CCHAP Newsletter Twenty-Three November 2008

Articles

Culturally-Based Beliefs About What Causes Illness

A Medical Home For All Children
A Tool For Evaluating Your Practice
 
Great News About Reimbursement on CHP+ Children
From Colorado Access
 
Practice Manager’s Corner

Language as a Communication Barrier in Medical Care for Hispanic Patients
Plus A Spanish Course For Providers

Phase II – Automated Reminder Recall

Ongoing Services
- Postpartum Depression Screening For Mothers
  And Training For Your Practice
- Child Psychiatrist Available to Provide Conferences for You In your Office
- The Cross-cultural Curriculum for the Department of Pediatrics
  The syllabus is now available for you and your practice
- Child Psychiatry Telephone Consultation on Medicaid Children
- Provider Resource Hotline for Children with Chronic Illness
- Integrating Developmental Screening In a Pediatric Practice
- Medical Spanish Training For Your Office Staff

^{Download Newsletter Twenty-Three}

Culturally-Based Beliefs About What Causes Illness

 
By Marcia Carteret © Copyright 2008
 
Patients' health beliefs can have a profound impact on clinical care. They can impede preventive efforts, delay or complicate medical care and result in the use of folk remedies that can be beneficial or toxic. Culturally-based attitudes about seeking treatment and trusting traditional medicines and folk remedies are rooted in core belief systems about illness causation, i.e., naturalistic, Ayurvedic, biomedical, etc. The range of understanding people have around what causes of illness is considerable – from witchcraft and soul loss to germs and weak immunity. In the Western world, the body is often thought of as an intricate machine which must be kept "tuned-up," and illness is viewed as a breakdown of the machine. This contrasts with eastern philosophies in which health is seen as a state of balance between the physical, social, and super-natural environment.
 
Let’s take a closer look at a few dominant theories of illness causation that influence people’s attitudes toward seeking treatment in cultures around the world. These fundamental theories are likely to have a strong influence on the health behaviors of many patients/families served by CCHAP practices.
 
Personalistic:
 
In a personalistic system of belief, illness is believed to be caused by the intervention of a supernatural being or a human being with special powers. A supernatural being might be a deity or a dead ancestor. A human being with special powers might be a witch or a sorcerer. Evil forces cause illness in retaliation for moral and spiritual failings. If someone has violated a social norm or breached a religious taboo, he or she may invoke the wrath of a deity and their sickness is explained as a form of divine punishment. Similarly, illness is seen in many cultures as punishment for failing to carry out the proper rituals of respect for a dead ancestor. Evil spirits possess the living to revenge the dead. Finally, illness in many cultures is accepted as simply bad karma or bad luck. Recovery from an illness arising from personalistic causes usually involves the use of ritual and symbolism, most often by practitioners who are specially trained in these arts. Many people in Asian and Latin American countries adhere to a personalistic beliefs system, as do many Native Americans.
 
Naturalistic
 
In the naturalistic system of belief, a person’s health is closely tied with the natural environment. A proper balance must be maintained and harmony protected. When balance is disturbed, illness results. Three of the widely-practiced naturalistic approaches to health are humoral, Ayurvedic, and vitalistic.
 
Humoral is a naturalistic approach with roots over two thousand years old. The humoral approach is widespread in Asia and Latin America, though it takes somewhat different forms on different continents. Maintaining humoral balance involves attention to appropriate diet and activity, including regulating one’s diet according to the seasons. Illnesses may be categorized into those due to hot and cold imbalances in the body. If a patient suffers from too much hot, the treatment would involve measures such as giving cooling foods and liquids and applying cool compresses.
 
Ayurveda is an ancient naturalistic approach to health in India. Therapy in Ayurveda includes a vast array of preparations made from herbs and minerals, and dietary advice also forms part of every prescription. It is believed that building a healthy metabolic system, attaining good digestion and proper excretion leads to vitality. Ayurveda also focuses on exercise, yoga, meditation, and massage. Ayurveda is actively practiced in India today and has shaped the way Indians think about their bodies in health and in illness. The practice is closely connected to religion and mythology. Ayurveda has gained recognition in the Western world and medical scholars have researched and outlined its various postulates. In the United States, the National Institute of Health conducts research on Ayurvedic medicine.
 
