Medical Homes in Florida

»Medical Home Initiatives	»Resources
»Related Grant Initiatives	»Educational Initiatives
»Partners in the State	»Screening Initiatives

Medical Home Initiatives
This section provides information on state medical home initiatives/programs. States that are a part of the mentorship network will have a "Promise to the State" which outlines how they will achieve ensuring that all children have a medical home by 2010. This is based on the Healthy People 2010 goals which is a 10 year action plan to achieve and measure success for all CSHCN.

Florida Medical Home Contact:

Name: Phyllis Sloyer, Division Director, Title V Agency
Contact: Phone: 850-245-4218 | Email: Phyllis_sloyer@doh.state.fl.us

Florida Institute for Family Involvement has been awarded an MCHB State Implementation Grant for Integrated Community Systems of Services for CSHCN - Abstract
This project, entitled “Integrating Families, Communities, and Providers” (IFCAP) is one of just six projects, nationally, funded by MCHB in 2005 under its initiative to support the development of community-based systems of care for all CSHCN. The purpose of this initiative is to promote and support the development of community-based integrated family-centered, culturally competent, community-based systems that serve all CYSHCN and their families.
Goal 1) work with four community coalitions in Florida to develop family-centered, culturally competent, community-based systems for all CYSHCN and their families using a medical home/family-professional partnership

FIFI invited applications from community-based coalitions in Florida to partner with FIFI to integrate family, community and provider efforts in support of the development of local family-centered systems of care for CYSHCN and their families. To learn more about the RFA click here.

Goal 2) evaluate, enhance, disseminate and promote use of the medical home/family-professional partnership model, statewide.

What FIFI is doing
In partnership with a statewide Taskforce, FIFI is currently developing a set of technical assistance and resource materials that communities can use to guide the development of their local CSHCN-systems of care.

FIFI has forged partnership with MCHB-funded National Resources Centers, secured the services of four nationally recognized experts has formed a Task Force comprised of individuals in Florida with expertise in the Medical Home and Family-Professional Partnerships. These consultants, along with members of the Task Force the staff of FIFI will provide on-going consultation and support to four “implementation” communities.

FIFI hosted the 2006 "Transformational Partnerships Conference" designed to help integrate family, community and provider efforts in support of the development of local family-centered systems of care for children and youth with special health care needs and their families. NOW AVAILABLE: Audio recordings and PowerPoint files.

MCHB Medical Home Grant: Medical Home in the Safety Net: Building Infrastructure for CSHCN in Community Health Centers Abstract
Contact: Lise M. Youngblade, Ph.D. Phone: 352-265-7220 | Email:LMY@cahs.colostate.edu
Project Period: 4 years from July 1, 2004 to June 30, 2008
Purpose: To link two cornerstones of Florida’s health-care system – Florida’s Title V program (Children’s Medical Services; CMS) and local community health centers (CHC) – to implement a model of the medical home in the “safety net” that capitalizes on community-based care, and enhances access to specialty care through telemedicine. The project specifically addresses the MCHB priority of subspecialty capacity building and improving service delivery to children from communities with limited access to comprehensive care. Our goal is to ensure that each CSHCN served by community health centers has a medical home that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and delivered in culturally competent environment.

Florida was selected to be part of the National NICHQ Medical Home Learning Collaborative - A fifteen-month collaborative activity to improve care for the growing population of CSHCN. This initiative focuses on 3 practices in the state and assists them in completing a quality improvement process to provide medical homes to their patients with special needs. It also assists in building the capacity of Florida's CMS and other health department programs to support and extend this approach after the completion of the project period. For more information you can go to the project overview.

Presentation from the CATCH and Medical Home National Conference - July 16, 2004 The Impact of a Medical Home on Financial Burden to Families with Children with Special Needs (206 KB)

David Lee Wood, MD, MPH, FAAP
Associate Professor of Pediatrics
Chief, Division of Community Pediatrics
University of Florida & Duval County Health Department

Research Design

• Title V program in Jacksonville, FL:
  • 2500 CHSCN,
  • 60+ pediatrician providers but less than 25% care for > 75-100 children in the Title V program
• Selected 3 intervention and 3 control practices
• Intervention:
  • Placed Title V care coordinator into offices.
  • Active CQI program to implement “Medical Home,”
  • Measurement/feedback to practices on Medical
• Prospective cohort study of 150 children & families in the intervention and 150 in the control practices
• Survey of families at baseline, and every 6 months for 3 years
  • Costs
  • Effectiveness of care coordination
  • Effectiveness of primary care services
  • Child health outcomes
• Qualitative study of families and practices

Healthy Tomorrows for Children Grant 2004-2008
Medical Home for Homeless Families: The Jacksonville Homeless Family Health Project
Contact: David Lee Wood, MD, MPH, FAAP Phone: (904) 665-2724 | Email: david_wood@doh.state.fl.us
Purpose: The program will provide comprehensive physical, mental, and social health assessments to children upon arrival at the Sulzbacher shelter through a Duval County Health Department comprehensive health center. The program focus will be on health-oriented care management with referral to a medical home. The program will also provide educational and therapeutic services to the homeless families, while also educating shelter staff and residents on preventive health services, prenatal care and pregnancy prevention, child development, and other pertinent topics. For more information on this project click here.

