Jill Abramson, MD

Rochester, MN

Preschool Vision Screening: A Community-Based Approach

Purpose: Establish a community panel and develop an action plan to address and identify barriers to vision screening for children at the age of three.

Activities: 1) Investigate perceived barriers to 3-year-old vision screening by gathering information through focus groups and other interaction with community members; 2) assemble a community forum to address the perceived barriers and develop an action plan; and 3) begin implementing the action plan by identifying and supporting champions to implement specific portion of the action plan.

Outcome: Data collected through interviews and surveys indicated that there is no consistent preschool vision screening in primary care clinics in Rochester, MN. Reasons given: providers not seeing the need; non-reimbursable cost, and lack of standardized protocol. Despite these limitations this project formed key partnerships with two community organizations who are working with the team on developing a vision screening program in Rochester, MN. Once the program is established, the future plan will include motivating clinicians to ask about results of vision screening done in preschools and to organize screenings in community settings where children not enrolled in preschools may be reached.

Saved Aly, MD

Bayonne, NJ

Bayonne Children's Initiative

Purpose: Assess the number of at-risk children, uninsured children, and those without a medical home in Bayonne, NJ.

Activities: A local task force will: 1) work to identify existing resources; 2) establish coordination between the schools and medical homes, and 3) plan for needed services in the community.

Outcome: The task force was able to assess current available services/resources for children in Bayonne. The assessment helped to recognize the amount of available resources and develop a plan on how to access future services. Through strengthened communication between school nursing staff and Family Health Center staff, health needs for local children has improved coordination of care. A plan has been established for a case management position that could help coordinate information between schools and medical homes and increase access to care. A funding search for coordination of services' supports is ongoing.

Alan J. Barton, MD

Fort Mohave, AZ

Children's Medical Home in a Rural Tri-state Area

Purpose: Assess the number of children needing assistance in the tri-state area (Laughlin, NV, Needles, CA, and Bullhead City/Fort Mohave, AZ) and create a network of specialists who are willing to come to the tri-state area or see patients through telemedicine.

Activities: 1) Define target population in tri-state area; 2) identify barriers to a medical home; 3) identify requirements needed to qualify as a medical home for each state; and 5) establish a working relationship and improve communication with pediatric sub-specialists.

Outcome: A zip code analysis by Children's Rehabilitative Services identified the target population in need of a medical home. The biggest barrier noted for parents seeking a medical home was travel costs. This project plans to obtain additional funding to implement a telemedicine program and seek specialists to qualify a number of different clinics in the three states in becoming medical homes.

Julia Hecht, MD

Albuquerque, NM

Linking Children with Hearing Loss

Purpose: Identify the barriers to a successful Early Hearing Detection and Intervention (EHDI) program from a variety of community perspectives.

Activities: 1) Identify the barriers to implementation of the guidelines outlines in the Joint Committee on Infant Hearing's Year 2000 Position Statement; and 2) make recommendations for overcoming these barriers by incorporating the medical home in the state EHDI program. Specifically, addressing universal newborn screening follow-up, diagnosis and early intervention at New Mexico's largest inner-city public hospital.

Outcome: N/A

Bradley S. Hood, MD

Tacoma, WA

Transitioning Adolescents with Chronic Conditions to Adult Care

Purpose: Educate YSHCN about their specific diseases, long term medical management goals, and educational/vocational plans through a new pilot clinic at Madigan Army Medical Center.

Activities: 1) Conduct focus groups with patients, caregivers and providers in the local community to assess barriers to transition; 2) develop and conduct a needs assessment and Department of Defense wide survey for YSHCN and their families; 3) facilitate a follow-up community forum to address identified barriers to transition; and 4) develop a plan for implementing transition to adult care clinic at Madigan Army Medical Center.

Outcome: N/A

Virginia Keane, MD

Baltimore, MD

Strengthening Medical Homes for Maryland: Needs Assessment

Purpose: Conduct a needs and asset assessment to determine the major barriers to providing medical homes for CSHCN.