Vitalism is based on a core belief that disease is the result of some imbalance in the vital energies which distinguish living from non-living matter. In the formative days of the Western medical tradition founded by Hippocrates, these vital forces were associated with the four temperaments and humours. In Eastern traditions, related terms are qi and prana. Today, vitalistic approaches to health are widespread in Asia. The ancient art of acupuncture in China is an example of this system which focuses on vital forces or energy within the body. If energy within a person’s body is flowing harmoniously, their health is deemed good. Illness results when this smooth flow of energy is disrupted and therapeutic measures are aimed at restoring a normal flow of energy in the body. In India, yoga (particularly hatha yoga, the physical form of yoga) is used therapeutically to restore a balanced energy flow through body and mind.
 
Biomedicine
 
Biomedicine is based on the “body-as-machine” metaphor. This metaphor has been a powerful way of conceptualizing the body in western medical practice. A core assumption of the value system of biomedicine is that diagnosis and treatment should be based on scientific data. One of the core theories of contemporary biomedicine, the germ theory of disease, is of relatively recent origin. Biomedicine is usually not concerned with the practice of medicine as much as it is with the theory, knowledge and research of it; its results lead to possible new drugs and a deeper, molecular understanding of the mechanisms underlying disease, and thus lays the foundation of all medical application, diagnosis and treatment.
 
The health beliefs of cultures worldwide are informed by some combination of the above theories, and these theories underlie the use of many traditional medicines and therapeutic practices. All theories of health and illness help patients make meaning of their bodily experience, allowing a sense of self-control in what can be frightening situations. In ideal circumstances, American medical professionals and their patients from different cultures negotiate an understanding of what causes illness. Through open communication they can agree on treatments that combine the advantages of several theories. While western medical professionals clearly need to be vested in the value of modern medicine and their training in it, an open and nonjudgmental mindset towards the ideas other people use to explain illness and treatment will ultimately achieve better health outcomes for their patients.

 
The following sources were used for this article.
 
http://en.wikipedia.org/wiki/Traditional_medicine
http://en.wikipedia.org/wiki/Modern_medicine
http://en.wikipedia.org/wiki/Biomedicine
http://en.wikipedia.org/wiki/Ayurvedic
http://www.enotes.com/public-health-encyclopedia/folk-medicine
http://www.enotes.com/public-health-encyclopedia/lay-concepts-health-illness
 
Recommended Resources for further reading.
 
Helman, C. G. (1994). Culture, Health and Illness: An Introduction for Health Professionals, 3rd edition. Bristol, UK: Butterworth-Heinmann.
Huff, R., and Kline, M. (1999). Promoting Health in Multicultural Populations: A Handbook for Practitioners. Thousand Oaks, CA: Sage Publications, Inc.
Helman, C. (1990). Culture, Health and Illness. Oxford, UK: Butterworth-Heineman.
Kinsley, D. (1996). Health, Healing and Religion: A Cross-Cultural Perspective. Englewood Cliffs, NJ: Prentice Hall.
Kleinman, A. (1988). The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books.

- contents - newsletter archive - home -

A Medical Home For All Children
A Tool For Evaluating Your Practice

 
If you have been reading about medical homes in the pediatric literature, you may be used to thinking of a medical home as primarily a concept related to children with special health care needs. But, recently the AAP has encouraged us to provide a quality medical home for all of the infants, children and adolescents.

