Replicating Promising Practices in Iowa and Montana

Last fall, AMCHP released a new request for application for replication stipends to foster connections between states interested in adapting a current emerging, promising or best practice in Innovation Station. AMCHP provided technical assistance (TA) funds and coordination to two states – Iowa to adapt the Florida CMS-CSHCN Youth and Young Adult Transition materials and Montana to replicate the Rhode Island Pediatric Practice Enhancement Project. Both states share their experiences, successes and lessons learned below:

Montana P6
Lisa Wilson, Parents, Let’s Unite for Kids (PLUK)

The TA site visit provided the PLUK Parent Center Parent Partner Pediatric Practice Pilot Project (P6) with valuable implementation materials and training, as well as a chance to look to the future and plan and implement with program growth in mind; including agreements with the pediatric offices to allow the PLUK Parent Center to bill for hours beyond those that are grant funded for greater stability and sustainability. There were six site visits at a variety of clinics that provided a wealth of information in a short period of time.

As a result of the TA, P6 has four trained parent partners in pediatric practices in two locations 400 miles apart. The two-day site visit propelled the effectiveness of P6 ahead by several years from the knowledge and experience of seasoned parent partners. The PLUK Parent Center gained a deeper understanding of program operations, including memorandum of agreements, program supervision and management, logistical details, and fitting into the social setting of the pediatric office.

With the implementation of P6, families and children with special health care needs in the pilot practices will have access to a family-centered medical home and all of the associated benefits. The new parent partners have already made their practices more family centered, culturally competent, accessible and comprehensive. Additionally, the project has raised awareness in both the family and medical community about not only medical home, but the meaning of a patient or family-centered medical home. Other practices in the state started calling before we had even fully implemented the project, asking if they could get a parent partner. The national recognition extended to the P6 project and PLUK Parent Center by being awarded a technical assistance grant afforded us some additional credibility and helped jump start statewide excitement for the project. Through implementation, we have strengthened relationships with our champion physicians and begun more formal partnerships with the Montana chapter of the American Academy of Pediatrics. We also had organizational growth that will allow us to serve more families in our state.

Additionally, the professional development and education for the new Parent Partners was considerably accelerated. They also began to gain a national perspective and understanding of Title V programs, as well as the purpose of Title V and the force for positive change that family leaders and parent centers can contribute to MCH systems.

Our TA site visit to Rhode Island fostered a mentoring relationship between our Parent Centers and Title V departments. We now have ongoing mentor-mentee calls and are receiving continuing support as our program grows. Through this assistance facilitated by AMCHP, we have avoided many missteps and our program implementation has gone smoothly.

Iowa Child Health Specialty Clinics
Anne Crotty, MPH, Child Health Specialty Clinics

Child Health Specialty Clinics (CHSC), the Iowa Title V program for children and youth with special health care needs (CYSHCN), received technical assistance from AMCHP and FloridaHATS to replicate the evidence-based FloridaHATS program. This project designed and pilot tested a transfer of care package for youth transitioning to adult care, and hosted Dr. David Wood and Janet Hess for a one-day conference. The transfer of care package included checklists for the pediatric and adult primary care offices, a transition plan, a referral letter to an adult provider, a portable medical summary, and a resource list. Family Navigators (FNs) identified interested youth 17-21 years with mental health conditions. A FN helped complete the transition plan, identify adult providers and create a referral letter. The FN followed-up with all parties to offer continued support.

"I really like [the process]. Maybe if [adult provider options] were already listed, then when the patient is in for a checkup they can see the options, it would be easier. I really appreciate your help with this."

Participants suggested guidelines for finding adult providers and tools for those with intellectual disabilities. Forty representatives from organizations serving CYSHCN and family members attended the conference. This included a lively discussion on engaging health care providers, families and educators, as well as feedback on the proposed tools.

This TA provided valuable guidance on designing a statewide transition program and allowed representatives from many organizations to gather for a common cause. CHSC will continue to refine these materials, eventually validating and implementing them statewide.

The value of sharing best practices

"We really appreciated the opportunity to share our experiences in building a Florida strategic plan for health care transition with our colleagues in Iowa. There is enormous value in states learning from each other’s successes and challenges, and not reinventing the wheel – especially in emerging fields such as transition to adult care. It was also nice for us to step back and reflect on the work that we’ve done in Florida, conceptualizing what Iowa and other states might do differently based on their unique needs, and identifying how we might improve our own efforts." – Janet Hess, MPH, CHES, Project Director, FloridaHATS and Dr. David Wood, MD, MPH, Director, Jacksonville Health and Transition Services (JaxHATS)

"The Pediatric Practice Enhancement Project (PPEP) has been a ‘medical home’ initiative in pediatric primary and specialty care practices in Rhode Island since 2004. During the soon to be 10 years of implementation, Rhode Island has gained of great deal of experience about what it takes to make an innovation a success. The value of providing technical assistance to other another state is that Rhode Island is able to share a wealth of knowledge regarding the lessons learned to assist in replicating the model.

The ability of Montana to travel to Rhode Island afforded the opportunity to visit several practices and meet face to face with PPEP site physicians/staff to learn how the PPEP is utilized in their particular site (private, group, hospital-based) and the impact. Of significant importance was the opportunity for HEALTH and RIPIN to exemplify how state systems and community partners work together as partners to promote the success of innovations that are key to creating system changes." – Deborah Garneau, MA, Chief, Office of Special Health Care Needs, Rhode Island Department of Health; Colleen Poselli, PPEP and Disability and Health Program Manager; and Lisa Schaffran, Associate Director, Rhode Island Parent Information Network