MCHB 2006 Federal/State Partnership Meeting

The Road to 2010: Which Road are you Taking?

October 15-18, 2006

MEG COMEAU: So one of the first things that folks are asking, when they're considering this Medicaid expansion is how many kids are we talking about and what's it going to cost us and we're hoping to be able to put that tool into the hands of advocates and program staff to help advocate for that kind of information.

UNKNOWN SPEAKER: Anybody have a sense if their states are going to be interested in the (inaudible) in terms of that (inaudible) or any other financing issues before we turn to our last session?

UNKNOWN SPEAKER: We would be interested, Ohio.

UNKNOWN SPEAKER: Great.

UNKNOWN SPEAKER: Looking at some of the issues in terms of potential costs of certain groups and individuals.

MEG COMEAU: Can I grab you before you leave the room, give you a copy of my card. I'd love to take your contact information as well. Thank you.

UNKNOWN SPEAKER: As far as our legislative mandate, we do all of the establishing family professional partnerships, doing (inaudible) putting in community systems in place our ultimate outcome for us is being able to transition our youth healthy and ready to work and that's a segue into our national center on transition, Tony Wall who is the project director and also children with special healthcare needs director as well.

TONY WALL: Hi. I'm Tony Wall and I'm really pleased to have the national center children with special health needs program because this is where the rubber hits the road, is that what it's called. We're the ones who have to actually implement all six of those. So part of the national center, although it's housed in Maine, we have experts all over the nation. Trish Thomas is our expert in cultural competence.

I want to go through this real quick. Kathy Bloomquist in Kentucky is our Title V expert. I mentioned John Nelson, in Utah with the Champions Project, is helping us a lot with our web‑based design, web‑based classes.

Chris (inaudible) (inaudible) our medical home experts and transitioning folks to adult health center.

Patty Becket, everybody knows Patty with her transition, she's moved to Maine. Great to have her there. Deb Gilbert is the expert in education, folks with education. She's actually ‑‑ National Association Special Ed Directors, NASED, has a connection with them. Getting ready to work. Tom Gloss is going to be our liaison to a lot of the national meetings. So it's great to have Tom back in the fold.

And Susie Chaplain, almost forgot her, youth and family expert.

I wanted to carry on with Meg's and give you a vision what 2010 I would hope look like for youth with special health needs. You spoke quite nicely of the medical home summary, I would love to have every kid with a special health need have a medical home summary not on a PDF, one of those things you carry around iPod. I don't have one, so ‑‑ whatever it is.

(Laughter)
First of all, all doors are open. Not just a single door that the state says here's the door you can go and twiddle your fingers and put squares in round pegs, but every door is open for youth.

Each state has an actively participating youth advisory council and we partner with youth just on every issue that involves them.

The sixth delegate to AMCHP, I would live to see that.

UNKNOWN SPEAKER: Just passed the fifth.

UNKNOWN SPEAKER: This is 2010, so ‑‑ and if all that, if all that works, we have family involvement, cultural competence, medical homes at work, insurance. Inclusive communities, the ultimate outcome is transition.

That's what we would really like to believe. We're going to make it happen.

I'd like to pass out our topical call, happening on November. This is how we'll involve you folks, how does it happen in the states.

Our first topical call is on youth advisory council, strengthening youth involvement. We have Ohio, Kentucky. Youth from Maine and Rhode Island will be participating on how they're doing, youth involvement in their state. And as we do this quarterly we just expect to invite more states to be on this topical call and really listen from the states from their perspective how they're doing things so we can actually mentor each other and make sure that transition does happen in 2010.

UNKNOWN SPEAKER: Do you have any more?

UNKNOWN SPEAKER: No, unless there's more.

UNKNOWN SPEAKER: Maybe we could get staff at the division doesn't take one.

UNKNOWN SPEAKER: Do you just want to talk about health and ready to work diversity as well?

UNKNOWN SPEAKER: Yes, the healthy ready to work university is going to be Deb Gilbert and Patty Hackett and it will be a on line course with help from John Nelson who will be designing that. That course actually won't be ready until next year. But there will be on line courses on healthy ready to work on transition, different aspects of transition. And we're really looking forward to doing that too. Our Web site as always is HRW.org.

