Ongoing Services

- Cavity-Free at Three Statewide Training
- How to refer children with developmental delays
- Provider Resource Helpline Helps Your Special Needs Children: Identify & Access All Resources and Care Coordination
- Medical Home Certification
- Post-partum Depression Screening
- Practice Manager's Meeting
   HEATHCARE INFORMATION TECHNOLOGY (HIT) INCENTIVE PROGRAM
   Is your practice eligible for federal stimulus dollars?
   Presented by: Robyn Leone, Director of the Colorado Regional Extension Center
   Tuesday, July 21st from Noon to 1PM @ TCH, RSVP carter.joyce@tchden.org
- Announcing an Interactive Cross- Cultural Communications Website Designed Especially for Healthcare Professionals
- Introducing the CCHAP Quick Reference Link
- Child Psychiatry Telephone Consultation on Medicaid Children
- Integrating Developmental Screening In a Pediatric Practice
- Medical Spanish Training For Your Office Staff
- Child Psychiatrist Available to Provide Conferences for You In your Office
- Language as a Communication Barrier in Medical Care for Hispanic Patients Plus A Spanish Course For Providers

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HEATHCARE INFORMATION TECHNOLOGY (HIT) INCENTIVE PROGRAM

You have probably heard about Federal dollars coming to Colorado to assist practices in affording to convert to electronic medical records or adapting their EHR for “meaningful use.”  This is a brief overview of the program.  The determination of eligible practices and assistance with obtaining the appropriate funding and assistance in implementation will be coordinated through CORHIO by the Colorado Regional Extension Center (CO-REC).  CCHAP will help CO-REC identify potentially eligible practices and CO-REC is contracting with other organizations to actually work with the practices.  This summary will introduce you to the criteria, so you can begin to determine whether you are likely to be eligible.  If you think your practice or a provider in your practice may be eligible, please contact Robyn Leone at 720-285-3245 or via email at rleone@corhio.org. Additional information regarding Regional Extension Center services in Colorado can be found on the CORHIO website, www.CORHIO.org.

The federal government has issued proposed rules for the HIT incentive program, including definitions of “meaningful use” and “certified” electronic health record systems.

WHO CAN PARTICIPATE?

• Eligible professional must be a “Medicaid provider” and must have a Medicaid provider ID number.
• Eligible professional is: Pediatrician(P); Non-Pediatrician(N): non-hospital based physicians, doctors of osteopathy, nurse practitioners and certified nurse midwives; Underserved (U) for needy populations, all other eligible professionals plus physician assistant-led rural clinics.
• Eligible professional must meet minimum thresholds of “patient volume,” which HHS has defined as the percent of Medicaid payable visits or encounters with a POS billing code of 11 (office).
• Eligible professional must be responsible for payment of the EHR technology costs (not a hospital or other entity).

ABOUT THE INCENTIVES

• Provider must elect to receive incentive payments from Medicaid; HHS will coordinate with the state to determine how and when incentive payments will be made.
• Medicaid incentive payments are meant to cover a portion of the cost of purchase and implementation of an EHR, and a portion of the support and maintenance costs for up to five years.
• If you are an early adopter of an EHR, you may or may not be eligible to receive the first year incentive monies. HHS is requesting public comment on this first year incentive for selection and implementation of an EHR in Medicaid practices where funds for the selection and implementation of the EHR already have been spent.
• There are currently no Medicaid penalties for non-adopters.

HOW MUCH MONEY?

• Maximum Medicaid incentive payment is approximately $63,750 over six years for eligible providers that see 30% or greater Medicaid visits
• Pediatricians with 20% to 29% Medicaid encounters can receive 2/3 of the maximum incentive payment or approximately $42,075. 
• Family physicians must be at or above the 30% level to be eligible.
• No incentive money is available before January 1, 2011 or after 2021.
• A start year after 2016 receives no incentive money.
• A start year before 2011 (early adopter) requires meaningful use, as defined by HHS and/or the state of Colorado, beginning January 1, 2011. 
• All others must demonstrate meaningful use beginning in the first subsequent year and each year after. Meaningful Use Criteria is available at:
  http://news.avancehealth.com/2010/01/meaningful-use-criteria.html

DO I QUALIFY?

• HHS has defined “patient volume” to be the percent of Medicaid visits or encounters billed with a POS code of 11 (office).
• You should be able to use data from your billing system (POS = 11, Responsible Party = Medicaid), to gather your actual past 12 month totals to use on the calculation.

DATA YOU NEED:

• TOTAL for last 12 months for this physician for ALL visits, or the number of patient encounters that you provided.
• Estimated or actual start year (first year of EHR technology selection and implementation). This first year may or may not require early adopters to also demonstrate meaningful use.

