Special Health Care - San Bernardino County,...
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Transcript of Special Health Care - San Bernardino County,...
Special
Health
Care
Needs
Created by: Marjorie Yanez, SSSP
Presented by: Marjorie Yanez, SSSP
Karen Quinn, Sr.SSP
Agenda
– Mission
– Medical Fragile / Medical at Risk/ Special Health Care Needs
– WIC 17710 Simplified
– Individualized Health Care Plan
– Placements
– Conclusion and questions
San Bernardino County CFS
Mission
– Protect endangered children , preserving and strengthening their families
– Develop alternative family settings
– Seek the safety, permanency and wellbeing of children
– Provide mental health services timely
– Support family and sibling connections
– Adhere to the Core Practice Model
SB County SHCN Unit Mission
– To promote the health and wellbeing of children who have Special Health Care
Needs by providing support, stability of placement, intensive support services
and resources in collaboration with the health care community, Public Health
Nurses and CFS regions.
Medical Fragile- Medical at Risk
– Medically fragile is a term used by medical personnel which refers to a child
who may be dependent upon multiple technologies to survive. It is also a term
used under Title 22 and the Health and Safety Code to describe some medical
conditions found under WIC 17710; which identify a child as meeting SHCN
criteria. (Title 22 5-2220; HSC 1760.2 (b)
– In SB County, Medical at Risk (MAR) refers to children who are at-risk of
complications due to a medical condition and must be monitored.
(SBC-CFSHB #1205 (08/17) 4-P2-3)
WIC 17710
SHCN
– (a) “Child with special health care needs” means a child, or a person who is 22 years of age or younger who is completing a publicly funded education program
– who has a condition that can rapidly deteriorate resulting in permanent injury or death or
– who has a medical condition that requires specialized in-home health care, and
– who either has been adjudged a dependent of the court pursuant to Section 300, has not been adjudged a dependent of the court pursuant to Section 300 but is in the custody of the county welfare department, or
– has a developmental disability and is receiving services and case management from a regional center.
Medical Conditions (WIC 17710)
– (g) Medical conditions requiring specialized in-home health care require
dependency upon one or more of the following: enteral feeding tube, total
parenteral feeding, a cardiorespiratory monitor, intravenous therapy, a
ventilator, oxygen support, urinary catheterization, renal dialysis, ministrations
imposed by tracheostomy, colostomy, ileostomy, or other medical or surgical
procedures or special medication regimens, including injection, and intravenous
medication.
SHCN Identifying Conditions (WIC 17710)
Medical Condition Additional Information
Cardiorespiratory Monitor
Colostomy
Enteral feeding tube G-Tube, percutaneous endoscopic gastronomy, and nasogastric tube.
Ileostomy Surgical opening to facilitate passing of intestinal waste.
Intravenous therapy (IV MEDS)
Ministrations imposed by tracheostomy Care related to tracheostomy
Medical or surgical procedures
Requires specialized in-home health care may include but not limited to certain shunts
SHCN Identifying Conditions (continued)
Medical Condition Additional Information
Special medication regimens, including injection and intravenous medication
Requires ongoing medical injections in the home including but not limited to injections for: diabetes management, anti-rejection medication, growth hormone injections, and medication for pulmonary hypertension.
Oxygen support
Total parenteral feeding (TPN) Nutritional Substitute via intravenous (IV) route
Urinary Catheterization
Ventilator
SHCN Identifying Conditions (Title 22)
Medical Condition Additional Information
AIDS
Bronchopulmonary dysplasia (BPD) Chronic lung disease usually in infants
Certain Congenital Defects Such as: • Hydrocephalus • Sickle Cell Anemia • Cystic Fibrosis
Premature Birth Infant is small, usually weighing less than 2.5 kg (5.5 pounds)
Severe asthma Infants receiving prescribed medication or using an aerosol machine or intermittent positive pressure breathing machine for severe chronic asthma
SHCN Identifying Conditions (Continued)
Medical Condition Additional Information
Severe Seizure Disorders A child may experience a grand mal seizure or go from one seizure to another as in status epilepticus. The infant or young child, who is prone, despite the correct administration of medications and/or medical procedures, to sudden relapses that call for re-hospitalization or the intervention of a health care professional to avoid further disability.
Severe gastroesophageal reflux (GERD) Chronic digestive disease usually in infants up to 18 months
Non- SHCN / Health Difficulties
Health Difficulty Additional Information
Cerebral Palsy CP in and of itself does not qualify for SHCN. If the child has additional medical concerns further evaluation is needed
Diabetes Controlled by oral medication
Failure to Thrive For all FTT children, the SW must consult with the SHCN duty worker
HIV Refer to CFS HB Volume 4, Chapter T
Mild Asthma
Multiple Fractures
Sickle Cell
Spica Cast Cast used to immobilize the hip or thigh
Wheelchair A child/youth may require a small family home licensed for non-ambulatory clients, but that does not qualify them for SHCN. The child/youth still need to meet the medical conditions described for SHCN.
Who Does Not Qualify?
– Conditions that are primarily psychological or behavioral. For example, Bi-polar,
Autism, and /or developmental delays unless these go together with another
SHCN qualifying condition.
INDIVIDUALIZED
HEALTH CARE PLAN
(IHCP)
WIC 17731 (c) (1)
RFA Section 11.1-05
– Prior to the placement of a child with SHCN, an individualized health care plan,
which may be the hospital discharge plan, shall be prepared for the child and, if
necessary, in-home health support services shall be arranged.
– A Specialized Resource Family shall not accept a child with special health care
needs unless the Resource Family has obtained an individualized health care
plan for the child.
