Bobby: Sure. This is Bobby Peterson. Our project is called the Families MAP Project, and it stands for Managed Advocacy Program. The project was developed about four years ago. We work with a number of families throughout the state of Wisconsin. We’re a public interest law firm, so we work quite a bit in the trenches with families who are encountering some of the difficulties in navigating systems. In the process of working with a number of clients and families, we identified a pattern of problems specific to managed care, managed care organizations. We were able to resolve a number of them, and we thought that it would be important for us to apply some of our knowledge of working with families on the street level to sort of bigger-picture issues and how we can translate those into system changes. And a key thing, I think, was the identification that the health care system had become much more integrated, much more sophisticated, and that the advocacy community necessarily didn’t follow the same development pattern. And we needed to pull together some of the strands and develop what we were calling a "managed advocacy program" of supportive services to parents that linked to other resources to help them in the process. And that’s really where the project came from.

Faye: And Nancy, could you tell us a little bit about your project?

Nancy: Sure. I’m Nancy Eddy. We have a project that has been funded through Maternal and Child Health for eight years. And we are--Parents Helping Parents is a family resource center, run and operated by parents of special needs children. And our entire focus is on strengthening families to be able to cope with the various issues that come up when you have a child with special needs. What we have done is to take our family resource center into the hospitals. We started with Kaiser facilities in our area, two hospitals, clinics, where we established a mini family resource center right in the hospital. And from that point we have been able to reach out to the pediatricians and other health care providers for children, educating them as to what family-centered care is, that the family really is an equal team member in the care of children, and then to reach the families and help them understand how to advocate for their child. It involves a lot of training, and we do a lot of one-on-one work with the families. The doctors will often just walk a family down the hall to us and say, "Here’s--this is so-and-so. Her child has--. Would you talk to them?" And we provide the peer support that a family needs when they’re learning that their child is perhaps not as perfect as they thought. We’ve expanded from the two Kaiser facilities into the local county Medi-Cal facility and into a for-profit hospital so that we now have all four types of medical care as examples that we can replicate and have been replicating nationwide.

Faye: Well, thank you, Nancy. Now, Kacie, please tell us about your project.

Kacie: Okay. I’m Kacie Fitzpatrick, and I kind of came on board with this project just last summer, so I kind of picked it up and started running. But the purpose of the project that they obtained almost four years ago was to increase the access to a full system of family-centered and community-based services to children and needs with SED and their families.

Faye: What is SED, Kacie? Could you please explain to us what is SED?

Kacie: SED is seriously emotionally disturbed.

Faye: Thanks.

Kacie: We were hoping that this system would be coordinated among all child-serving agencies and would be integrated in the managed care system that we have here in the state. And Tennessee Voices for Children is a statewide advocacy organization that focuses on children and families that have special health care needs--and especially mental illness--and trying to serve those children in their communities. And we were hoping that through an extensive training project at the executive level and the direct-care level of staff of the managed care plans, they would increase their understanding of this special population and the services that these children require. We were also hoping that this would allow the MCOs and the BHOs to be able to prepare more direct service planning and procurement of services for children with SED and their families. We’ve been working with families over a large scale across the state who’ve been having difficulties navigating the system as well, especially in regards to barriers to accessing services. We’ve seen lots of changes and are hoping that they’re going to be a direct impact on system changes. We do a lot of advocacy. We do a lot of training, one-on-one with families to try to teach them and empower them to be able to serve as advocates in trying to get what their children need as far as service provision.

Faye: Well, thank you so much, Kacie. Now could each of you please tell us a little bit about the history of your project, specifically how you developed the idea, who are your collaborative partners, and why did you decide to get involved in this initiative?

Bobby: Okay. Well, I can start out with that. This is Bobby. I touched on that briefly, but I think that one of the areas that I didn’t touch on is our collaborative partners. We looked at the issues that we were working with families in navigating managed care systems and some of our partners around the state. We identified a couple of pilot sites for our project, one in a large, urban area that has most of the significant poverty within the state of Wisconsin in the city of Milwaukee. And we also selected a pilot in rural northwest Wisconsin, which is primarily agricultural, has also mixed industrial, but it was a good area that we had worked with in the past, the Public Health Department in Chippewa County. Then we had a pilot here in Dane County. This was a good opportunity for us to see the spectrum of issues across the state and different ideas, and get some opportunities to really analyze what we were tracking with some of our casework, whether this was happening across the state. We also pulled together with our partners’ Health Watch committees. Those included a spectrum of community stakeholders. It included other people from health care providers. Parents were a dominant part of both committees, each of the committees was chaired by a parent. We had representatives from managed care organizations from the state of Wisconsin, from the county, so it was a good sort of working group to both identify issues, problem solve, and develop policy recommendations that we would look at from a statewide perspective and coordinate some statewide events as well. So that’s basically a little bit of the background or the partners that we work with.