The American Academy of Pediatrics believes that all children should have a medical home where care is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.
Accessible
• Care is provided in the child’s community
• All insurance, including Medicaid, is accepted and changes are accommodated Family-Centered
• Recognition that the family is the principal caregiver and the center of strength and support for children
• Unbiased and complete information is shared on an ongoing basis
Continuous
• Same primary pediatric health care professionals are available from infancy through adolescence
• Assistance with transitions (to school, home, adult services) is provided
Comprehensive
• Health care is available 24 hours a day, 7 days a week
• Preventive, primary, and tertiary care needs are addressed
Coordinated
• Families are linked to support, educational, and community-based services
• Information is centralized
Compassionate
• Concern for well-being of child and family is expressed and demonstrated
Culturally Effective
• Family’s cultural background is recognized, valued, and respected

A medical home is not a building, house, or hospital, but rather an approach to providing health care services in a high-quality and cost-effective manner. Children and their families who have a medical home receive the care that they need from a pediatric health care professional whom they trust. The pediatric health care professionals and parents act as partners in a medical home to identify and access all the medical and non-medical services needed to help children and their families achieve their maximum potential.

How Can We Know How Well We Are Doing In Providing a Medical Home?

The Medical Home Index (MHI) is a validated self-assessment and classification tool designed to translate the broad indicators defining the medical home (accessible, family-centered, comprehensive, coordinated, etc.) into observable, tangible behaviors and processes of care within any office setting. It is a way of measuring and quantifying the "medical homeness" of a primary care practice. The MHI is based on the premise that "medical home" is an
evolutionary process rather than a fully realized status for most practice settings. The MHI is a nationally validated tool that measures a practice's progress in this process.

What can the MHI do for your practice?
• You can identify your practice’s strengths
• You can identify what aspects of a medical home you would like to build on or improve
• It gives you a clear starting point
• It allows you to measure your progress
• It promotes the conversation among all providers and staff about what you want the practice to be
• It is a great way for a practice to begin a quality improvement process, because it creates buy-in among all staff
• It will improve care
• It will help you improve patient- and parent-satisfaction.
• Health plans are going to be requiring something like this within a few years. Get a head start on it, now

You can learn more about the MHI by visiting the

National Center of Medical Home Initiatives website www.medicalhomeinfo.org

The National Center for Medical Home Implementation supports medical home implementation in order to ensure that all children and youth, including those with special health care needs, have the services and support necessary for full community inclusion.

- contents - newsletter archive - home -

Colorado Access and CHP+

 
Colorado Access offers a CHP+ Health Plan, often referred to as Colorado Access CHP+ HMO (or MCO), and is also contracted with the Department of Health Care Policy and Financing to provide administrative services for the CHP+ State Managed Care Network.
The following information provides highlights of Colorado Access’ CHP+ HMO product, and comparative information about the CHP+ State Managed Care Network.

Colorado Access CHP+ HMO
Children eligible for CHP+ that live in one of Colorado Access’ active counties can select CHP+ offered by Colorado Access as their health plan. CHP+ offered by Colorado Access is active in 32 counties. Once enrolled, members will receive a Colorado Access ID card. The ID card is distinguishable by the Colorado Access Child Health Plan Plus logo (pictured) and includes the member’s copayment information, ID number, effective dates, the name and phone number of their primary care provider (PCP) and claims submission information. Providers should use the information on this ID card to submit claims for services rendered to eligible members.

Members enrolled in CHP+ offered by Colorado Access receive benefits beyond the standard CHP+ benefits. Some of the enhanced benefits include:

• A robust formulary that includes coverage of over-the-counter medications when prescribed by a doctor.
• Reduced co-payments for prescribed medications.
• Vision - $150 toward the purchase of eyeglasses or contact lenses.
• Hearing aids - $1200 toward the purchase of hearing aids.
• Physical, occupational and speech therapy - 40 visits for covered services. 
• Mental Health – 30 visits for covered services.

Covered services are offered by contracted providers in the Colorado Access CHP+ provider network. Members in need of specialized care should be referred to providers within this network.

As of July 1, 2008, Colorado Access CHP+ HMO has updated and increased their reimbursement rates for preventative medicine and office visit codes to closely match the Medicaid reimbursement rates for CCHAP practices.

More information about CHP+ offered by Colorado Access, including an updated Provider Directory, Member Handbook and EOC, Provider Manual and plan formulary, can be located on Colorado Access’ Web site www.coaccess.com. You can also reach Customer Service at (303) 751-9021 or toll free 1-888-214-1101.