RESOURCES:
http://www.cms.org/HIT/1HITHome.html
http://www.corhio.org/

REGIONAL EXTENSION CENTER DETAILS:
Regional Extension Center or RECs were funded as part of the HITECH Act in the American Recovery and Reinvestment Act (ARRA), known as the federal stimulus bill. Three elements of HIT were included in the bill including the federal incentives discussed above, Medicare incentives, funding to advance Health Information Exchange (HIE) across the country and Regional Extension Centers to assist primary care providers towards meaningful use of an EHR. CORHIO, the state designated HIE was awarded grants for both HIE and REC services. Eligible providers in Colorado will receive the following services at no charge:

• General education and outreach on effective strategies and practices to select, implement and meaningfully use certified EHR technology
• Practice and workflow redesign
• EHR vendor selection and group pricing agreements
• EHR implementation and project management services
• Privacy and security best practices
• Progression toward meaningful use and interoperability (ability for your EHR to connect with the HIE)

Services are being delivered by one of six Colorado based healthcare organizations which include:

• Colorado Community Managed Care Network
• Colorado Foundation for Medical Care
• Colorado Rural Health Clinics & ClinicNET
• Health TeamWorks (formerly Colorado Clinical Guidelines Collaborative)
• Physician Health Partners
• Quality Health Network

The CO-REC has identified about 3,700 providers who meet the federal definition of Priority Primary Care Providers. It has set a goal of helping 2,295 of those providers to reach meaningful use in the next two years. The initial target group of about 1300 will be providers who are eligible for the EHR incentive program (see above) and who have existing relationships with CO-REC partner organizations (above). Some are practices that already have expressed an interest in working with the CO-REC.

CO-REC services will start with an assessment of a practice’s readiness for HIT adoption and practice needs. The CO- REC will provide resources for those practices that are waiting for services or have work to do to prepare, such as training for staff. It also is in the process of screening EHR vendors for a group-pricing discount.

Please contact Robyn Leone, the Director of the Colorado Regional Extension Center for more details. She can be reached directly at 720.285.3245 or via email rleone@corhio.org.

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Quality Improvement

Most practices that are starting QI are selecting a project to increase “family involvement” in their practice

Increasing Family Involvement in Your Practice
A medical home is not a building, house or hospital, but a team approach to providing quality and cost-effective health care. A Medical Home is a family-centered approach that provides comprehensive, continuous, coordinated, family-centered, accessible, compassionate, and culturally-competent care. Family Involvement, through Family-Centered Care, is this month's QI focus.

Family-Centered Care can be described as:

1. the practice of “recognizing family as the principal caregiver and center of strength, knowledge, and support for the child.” (HCPF)
2. a “trusting, collaborative, working partnership with families, respecting their diversity and recognizing that they are the constant in a child's life.” (Joint Principles of the Patient-Centered Medical Home)

What could Family Involvement look like in your practice?

    Family Feedback:
        •    Surveys of parents
        •    Focus groups with parents
        •    Families participate in an advisory role
    Care Coordination:
        •    Family members lead/ co-lead family support groups
        •    Families participate in decision-making regarding health care services and the development of the health care plan for their child
        •    Parents, as partners with the practice, co-manage their child's care using specialists for consultations and information (unless they    
             decide it is prudent for the specialist to manage the majority of their child's care)

Looking for other ways to involve families in your practice? The Medical Home Portal (http://www.medicalhomeportal.org/clinical-practice/building-a-medical-home/care-coordination) provides more information on families and family involvement, as well as specific ideas on how to directly incorporate family involvement in your practice. Check it out today!  

           
       
     
Thirteen CCHAP affiliated practices, after completing the MHI, have chosen to pursue Family Feedback as their QI project. As such, they are committed to gathering feedback from families regarding their perception of care through a systematic method. Each practice has created a survey, developed a process for their staff to review the feedback and begin problem solving. This level of QI places each of the following practices at a “Level 2 – Complete” on the Medical Home Index:

 
Obtaining a “Level 3 – Complete” on the MHI: in addition to systematically gathering feedback (from families through surveys, focus groups, or interviews), practices would need to create a parent  advisory group that directly involves families and empowers them to help practices identify needs and implement creative solutions.

There is value in Family Feedback!

• your practice has the opportunity to focus improvement efforts on areas that matter most to the families you serve
• it increases patient/ family satisfaction 
• it can improve health outcomes for the children, too

Want to look at a sample QI or sample Surveys?
 
Ready to implement a family survey?
 
It’s as Easy as 1 …2 … 3!

1. Contact your Quality Improvement Coach to get started! Angie can be reached at angela@cchap.org.
     
   
2. Meet with your QI Coach to plan and implement a project – including the use of applicable resources, as outlined above. Develop a QI plan using the Plan, Do, Study, Act (PDSA) cycle of improvement. Your QI Coach will assist. PDSA is a widely accepted model for the implementation of a QI project. PDSA is a relatively simple and effective way to evaluate and improve current or future processes by planning what you want to do, implementing the plan, studying the results, and then acting on your findings in order to produce better outcomes.
     
   
3. Study the results of your change package, and consider next steps: Did you reach your goal? How can you improve the outcomes of your QI project? What’s your action plan?

As always, your QI Coach is available for FREE technical assistance.
Angie Goodger, MPH, MHA
Quality Improvement Coach
720-346-4903 Cell
720-777-7338 Fax
angela@cchap.org

~ Quality is never an accident; it is always the result of high intention, sincere effort, intelligent
 direction and skillful execution; it represents the wise choice of many alternatives. ~
William A. Foster

Key Elements of Family-Centered Services -see the AAP Medical Home web site -
http://www.medicalhomeportal.org/clinical-practice/building-a-medical-home/care-coordination

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Practice Spotlight:
Family Involvement

 
Pediatric Partners of Glenwood, Glenwood Springs, CO

Pediatric Partners have had their survey in place for just over a year. During their planning phase, the practice determined that using a survey company would be cost prohibitive.  The first survey tool they created was a 10 question – yes or no – paper survey. At the same time, they started using Survey Monkey (www.surveymonkey.com) as a web based option for families to use. Brian McGill, the Director of Pediatric Partners, looked to Survey Monkey to provide basic analysis reports (which he found to be simple to use and create).