Barbara: I’d like to add to that. This is Barbara Katz. I'm the parent consultant at ABC working on this project. And as the project evolved, we’ve also become more involved with the disability community and connected with other statewide initiatives that are occurring such as the Healthy Ready to Work Transition Project that just began in this state about a year ago. And we’re now currently also working with the state Title V program in advancing the medical home notion in the state. So as a result of this project and as a result of the issues that have been identified through the project, we’ve been able to effectively hook into other efforts that are going on and bring our projects into a broader realm as well.

Faye: Oh, great. Now Nancy.

Nancy: We originally saw and continue to see actually, a lot of frustration on both the family’s part and on the medical professional’s part in working with children with special needs. They simply, no matter whether it’s a child with a light ADD, attention deficit problem, or a very involved case, they all take extra time, and doctors are allowed their ten minutes per patient. They can’t really work with the family to help the family understand what needs to happen next. And the medical profession doesn’t have an understanding, and probably doesn’t need to have an understanding, of what the other systems of care are in the community that the family can be referred to. The family, of course, ends up frustrated and not understanding or knowing how to proceed. So looking at that, we felt that if we could have much more ready access to the family when they first receive news or are there at the doctor’s office trying to deal with some new aspect, that we would be able to step in much more efficiently and provide services and referrals for the family. Not the same as the social worker, who is also very busy, but in doing a peer--we’ve been there. All of our employees have kids with special needs. We know what it’s like, and we can have a peer relationship. We can set up a mentor-parent relationship so that they have somebody who is in the same disability with the same language that they can talk to just as a friend. So we felt that the need was to provide--to empower families to advocate for their child, and to help the medical profession really establish much more of a medical home where they are coordinating services or have someone there on the staff who can help do that. Our people are not employees of the hospitals but of PHP, so there’s an independence there that families feel they can talk to us easier sometimes.

Faye: And, Nancy, who are your collaborative partners in the project?

Nancy: We have many, many, many. To begin with the hospitals that we're working with, and we work very closely with California Children Services, which provides much of the occupational, physical therapy, and case management to lower-income children. We work with our regional center, which is the developmental disability focus. We work with other medical, other insurers, to help them provide more of a medical home or encourage medical homes in their environment. We work very closely with all the school districts in the area, in helping parents achieve the right placement once they are in the school system. And with our Early Start people here who work with the kids from zero to three in getting a real early start in raising the children. I don’t think there’s an agency that we don’t work with. We’re closely connected with Family Voices. We are a member of Family Voices, so that we have a reach throughout the state in providing information about family resource centers.

Faye: Well, that’s great. Now, Kacie, we’d like to hear about your project, about the history, your collaborative partners, and how you decided to get involved.

Kacie: Okay. Well, a lot of our supporters are the same as those that have gone previously. I think just the mission of Tennessee Voices for Children, in that we work with families and children that have special health care needs to make sure they have coordinated services and services that are focused around their community, so that they don’t have to travel distances. We too have lots of employees here that are parents of children with special health care needs, and we feel like, too, that those families are really able to talk to other families much better because they’ve gone, or are going through the same and similar process that these parents are going through. We have lots of collaborative partners, as well as stakeholders, and they kind of serve two different purposes for us. Just a few of our collaborative partners are the Department of Mental Health, the Department of Health, our BHOs and our MCOs, and we have these on board--and especially our state agencies--to assist us with policy changes as we, you know, see that are necessary. And then we also have stakeholders involved across the state that come to the table once a quarter to initiate and to implement system changes, and these are private and public mental health providers. We have several clinical psychologists. We have direct care providers from the BHO and the MCO, the Children’s Health Initiative, Teen Care, and several psychiatric hospitals. And it’s really nice that these people can come together. We can pinpoint service gaps, and then we can go back out across the state and try to implement change for these families. We have noted several areas of breakdown in referrals and services, and we do see a lot of that, especially when a child goes in for EPSDT and they may need a mental health referral. And a lot of times, the pediatrician is not familiar with the mental health aspect of a child’s life, and so therefore, they really don’t know who to refer to or what to tell the family to do after that. So it’s been really great for our families so we can step in and continue that service provision and assist them, and get them to the right care that they need. We work extensively with a lot of local projects too: With Family Voices, we’re very active with the Medical Home Project and believe that every child should have a medical home, and that’s especially important with EPSDT; with the Autism Society; the Tennessee Disability Coalition, just to name a few. But it’s been very important, and it’s been a great effort for us and for these other agencies because it’s really brought a lot of people to the table to educate and teach them about the principles regarding a system of care. And so much, much has happened in getting people on board and taking that back out, and then implementing those principles in their own agencies in how they serve children and families.