CHP+ State Managed Care Network
Effective July 1, 2008, Colorado Access began to provide administrative services for the CHP+ State Managed Care Network. Colorado Access was awarded this position through a competitive bid process. As the administrator, Colorado Access provides claim payment services, provider relations services, provider contract administration, and utilization management for providers and members of the CHP+ State Managed Care Network.

Members of the CHP+ State Managed Care Network include:

• Women in the Prenatal Care Program;
• CHP+ members that live in counties that do not have a CHP+ HMO option; 
• Children in the CHP+ pre-HMO period (the period during which members who live in counties where there is an HMO option are waiting to choose, or be assigned to, their preferred HMO); and 
• Women and children that are found to be presumptively eligible for the CHP+ program.

With the exception of presumptively eligible members, enrollees receive a CHP+ State Managed Care Network ID card. This ID card will have the State’s Child Health Plan Plus logo (pictured), as well as the member’s ID number, effective dates, the name and phone number of their PCP and claims submission information. Providers should use the information on this ID card to submit claims for services rendered to eligible members.

Members enrolled in the CHP+ State Managed Care Network receive the standard CHP+ benefit package. Some of the standard benefits include:

• A robust prescription drug formulary (over-the counter medications are not covered).
• Vision - $50 toward the purchase of eyeglasses or contact lenses.
• Hearing aids - $800 toward the purchase of hearing aids
• Physical, occupational and speech therapy - 30 visits for covered services. 
• Mental Health – 20 visits for covered services.

Covered services are offered by contracted providers in the CHP+ State Managed Care Network. Members in need of specialized care should be referred to providers within this network.

More information about the CHP+ State Managed Care Network, including an updated Provider Directory, Member Benefit Booklet, Provider Manual and plan formulary, can be found online at www.chpplusproviders.com. You can also reach customer service at (303) 751-9051 or 1-800-414-6198.

Colorado Access Provider Service
Colorado Access strives to provide superior service to each contracted provider. In order to ease administrative duties, Colorado Access does not require a formal referral to in-network providers for payment purposes, for either the CHP+ HMO or CHP+ State Managed Care Network. Also, Colorado Access maintains formularies for both plans, which are updated and modified through out they year by the Colorado Access P & T Committee. Over the past 6 months, the company has significantly increased the number of first-line medications on the formularies which do not require a prior-authorization. Additionally, Colorado Access offers providers convenient online tools such as eligibility verification, claim status, and even online PCP changes. Each tool can be located on the company’s Web site, www.coaccess.com.

Also, any physician provider can contact Ed Berman, M.D. directly at edward.berman@coaccess.com or 303-618-3613.

- contents - newsletter archive - home -

Practice Manager’s Corner
November, 2008

By Christina Ells

New Website!
The Colorado Department of Healthcare Policy and Financing has a new website. The new address is: Colorado.gov/hcpf. To access Provider Services form the Department’s home page, select the “Providers” option on the menu bar.

Practice Manager’s Meeting
Don’t forget that the next PM meeting will be held November 18th from 12 – 1:00 pm. Please submit topics for discussion to me at ells.christina@tchden.org. More details to follow about location, etc.

Survey
Thank you all for completing the CCHAP performance survey. We were able to get a lot of great feedback and will share it with you in the near future. We had a lot of responses and are busy tallying and analyzing the information.

- contents - newsletter archive - home -

Abe Grinberg MD, FAAP MPH
   

Language as a Communication Barrier in Medical Care for Hispanic Patients
 

           Communication with patients and their families is essential in providing quality medical care. Cultural and language barriers create a void in the delivery of safe health care, customer satisfaction and quality of care. The public debate on how to bridge cultural and language barriers has a long history. The use of formal interpreters and translators is associated with the ability to eliminate these barriers; however, the ability to communicate directly with health professionals in a common language is associated with an increase level of trust in medical settings.