Their survey delivery method changed multiple times during 2009: from being handed out by the physicians at the end of the visit, to nurses at the start of the visit, and finally to registrars at check-in (which was consistent, but had lower response rates by families).

Barriers/ Lessons Learned:

• inconsistency in giving out the survey (at all points of contact)
• parents were eager to be on their way and therefore declined the opportunity to complete the survey
• staff expressed they were uncomfortable with incorporating the survey into the visit
• insufficient data: only 79 surveys were completed during 2009 – the practice did not feel they had enough surveys to study

Method:
Unsatisfied with their 2009 results, Pediatric Partners started the Plan Do Study Act Cycle (PDSA) over. Back to the drawing board, they decided that in 2010 they would have the registrars ask patients at check out if they would be willing to write down their email address so the Practice could invite them to complete a short on-line survey regarding their visit. The practice continues to use Survey Monkey (it allows users to create an email invitation linked to the survey and send it to identified email addresses).

Results:
So far, the change is working! Families are able to complete the survey when it is more convenient, and the survey link is embedded in the email so it is very simple to access and complete. Pediatric Partners is currently averaging a 30% response rate to invitations sent out and are averaging 30 responses a month!

McGill lists the following positive outcomes of family involvement through survey:

• new insight and comments have helped the practice to improve
• the staff is more conscious of their behaviors related to the survey questions and after some “tweaking,” the practice has focused their efforts and made improvements
  • Example: “Did the administrative staff thank you for your visit?”
  • Initial responses yielded more No’s than the practice wanted
  • Action: the registrar staff was challenged to bring the score up
  • Plan: Registrar staff changed their behaviors and began focusing on wishing everyone a farewell and to use the words “thank you” more often.
  • Study Results: increased positive results by almost 10%. 
• a general comments section helped validate the importance of wait times

The Pediatric Center, Boulder, CO

The Pediatric Center used a paper survey prior to completing the MHI. However, after looking at survey results from 2009 (there were only 3 completed surveys), Judy Dietz (Practice Manager) decided that it was time to consider a change to their process. During the Planning phase of their PDSA cycle, Dietz decided to review their survey questions and to change modalities. Her rationale was twofold: (1) that the questions needed to be pertinent and actionable, and (2) that it is difficult for families to complete a survey while at the clinic (ill children, caregivers needed to get back to work, etc.). It was time for change.

This time around, she would try an electronic survey and hope to:
        1.    eliminate any need for staff time to tally results
        2.    use customizable (Survey Monkey) reports and graphs
        3.    allow families to complete the surveys when most convenient

Method:
Families receive an email asking them to complete a survey. Data will be reviewed quarterly during staff meetings, the practice will identify areas of concern and appropriate Action Plans will be developed and implemented.

Results:
After their first month of using Survey Monkey, they had 232 respondents (return rate of approximately 23%)! With so many responses, The Pediatric Center now has meaningful data to review and can begin problem solving. Dietz has been very happy with the decision to use Survey Monkey due to its ease of use and cost effectiveness.

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Practice Manager’s Corner - June

Kevin Heckman

Transportation
Transportation options are available for your Medicaid and CHP+ patients…

LogistiCare
Did you know that ALL Medicaid participants are eligible for transportation benefits? LogistiCare offers transportation services at no cost to Medicaid recipients:

RTD (Metro Denver)
Access-a –Ride (Not paid by Medicaid)
Access-a-Ride provides transportation to passengers with disabilities who are unable to use RTD’s regular lift-equipped fixed route bus service and who qualify for certification under the eligibility guidelines established by the Americans with Disabilities Act (ADA) of 1990. The Access-a-Ride program is open to persons with disabilities under the following conditions:
    1.    An individual requires a lift-equipped bus and the bus they need does not have a lift.
    2.    An individual is unable to independently get to and from a bus stop or cannot get on and off the bus.
    3.    An individual is unable to understand how to complete bus trips.
Taxi
As a Last Resort: CCHAP affiliated providers can utilize CCHAP Taxi Accounts for CHP+ and uninsured patients or when Medicaid cannot provide services for Medicaid patients.  CCHAP will pay for taxi service as a last resort to finding transportation. Records must be kept by the practice and provided to CCHAP so we can track usage for payments of taxi invoices.  Your CCHAP transportation chapter 8 has the log for your use to keeping this recorded and faxing this to CCHAP.

Medicaid Add-A-Baby Process Update
The Department is currently experiencing a 3 week delay in processing the Add-A-Baby requests. In March there were 1,618 requests, note that 350 of them were duplicate requests; therefore 1,268 babies were added in the month of March. As of April 30th there are 1,309 requests, many of which may include duplicate requests. This has added more processing time – each request is researched before it is identified as a duplicate.

A temporary state worker has been hired through June 30, 2010 to help with the requests; in addition, there is an FTE who dedicates 50 percent of their time to processing requests.
If you have an emergent request, please contact Shawna Moreno at 303-866-4456.

Note: Tracy Vallejo ((303) 866-6103) can also work Emergent Add-A-Baby’s. If you can’t reach her or Shawna Moreno, then you can contact their supervisor Gail Seller (303) 866-2139.