Faye: Well, that’s wonderful. I see that all of you are really involved in very complex and comprehensive multiple systems in your state, so I’m very encouraged about that. I’d like to follow up with asking you if you have additional comments about how you have involved families to achieve your project’s goals and objectives and also specifically if your projects involved youth with special health care needs.

Barbara: This is Barbara from ABC. Family--involving families is sort of the core principle--one of the core principles, guiding principles of the Families MAP Project. Our vision is that for families to become empowered, to become effective advocates for their children and for their whole family system within managed health care, they need to be well informed. They need to be confident, and they need to be well equipped to be fully participating members of a decision-making team. And we feel that our Families MAP objectives and the trainings that have gone along with it, as well as the health benefits counseling and the legal back up, has enabled families to become effective partners and become effective advocates. So family involvement is most definitively at the center of our program. We have not really involved youths with special health care needs in our activities. And now becoming involved with the Healthy Ready to Work Initiative, we realize how important that is, and we look to advancing our concepts in the future. Involving youth is certainly something that we are going to be considering strongly.

Faye: Okay, thank you, Barbara. And, Nancy, do you have any additional comments about some specific ways your project involved families, and also did your project involve youth with special health care needs?

Nancy: Well, certainly families are the core of our project. We do attempt to get families onto various advisory boards in the hospitals and medical plans, as well as the advocacy for families. The children with special health care needs, really we're trying to empower families to help their own children, but we do have support groups for kids, you know, siblings and youth with very serious disabilities and teenagers, but that’s not the same as involving them in decision-making processes. As we begin to move more and more into the transition to work projects, the youth need to be involved there, and we're beginning to build a core of young people who can do that.

Faye: Well that’s great, and Kacie?

Kacie: Yes. Well, parents are a core of our effort too. Like I said, we have many parents that are working here at the center that are parents with children with special health care needs. We have long advocated for parents to be a part of boards, task forces, and councils, so that has really become integrated. And a lot of the agencies that are working with us because they’ve been able to see how we’re incorporating families, and I think it’s given them ideas for them to go back and then implement that too in their agencies. So we’re really seeing a lot more families become involved even on a state level, which is really great here in Tennessee. We have done a lot of one-on-one educating parents to become effective advocates and to really participate in the treatment planning for their child, because I think that has not always been true in the past. I think typically parents have not been encouraged to participate or be a part of the treatment plan for their child, and they’ve just kind of been left to, you know, be the transportation or whatever. And so we’ve really been advocating for parents to step up and take this role to heart and really get involved with the doctors and participate in a treatment planning process. We also have support groups too that meet monthly, and we have parents that are co-facilitators at our support groups. And we find that the other families really enjoy this. It gives them some time to really talk one-on-one to other parents about the same position that they’re in. And I think it just gives them some kind of really good feedback to know that they’re not alone, and that other parents have taken those steps that they’re taking now, and that they can have a positive outcome that it, you know, it is possible. We do have a youth council here at Tennessee Voices, and through that youth council they’ve developed for us a 30 second PSA regarding children with mental health. And it’s been showing all over our state. And it's getting quite a bit of play, and it’s really good. We’ve shown it to the legislative body several times this past session, and they seem to really like it. And they’re working on a longer version too, and they’ve also helped us with a system of care video, which has been great, and we use that a lot in our training when we’re training providers, MCOs and the BHO.