           There are 7 important points to have in mind when addressing cultural and language barriers with the Hispanic patients and their families:

1. The number of people speaking a language other than English at home and the number of Americans Limited in English Proficiency (LEP) in the United States is significant. It is expected that the total number of people in these two groups will continue to increase at a faster rate than the one of the general population in the USA. About two thirds of them are Spanish speaking individuals (₁) (₂).
2. Multiple studies document that quality of care can be seriously compromised when Spanish LEP patients need but do not get translation and interpretation services (₃) (₄).
3. Studies also document that the quality level of interpretation offered by bilingual providers and professional hospital interpreters is high. However, the quality of interpretations offered by hospital employees who are not professional interpreters, family members, relatives, friends, and ad-hoc translators are many times incorrect and of poor quality (₅).
4. Interpretation errors are common. About 60% of the errors have potential clinical consequences. Even professional interpreters commit significant errors about 50% of the time (₅).
5. Patients, who interact with a bilingual provider, frequently rate them as more friendly, respectful, and concerned when compared to those who interact with a translator or interpreter. Patients and families who are taken care by a provider who speaks their own language frequently have a more accurate recall of critical information about the encounter than those who interact with a provider who uses a translator or an interpreter(₆)(₇).
6. There are data that suggest that the length of hospital visits, the incidence of any testing, the cost per visit and the number of hospital admissions are decreased in those patients who interact with a provider who speaks their own language when compared to those providers who use a translator or interpreter during the course of the medical encounter (₈). 
7. There is evidence that courses in Medical Spanish can help health care professional achieve fluency in Spanish at the functional level and promote cultural awareness that strengthen communication skills. The promotion of such courses is associated with decreased interpreter use and increased patient and family satisfaction (₉).

          Bear in mind that Hispanics embrace people when they make an effort to speak their own language. They tend to be tolerant and have a tendency to develop relationships that are based on friendship and respect. You will make them fill comfortable and help them feel that you are concerned about their medical care.
 
          “Dele a un hombre un pescado y él comerá por un día. Enséñele cómo pescar y comerá por el resto de su vida” (Lao Tzu. Filósofo Chino).

1. 1. Flores Glenn. 2005. The Impact of Medical Interpreter Services and the Quality of Health Care: A Systematic Review. Medical Care Research and Review 62: 255-299
2. Colorado Alliance for Immigration Reform. U.S Immigration Data, Projections and Graphs. Retrieved: October 2, 2008. http://www.cairco.org/data/data_us.html
3. Flores, Glen., Abreu, Milagros., Schwartz, Ilan., and Schwartz, MD, and Hill, Maria. (2000). The importance of language and culture in pediatric care: Case studies from the Latino community. The Journal of Pediatrics. 137 (6): 842-848
4. Flores G. Language Barriers to Health Care in the United States. NEJM 2006; 355:229-23
5. Flores G., M.B. Laws., S.J. Mayo., B. Zuckerman., M. Abreu., L. Medina and E. J. Hardt. 2003. Errors in clinical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 111: 6-14
6. Baker, David W., Hayes, Risa., and Puebla Julia. 1998. Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients. Medical Care. 36(10):1461-1470 
7. Seijo, R., H. Gomez and J Frienderber. 1995. Language as a communication barrier in medical care for Hispanic patients. In. Hispanic Psychology_Critical issues in theory and research, edited by A.M. Padilla, 169-181. Thousand Oaks,Ca: Sage.
8. Hampers, L. C and., McNulthy, J.E. 2002. Professional Interpreters and Bilingual Physicians in a Pediatric Emergency Department. Arch Pediatr Adolesc Med. 156:1108-1113.
9. Suzan S. Mazo., Louis C. Hampers., Vidya T. Chande. Steven E. Krug. (2002).Teaching Spanish to Pediatric Emergency Physicians: Effects on Patient Satisfaction. Arch Pediatr Adolesc Med 156: 693-695

Course in Medical Spanish customized for pediatric care providers. Once a week for 12 weeks (2 hour class), includes also 6 month internet access to “Spanish for health care course”. Flexible schedule to accommodate participants’ preferences; Classes take place at the providers’ office for groups of 8-12 students.
$ 389 dollars per student. Includes 6 month internet access to the on line training course.
          Contact: Abe Grinberg MD (720) 748-7669.
          abe@bilingualmed.com my web-site www.bilingualmed.com