For more information on the Healthy Tomorrows Grant Program click here. For more information on this HTPCP project, please e-mail your name, address, telephone, and fax numbers with your specific request to healthyt@aap.org.

Related Grant Initiatives
This section provides information on current state grants that are working on medical home initiatives. This includes the grant abstract as well as key contacts for the grant.

Dyson Community Pediatrics Training Grant
University of Florida Health Science Center/Jacksonville Pediatric Residency Program
The Initiative, in conjunction with other regional academic institutions, the Duval County Health Department, public and private sector human services agencies and the Jacksonville Community will implement a Residency Program in Pediatrics and Community Health. The Initiative will introduce residents to the social, political, cultural, environmental and behavioral determinants of child health and the evolving epidemiology of child morbidity.

University of Miami School of Medicine
The Initiative will firmly establish a model advocacy program that will improve child health through stimulating and self-sustaining innovative partnerships between pediatricians and community-based organizations in South Florida, and will instill in the minds of pediatricians in training the positive impact that such collaborative efforts can have on the lives of children.

The ultimate goal of the Dyson Initiative is the development of pediatric professionals with greater skills and interest in community-based medicine, advocacy, and the capacity to improve the health of children in their communities. Here you can learn how diverse programs around the country are educating residents about community pediatrics and fostering practical community experiences. www.aap.org/commpeds/cpti/grantees.htm

Partners in the State
This section provides information on who in the state (individuals and agencies) are working together to create medical homes for children.

American Academy of Pediatrics (AAP) Chapter: http://130.160.156.137/artman/publish/index.shtml

American Academy of Family Physicians (AAFP) Chapter: www.fafp.org/

Title V CSHCN Program - Children's Medical Services: www.cms-kids.com/

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.

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.

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, link newborns to a medical home and strive to eliminate geographic and financial barriers to service access.

Name: Lois Taylor, RN, Unit Director, Screening Programs
Contact: Phone:850-245-4670 | Fax: 850-922-5385
Email: Lois_Taylor@doh.state.fl.us

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.

Name: Monica Rutkowski, Part C Coordinator
Contact: Phone: (850) 245-4221 | Fax: (850) 921-5241
Email: monica_rutkowski@doh.state.fl.us
Web site: www.cms-kids.com/

Section 619/ Preschool Grants Program of the Individuals with Disabilities Education Act (IDEA). This program provides free appropriate public education (FAPE) for children, ages 3 through 5 years, with disabilities:

Name: Cathy Bishop, Interim 619 Coordinator
Contact: (850) 245-0478 (Bishop) | Fax: (850) 245-0955
Email: cathy.bishop@fldoe.org

Name: Carole West, Part C Liaison
Contact: Phone: (850) 488-1106 (West) | Fax: (850) 922-7088
Email: carole.west@fldoe.org

Web site: www.firn.edu/doe/bin00014/home0014.htm

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.

Name: Ilene Wilkins, President/CEO
Contact: Phone: (407) 852-3303 | Fax: (407) 852-3301
Email: iwilkins@aol.com

Resources
State Waiver Information: www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/08_WavMap.asp
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.

Florida’s Quality of Care Chartbook:
http://ichp.ufl.edu/new-from-ichp-l/Quality_of_Care_Chart_Book_Florida_KidCare_Program.pdf
The Institute for Child Health Policy has completed a chart book examining the quality of care provided to children in the Florida KidCare Program. The quality of care indicators assessed include:
(1) children's compliance with well child visits, (2) children's access to primary care practitioners, (3) families' satisfaction with their children's medical homes, and others. Often quality of care assessments are reported for children as a group, without considering their health status.

Educational Initiatives
This section provides information on training initiatives on the medical home. Some states will discuss their outreach projects in relation to physicians, families, and the community.

No information is currently available for this category.

Screening Initiatives
This section provides information on surveillance and screening initiatives in the state.

State Newborn Screening & Genetics Programs: genes-r-us.uthscsa.edu/resources.htm

• State Newborn Screening Program Links
• State Genetics Program Links
• Regional Genetics and Newborn Screening Collaborative Links
• Newborn Screening State Contact Fact Sheet

Evidence-based Developmental Screening: A Quality Improvement Project
Developmental Screening with a standardized tool such as the Ages and Stages Questionnaire (ASQ) is recommended at every well child care visit. Pediatricians report that they use these tools in 23% of visits and that they use the ASQ in 7% of visits. An informal survey of training programs in Florida indicates consistent use of focused developmental questions, but not standardized, evidence-based tools. In order to facilitate resident learning in evidence-based screening, we are including the ASQ process in the 15 and 18 month WCC visits. It is hoped that this experience will better prepare the pediatric and internal medicine-pediatric residents to identify children with developmental concerns and to assist families in early language and learning opportunities. Although focusing on one age is far from ideal, it will allow us to identify barriers on a small scale and explore the possibility of further implementation.

This program is supported in part by the Pediatric Clinical Research Center of All Children’s Hospital and the University of South Florida, and the Maternal and Child Health Bureau, R60 MC 00003-01, Department of Health and Human Services, Health Resources and Services Administration.

Pediatricians interested in the program can contact Mary H. Pavan, MD, FAAP through mpavan@hsc.usf.edu or 727-767-6723.

State Resources on the Internet

Note: The information provided on the state pages was submitted by the state medical home teams.As this is not an exhaustive list, please let us know if you have additions for your state resource page. You can contact us at: medical home@aap.org.