Faye: Well, thank you, Kacie. And a note to everyone who’s listening into the webcast, we will have extensive resources that our speakers are referring to in the resource section of the web site, so you can access some of these great materials and ideas as well. Now I’d like to move on to asking each of you when you started out, how much do you feel the managed care plans understood about the importance of including families in program and policy development, and how interested do you think that they were in involving families and youth in these activities?

Bobby: This is Bobby. I think that at the beginning in any type of project like ours there were questions. This was not the usual course of business. I think that at a certain level our role as a public interest law firm maybe raised even some additional questions. But I think as we moved into the process and we sat around the table, and we started building a level of comfort that changed. I think that there was recognition that we could work on problem-solving strategies and things to avoid, things from becoming bigger issues if we were able to work together with families and managed care organizations at the table. I would say that the organizations have really come a long way in terms of some of their growth and development and support for the idea. I think there’s still additional work that needs to be done, but for the most part I think that we have, you know, one of the managed care organizations in Milwaukee has set up a committee, a customer’s committee that involves parents. It’s been reported at a couple of our meetings and it’s been working really well, and those efforts I think have a cascade. They recognize this as an important element of customer service and working with these issues upfront rather than letting them sort of languish and become problems later on.

Faye: Okay, Nancy, could you let us know about how you worked with the managed care plans, and what was your read on how they understood the importance of including families?

Nancy: Well, you know, I think there was a glimmer of understanding when we began, because the way that we developed the relationships originally was to find an advocate within their system that was supportive of what we wanted to do. So we had to find first that glimmer of understanding of a family’s importance, and there were two or three people in each organization that understood and really wanted us to come in and set the example. So there was some understanding, but certainly it has developed immensely. I remember going into one of the hospitals, the county hospital. The head pediatrician said, "Well, I don’t see any need for this, but it’s free so come on in." You know, free as in the MCH grant was sponsoring it. Today, we are now near the end of that grant and having to ask the hospital to pay for it themselves, and she not only wants one person but two people, and can’t believe how she lived without having families connected into the hospital. So, you know, the growth has been tremendous, but there’s always need for more growth. There’s always areas where there is some misunderstanding of how families can be involved. I see that now as we’re really looking at being on quality control committees, which look at where the hospitals made mistakes and how they can make--not make that mistake again. And they are very nervous about putting families onto committees like that, that have a real in-depth look at how they operate. So, you know, it’s an ongoing road, but a great deal of progress has been made at showing how important families are.

Faye: Well, that’s really wonderful. Kacie?

Kacie: Yes. Well, we’ve kind of had the same challenge here when we started. They were very reluctant to include families. And I think a lot of their reluctance was based on cost, that they thought that bringing parents to the table might increase their cost as far as providing services. And they really weren’t thinking about just bringing families to the table to let them express their own ideas for change that, you know, might even benefit the MCO in a way that wouldn’t impact them fiscally. It is a big part of our training when we go to the MCO providers and to the BHO to discuss the role of parents and how their perspective is totally different from that of the care staff and the MCO and executives. And they have been slow to warm up but it--I can say that it is happening. We do have room to grow here as well but at least it’s happening, and we can see them participating and the organizations have come a long way in accepting families in the process. But I think as we go and the role of the parent is more clearly defined, that they’ll even be more accepting of them coming on board and helping. It’s kind of just an unknown entity and people are not used to bringing families in and participating on boards and councils and in the planning process. So it’s a brand new thing but at least it is happening here, and we’re very thankful and hope that it will even be more widespread.

Faye: Well, it sounds like all of you are making significant progress in this area. And now we’d like to hear a little more specifics about the type of training you provided to the health plans and any other ways that you work to successfully get them involved with involving families.

Barbara: This is Barbara. I think our Families MAP program has done this in a number of ways. The Health Watch initiative that Bobby talked about earlier is one way that we really were successful in bringing parents, providers, and advocates to the table to identify issues that affect health care access and coverage for children with special health care needs. As an outgrowth of that, we’ve identified a number of training issues which were of significant impact to families in our state, such as the funding stream coordination for therapy, whether it comes from school-based therapies or community-based therapies and engaging the Department of Public Instruction in conversation along with the Commissioner of Insurance and the Department of Health Care Financing. So we felt that that coordination and having conversations with advocates and families and managed health care organizations was really important. We’ve done panels on HMO access. We’ve done panels on prior authorization access and denials, and what to do to avoid those denials. And in all of our trainings we’ve had the various areas represented, and we felt that that really was an effective way of opening up communication lines between the providers, the advocates, and the managed care organizations, so they were both involved in issue development and in direct trainings.

