Emerging Practice

Care Connection for Children

State/Jurisdiction: Virginia
Setting: Community
Population: CYSHCN,
Topic Area: Service Coordination & Integration,
NPMs: NPM 11: Medical Home NPM 12: Transition NPM 15: Adequate Insurance

Approximately 20 years ago, the VDH Children and Youth with Special Health Care Needs (CYSHCN) program went through a partial restructure and transformed Children’s Specialty Services (CSS) to the Care Connection for Children Program (CCC). This transition was based on a study commissioned by the Virginia Department of Health and the evolving vision of Title V at the time. CSS was a program that focused mostly on clinical services that were provided at local health departments. Since these services were routinely being provided elsewhere (at major pediatric health care systems), VDH decided to transform the CSS to a care coordination-based program and the CCC was born. The study that informed this decision involved the establishment of an advisory task force charged with overseeing the project’s stated goals. Members of the task force included parents, primary care/specialty pediatricians, public health nurses, early intervention and special education providers, representatives from private and public insurance providers, and several state agencies. Approximately 40 people were on the task force. In its current form, the Virginia Care Connection for Children (CCC) Program provides care coordination services for children with special needs who have a condition that is of a physical basis. Services are provided in partnership with major medical centers across the state. The goal of the CCC program is to improve health outcomes for the CYSHCN it serves by: (1) Helping families attain and maintain a relationship with a medical home to include specialty provider care; (2) Assisting with the transition from pediatric to adult care and life by working with families to prepare for transition; (3) Serving as a safety net to provide durable medical equipment, pharmaceuticals, and specialty copays as a payer of last resort; (4) Helping families to understand their health insurance benefits and to apply for Medicaid and; (5) Helping families to understand their child’s condition and any recommendations from practitioners. Children are eligible for care coordination services if they are residents of Virginia, between the ages of 0-21, and have a condition that is physical such as cystic fibrosis or diabetes. The program does not provide care coordination for conditions such as asthma, allergies, or diseases where families can generally get services elsewhere (cancer, HIV/AIDS, hemophilia).

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Implementation Handout

Virginia Department of Health
Marcus C. Allen
Practice Website
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