Medicaid and CHP+ Eligibility Expansions
Almost 70,000 more Coloradans will be eligible for Medicaid and CHP+ as of May 1, 2010. This is the first expansion as a result of the Colorado Health Care Affordability Act provider fee.
An estimated 44,000 parents who have a child on Medicaid and 24,000 children and pregnant women will be eligible for health care coverage as a result of the hospital provider fee, at no cost to the taxpayer.

CHP+ eligibility is increasing from 205% of the FPL, or $45,000 per year for a family of four, to 250% FPL, or about $55,000 per year for a family of four. Eligibility for parents with a child on Medicaid can now make up to 100 percent of the federal poverty level - $22,056 per year for a family of four. This is up from 60%, or $13,234.

FY 2010-2011 Medicaid Reimbursement Reductions
Effective July 1, 2010, most fee-for-service (FFS) reimbursement rates will be reduced by 1%. This is the rate reduction for 2010 that we reported to you early in 2010.  This is not a new rate reduction.  Rates paid to physical health managed care organizations will also include a corresponding decrease as these provider payments are based on FFS expenditures.  The Pay-for-performance fee practices receive for being a medical home for children on Medicaid (CCHAP-affiliated practices) is not affected.
Affected services include:
  •    Physician and Clinic
  •    Early Periodic Screening, Diagnosis, and Treatment
  •    Emergency and Non-Emergent Transportation
  •    Dental
  •    Vision
  •    Occupational, Physical, and Speech Therapy
  •    Rehabilitative
  •    Outpatient Substance Abuse Treatment
  •    Ambulatory Surgery Center
  •    Dialysis
  •    Anesthesia
  •    Laboratory and Radiology
  •    Durable Medical Equipment and Supplies
  •    Drugs Administered in the Office Setting Including Vaccine Administration
  •    Family Planning
  •    Hospital

An updated fee schedule reflecting these rate changes will be posted in the Provider Services section of the Department of Health Care Policy and Financing’s (the Department’s) Web site at colorado.gov/hcpf in July 2010. Please contact Christy Hunter at 303-866-2086 or christy.hunter@state.co.us if you have any questions.

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Guidelines for Working with Interpreters

By Marcia Carteret

Consistently, one of the biggest challenges faced by health care professionals is communicating with patients and families who have limited English proficiency. In this issue of the CCHAP cross-cultural communications newsletter, we focus on some basic guidelines to follow when working with an interpreter. Though the context of each patient encounter is unique, there are some fundamentals of working with interpreters that can make a significant difference in patient understanding and compliance. These guidelines may take a little more time and planning up front, but can actually save time in the long run by decreasing miscommunication.
Hold a brief pre-interview meeting with the interpreter.
Plan to meet with the interpreter for a couple of minutes before the interview to explain the situation and any background needed for understanding what you plan to talk about. Agree with the interpreter in advance on such things as how the interview will start and where the interpreter should sit.
Plan to allow enough time for the interpreted sessions.
Schedule enough time for the interview, remembering that an interpreted conversation requires every statement or question to be uttered twice. If family members are part of the conversation, it will further extend the time needed. Remember that what can be said in a few words in one language may require a lengthy paraphrase in another.
Don’t ask or say anything that you don’t want the patient to hear.
Expect everything you say to be interpreted as well as everything the patient and his family says.
Use carefully chosen words to convey your meaning, and limit the use of gestures.
When speaking English, you may be used to supplementing your words with gestures to help convey your meaning. Competent interpreters will convey the meanings of your words and not take the liberty of interpreting your gestures. The patient may be confused by gestures that are not linked to words they understand, and may misinterpret your meaning.
Speak in a normal voice, clearly, and not too fast or too loudly.
You don’t need to speak more loudly or slowly (unless the interpreter asks you to slow down). It is usually easier for the interpreter to interpret speech produced at normal speed, with normal rhythms, than artificially slow speech.
Avoid jargon and technical terms.
Avoid idioms, technical words, or cultural references that the interpreter might have difficulty translating. (Some concepts may be easy for the interpreter to understand but extremely difficult to translate.)
Keep your utterances short, pausing to permit the interpretation.
For consecutive interpreting, you should speak for a short time—one longer sentence or three or four short ones—and then stop in a natural place to let the interpreter pass your message along. Be aware of the length and complexity of your speech so as not to unduly tax the interpreter. She may need to hear the whole sentence before she can even start to interrupt it.
Ask only one question at a time.
If you string questions together, you may not be able to match questions with answers, and you may confuse the patient.
Expect the interpreter to interrupt when necessary for clarification.
Let the interpreter know that you are prepared for him to interrupt when necessary, to ask you to slow down, to repeat something he didn’t quite get, to explain a word or concept he might not be familiar with, or to add background information for the patient’s increased understanding.
Expect the interpreter to take notes if things get complicated.
Don’t be surprised if the interpreter takes notes to facilitate recall. This is an aid to memory, not an interruption.
Be prepared to repeat yourself in different words if your message is not understood.
If mistranslation is suspected (for example, the response doesn’t seem to fit with what you said), go back and repeat what you said in different words.
Have a brief post-interview meeting with the interpreter.
Meet with the interpreter again after the interview to assess how things went, to see if the interpreter is satisfied or has questions or comments about the process of communication.
Remember that the interpreter is not there (just) to interpret for the patient or to interpret the patient’s language.
The interpreter is there to interpret for two clients who don’t know each other’s languages, you and the patient. The interpreter is there to facilitate communication between the two of you.
Use a seating arrangement in which you, the patient, and the interpreter form the points of a triangle.
This arrangement makes it easy for the provider and patient to address each other directly, both verbally and visually, and for the interpreter to support both parties in the exchange of information.