Faye: Well, that’s great. Anyone else like to tell us about the types of training you did, and how you engaged the managed care plans in these activities?

Nancy: This is Nancy. I think it’s a major PR job. It just takes a lot of constant going back over and over what it is that we’re trying to do. A lot of that is individual work where the position we call parent liaison in the hospital just talks to doctors individually, over and over, and then she gets a few referrals and immediately gives feedback to the doctor. The doctor likes what he sees and spreads the word to the next person. And so it’s a lot of word of mouth and individual working with the medical professional and also with the medical social worker, who is a bit challenged by our physicians in the hospitals at times. But we’re not doing the same job. We do a lot of trainings to groups of medical professionals. We do a full day nurses training on family-centered care: what is it; how to implement it. The same with social workers--we’ll do a full day training. Doctors we try to get into going rounds with them a couple times a year so that we can talk about what PHP is doing. We have trainings on better ways of presenting news and do some funny role-plays with them that really in a comic way, let them know that there are different ways of talking to families that make families more comfortable. So it’s a combination of trainings and individual work and also at the same time training families to be better advocates.

Faye: Oh, good. And Kacie?

Kacie: We do some of the same. We, along with the stakeholders, IDed training needs across the state and then started from there. And it is a lot of PR and it’s a lot of networking, and one networking event kind of leads to the next networking, which hopefully will get you several trainings. Our trainings have consisted of prior authorization, EPSDT, doing the full panel screens and billing, the system of care principles, cultural competency, grievance and appeals, and a lot of communication as far as working with families. Our goal there is to make the doctor more comfortable with the family, and then make the family more comfortable with the doctor. And we hope that by doing that we can progress the dialogue so that ten minute visit that is really short and needs to be straight to the point, the parent really feels comfortable in going in with a list of questions and saying "I don’t understand," or "What do I need to do next?" And the doctor will know how to handle those questions and take them and be appropriate with the family. We have used parents in our training. I’ve used staff across the state to assist in training. We have done quite a bit of training over the last four years, and it’s an ongoing process. And I believe the more people that are educated the better off, you know, their families will be, so it’s an ongoing process for us.

Faye: Well, all of you are doing some really exciting things in the training arena, and I’m glad that we’re able to share resources from each of your projects on the web site. Now I’d like to get some brief comments from each of you about what do you think are the constraints to involving families and youth, and what kind of incentives do you think would be beneficial for the health plans to get them to do more family involvement?

Barbara: Well, for Families MAP, I think one of the biggest constraints that families feel is that they are totally intimidated by the system. And one way that we have addressed that, again, has been through our training, through our information dissemination. We provide a quarterly newsletter that’s directed toward families with different advocacy strategies. We have a web site with numerous links, and we’re in the process of finalizing a health insurance guidebook that will help give parents some answers to questions that they ask, and hopefully give families more confidence in working with managed care organizations as they understand their rights and responsibilities more. For incentives for plans to involve families, I think the more that we can inform them about coordination of benefits and how private and public insurance can work together and decrease outstanding bills and increase the payment that they actually receive can be a very powerful incentive to health plans. And again, we accomplish that through our trainings and our information dissemination.

Faye: Okay, anyone else?

Bobby: Can I just add something? This is Bobby. One of the things that Barbara alluded to is that, you know, working with the providers, I think that a lot of the folks that we’ve been involved in training are sort of in a role as benefit managers in making sure that the funding systems are paying what they’re supposed to. This can add important revenues to the health care provider to make sure that they’re able to provide the services. We’ve been talking with our state-planning group on the medical home, and one of the big impediments is that it costs a lot more money, I mean, to develop the concepts around the medical home. And we’ve been exploring the ways that we can sort of integrate some of the health benefits counseling and benefits management as a way to really make sure that all available resources that can be pulled in are directed towards the family and the child, and this helps to provide extra resources for some of the additional services that are required.

Faye: Thanks.