Activities: 1) Focus groups will be conducted with local pediatricians in five regions of the state (Baltimore City, Central Maryland, Eastern Shore, Western Maryland, and DC Metropolitan) to identify potential solutions to barriers deemed feasible by community based physicians. Results will be used to prepare a survey that will be sent to 500 Chapter members to plan interventions to improve access to medical homes.

Outcome: The grant allowed the team to enhance the perception of medical homes to the Maryland Chapter of the American Academy of Pediatrics. The team was able to conduct effective focus groups and surveys, provide expertise and present this expertise effectively to groups, advocate for children’s health through committee work/coalitions and partner with organizations with similar missions to advance health care for CSHCN. The team is now in the process of applying for a CATCH Implementation Grant to achieve the ultimate goal of improving access to a medical home for children in Maryland.

Cheryl B. Kerr, MD

Binghamton, NY

Strategic Planning for Children's Medical Homes Through Telemedicine

Purpose: Create a partnership that will develop a written plan to implement pediatric telemedicine in order to provide children with a virtual medical home in significantly under-served counties of Upstate New York (Broome, Chenango, Delaware, and Tioga counties).

Activities: 1) Establish an advisory group and regional network of people committed to the realization of a virtual medical home; 2) promote community investment through focus groups, site visits and a institutional survey, which was noted to be a critical factor for future implementation; and 3) provide the community with a plan to enact throughout the identified region.

Outcome: Completion of a strategic plan for Children's Medical Homes Through Telemedicine has lead to receiving additional funding from ARC and the Community Foundation of South Central New York for implementation. Long range plans for this telemedicine project are to: improve access to care and professional collaboration; and to provide education to help create a program that may be replicated.

Lawrence Laveman, MD

Hoboken, NJ

The Bon Secours Children's Development Center

Purpose: Compile a comprehensive Special Children's Directory and form a parent /provider coalition committed to educating the community and advocating for the formation of a coordinated medical home approach.

Activities: 1) Address the increasing number of New Jersey children identified as exhibiting behavioral/developmental problems; 2) form a parent/provider coalition; 3) gather information about existing Hudson County services for special needs children for later use in text and on a web site.

Outcome: A coalition was formed to gather information for future development of a text and web site directory of existing services in the county for CSHCN. Future plans for this project include writing a grant for additional funding to: 1) complete the text directory and web site; 2) print the text and distribute to county health and social services; and 3) integrate the web site into existing county health services web sites.

Jacqueline H. Marshall, MD

South Holland, IL

A Medical Home for Every Ford Heights Child

Purpose: The Ford Heights Partnership will address ineffective access by children to existing health resources.

Activities: The Partnership will: 1) survey community residents through interviews, focus groups and town meetings to produce a qualitative and quantitative description of the barriers that prevent children from getting a medical home.

Outcome: Community members in Ford Heights and the Cook County Department of Public Health (CCDPH) formed the Ford Heights Partnership (FHHP) in 2001. The goal of the Partnership was to address health problems and measure to what degree a medical home was being provided through activities and planning led by community residents. The partnerships first decision was to decide on their sample population. For the purpose of this assessment, the parents of 3rd and 4th grade students in three schools from the Ford Heights school district were chosen to survey using the Child Primary Care Assessment Tool-Child Edition Expanded Version (PCAT). This tool, developed by Barbara Starfield, MD FAAP, conceptualizes primary care as having four main characteristics, 1) Accessibility and Utilization; 2) Affiliation and Relationship (Continuous Care) 3) Information Systems and Integration of Services (Coordinated Care); 4) Services available and Services provided (Comprehensive Care); 5) Family Centered; and 6) Community Oriented.

This assessment project was to propose actions, such as: 1) raise awareness among local physicians regarding barriers to a medical home; 2) Provide information and support to Ford Heights parents; and 3) Produce reports for Advocates and policy makers to improve access to a Medical Home for all Ford Heights children. The team is now using the information from the surveys to improve access to a medical home for all children in Ford Heights.