Individualized Health Care Plan (IHCP)
– Per RFA it means a written plan developed by an individualized health care plan
team and approved by the team physician, or other health care practitioner
designated by the physician to serve on the team, for the provision of
specialized in-home health care to a child with special health care needs as
specified in Welfare and Institutions Code section 17731.
(RFA Written Directives Version 4.1 Date: 06/09/2017)
Individualized Health Care Plan (WIC 17731)
• Developed by the child's physician or his or her designee
• Can be the hospital discharge plan
• It is convened by the county social worker or regional center worker
• Way to discuss the specific responsibilities of the person or persons specified under
Section 17710 (h) for provision of in-home health care in accordance with the IHCP
• May include the identification of any available and funded medical services that are
to be provided to the child in the home
• Delineate the coordination of health and related services for the child
WIC 17731 (c) (1)
IHCP Meetings
– Intended to promote a safe transition for the child.
– A brief medical history is given, future medical needs/ appointments of the child are discussed, as well as who will be responsible for completing the different parts of the plan.
– Placement paperwork is completed by the Social Worker. A signed medical consent and straight Medi-Cal must be provided to caretaker.
– Held on the day that the child is discharged from the hospital (Initial IHCP), every six months, when a child’s needs change and at every placement change.
– Count as a CFT meeting for class and sub-class. Meetings include informal supports, mental health and schools when indicated, providing a holistic approach.
Who are the team members?
– Primary care physician or other health care professional designated
by the physician
– Any involved medical team
– Health care professionals designated to monitor the child’s IHCP
– If the child is in a certified home, the registered nurse employed by
or under contract with the agency to supervise and monitor the child
– Representatives from the California Children’s Services Program or
the Child Health & Disability Prevention Program, or regional centers
Team Members (continued)
– the county social worker or regional center worker
– a public health nurse
– county mental health representative
– the prospective specialized foster parents, who shall not
participate in any team decision per WIC
– and where reunification is the goal, the parent or parents, if
available and appropriate
WIC 17731; WIC 17732 & WIC 17710
PLACEMENTS
Options / Steps
SHCN Placement Options
– Specialized Resource Families
– Foster Family Agencies
– Small Family Homes
– Intermediate Care Facility Developmentally Disabled-N – nursing component
– Intermediate Care Facility Developmentally Disabled-H – habilitative
component
– Sub-acute/Rehabilitation Centers (one step down from a hospital)
– Short-Term Residential Therapeutic Centers (STRTC) that care for SHCN children
Specialized Resource Families (SRF)
– (a) The capacity of a SRF may not exceed six children as specified in Section 10-03(a)(1).
– (b) May not care for more than two children or nonminor dependents with or without special health care needs except as provided in subsection (c).
– (c) May accept a third child or nonminor dependent with or without special health care needs under the following conditions:
Conditions
– the capacity is not exceeded
– there is no other specialized home in the county or regional service
area in which the SRF Is located
– the psychological and social needs of the child or nonminor
dependent.
– The individualized health care plan team for each child with SHCN
placed with the SRF has considered the number of children in the
home and determined that placement of a third child or nonminor
dependent will not jeopardize their health and safety
*Note- this criteria also applies to Foster Family Agencies
Small Family Homes
ICFDD
– Paid by Medi-Cal/Inland Regional Center
– Take Non-Ambulatory Children
– No more than 6 children can be placed in the home
ICFDD-N Intermediate Care Facility Developmentally Disabled with Nursing
– Paid by Medi-Cal/Inland Regional Center; if no open IRC case 100% county pay
– Take Non-Ambulatory Children
– Provide 24-hour personal care
– Developmental services
ICFDD-H
– Some take Non-Ambulatory Children
– Must have IRC case
– Paid by Medi-Cal
– Provide 24-hour personal care, habilitation, developmental, and supportive
health services to developmentally disabled persons.
Sub-acute/Rehabilitation
Centers
– Paid by Medi-Cal
– Must have IRC/CCS in place
– Used for children who’s medical needs are more than what can be serviced by
any other provider
– Once medical condition stabilizes the child must be moved
STRTP that care for SHCN
Children
– May have a nurse or nurse consultant on staff
– a residential facility that provides integrated program of specialized and
intensive care and supervision, services and supports, treatment, and short-
term 24-hour care and supervision to children
– Effective January 1, 2017, the new STRTP rate is $12,036. For all out-of-state
group home placements, the rate the county pays is based on the out-of-state
group homes rate; however, the rate paid cannot exceed the new STRTP rate.
PLACEMENT
STEPS
PRE AND POST
Medically Urgent or Emergency
– Remember the role of the PHN is that of a consultant- a resource for the SSP
through her/his knowledge and assessment skills. PHNs cannot diagnose or
treat a client.
– If the situation appears to be medically urgent or an emergency call 911. Ask
yourself: Will the child’s condition rapidly deteriorate? Err on the side of
caution, be safe not sorry.
– Examples of emergent care: shortness of breath, respiratory distress, altered
state , significant injuries, etc.
Pre-Placement Steps
– Have the child medically evaluated by a medical professional
– Obtain as much medical information as possible (if the child is in the hospital contact
the hospital,) review Health & Education Passport
– Determine the level of care needed
– Contact the local Regional Center to determine if the child is a consumer
– Search for placement
– Schedule an IHCP/CFT Meeting
Post Placement
All SHCN placements are to be re-assessed every six months (IHCP/CFT)
– If the child no longer meets criteria
– End project code in CMS
– E-mail the assigned Social Worker, assigned Supervisor, and Public Health
Nurse
Contact Information
– SHCN Coordinator : Corina Chavez (909) 388-4733
– SHCN OAIII: Irma Romero (909) 388-4716
– SHCN SSSP: Marjorie Yanez (909) 388-0400
– SrSSP: Karen Quinn (909) 388-4744
– Office located at 1094 South “E” Street, SB 92415