Nancy: I think that’s very important that we can educate insurers on how by using the benefits available through the public systems that they can reduce or not--at least not increase their cost of care. And that by having people, families involved, who can work as a peer with other families, that they’re providing more of a medical home, with very little increase in cost to themselves.

Kacie: And that’s sort of the same premise we’re taking as well.

Faye: Okay. Also, I’d like to hear from each of you in brief about what you feel is the single greatest achievement of your project, and if you encountered any obstacles in achieving your project goals.

Bobby: This is Bobby. I think that the greatest single achievement has been the development of sort of the community of people that we're working with that are sitting together at the table cross the spectrum. I think that it’s--once you start going, getting into it, you realize how many different individuals are involved in the lives of children with special health care needs and their families, and how collectively they have a much more powerful voice to help, you know, move systems. I think that we’ve gained a tremendous amount of recognition for a lot of the issues. One of the issues in particular that Barbara mentioned is funding stream coordination. We had a legislator that came to a couple of our meetings and really took it on his--something that he was really stressing and pursuing, and helped us in significant ways get the attention that this issue deserves, get a legislative audit bureau to investigate some of the issues that are on prior authorizations as they relate to therapy services. And that would not have happened had we not had the spectrum of individuals there at the table with us to increase our voice and our leverage to help illuminate the issues that we were working on.

Faye: Wonderful. Anyone else like to let us know about your greatest achievement and any obstacles that you may have encountered?

Nancy: The greatest achievement is seeing families who are empowered to advocate for their children, particularly those families who were--the lower income, often English is not the first or even one of their languages--still be empowered to be able to act as a team member for their child’s care and be the real decision maker and ask questions and learn more. I think that’s the real achievement. There’s lots of things that show how that is happening, but that’s the important part of the goal, and seeing that the medical facilities are accepting our method of reaching families by inviting us back and once the grant runs out, they’re willing to take on the cost. They’ve seen that it is worthwhile to themselves to continue having a family person that is there to work with their family. And obstacles, there have been many obstacles, mostly the lack of understanding of the medical profession as to what it is that parents have to offer and that parents do have an understanding of what their child needs.

Faye: Thank you, and Kacie?

Kacie: I think our greatest *progression has been, and the thing that we’re probably most happy with, is the fact that we have been able to bring so many people and agencies and providers from across the state who work together to facilitate this initiative to develop the system of care for children with special health care needs across the state of Tennessee. Our state is very large and we cover a lot of territory, and especially a lot of rural territory where there aren’t many services available. And it’s been great to have everybody come together and finally work together as a team to go back and really put in, in these rural areas where we have service gaps, and to provide for these children and to give them services at home. And it’s been really nice, too, to get a lot of the legislators on board, especially the legislators in some of these rural counties that have families that are having a hard time accessing services. They have health insurance, but they can’t get the services. And through that we’ve been able to get the legislators on board. They’ve come, participated in our meetings. They go back home to their communities and assist us, and then they come down and come in for a session and assist us with policy. And it has worked really well to have them working with us. It’s been really nice to empower the family through this process too. It’s great to have families calling now for a need, but then to also have them call back to let us know what positive things are happening--what they’ve been able to accomplish because of what we’ve helped them with. And I think that the more we do that, the more we empower these families, and then they can turn around and empower another family, I just think that that’s the best way to implement the whole process. We, too, with an obstacle has been the lack of understanding from providers regarding children with special health care needs. I think it’s just a very shaky area as far as providers are concerned and knowing what these families need as a whole. And so that education has been very important and been very trying to try to get that across to providers, so that they cannot have a break down in referral or in services and keep the family continuing down the process. So we’ve--you know, for us, I think that’s probably been the biggest barrier.

Faye: Well, you should all be very proud of your really significant achievements. Now we’re getting ready to wrap up, and I have a few closing questions for each of you. I’d like to know how your project addresses the Healthy People performance goal that children with special health care needs should have adequate health insurance.

Barbara: At ABC for Health, a backbone of the Families MAP program is our client services area, which provides health benefits and counseling to families that have children with special health care needs. And what that health benefit counseling does is it helps families utilize the benefits that they have in their existing plan, whether they be private or public, or a combination of both, and work with the families to best coordinate their benefits and most importantly understand them. Additionally, we’ve informed lots of families and advocates about the Health Check services in our state, and particularly what Health Check other services can provide for families that have access issues for different either services or equipment or other kinds of items that they might need. So I think that coordination of benefits is one way that we have worked effectively to make sure that children with special health care needs in Wisconsin have adequate insurance.