Read related newsletters on this topic listed under newsletters at www.dimensionsofculture.com
Some Basics for Conversing Across Cultures
8 Tips for Conversing With Limited English Proficiency Patients and Families

Resources: The information provided in this newsletter is borrowed with permission from The Provider's Guide to Quality and Culture, a joint project of: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, and Management Sciences for Health (MSH) at erc@msh.org.

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Health Care Reform
From the Governor’s Office

Greetings –
It is our pleasure to announce the availability of Colorado’s new Health Reform website (http://www.colorado.gov/healthreform), a dedicated portal for information and communication on the national Patient Protection and Affordable Care Act and its implementation in Colorado.

We will update this site with the most pertinent and important information on health reform and its effects on Colorado.  Please take a moment to look through the site to find information on the immediate benefits of the legislation, projected impacts on coverage and affordability in Colorado, long term initiatives and system changes, and many other aspects of these historic policy reforms.  

This site will also house information on the work underway in state government to successfully implement the many provisions of the Patient Protection and Affordable Care Act, including the proceedings of the Interagency Health Reform Implementing Board and some of the most immediate initiatives such as the Temporary High Risk Pool and other upcoming grant opportunities.

http://www.colorado.gov/HealthReform

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Cavity-Free at Three

Cavity Free at Three is a statewide effort aimed at improving oral health in children and pregnant women.  We are working with CCHAP to offer our program model to interested participants.  Recent Medicaid guidelines allow primary caregivers to provide oral health counseling along with fluoride varnish application and receive reimbursement for these services.  In order to participate, the medical provider as well as staff members involved in this provision of care should complete online training through the Smiles for Life Curriculum.  

Simply visit  http://www.smilesforlife2.org, and complete Module 2:Child Oral Health and Module 6: Fluoride Varnish.   After the online process is completed, we plan a coordinated effort for site visit based training opportunities offering hands on demonstrations as well as follow up and support of our program.

We are in the process of coordinating training opportunities throughout the state of Colorado beginning early 2010.  This will allow for representatives from your group to attend trainings in your area.  If you are interested in hosting a training, or learning more about Cavity Free at Three opportunities, please contact Anita Rich at rich.anita@tchden.org.  If you have questions specific to our program, please contact karen.savoie@ucdenver.edu or visit  http://cavityfreeatthree.org. Thank you.

Announcements:

Thank you to Pediatric Partners of Glenwood Springs, particularly Brian McGill, for coordinating a Cavity Free Training on February 16th.  15 people attended.  That is a great turnout.  

More training is scheduled for March. March 18th in Durango hosted by Pediatric Partners of the Southwest and on March 26th hosted by Miramont Family Medicine in Ft. Collins.

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How to Refer Infants and Toddlers for Early Intervention Services

Bill Campbell

This is a quick reminder that for children suspected of having developmental delays, the referral resources depend on the age of the child.   Refer  infants and toddlers to Early Intervention Colorado if they are suspected to have significant developmental delays, or if they have any health conditions associated with a high probability of developmental delay.  Refer preschoolers and children not already enrolled in public school to Child Find for similar concerns.  For families whose children are already enrolled in public school, the parents have the right under special education law to request a comprehensive educational evaluation, but it’s best if they start by request a formal meeting with school staff, including the teacher, a special educator, and a school administrator.  At the end of this article you’ll find a link to a referral flow chart that outlines the decision-making process for referring children of different ages for developmental and educational assessments, but the following paragraphs will focus on how to refer infants and toddlers for early intervention services.

Developmental delay is common among infants and toddlers (at least 10 percent of infants and toddlers have delays in one or more areas of development).  Early intervention services have been shown to be effective in helping children with developmental delays, particularly children with autism spectrum disorders and other communication handicaps.  All 50 states have developed early intervention programs in accordance with Part C of the Individuals with Disabilities Education Act.  All 50 states also have special education procedures and services for preschoolers and school-age children.  

Colorado’s early intervention program is called Early Intervention Colorado (formerly Early Childhood Connections), or “EI Colorado” for short.  It’s designed to promote the best possible outcomes for infants and toddlers (birth up to 36 months of age) who have significant developmental delays (or health conditions associated with a high probability of developmental delay).  In order to take advantage of early intervention services during this critical developmental period, families need to know how to access them.  The following paragraphs explain this, and additional information can be found in the “Make a Referral” section at www.eicolorado.org.

While anyone – including the parents -- can refer a family to EI Colorado, primary care providers (PCPs) are the main source of referrals.   And using a standardized screening test is the most reliable way to identify children with delays.   A recent quality improvement initiative in the Denver metro area suggests that infants and toddlers are more likely to proceed through the evaluation phase if the PCP sends a referral form to the local EI Colorado program, in addition to having the family call the referral contact person there.
The PCP should inform the family that further evaluation is recommended to see if the child and family may benefit from early intervention services.  You can give the family an early intervention flier or panel card that briefly explains this, and also tells the family how to contact their local EI Colorado program.  These informational cards can be obtained for free from your local EI Colorado program office (e.g., from Denver Options for those residing in Denver), or you can order panel cards for free on the EI Colorado website (www.eicolorado.org) by clicking the “order public awareness materials” link on the home page or in the “Make a Referral” section.  You’ll find a lot of other information in the “Make a Referral” section, such as explanations of the early intervention assessment process and even links to professional medical society recommendations for the medical evaluation of children with developmental delay.