- contents - newsletter archive - home -

Immunizations Corner

Kick Off Phase II of Reminder Recall
(For those practices that participated in the Phase I Project)

            We are about to kick off Phase II of the reminder recall. I have tried to take your concerns into consideration by reducing the amount of time required on your end to build a sustainable recall system. Phase II will use an automated recall system which will use recall lists generated by CIIS tracking the initial cohort of kids whom services were billed to Medicaid from April 2006-April 2007 in your practices. Since so many of these kids have either moved, changed practices, or been discharged, kids in Phase II will be identified to your practice based on last service visit indicated in CIIS, rather than based on our initial list from ’06-’07. The computerized system will automatically identify and link siblings based on phone number. Therefore, only one set of calls will be made to a household for all identified children.

           Based on our results from Phase I, we decided there is not a strong return on making more than four call attempts. Therefore, we will attempt a family up to four times. The automated system is able to recognize that a line is picked up and will deliver the message with no delay for answering machine recognition. In order to manage a possible delay if there is an answering machine we are providing brief introductory information which will be heard in cases where a live person answers the phone as a time buffer to allow those with an answering machine to pick up, but pertinent information will be relayed later in the message. When a call is unanswered, the computerized system will make another attempt at a different time of day. It is estimated that the actual call cycle will take no more than two weeks for this cohort of kids.

           In an effort to address HIPAA issues, we will not identify children by name on the automated messages. Instead we will only identify children based on month and year of their birth. When a child can be identified with a practice based on the CIIS indication, there will be an option to be transferred to the practice scheduler after the message is delivered. When a child cannot be identified with a practice, the message will be the same except there will be no option to transfer the call. The message will be phrased similarly to:

- contents - newsletter archive - home -

Postpartum Depression Screening For Mothers
And Training For Your Practice

Postpartum Depression is a significant public health issue affecting 1 out of 8 new mothers. In Colorado, it is underidentified and undertreated. The Rose Community Foundation has funded Dr. Brian Stafford and The Kempe Center¹s Postpartum Depression Intervention Program to provide Free Medical Education and On-Site assistance to practices in the Denver Metropolitan area in order to assist their identification, education, treatment, and referral for women with this condition. Practices will receive a free talk as well as a free tool kit and fliers and brochures to assist them. This provider education is paired with a public awareness campaign on this issue titled, 'Oh baby, this isn¹t what I expected.' Interested practices or practitioners should contact the Kempe Center at 303-864-5845 or Dr. Brian Stafford at tafford.brian@tchden.org to schedule the on-site pre-clinic or lunchtime training.

- contents - newsletter archive - home -

Child Psychiatrist Available to Provide Conferences for You In your Office

Rick March, MD is a child psychiatrist at the Mental Health Center of Denver.  He is available to provide teaching on a variety of child Psychiatry topics (below) in your office.  He is also willing to discuss cases with you, as well.  Please contact him to take advantage of this wonderful opportunity.
He can be reached at Rick.March@MHCD.org

Here are some of the topics he can cover for you.

• Diagnosing Depression in Children and Adolescents
• SSRI’s and Black Box warnings
• Suicide and self-abuse
• Diagnosing Bipolar Disorder in Children and Adolescents (including differential diagnosis)
• Atypical Antipsychotics
• Mood Stabilizers and Antidepressants
• Pediatric Psychopharmacology and the FDA
• Kid with ADHD who don't get better on stimulant medication
• Psychosis in Children and Adolescents

And, remember there is a child psychiatrist on call available by phone for your Medicaid children…..

- contents - newsletter archive - home -

The Cross-cultural Curriculum for the Department of Pediatrics
The syllabus is now available for you and your practice

There is a syllabus available on the CCHAP web site that covers a variety of topics related to cross cultural health care.   Click Here to view the entire curriculum or visit www.cchap.org/cchc-syllabus/. The following topics are covered:

Demographics of Colorado’s Children

Health Disparities among Colorado’s Children

Health Disparities
              Poverty
              Genetics 
              Environmental exposures 
              Life style behaviors 
              Provider’s ability to understand/accommodate the patient’s / parent’s culture
              Provider’s ability to communicate well with families
              Patient’s / parents limited English proficiency
              Patient’s / parent’s limited health literacy 
              Disimination

What can Providers do to improve outcomes?

