By Carolyn McCoy, MPH
Senior Policy Manager, AMCHP
Veronica Helms, MPH
Program Manager, Child & Adolescent Health, AMCHP
Recent discussions in the field of child and family health have focused on the intersection of home visiting (HV) programs and the family centered medical home (FCMH). Such systems integration initiatives have the potential to decrease redundancy and promote effective systems of care for MCH populations.
Title V programs play a crucial role in both HV and medical home programs. The ACA includes a provision authorizing the creation of the MIECHV program under a section of Title V and provides substantial funding to develop and implement evidence-based home visitation models. State MCH programs have a long history of utilizing home visiting strategies. Prior to passage of the ACA, nearly 40 states managed or financed home visiting programs. When considering the role of Title V and the FCMH, it is important to note that more than 35 state Medicaid and CHIP programs have taken steps to promote the medical home model; state Title V MCH programs are key partners in many of these efforts. State Title V MCH programs administer numerous public programs that are critical, natural access points for building and strengthening integrated service delivery systems, including medical home initiatives.
Home Visiting and the Family-Centered Medical Home: Synergistic Services to Promote Child Health
In response to the emergence of increased funding opportunities and the inclusion of both programs in the ACA, the American Academy of Pediatrics-Academic Pediatric Association (AAP-APA) Workgroup on the FCMH developed a comprehensive policy brief to provide guidance regarding strategies based on integrating care between the FCMH and HV.
When home care activities are systematically integrated with the FCMH, there is great potential to promote positive child health outcomes and reduce health disparities. Since both programs share similar goals, integrating HV and the FCMH seems like an obvious fit. In AAP policy brief, Home Visiting and the Family-Centered Medical Home: Synergistic Services to Promote Child Health by Sara Toomey and Tina Cheng, the authors discuss synergistic collaborations between the FCMH and HV and discuss strategies to evaluate coordination. Article highlights are briefly summarized below.
What are the Contributions of HV Programs and FCMHs to the Health of Children? Research suggests that both home visiting program and the FCMH model have been successful in promoting the health of children and their families.
HV programs provide culturally relevant, ongoing service delivery to support children and families in their own homes. Data indicates that high-intensity HV programs for young children have resulted in better child and family outcomes, including improved social skills, reduced children maltreatment, and improved parenting skills. Research also suggests that HV by health care providers has led to enhanced provider-family relationships, including enhanced trust (Toomey and Cheng, 2012).
Although variant in structure and approach, the FCMH provides "comprehensive, coordinated, family-centered primary care that facilitates partnerships between patients, families, clinicians, and community resources and services" (Toomey et al., 2012). By focusing on the delivery of optimal health care services, the FCMH attempts to maximize health outcomes and coordinate care across various providers and venues. Research suggests the FCMH can decrease barriers, improve family satisfaction, and improve child and family outcomes.
Coordination and communication between HV programs and the FCMH can be challenging. However greater integration between HV programs and FCHMs could simultaneously enhance HV program effectiveness and help reinforce guidance given by primary care providers (Toomey and Cheng, 2012).
How Can HV Programs and the FCMH Best Serve Families and Children?
Addressing the health and complex psychosocial needs of families requires a range of support services, many of which are maximized in a home setting. HV programs developed within a FCMH framework can provide effective care at both the individual patient and population levels. Partnership between HV and the FCMH can provide advantageous benefits that align with the Title V program mission, including:
- "Assisting families in care coordination
- Facilitating referrals to community resources (e.g., early intervention), medical evaluations (e.g., audiology) and community supports (e.g., parenting groups, nutrition services)
- Identifying community needs that are important in managing population health
- Assisting transition across multiple settings, (e.g., early intervention, health care, education)"
Source: (Toomey et al., 2012)
For a full list of program coordination benefits, please read the full AAP policy brief.
As outlined above, integration of HV and the FCMH has the potential to promote sustainable health outcomes for children and their families. Moving forward, Title V programs and key partners must take advantage of emerging funding opportunities in this space and continue to explore strategies to integrate HV and the FCMH.