Christopher F. Koller, Troyen A. Brennan, and Michael H. Bailit - Health Affairs, May 2010; 29(5): 941-947
Primary care is viewed both as the solution to better health care in the United States and as a threatened institution, beset by poor payment and difficult working conditions. Rhode Island has taken a direct approach to making primary care more effective for patients and more attractive for physicians. In 2009 the state’s Office of the Health Insurance Commissioner developed "system affordability priorities" for Rhode Island’s commercial insurers, including a directive to almost double the portion of their medical expenses devoted to primary care. Initial plans of those insurers to meet those expectations are now being implemented; this paper describes those plans.
Projects and Grant Initiatives
AAP: Community Pediatrics Grant Database
The Community Pediatrics Grant Database archives previously funded Community Pediatrics grant projects, including those funded through the CATCH Program, the Healthy Tomorrows Partnership for Children Program, the Community Pediatrics Training Initiative and the Healthy People 2010 Chapter Grants. The database is searchable by seven major categories: target population, health topic, state/territory, project activity, AAP program, AAP district, and project year. Members of the AAP can obtain grantee contact information by searching through the Member Center. If you are not an AAP member, but have questions please contact docbi@aap.org.
State Implementation Grant (D70) for Improving Systems of Services for Children and Youth with Special Health Care Needs (CYSHCN) Grant Period: 2008-2011 (or 2009-2012, depending on which class they are) RHODE ISLAND DEPARTMENT OF HEALTH
3 Capitol Hl, Providence, RI 02908-5034 Program Director: Deborah Garneau Lee Phone: 401/222-5929 | E-mail: Deborah.garneau@health.ri.gov
Pediatric Practice Enhancement Project (PPEP)
PPEP provides parent support personnel to primary care physician who serve a large percentage of CSHCN and their families. Parent consultants are currently placed in 20 primary pediatric offices statewide and assist the physician in providing a comprehensive coordinated medical home to more than 1400 families annually (as of 2006). Parent consultants link families with necessary community resources, assist physicians and families in accessing specialty services, and identify and resolve with the PPEP Steering Committee systems barriers to coordinated care. The PPEP is partnership between the Rhode Island Department of Health (DOH), Department of Human Service (DHS) and the Rhode Island Chapter of the American Academy of Pediatrics (AAP). The PPEP funding sources include the DOH and State and Federal Medicaid. Oversight and monitoring of the PPEP is a collaborative effort among the DOH, DHS, Neighborhood Health Plan of RI, and the Rhode Island Parent Information Network (including Family Voices), with the DOH being the lead agency.
The PPEP aims to fully embrace the Medical Home model of care by fostering partnerships among families, pediatric practices, and available community resources, including CEDARR (Comprehensive Evaluation Diagnosis Assessment Referral Re-evaluation) Family Centers. The outcomes identified for the PPEP include:
Pediatrics practices will provide coordinated and comprehensive care to CSHCN with greater operational efficiency within the practices
Pediatric practices will have improved awareness and communication with available and appropriate community resources for their CSHCN
Families of CSHCN will receive ongoing, comprehensive, and coordinated care, where the family is recognized as a critical decision maker, resulting in improved health outcomes for the child
Families of CSHCN will have improved understanding of both the health care delivery system and the community resources available to them and demonstrate the ability to access those resources.
The evaluation plan is a two-tiered approach that includes assessment of the overall effectiveness of the PPEP and identification of key system barriers that limit the families' access to appropriate services and supports. Evaluation of the PPEP is accomplished through pre/post intervention surveys administered to families and practice staff. In addition, aggregate data is analyzed based on parent consultant activities. System barriers are identified through parent consultant documentation resulting from their work with the families. Several state and community agencies are anticipating this feedback from parent consultants to direct their quality improvement efforts. For more information on PPEP contact
Deborah Garneau at 401/222-5929 or Deborah.Garneau@health.ri.gov.