The process for having the infant or toddler evaluated begins with making a referral to EI Colorado.  The referral form should be completed by the PCP office during the visit, and the parent or legal guardian should be asked to sign the consent to release medical information at the bottom of the referral form.  You can obtain referral forms in English and Spanish for free from the EI Colorado website.  Or you can access the referral forms specific to your local EI Colorado program in the “Make a Referral” section of the website by clicking on the “Make a Referral” link and then scrolling down to the link that says: “To refer to Colorado's early intervention system click here to locate the appropriate Community Centered Board! (includes referral form)”.  You’ll then be taken to a page where you can enter or search for the specific local EI Colorado program, which will then take you to a page with that program’s contact information and links to referral forms with preprinted local program name and fax number.  I’ve found it easiest to keep preprinted referral forms handy rather than printing a form for every referral.

If the child was referred because of concerns on standardized developmental screening, please document the tool you used and fax the screening instrument along with the referral form; this will help the evaluation team understand the screening results and develop an assessment plan without repeating the screening.  I should mention at this point while the evaluations are conducted by Child Find teams from the local school districts or BOCES, the local EI Colorado programs arrange these and provide coordination throughout the process, so please refer infants and toddlers to the local EI Colorado programs directly (a service coordinator will be assigned and contact the local Child Find team within a couple of days).

Provide the family with a copy of the referral/consent form and the contact information for the local EI Colorado program, and arrange a follow-up visit for about 2 months later.  Explain to the family that a service coordinator will be assigned within a couple of days of the referral to help the family through the next steps; the developmental assessment should be completed within 45 calendar days, as well as the Individualized Family Service Plan (IFSP) if the child is found to be eligible for services (both are at no cost to the family).  Ask the family to bring copies of the IFSP and any evaluation reports.  Even though the Early Intervention and Child Find teams do not provide medical diagnoses, their findings can be important to you in helping the family understand the significance of the developmental delays and in guiding further appropriate medical evaluations.

Speaking of medical evaluations, you may have already initiated some when you first became concerned about possible developmental delays.  For example, children with language delay should be referred for formal audiology evaluations.  You don’t need to wait for audiology or other medical evaluations or treatments to be completed before referring to EI Colorado for early intervention evaluations and services.  The link to the referral flow chart at the end of this article illustrates the parallel processes for medical and developmental evaluations.  Professional medical society recommendations during recent years have offered specific recommendations regarding the medical evaluation and follow-up by primary care physicians/clinicians for children with developmental delay, cerebral palsy, and autism spectrum disorders.

And speaking of developmental evaluations, you can usually wait for the results of the early intervention or special education evaluations before referring for diagnostic medical developmental evaluations, such as those done in the Child Development Unit at The Children’s Hospital.  But if an autism spectrum disorder is suspected, then you should refer simultaneously to EI Colorado (for early intervention services) and to a medical center or clinic with special expertise in autism spectrum disorders (for the diagnostic medical evaluation).  The referral flow chart below gives other examples of where to refer children for medical or behavioral evaluations and treatment.

Click here to view the referral flow chart

I hope this information is helpful to you in getting early intervention services for infants and toddlers as soon as possible, and in getting preschoolers and school age children the help they need.

Please feel free to call me with any questions at 720-777-6632, or email me at Campbell.william@tchden.org.

Also see these two web sites for more detailed algorithms

The link for the 0-3 year-old flow diagram: click here
The link for the 3-5 year-old flow diagram: click here

These are the referral forms that are used state wide for Early Intervention.

• English - click here
  
• Spanish - click here

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The Provider Resource Helpline Helps Your Special Needs Children:
Identify and Access All Resources
Assists with Care Coordination

          The American Academy of Pediatrics has promoted the concept of providing a medical home for children with special health care needs for over a decade.  At a recent focus group of family physicians and pediatricians discussing medical home, primary care providers said that finding the available resources and coordinating care for children with multiple problems was the most challenging of the roles of a medical home.  
          The Provider Resource Helpline is a service created to address this need through a collaboration among CCHAP, Family Voices, and the Colorado Department of Health Care Policy and Financing (HCPF), which administers Medicaid and CHP+.  Family Voices of  Colorado is a chapter of the national, grassroots organization composed of families and friends who care for and about our children with special health care needs.

Provider Resource Helpline
Helping care for our children with special health care needs

Information for families
Valuable community resources
Care coordination

1.877.731.6017

The Colorado Provider Resource Helpline is here:

• To give providers information and access to valuable community resources for children with special health care needs.
• To provide case management and care coordination services to families.
• To identify shortages in services/barriers through the data collected.
• To provide family-centered programs, training and education.

When Calling, Please Have the Following Information:

• The PCP name and office phone and fax information.
• Name and date of birth of patient.
• Medical condition / disability of patient.
• Resource question or service need of patient/family.
• Family Contact information, if the provider wishes us to follow up directly with the family.

