports. "

www.childrenspartnership.org

What can be done? "

n  Children in foster care need cross-sector, coordinated, continuous behavioral and medical care."

n  Key to this coordination: Communication and information sharing by the adults caring for these children."

Ø Electronic information exchange and electronic records can help."

www.childrenspartnership.org

Better Outcomes at Lower Cost"

n  Early efforts are making a difference:"•  Wraparound Milwaukee (WI) – Improved coordination has resulted

in reduced inpatient psychiatric care, residential treatment, and juvenile corrections placements."

•  UPMC For You (PA) – Improved coordination has increased the proportion of foster children receiving annual well-child and dental visits."

n  We will hear from Texas and San Diego next about how electronic information exchange has made a difference for foster children in those communities. "

www.childrenspartnership.org

What needs to happen:"

n  Bring stakeholders together "-- develop champions "-- work together to address key hurdles (information

sharing agreements, back-end IT capabilities, and funding)"

-- leverage existing efforts that can help (initiatives, systems projects, etc.)"

n  Use Health Education Passport as starting point"

www.childrenspartnership.org

Contact"

Beth Morrow!Director, Health IT Initiatives"

(718) 832-6061!bmorrow@childrenspartnership.org!

http://www.childrenspartnership.org/our-work/foster-care-coordination""

"

Texas STAR Health Program

Rebecca Alejandro, Texas HHSC Health Plan Specialist

January 28, 2013

Star Health Program Background

•  In 2005, the Texas Legislature required the Texas Health and Human Services Commission (HHSC) to design a comprehensive medical services delivery model to meet the healthcare needs of children in foster care.

•  In April of 2008, the STAR Health program was implemented.

•  Eligible clients include: •  Children and young adults in conservatorship of the Texas

Department of Family and Protective Services (DFPS). •  Youth age 18-21 who voluntarily continue in a foster care

placement. •  Former foster care youth who continue to receive Medicaid

benefits through age 21. •  Former foster care youth enrolled in higher education.

Main Objectives

•  Immediate eligibility •  A statewide network of providers •  An increased focus on behavioral health services •  Service management and coordination teams •  Psychotropic drug utilization review •  Health Passport

Health Passport

•  Medical, behavioral health, vision, dental, and prescription claims

•  Lab results •  Immunization records •  Allergies and known reactions, vital signs, weight, height,

and other such details •  Forms including Healthcare Service Plans, Psychotropic

Utilization reviews, Texas Health Steps exams, and psychological evaluations

Health Passport

•  A DFPS caseworker can view all information in the child’s record.

•  A foster parent can view all information except for the Behavioral Health tab.

•  DFPS contracted residential providers have a few designated staff who have the same viewing rights as foster parents.

•  A network provider can view all information as well as interact with the system to enter data and upload forms.

•  Access is restricted to comply with HIPAA privacy and security rules.

Making it Happen

•  Interagency and Public-Private Collaboration •  Extended Timeline •  Cost of Implementation •  Performance Metrics •  Availability of Data

A complete training video on the Health Passport can be accessed on Superior HealthPlan’s website at:

http://www.superiorhealthplan.com/wp-content/training/

clinicalTX/default.html

For additional information, contact:

Rebecca Alejandro Texas HHSC Health Plan Specialist Rebecca.Alejandro@hhsc.state.tx.us

512-491-1864

Conclusion

Information Sharing to Increase Education Outcomes for Students in Foster Care

 Michelle  Lustig,  Ed.D,  MSW,  PPS  

San  Diego  County  Of<ice  of  Education  Student  Support  Services  

Foster  Youth  and  Homeless  Education  Services  

California: County Offices of Education

County  Of*ices  of  Education  õ  There  are  58  County  Of<ices  of  Education  (COEs)  which  provide  services  to  school  districts.  COEs:  ô  Support  school  districts  by  performing  tasks  that  can  be  done  more  ef<iciently  and  economically  at  the  county  level  

ô  COEs  provide  a  wide  range  of  services  including  <iscal  oversight,  special  and  vocational  education,  programs  for  youths  at  risk  of  failure,  and  instruction  in  juvenile  detention  facilities  

Foster Youth Services Programs

Foster  Youth  Services  (FYS)  Programs  õ  Provide  support  services  to  foster  children  who  suffer  the  traumatic  effects  of  displacement  from  family  and  schools  and  multiple  placements  in  foster  care  ô  Services  are  designed  to  improve  the  children's  educational  performance  and  personal  achievement,  directly  bene<iting  them  as  well  as  providing  long-­‐range  cost  savings  to  the  state  