Race, Ethnicity and Culture (Definitions)

Cross-cultural Communication 
              Generalization versus stereotyping 
              What providers need to know about culture? (Dimensions of culture) 
              Basics of cross-cultural communication

How to communicate with and help families with Limited English Proficiency

How to communicate with and help families with Limited Health Literacy

The Cross-cultural Health Care toolkit 
              Keys to success in cross-cultural communication 
              LEARN mnemonic 
              Cross-cultural health care Review of Systems

Case Studies

Examining our Own Personal Biases

8 Steps You Can Take to Enhance Your Skills in Cross-cultural Health Care

The Institute of Medicine’s Guidelines

The CLAS Standards (Guidelines for organizational change)
  
References

- contents - newsletter archive - home -

Child Psychiatry Telephone Consultation on Medicaid Children

The Behavioral Health Organizations and the Mental Health Centers in the greater metro area have very generously made available telephone consultation by child psychiatrists to help providers in CCHAP – affiliated practices manage their  Medicaid children with complicated mental health issues or complicated medication regimens.   These child psychiatrists are also willing to come visit your practice to get to know you and even to discuss cases.   We are very grateful for this very generous support for your Medicaid children.

Denver County – Rick March, MD – 303-504-1520
Jefferson County – Don Bechtold, MD – 303-432-5172
Adams, Arapaho and Douglas Counties - Joe Pastor, MD – 303-853-3888
 

- contents - newsletter archive - home -

PROVIDER RESOURCE HOTLINE

(Clarification of previous information)

To Help You Find All Appropriate Services and Resources
           for Your Chronically Ill or Special Needs Patients

Including Case Management or Care Coordination for the Child

And Education Resources and Support Services for Their Parents

                       Call  1-877-731-6017

                       Fax: 303-691-0846

                       Email: providerhotline@familyvoicesco.org

The PROVIDER RESOURCE HOTLINE assists  providers to identify all appropriate services and resources for children with chronic illness or special needs and for their parents:

• Case management
• Care coordination
• Specialized services, resources, medical equipment, therapies
• Parent/patient education about chronic illness / special needs
• Parent/patient support services
• Help in finding funding for uncovered services

Examples:

• You are seeing a new patient (new to Colorado) who is an infant with 22q Deletion Syndrome,  congenital heart disease, cleft palate and an oxygen requirement of undetermined etiology.  Parents want to link up with all of the support services and a parent group like they had where they used to live.
• A child with multiple developmental delays also has behavioral problems.  The parents are not sure they are getting all the help their child is entitled to and they want a parent  support group and they are asking for counseling.
• A parent with a disabled child wants your help in applying for some sort of waiver that you aren’t familiar with.

Monday thru Friday from 8AM to 4PM
Voicemail available 24/7

Provides follow-up with the provider office and with the family

CLARIFICATION 
Contact Erlinda or Lorena with CCHAP at PHONE 720-744-5522; FAX 303-751-9048
  –   When you are only wondering about socio-economic issues like food stamps, housing, Medicaid 
        eligibility, legal aid, abuse, etc.
 
If the hotline can answer your questions immediately, you can pass the information to the family while they are in the office or we can contact the family and give the information to them.

If the information is not immediately available, we will research the question or case and provide the information to you and the family later in whatever manner you and the family wish (via phone, fax, or email).

If you feel the family needs more assistance or follow- up, just let us know and share the family’s contact information with us or provide the family with our number for them to contact us directly.