If the helpline can answer your question immediately, you can provide the information to the family while they are still in the office.  If we are unable to answer immediately, we will contact you with an answer as soon as possible following the patient’s visit (via phone, fax, or email). 

Download Flyer

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Medical Home Certification

Around 50 of the 150 pediatric and family practices that CCHAP currently works with are in the process of obtaining “medical home certification.”    The Colorado Department of Health Care Policy and Financing (HCPF), which administers Medicaid in Colorado, is directed by  Senate Bills 07-130 and 07-211 to document that children on Medicaid receive care in a quality medical home.  So, HCPF is asking practices that are receiving the enhanced reimbursement (as a CCHAP – affiliated practice) to obtain Medical Home Certification to document the quality of the medical home they provide to children on Medicaid.  Practices that have affiliated with CCHAP in the past 8 months have already begun the certification process.  The remaining CCHAP-affiliated practices will be asked to begin the certification process very soon.  

Medical home certification is a three step process.  The CCHAP orientation is step one.  The following are the two steps needed for medical home certification for practices that were oriented in the past and are already receiving the enhanced reimbursement.  Each CCHAP-affiliated practice will be asked to:

• Conduct a self-assessment survey of practice staff and providers called the Medical Home Index.  This brief survey seeks to determine your perception of how well you are doing in providing a medical home.  The survey also will be given to some parents in your practice.
• After reviewing your survey results, you will be asked to select some aspect of “medical home-ness” to improve using a quality improvement process.  CCHAP staff is available to coach you through the quality improvement process if you wish and we have QI projects already prepared for you to implement easily in your practice if you wish.  You may already have QI projects going, which will likely meet this objective.

Medical Home
The American Academy of Pediatrics and the American Academy of Family Practice have promoted the concept of a medical home for many years now.  A recent combined statement by the two academies reaffirmed their support of the concept.  The Academies believe that all children should have a medical home where care is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective.  For a reminder of the American Academy of Pediatrics and the American Academy of Family Medicine description of a medical home for children, click here. 
And if you want someone to come to your office to present a more description of what a medical home is and does, please contact: Anita Rich (Rich.Anita@tchden.org) or Angie Goodger (angela@cchap.org) for more information.

Medical Home Index
Starting in April 2009, recently oriented CCHAP practices began the process of Medical Home Certification.  The Medical Home Index is completed at a group meeting of your practice with as many of the practice staff and providers as possible. During this meeting the group will complete a Medical Home Index self-assessment, discuss how each indicator rated relates to a quality Medical Home.  The facilitator will conduct informal interviews of families coming to your practice that day asking them to assess the practice’s medical “homeness.”  For a look at the medical home index, click here.

Quality Improvement Projects
Within a few weeks after the practice takes the MHI, you will be contacted by a Quality Improvement Coach with CCHAP. At that time, you will receive your Medical Home Index results, as well as guidance as to how to interpret the results. HCPF asks that you select an element of being a medical home that your practice wishes to work on.   The Quality Improvement Coach from CCHAP – at no cost to your practice – is available to help you decide what your practice would like to work on, develop strategies for making the changes you want to make, and measure the effectiveness of the resultant changes.   

The higher reimbursement practices receive for preventive care is the reward for your practice’s commitment to providing a quality Medical Home for children on Medicaid.

AAP and AAFP Board Certification for pediatricians and family physicians
Both the AAP and the AAFP require that all physicians, when they recertify, develop a quality improvement project in their practice as part of their recertification.  So, CCHAP is helping you obtain both professional board certification and Colorado Medicaid medical home certification.

For more information
Shortly, we will be expanding the Medical Home Certification process to all CCHAP practices.  More information will follow. You may also contact Anita Rich (Rich.Anita@tchden.org) or Angie Goodger (angela@cchap.org) for more information.

Quality Improvement Coach
Your CCHAP Quality Improvement Coach is Angie Goodger. Angie holds masters degrees in Public Health and Healthcare Administration.  Angie comes to us from Minnesota where she previously worked as a home healthcare manager. Angie is very excited about working with your practice using Quality Improvement methods to work on those issues you want to address.

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The Colorado Pediatric Postpartum Depression Screening and Referral Toolkit

Developed by Brian Stafford, MD, MPH
Medical Director, Perinatal Mental Health Program, The Children’s Hospital

Click here to download the complete toolkit to enable a primary care practice
to recognize and refer women with post-partum depression.    

Why should every pediatric and family practice implement this toolkit?

•  Postpartum depression is a serious medical and psychiatric illness and a significant health concern.
• Approximately 12% of all new mothers develop symptoms consistent with a major depression in the post-partum period
• If left untreated, half of these mothers, about half will continue to have symptoms that last greater than1 year.
• These symptoms include sadness, lack of energy and pleasure, irritability, guilt, anxiety, as well as thoughts of wanting to harm the infant.
• Several lines of research have shown that post-partum depression has significant risk for the child’s cognitive, social, and emotional development and may impact school readiness.
• In addition, the depressive symptoms lead to difficulties in the mother-infant and parental relationship.
• The depressive symptoms are also associated with excessive urgent care and emergency room visits as well as missed scheduled routine pediatric visits.
• Providing pediatric anticipatory guidance to a depressed caregiver does not change any parental behaviors in regard to safety, sleep, nutrition, reading, and interaction.
• Pediatric care providers of infants are in a strategic position to screen and refer depressed mothers for behavioral health evaluation and support.
• Pediatric provider inquiries about maternal health have been viewed as appropriate by mothers.
• Pediatricians, historically, like other primary care providers, have low rates of detecting maternal depression and few pediatricians have a systematic approach to screening for maternal depression.