Newport County CATCH/Medical Home Initiative
The purpose of this initiative is to facilitate the creation of medical homes for all children in Newport County. Its goals include: develop and implement a care coordination system to support the medical home, identify and reduce barriers to medical homes, provide medical home training to parents, medical and human service providers, evaluate the impact of our interventions, and mplement systems to sustain and ensure quality medical homes for all children. Future initiatives for this project include: collaborate with the PPEP to define access barriers and capacity issues & continue collaborative problem solving with providers and families, collaborate with the RI Lung Association, Hasbro Children's Hospital and Newport Hospital to implement community needs assessment and training for asthma, develop Neighborhood Training Teams in collaboration with the Newport Housing Authority, provide medical home training to school educators, FSC(s) and health advocates as part of the Train the Trainer Initiative, collaborate with mental health and special education services to integrate care into the medical home, develop a Newport County Medical Home Web site for families and providers, maintain and build upon established medical home services and products, and obtain funding to sustain Newport County CATCH/Medical Home Initiative. For more Information on the Newport County CATCH/ Medical Home Initiative contact
James Sattel, Newport County CATCH/Medical Home Coordinator
The Triplett School at
401/847-2100 ext 223 or jsattel@ebcap.org.
Healthy Tomorrows Partnerships for Children Grant:The Child Care Health and Mental Health Consultation Network of Rhode Island (The Network) Project Period: 2006-2011
A majority of Rhode Island's young children are cared for outside of the home, in regulated or non-regulated child care settings. The purpose of this project is to increase health and mental health services provided through child care settings to families, which is currently an unmet need in Rhode Island. The project will develop and implement a high-quality model of child care health and mental health consultations for child care centers and family care homes.
Projects Goals & Objectives:
To develop an infrastructure to support accessible and effective health and mental consultation for child care providers,
To increase child care provider's knowledge and ability to support young children's healthy development,
To identify children at risk for poor developmental outcomes and connect these children and families to the medical home and other developmental intervention services,
To improve collaboration and coordination between child care providers, medical homes, and other community resources to ensure child and family access to services that promote health and development.
Partners in State
American Academy of Pediatrics (AAP) Chapter - Rhode Island Academy chapters are organized groups of pediatricians and other health care professionals working to achieve AAP goals in their communities. Chapters are the channels of representation for individual members of the Academy. Please contact your local chapter for additional state resources
Family Voices Chapter - Rhode Island
Family Voices aims to achieve family-centered care for all children and youth with special health care needs and/or disabilities. Through a national network, they provide families tools to make informed decisions, advocate for improved public and private policies, build partnerships among professionals and families, and serve as a trusted resource on health care
Family-to-Family Health Information Centers (F2F HICs)
F2F HICs are non-profit organizations that help families of children and youth with special health care needs (CYSHCN) and the professionals who serve them. F2F HICs are in a unique position to help families because they are typically staffed/run by parents of CYSHCN themselves, and as parents, they have traveled through the maze of services and programs designed to help CYSHCN. Staff at F2F HICs understand the issues that families face, provide advice, offer a multitude of resources, and tap into a network of other families and professionals for support and information. Family Voices, through the National Center for Family / Professional Partnerships, provides technical assistance, training, and connections to other F2F HICs and partnering organizations.
Title V Block Grant to States
Title V of the Social Security Act is one of the largest Federal block grant programs. It leads the nation in ensuring the health of all mothers, infants, children, adolescents, and children with special health care needs (CSHCN). Title V is administered by the Maternal and Child Health Bureau (MCHB) as part of the Health Resources and Services Administration, U.S. Department of Health and Human Services.
Maternal and Child Health Contact
Ana Novais , Executive Director, Rhode Island Department of Health Address: 3 Capitol Hill, Providence, RI 02908 Phone: 401/222-5117 | E-mail: Ana.Novais@health.ri.gov
Title V and Children with Special Health Care Needs
MCHB Objective: Support development and implementation of comprehensive, culturally competent, coordinated systems of care for the estimated 18 million U.S. children who have or are at risk for chronic physical, developmental, behavioral or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.
Children with Special Health Care Needs (CSHCN) Contact
Deborah Garneau, Chief, Spec Health Care Needs Address: 3 Capitol Hill room 302, Providence , RI 02908 Phone: 401-222-5929 | Fax: 401-222-1442 fax | E-mail: Deborah.Garneau@health.ri.gov
Early Hearing Detection & Intervention (EHDI) Contact(s) State EHDI programs promote universal newborn hearing screening, develop effective tracking and follow-up as a part of the public health system, promote appropriate and timely diagnosis of the hearing loss, prompt enrollment in appropriate Early Intervention, ensure a medical home for all newborns and strive to eliminate geographic and financial barriers to service access.
Newborn Screening and Genetics Collaborative – HRSA Region 1
Translating research into practical health care services and systems to improve the health and quality of life of individuals with heritable disorders through Collaboration and Partnership
Early Intervention/Part C Coordinator
The Program for Infants and Toddlers with Disabilities (Part C of IDEA) is a federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilities, ages birth through age 2 years, and their families.