When contacting us, please provide us with the following information:
Your provider office and PCP name
Name of Child
Date of Birth
Medical Condition / Primary Disability
Type of insurance
Resource or service requested
Who should we contact with information?
Family Contact Information
How is it best to provide information back to you: phone, fax, email or voicemail

DOWNLOAD A REFERRAL FORM CLICK HERE

DOWNLOAD AN 8.5 x 11 FLIER TO KEEP ON HAND AS A REMINDER  CLICK HERE

Next time you see a special needs child, call us to see how we can help

Questions about the hotline?  Call 1-877-731-6017

The Provider Hotline Is Sponsored By
Family Voices and CCHAP

 

   

- contents - newsletter archive - home -

Integrating Developmental Screening
Into a Pediatric Practice

• The Colorado Assuring Better Child Health & Development (ABCD) project has received a three year grant to provide training and technical assistance to providers to implement a “validated” developmental screening tool at well child visits for infants/toddlers birth to five.
• The ABCD project is partnering with CCHAP to provide training and support to pediatric practices to implement developmental screening.
• Medicaid will reimburse $34.00 to providers if you use a standardized, validated developmental screening test at an EPSDT visit.
• The Colorado Chapter of the AAP supports the ABCD project.
• Early detection and intervention improves outcomes.  Many delays in children’s development are missed in the first 4-5 years of life without a standardized, validated screening test. 
• The most time-efficient tool is one in which the parent completes a questionnaire.
• To comply with 2010 recertification guidelines by the American Board of Pediatrics, documentation will be required to show levels of involvement in practice improvement initiatives. By implementing the use of a “validated” developmental screening with a sensitivity and specificity rating of 70% or greater like the ASQ or PEDS, practices are taking steps to integrate quality improvement into their practices.
• What providers are saying about implementing either the ASQ or the PEDS parent questionnaire developmental screening tools:
  •  
    • It takes 1-2 minutes for an MA, LPN or RN to score.
    • It takes less than a minute of the provider’s time if the MA, LPN or RN scores the questionnaire.
    • In many instances, it reduces the length of the visit.
    • It helps providers concentrate on the concerns/priorities of the parents.
    • It reduces the number of concerns that come up as you are walking out the door at a well care visit.
    • It improves patient satisfaction.
    • It promotes positive parenting practices.
    • It increases provider confidence in decision-making for when to refer a child for further developmental evaluation.
• Eileen Auer Bennett, the Colorado State ABCD Coordinator and her team are available to assist providers in getting started. Training and technical assistance will be provided to practices to implement a standardized tool such as the ASQ or PEDS. Support will also be given to office staff on how to incorporate a standardized developmental screening tool into the current office work flow.

For more information, please contact:
            Eileen Auer Bennett
            720-333-1351
            ileanben@yahoo.com

The Ages & Stages Questionnaire (ASQ) is a well respected screening tool.  It has the best sensitivity and specificity.  It is standardized across various common minorities.   Health care providers have identified the following advantages:

• Parent completed—Parents are partners in their child’s
  assessment and intervention activities.
• Serves as a talking guide with parents identifying a
  child’s strengths as well as things the child is not
  doing yet.
• Practical—Scoring takes 1-2 minutes and can be done
  by paraprofessionals.
• Cost-efficient—May be photocopied repeatedly.
• Scoring is simple—Only three responses:
  1. Sometimes, occasional or emerging response from
     child = 5 points
  2. Yes, child performs specified behavior = 10 points
  3. Not Yet = 0 points
• If the child’s total score falls in a shaded area of the bar
  graph for any developmental area, further diagnostic
  assessment is recommended.

• Developed out of four cross-validation studies on a
  nationally representative sample of families.
• Uses parent concerns or judgments about the child’s
  development and behavioral status.
• Easy to score—two minutes to elicit and interpret.
• Enables health care providers to determine the need to
  refer and where.

Visit www.pedstest.com to view and order the PEDS tool online.

- contents - newsletter archive - home -

Spanish Interpretation Training for Pediatric Practices

An assessment of each individual’s skill level will be done during a 5-10 minute phone call prior to first telephone conference/class.  Maria will contact you to schedule this initial individual telephone call upon receipt of your registration email.  A certificate of completion will be given after completion of all 6 sessions. The faculty is Maria Soto, a certified Spanish interpreter and trainer with International Language Services.

- contents - newsletter archive - home -

Copyright 2008 Colorado Children's Healthcare Access Program and other entities as noted.

 CCHAP Home > Newsletter Articles > Newsletter Twenty-Three, November 2008