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Announcing an Interactive Cross-Cultural Communications Website
Designed Especially for Healthcare Professionals

dimesionsofculture.com

 
Register now! Click the link above and get full access
with your own secure login and password!

A Website to Support On-going Training for Healthcare Professionals in Colorado

Because culture can have important clinical consequences, this website is devoted to supporting the self- development of healthcare professionals in basic cross- cultural communication competencies that impact health outcomes for patients. In place of the typical "diversity training" approach, practical communication strategies are emphasized that can be put to use immediately in private practices, clinics, and hospital settings.

An Interactive Website for Building a Learning Community
 
The content of this cross- cultural communications website focuses on reinforcing key concepts presented in cross-cultural communication trainings by Marcia Carteret. Additionally, this site presents the opportunity for physicians and staffs in multiple healthcare settings to interact with one another through threaded discussions. Because nothing can replace real life experience in the learning process, a virtual learning community will make it possible to share true stories and post useful questions while culture and medical experts facilitate discussions.
 
Website Features
 
Listed here are the pages that currently make up dimensionsofculture.com. Please note that some pages require a login and password because only select groups of healthcare professionals, including all CCHAP pediatric practices, will have full access to the “community” pages.

Public Pages

• Home Page
• Greetings from the Site Editor
• Culture Calendar- Monthly religious and cultural holidays
• Culture Quest – Information about cultural happenings in our community, as well as statewide and nationally.

Healthcare Community Pages (Login/Password Protected)

• Newsletters – Monthly articles addressing key cross-cultural communication topics written by Marcia Carteret and other guest contributors.
• Interactive Forums– an interactive on-line community dialogue between healthcare professionals about communicating with patients from different cultural backgrounds. 
• Provider Profiles– An ongoing series of profiles introducing some of the dynamic and culturally diverse doctors working in the CCHAP network of pediatric practices
• Culture Ambassadors – A panel of representatives from cultures around the globe, with a strong focus on the cultures most heavily represented across out state.

This website is designed to meet the needs of the healthcare community served by Colorado Children’s Healthcare Access Program. If you are a participating CCHAP provider or staff member and have suggestions for the website, please contact Marcia Carteret at mcarteret@gmail.comor 720-777- 3124. Your comments and suggestions will help make dimensionsofculture.com an effective tool for learning and community building.

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INTRODUCING THE CCHAP QUICK REFERENCE LINK!

Do you need to know the one telephone number to call for a Medicaid mental health referral?  Want to reach the CCHAP social worker?  Need help in finding resources for a special needs child?  Having trouble remembering all of the 14 support services CCHAP provides for your practice?    We have a quick reference link for your desk top!  For these things and many more…

Recently, our advisory group of physicians and practice administrators suggested an idea for a quick and easy way to access CCHAP affiliated resources for frequently used contacts and services.  We liked the idea and have developed a web link that will quickly access a single page that contains contact information as well as additional links to documents and web pages.  The goal is to have a computer desktop shortcut that, with just a click or two, will provide CCHAP affiliated providers and staff with the information you need, when you need it.  

Because this new tool is for you, we want it to be pertinent and efficient.  So please, if you have ideas as to how to improve on this, contact Kevin Heckman heckman.kevin@tchden.org or 720.777.6309, our Program Administrator, with your feedback and suggestions.  Thanks!

INSTRUCTIONS:

1. Click on this link http://www.cchap.org/qr/ to open the Quick Reference Link web page (Note: you can also type this address into a web browser manually).
2. In your browser window menu (upper left corner) click File>Send>Shortcut to Desktop. 
3. The Quick Reference Link is available from any computer with internet access.

Kevin C. Heckman
Program Administrator
CCHAP
720.777.6309

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All CCHAP-affiliated Practices Now Can Receive
TELEPHONE CONSULTATION ON MENTAL HEALTH ISSUES
FOR CHILDREN ON MEDICAID

Rick March is a child psychiatrist who has received grant monies to provide phone consultation regarding children and adolescents with mental health problems throughout Colorado.  He has over twenty years experience in child psychiatry and is available weekdays during regular business hours.  If you do not reach him directly, he would be able to speak with you, at the outside, by the next business day.  Dr. March is at the Mental Health Center of Denver which provides services for children who live in Denver County.  However, he may be able to arrange to see other patients outside this catchment area, possibly in your practice in very difficult cases.  He is also available to provide educational presentation for your providers on a wide variety of mental health topics.

His direct line is 303-504-1500

So, telephone consultation from a child psychiatrist for Medicaid children cared for in a CCHAP-affiliated practice is now available in all counties in Colorado.  

For Boulder and Jefferson Counties – Don Bechtold, MD – 303-432-5172
For Adams, Arapahoe and Douglas Counties – Joe Pastor, MD – 303-853- 3888
For all other counties (including Denver) – Rick March, MD – 303-504-1500

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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.comto view and order the PEDS tool online.

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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.

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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
• Kids 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…

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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

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Copyright 2010 Colorado Children's Healthcare Access Program and other entities as noted.

 CCHAP Home > Newsletter Articles > Newsletter 39, June 2010