Brenda DuHamel, Center for Child & Family Health, RI Department of Human Services Phone: 401/462-0318 | E-mail: BDuhamel@dhs.ri.gov
State Interagency Coordinating Council (ICC) Chairs The ICC advises appropriate agencies on the unmet needs in early childhood special education and early intervention programs for children with disabilities, assists in the development and implementation of policies that constitute a statewide system, and assists all appropriate agencies in achieving full participation, coordination, and cooperation for implementation of statewide system.
Medicaid Medicaid is Title XIX of the Social Security Act and is a federal/state entitlement program that provides medical assistance to certain individuals and families with low incomes and/or special health care needs. Medicaid is of unique importance to children; together with the Children's Health Insurance Program, Medicaid insures over 1 in 4 children in the United States, with millions more eligible but currently unenrolled. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program is a critical component of Medicaid, which guarantees that children enrolled in Medicaid are screened for medical or developmental problems early, and that necessary treatments and services are provided.
State Waiver Information
Waivers are the result of a process that allows state Medicaid agencies to apply for and receive permission from HCFA to provide services not otherwise covered by Medicaid and/or to do so in ways not described by the Social Security Act. Most Medicaid managed care programs require Waivers. The Waivers, which can differ greatly, are known by their numbers (1115, 1119), or as home-and community-based, or as Katie Beckett Waivers.
Children's Health Insurance Program (CHIP)
CHIP is Title XXI of the Social Security Act and is a state and federal partnership that targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage. Within federal guidelines, each state determines the design of its individual CHIP program, including eligibility parameters, benefit packages, and administrative procedures. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized the program through FY 2013, and includes many incentives for states to find and enroll more eligible children in both Medicaid and CHIP. CHIPRA also includes a number of quality provisions that aim to monitor and improve care delivered through the Medicaid and CHIP programs. Each state does have a CHIP program, and the names of these programs differ from state to state.
Children’s Health Insurance State Program Director For the most updated contact, please refer to the CMS listing of CHIP Directors.
Community Health Centers in the State Federally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide checkups when you're well, treatment when you're sick, complete care when you're pregnant, immunizations and checkups for your children, dental care and prescription drugs for your family, mental health and substance abuse care if you need it. For a listing of CHCs in Rhode Island, please use HRSA’s ‘Find A Health Center’ search engine.
Public Policy/Legislation
Association of Maternal and Child Health Programs (AMCHP) Rhode Island State Profile
These state profiles provide a snapshot of how the Maternal and Child Health Block Grant works in specific states. The profiles detail the Federal funds appropriated to each state, state match, specific programs funded, numbers of people receiving services and state health needs.
AAP Issue Brief: Implementing the Medical Home in Medicaid, CHIP, and Multistakeholder Demonstration Programs (AAP Member access only)
The Medical Home Issue Brief serves to provide guidance to AAP chapters working with states to implement medical home projects in Medicaid and CHIP as well as multipayer demonstration programs. It also addresses a number of the policy questions that frequently arise in creating state supports for the medical home.
National Adolescent Health Information Center (NAHIC) Adolescent Health Database
The NAHIC database includes national and state-level profiles of key measures of the health of adolescents and young adults, based on Healthy People 2010. Known as the Data Project, the online resource contains information on recent progress in key areas of adolescent health. National-level data is available by gender and race/ethnicity and also state-by-state, with summaries and data tables. The site also features information about data collection and presentation, state and national Excel files and guidance for using this data to improve the health of adolescents and young adults.
2010 KIDS COUNT Databook
The Annie E Casey Foundation has released the 2010 Kids Count report. The annual Kids Count report is a national and state-by-state profile of the well-being of America's children that seeks to enrich discussions concerning ways to secure better futures for all kids. The 2010 Kids Count report data is available as an interactive databook, a complete PDF-format report, and on request, in print. Data and rankings on 10 key indicators of child well-being are available by state, county, and city.
Other Resources
KIDSNET Rhode Island's child health integrated system houses data from several public health programs, and for the last two years, has provided online access to pediatric providers and other users. The new public-facing site offers information for parents, providers, and other users, answers to frequently asked questions, our confidentiality policies, and program highlights. The KIDSNET system is available to Head Start, the home visiting nurses agencies, WIC, Comprehensive Child Care Service Programs, school nurses, Lead Centers, and Early Intervention sites. KIDSNET provides the immunization schedule for each child in the system.