ô Mandates  are    incorporated  into  Education  Code  

California Law Relating to the Education of Students in Foster Care

California  Education  and  Welfare  an  Institutions  Code  ô  School  of  Origin  rights/proximity  to  school  ô  School  Stability  Provisions  ô  Equal  access-­‐curricular  and  extra  curricular  (CIF)  ô  Immediate  Enrollment  ô  Stay  put  rule  ô  Least  restrictive  ô  Foster  Care  liaison  ô  Best  Interest  determination  ô  Noti<ication  to  schools  districts  ô  Transfer  of  records  ô  Partial  credit  protection  ô  Graduation  requirements  ô  Notice  of  manifestation,  suspension,  expulsion  

Relationship Between Data Sharing and Educational Outcomes

õ  Increased    ô Awareness  ô  Cooperation  ô  Collaboration  ô Responsibility  ô Matriculation  ô Academic  performance  ô  Graduation  rates  ô  School  stability  

Background and History San  Diego  County  Of*ice  of  Education,  Foster  Youth  Services    (SDCOE,  FYS)  

õ  Court  Leadership  õ  Collaborative  history  õ  Court  Orders  (2002,  2003,  2005,  2008,  2011)  õ  Database  Agreement  (2006-­‐2011,  2011-­‐2016)  õ  Interagency  Agreement  (2006-­‐2011,  2011-­‐2016)  

 

Foster Youth Student Information System (FY-SIS©)

õ  Shared  Governance-­‐FY-­‐SIS©  Advisory  Group    

õ  Data  Warehouse  õ  SDCOE  is  responsible  for  ensuring  secure  and  <iltered  access:  unique  screen  sets  based  on  user  group    

õ  Restricted  access  to  certain  data    õ  Security/Firewalls/FTP  process    

Foster Youth Student Information System (FY-SIS©)

õ Weekly  feeds  from  Child  Welfare  and  Probation  

õ Daily  feeds  from  Juvenile  Court  and  (nearly  all)  42  school  districts  

õ User  group  Administrator  role  õ User  group  permissions  de<ined    

Foster Youth Student Information System (FY-SIS©)

FY-­‐SIS©  Contains:    

¡  Demographic  Information  ¡  Assigned  Social  Worker/Probation  Of<icer    

¡  Assigned  Attorney  ¡  Education  Rights  Holder  ¡  School  History  including  current  school  

¡  Grades  and  Attendance    ¡  Unof<icial  Transcript  

 

¡  Health  Information  ÷  Medications  (restricted)  ÷  Well  Child  history    ÷  Immunizations  

¡  Placement  History  (Restricted)  ¡  Probation  Only:  Minute  orders,  conditions  of  Probation,  Waivers  and  hearing  dates  

¡  Ca  English  Language  Assessment  

Foster Youth Student Information System (FY-SIS©)

 FY-­‐SIS©  Does  Not  Contain:  

¡  Reason  for  removal  (300  code)  

¡  Family  of  origin  information  

¡  Sibling  information  ¡  Psychiatric  Diagnosis  ¡  Mental  Health  History  

 

¡  Special  Education  Information  

¡  Discipline  Information  (planning  stages)  

¡  STAR    and  CAHSEE  test  scores  (planned  for  2013)  

 

Considerations and Lessons Learned Cross System Data Sharing

�  Begin  with  the  end  in  mind.  �  Engagement  of  all  stakeholder  groups  

�  youth  and  caregivers  �  Determine  the  best  way  to  meet    competing  demands,  policies,  mandates  and  restrictions.  

�  Shared  understanding  and  interpretation  of  FERPA,  HIPPA  and  SACWIS:  intersections  and  hurdles.  

�  Consideration  of  �  who  maintains  the  database  �  who  owns  the  data  �  who  owns  the  intellectual  property  that  is  the  physical  database  

Thank you!

Michelle  Lustig,  Ed.D,  MSW,  PPS  mlustig@sdcoe.net  P-­‐858-­‐503-­‐2628  F-­‐858-­‐503-­‐2636  http://www.sdcoe.net/ssp/support/?loc=fys&m=9  

 

What needs to happen:!

n  Bring stakeholders together !-- develop champions !-- work together to address key hurdles (information

sharing agreements, back-end IT capabilities, and funding)!

-- leverage existing efforts that can help (initiatives, systems projects, etc.)!

n  Use Health Education Passport as starting point!

www.childrenspartnership.org