UNKNOWN SPEAKER: We'd like to hear from you in terms of how this is working in your states or any questions you have. I think you'll see that we've got some great resources in terms of financial centers.

So I know it's late in the day and we didn't get all the chocolate that was in the bag. Pass that around first. While they're thinking, the champions for inclusive communities is also looking at a variety of community development initiatives from the national level on to state and local, to see if there's strategies to bring those initiatives together so that they can work with you on integrating systems that are ‑‑ Adrian was talking about another project.

UNKNOWN SPEAKER: I have a question about this topical call. It specifically talks about the strengthen youth involvement in the state children with special health needs programs.

But I presume the principles that would be presented would be applicable to any programs.

UNKNOWN SPEAKER: Oh, yes, most definitely. I think one of the most exciting things is Rhode Island. Rhode Island is actually going out to regionalize their youth advisory council.

I'm really excited about it because I just have wanted at the Capitol level and I was wondering how to get it up to ‑‑ to hear it from them it's like great Rhode Island is such a small state someone said you could walk like this.

(Laughter)

UNKNOWN SPEAKER: This is sort of more directed towards Adrian and the inclusive communities and not taking up a lot of time as background, one of the things we're trying to do in Minnesota is replicate the learning session collaborative model used in medical home learning sessions to the broader community to deal with ‑‑ is there a pause button on the camera, where I think we can deal with some of the reluctance of other state agencies to get involved.

So there's this whole change agent facilitation concept in terms of the role in the program over the next few years in accomplishing not only the six outcomes but accomplishing a lot of other goals.

And personally I would ‑‑ speaking personally, not a sole recommendation but I would pour as much money in my own program in Minnesota in the training of my staff in those areas as I could. And in fact I would. The only barrier is the out of state travel. It's almost asinine to say you're willing to spend 15 to $20,000 to help train individual staff people on something like an IHI kind of thing but you can't do it because the out of state travel is not required by a grant.

The logic of I understand the reasons for it, but I think that the whole focus on developing that level of expertise and skill and abilities in the program are great dividends over the next few years not only on Title V activities but beyond Title V activities.

UNKNOWN SPEAKER: Can I throw out a few ideas because I totally agree. I think we're kind of working on the back end right now in that we're trying to get to people who are already out in the field to learn about a system or a new way of thinking. It's a lot harder when people are out of school and out in the community, it's a lot easier if we get to them.

So to the extent we're doing out of state damage control. But the truth is I think what you're going to see is that there's going to be two ways that are going on right now.

We have a huge approach to getting to the school for public health and into residency programs, to schools of social work, schools of nursing, just to educate them on more systems of care coordination, medical home, family centered care, culturally centered care. This is the work we're doing before they get out in the community. Two‑prong approach. What's nice there's some great models where there were well funded programs in some of these areas where they're going to put together their best practices so you don't need to get that few hundred thousand dollar grant to say how do I infuse medical home into an entire residency curriculum, who did it in different venues and just to throw out a quick one on that, Hawaii did a lot around faculty development in residency programs. Indiana did a lot in quality improvement in medical home into the whole curriculum.

The two of them are already talking and they're going to test each other's systems, what's nice again, one's high tech, one low tech. They'll have to play with each other and see how do you really show different ways of educating medical home into residency programs and completely different settings.

So that's kind of one thing to kind of look at. At the same time, I think of Arizona, and I'm going to throw out states because I really want you guys to realize you all are doing it.

Arizona looked at the fact that they have training programs going on throughout the entire state. People were creating them and they all kind of had different vocabulary. They were describing things differently. And I'm pretty sure in their integrated service grant, one of the major goals was we need to be talking the same talk. So what they're doing is for every type of statewide training, they're looking at what other core components so you're not having to reeducate or say if we're going to talk about a certain professional development issue or an in‑service, there's going to be core components that do more capacity building and work force development.

So those are kind of just some really, I think, neat strategies that states are doing but there are also a lot of great ways for you guys to network with states. There are a lot of list serves and a lot of chat rooms and conference calls.