Faye: Oh that’s great.

Bobby: Just in case people aren’t aware, we call EPSDT Health Check here in Wisconsin--just so people are clear.

Faye: Yeah, thank you for explaining that, Bobby.

Bobby: Sure.

Faye: Nancy?

Nancy: At PHP we’re lucky that the county that we’re working in primarily, Santa Clara County, is the only county in California that provides health insurance for all children. There is no gap for any level of child in the county. What we do is to help the families understand that they have insurance and to apply for the benefits that are there waiting for them to ask for, and many families are very underserved, even though it’s a metropolitan community by and large. The word doesn’t get down to some groups and subgroups of people that they do have coverage, all they have to do is ask for it, and so we help people to obtain that. And we help families to coordinate health insurance with the other public available things for the additional care for their children.

Faye: Okay, and Kacie?

Kacie: We, too, assist in coordination of benefits and services. We have public and private insurance services that we work with. A lot of our families have health insurance, but they don’t know what services they’re entitled to, and a lot of that is an education process and we do a lot of that. We do have several families that we work with to get them health insurance. They don’t know that they’re eligible for it, so we walk them through that process, because a lot of times it can be a daunting task for families that are either in crisis or soon to be in crisis and don’t have health insurance, so we do a lot of that. And then we also do a lot of walking them through the system and navigating the system so that they get the most appropriate service that the child needs.

Faye: Okay, now we’re almost ready to finish the webcast, and I’d like to ask in closing for some feedback from you regarding your plans for continuing the work that you’ve been doing related to children with special health care needs and managed care, and also if you have recommendations of Maternal Child Health Bureau to promote family professional partnerships.

Bobby: This is Bobby. I think one of the things that we’re trying to do is to seed the idea of these Health Watch committees, which we started in a couple of areas across the state. I think it’s really an important way to identify local concerns, pull together the key stakeholders in the community, and help to articulate the key issues. It’s a point where families can express themselves, not only the frustration, but then identify strategies and solutions. I think it’s really an area for potential growth. We’re also trying to link to some of the efforts that we’re doing in part of our Covering Kids Project, which is a national initiative that is linking uninsured children to health insurance coverage. And we want to make sure that there’s a real strong emphasis on children with special health care needs, and building bridges to some of these other national efforts, I think, is really important.

Faye: Okay, Nancy?

Nancy: We have gone back to the hospitals that we have a parent liaison located in, and they have all agreed to take up the funding that MCH has provided to make sure that our services continue. We’re also providing symposiums that train other groups, family resource centers, medical centers on how to set up the same type of organization that we have in their local area. We have conducted two symposiums and anticipate more to come. And we’re ongoing with the work and growing, making sure that we reach all the hospitals in our area and expand throughout the Bay area, instead of just the South Bay.

Faye: Kacie?

Kacie: Well, we, too, are ongoing, and we feel like that it’s become such a widespread initiative that it really needs to continue and especially in getting a lot of the stakeholders and providers on board in educating about the principles of care. We, too, are working and directing with national and local initiatives and our stakeholders to try to keep up the facilitation.

Faye: So I guess what I’m hearing from all of you is that you have made significant progress, and you really have achieved many important goals and outcomes in your states, but there’s still quite a bit of work to do in the area of children with special health care needs and managed care health insurance, but you’ve developed some really sound working models. I think you’ve really shared with us some really important information and insights based upon your projects, and the hard work that you’ve been doing over the last few years. You’re doing really important things to help children with special health care needs. I want to thank you for logging onto our webcast production on "Children with Special Health Care Needs and Managed Care." We’re really interested in your comments and questions about the webcast, and we invite you to contact the project officer, Linda Honberg at lhonberg@hrsa.gov, or you can reach her by voice at (301) 443-6314. We hope that you’ve enjoyed this broadcast, and that you’ll join us for future broadcasts on children with special health care needs and managed care. Please note that once each webcast is aired for the first time, it will then be archived on our web site, which is www.uic.edu/sph/cade/kidsmco, and it can be accessed at anytime, day or night. Thank you for joining us.

Bobby: Thanks a lot, Faye.

All: Thank you.