Coordinator s Introduction to Community Connections Network (CCN): Child Health Team

Transcription

1 Coordinator s Introduction to Community Connections Network (CCN): Child Health Team Oregon Center for Children and Youth with Special Health Needs, 2015

2 Instructions 1. Please watch the first PowerPoint Introduction to Community Connections Network (CCN): Child Health Team before continuing with this PowerPoint. 2. After reading this PowerPoint, click on the link to complete a SurveyMonkey quiz. Following the quiz, you will contact your OCCYSHN consultant. Information will be provided on the last slide.

3 Learning Objectives Describe the roles and responsibilities of the coordinator Describe how to implement the team process Describe the difference between the Child/Family Visit and a Team Meeting

4 To Review the Previous PowerPoint CCN is a program of community-based child health teams in partnership with the Oregon Center for Children and Youth with Special Health Needs (OCCYSHN). A CCN Child Health Team is made up of a child s parents and the local professionals who partner together to coordinate care for the child. Teams also share expertise and resources, create new partnerships, and improve existing community practice.

5 OCCYSHN Supported Team Roles Team make-up depends upon a child s specific needs and will always include: You are here! Coordinator schedules meetings, obtains releases and records, maintains records, and coordinates communication among the CCN team members Physician or Nurse Practitioner reviews records, conducts evaluations, and provides a medical perspective Professional Adjunct supports the coordinator and conducts community outreach and networking on behalf of the team Parent Partner provides support to families of the children seen during the CCN team process

6 Coordinator Responsibilities A complete list of Coordinator Responsibilities is included in your Coordinator Training Packet, but your basic role is to: 1. Coordinate and schedule Child Health Team Meetings. 2. Create and maintain files from medical, education, and community-based services in a HIPAA and FERPA compliant manner. 3. Disseminate reports and shared care plans appropriately and communicate with community partners as needed to ensure effective team meetings and coordination of care. 4. Coordinate shared care plan tracking with the Parent Partner. 5. Submit program data forms on a timely basis to OCCYSHN and facilitate data collection, as requested by OCCYSHN. 6. Participate in CCN Child Health Team learning opportunities provided by OCCYSHN.

7 Two Types of Meetings The CCN team holds two types of meetings, though they are typically scheduled on the same day each month: 1. Team Meeting 2. Child/Family Visit

8 Team Meeting The Team Meeting is used to: Discuss new referrals to determine if a referred child and family can be served by the the team Review open Shared Care Plans of children previously seen with input from the Parent Partner Share ideas, information, and resources including local agency updates The Team Meeting Facilitation Guide provides a template for conducting the Team Meeting

9 Child/Family Visit The family attends a meeting with the Child Health Team. This is referred to as the Child/Family Visit The family s concerns and needs are shared The team creates a Shared Care Plan with the family The physician may provide an exam ( Child Visit ) prior to the meeting The Parent Partner follows up with the family some time after the meeting to track recommendations The Child/Family Visit Facilitation Guide provides a template for conducting the Child/Family Visit

10 CCN Team Participants Intensive Care Case Manager/DME Coordinator or CCO Representative School Counselor or Psychologist Child Psychologist, Psychiatrist, or other Mental Health Provider Teacher; Special Educator Program Administrator Early Interventionist Interpreter/ Community Health Worker Childcare Provider Child/Youth & Family Vocational Rehab Counselor OT, PT & Speech/ Language Pathologist CCN Child Health Team Physician Parent Partner Social Worker Nutritionist Head Start Primary Care Provider/Care Coordinator DHS Self- Sufficiency or Child Welfare Developmental Disabilities Case Manager CaCoon or Public Health Nurse; School Nurse A representative from the PCPCH (or PCP), education, social services, and other health care fields may be regularly attending members of the team. Other community professionals may be invited to attend the meeting on a child-bychild basis. In addition, consult with the professional adjunct to determine the appropriate team members.

11 The Basic Process Though all teams differ slightly in their make-up and procedures, the complete process might look something like this: 1. A referral is received from the community or a Health Team member. 2. The child s referral is discussed in a monthly Team Planning Meeting. 3. The coordinator requests records and invites the family to attend a subsequent CCN Child/Family Visit meeting. 4. During the Child/Family Visit Meeting a Shared Care Plan is developed. 5. Following the Child/Family Visit, the Shared Care Plan is distributed. 6. The Parent Partner follows up with the family to track how implementation of the Shared Care Plan is going and reports back at the next Team Meeting. 7. When all recommendations on the Shared Care Plan are resolved, or the family opts out, the plan is closed. The family may return to the Child Health Team for further support when needed.

12 Team Process Flow Chart

13 Submitting Forms to OCCYSHN The Coordinator is responsible for faxing or otherwise securely sending the following forms to OCCYSHN: Child Visit Data Form submit one week after meetings Team Activity Data Form submit one week after meetings Child Roster submit entire history in January and June Shared Care Plan Tracking Tool as soon as it is closed

14 Resources: The Coordinator Packet The Coordinator Training Packet includes the following important resources you will need: 1. An organized list of coordinator responsibilities arranged by Before, During, or After a meeting. 2. A list of all forms and a brief description of each is included. 3. A complete list of Coordinator Responsibilities. Please click on the link above and print or electronically save the Coordinator Training Packet.

15 Where to find what you need The referral packets, needed forms, and organizational tools can all be found in the CCN Child Health Team Toolkit on the OCCYSHN website at: CCN Forms, Documents, and Training Webinars In addition, tips for completing each form may also be found here.

16 Time for a Quiz! Please click on the link below and complete the Survey Monkey Coordinator Quiz. You will need access to your Coordinator Training Packet. Survey Monkey Coordinator Quiz: Click Here When you have finished the quiz, please click the link below to your OCCCYSHN consultant to set up a phone appointment. Have your questions ready! Community Consultants: Marilyn Berardinelli: Linn-Benton, Lincoln, Wasco, and Tillamook Karen Brown: Clatsop, Hood River,and Salem Amy Doss: Ontario and Coos Bay