If there's the biggest take‑home message I would give to all, and again not being part of the national centers anymore, this is really a plug, and I really think you should do it, is get on all of their, get on their list serves, get on their E‑newsletters, get their phone numbers, because they really do talk to each other and they really can help you know what other states are doing that might make more sense for your state, but there are some really great things happening.

So what I hope is you guys can play on their Web sites and go ahead and start contacting them and start getting some mentorship from other states because I think what you're happening is actually happening in some other areas.

UNKNOWN SPEAKER: On the part of what Lauren was talking about, and actually John you were a part of it, there was a case study that's actually being developed around medical home and about some of what John has done and around building the system of care that's actually going to be able to go out through AMCHP, through maternal and child health training programs, helping to use that to train up and coming leaders and I think that's a great way to sort of integrate those who are early on in their career sort of having them get an education around the system of care, around the break‑through series, around quality improvement and being able to train them a little bit earlier on in the pipeline as opposed to waiting until they're already out in practice and saying we need to reeducate you about some of the issues that are applicable.

So I think that's a great opportunity and we're sort of looking at different ways to be able to get that case study out to talk about the financing issues, to talk about community integration, working with the division of research and training to sort of get it out there. But that's up and coming and another thing we need to be looking at is the training of residents but not just residents, really looking at cross training, across disciplines.

UNKNOWN SPEAKER: And also if you're doing strategic planning for, you know, what you want your staff, you know what knowledge base you want for your staff, it may be that you ask for some technical assistance from the centers to help you with that.

Lindy and I went out to Oregon across the programs, the Title V, the research, just to look at integrating cultural linguistic competence into strategic planning.

So it may be that when you're looking at, you know, orientation or staff training sessions, that you can either have telephone conversations, we can set that up with the national centers. There's a little bit of money in the division of saving community health for technical assistance.

So if you hurry up and request it ‑‑ (inaudible) you combine that with the center's funds or something.

UNKNOWN SPEAKER: (Inaudible) is also persuading your superiors and interagency (inaudible) for Title V.

UNKNOWN SPEAKER: There's also a lot of activities not just, you know, in our little world, but for instance the (inaudible) initiative just got done with their learning collaborative. And so they're looking at, you know, Illinois participated in it. Oregon participated in it.

And IHK had learning initiatives, asthma and obesity, that maybe if it's local or not too far away you could send staff to.

So that's the issue is the travel.

UNKNOWN SPEAKER: (Inaudible) Wisconsin, 32 miles ‑‑

UNKNOWN SPEAKER: If you set it up you can have someone from the national center or someone come meet with the staff and maybe an outside person.

UNKNOWN SPEAKER: I guess (inaudible) national centers, I know champion, like medical home, one of the things that that center can do is actually help you put a group together and do kind of a kick‑off strategic planning session. Those funds are actually built in to go out to your state and work with you on those initiatives. And that's something where if you connect in, the national centers can talk about the different avenues they have to do that because they also have funds to do that.

UNKNOWN SPEAKER: I'm mindful of the time. I know Meg wants to say something, and did you have a ‑‑

UNKNOWN SPEAKER: Just a quick one, actually it was directed at Meg but actually all the national centers also AMCHP is trying to support in many ways. I want to make sure that the centers communicate, coordinate with them. The reason why I was thinking of Meg specifically I know AMCHP has a committee on healthcare financing, and some of the things that the Catalyst Center is interested in doing I think they're interested in doing. I would hate to see those get developed in parallel tracks.

So just a reminder.

UNIDENTIFIED SPEAKER: I'm an official member of the committee. I didn't make the meeting on Sunday because I was at the Special Olympics. But I'm very excited about that opportunity for collaboration.

I just wanted to say in closing, I'm going to put my project director hat on and say I know from my professional experience how frustrating this work can seem sometimes. You can feel like you're working your head off and it's so challenging and there's so many barriers and you work really hard and the progress is measured in inches rather than miles and we feel like we've got so many miles to go on that road to 2010.

As a parent, I want to switch hats for a second, say as much as I appreciate how hard this work can be, I want to thank you all for everything you do for kids and families. Your work really does make a difference even though you can't always see it, you can't always feel it it's there it makes a difference to kids and families and we really appreciate it and I want to encourage you to go back home, get back into your office and work twice as hard.

(Laughter)

(Applause)