Special

Health

Care

Needs

Created by: Marjorie Yanez, SSSP

Presented by: Marjorie Yanez, SSSP

Karen Quinn, Sr.SSP

Agenda

– Mission

– Medical Fragile / Medical at Risk/ Special Health Care Needs

– WIC 17710 Simplified

– Individualized Health Care Plan

– Placements

– Conclusion and questions

San Bernardino County CFS

Mission

– Protect endangered children , preserving and strengthening their families

– Develop alternative family settings

– Seek the safety, permanency and wellbeing of children

– Provide mental health services timely

– Support family and sibling connections

– Adhere to the Core Practice Model

SB County SHCN Unit Mission

– To promote the health and wellbeing of children who have Special Health Care

Needs by providing support, stability of placement, intensive support services

and resources in collaboration with the health care community, Public Health

Nurses and CFS regions.

Medical Fragile- Medical at Risk

– Medically fragile is a term used by medical personnel which refers to a child

who may be dependent upon multiple technologies to survive. It is also a term

used under Title 22 and the Health and Safety Code to describe some medical

conditions found under WIC 17710; which identify a child as meeting SHCN

criteria. (Title 22 5-2220; HSC 1760.2 (b)

– In SB County, Medical at Risk (MAR) refers to children who are at-risk of

complications due to a medical condition and must be monitored.

(SBC-CFSHB #1205 (08/17) 4-P2-3)

WIC 17710

SHCN

– (a) “Child with special health care needs” means a child, or a person who is 22 years of age or younger who is completing a publicly funded education program

– who has a condition that can rapidly deteriorate resulting in permanent injury or death or

– who has a medical condition that requires specialized in-home health care, and

– who either has been adjudged a dependent of the court pursuant to Section 300, has not been adjudged a dependent of the court pursuant to Section 300 but is in the custody of the county welfare department, or

– has a developmental disability and is receiving services and case management from a regional center.

Medical Conditions (WIC 17710)

– (g) Medical conditions requiring specialized in-home health care require

dependency upon one or more of the following: enteral feeding tube, total

parenteral feeding, a cardiorespiratory monitor, intravenous therapy, a

ventilator, oxygen support, urinary catheterization, renal dialysis, ministrations

imposed by tracheostomy, colostomy, ileostomy, or other medical or surgical

procedures or special medication regimens, including injection, and intravenous

medication.

SHCN Identifying Conditions (WIC 17710)

Medical Condition Additional Information

Cardiorespiratory Monitor

Colostomy

Enteral feeding tube G-Tube, percutaneous endoscopic gastronomy, and nasogastric tube.

Ileostomy Surgical opening to facilitate passing of intestinal waste.

Intravenous therapy (IV MEDS)

Ministrations imposed by tracheostomy Care related to tracheostomy

Medical or surgical procedures

Requires specialized in-home health care may include but not limited to certain shunts

SHCN Identifying Conditions (continued)

Medical Condition Additional Information

Special medication regimens, including injection and intravenous medication

Requires ongoing medical injections in the home including but not limited to injections for: diabetes management, anti-rejection medication, growth hormone injections, and medication for pulmonary hypertension.

Oxygen support

Total parenteral feeding (TPN) Nutritional Substitute via intravenous (IV) route

Urinary Catheterization

Ventilator

SHCN Identifying Conditions (Title 22)

Medical Condition Additional Information

AIDS

Bronchopulmonary dysplasia (BPD) Chronic lung disease usually in infants

Certain Congenital Defects Such as: • Hydrocephalus • Sickle Cell Anemia • Cystic Fibrosis

Premature Birth Infant is small, usually weighing less than 2.5 kg (5.5 pounds)

Severe asthma Infants receiving prescribed medication or using an aerosol machine or intermittent positive pressure breathing machine for severe chronic asthma

SHCN Identifying Conditions (Continued)

Medical Condition Additional Information

Severe Seizure Disorders A child may experience a grand mal seizure or go from one seizure to another as in status epilepticus. The infant or young child, who is prone, despite the correct administration of medications and/or medical procedures, to sudden relapses that call for re-hospitalization or the intervention of a health care professional to avoid further disability.

Severe gastroesophageal reflux (GERD) Chronic digestive disease usually in infants up to 18 months

Non- SHCN / Health Difficulties

Health Difficulty Additional Information

Cerebral Palsy CP in and of itself does not qualify for SHCN. If the child has additional medical concerns further evaluation is needed

Diabetes Controlled by oral medication

Failure to Thrive For all FTT children, the SW must consult with the SHCN duty worker

HIV Refer to CFS HB Volume 4, Chapter T

Mild Asthma

Multiple Fractures

Sickle Cell

Spica Cast Cast used to immobilize the hip or thigh

Wheelchair A child/youth may require a small family home licensed for non-ambulatory clients, but that does not qualify them for SHCN. The child/youth still need to meet the medical conditions described for SHCN.

Who Does Not Qualify?

– Conditions that are primarily psychological or behavioral. For example, Bi-polar,

Autism, and /or developmental delays unless these go together with another

SHCN qualifying condition.

INDIVIDUALIZED

HEALTH CARE PLAN

(IHCP)

WIC 17731 (c) (1)

RFA Section 11.1-05

– Prior to the placement of a child with SHCN, an individualized health care plan,

which may be the hospital discharge plan, shall be prepared for the child and, if

necessary, in-home health support services shall be arranged.

– A Specialized Resource Family shall not accept a child with special health care

needs unless the Resource Family has obtained an individualized health care

plan for the child.

Individualized Health Care Plan (IHCP)

– Per RFA it means a written plan developed by an individualized health care plan

team and approved by the team physician, or other health care practitioner

designated by the physician to serve on the team, for the provision of

specialized in-home health care to a child with special health care needs as

specified in Welfare and Institutions Code section 17731.

(RFA Written Directives Version 4.1 Date: 06/09/2017)

Individualized Health Care Plan (WIC 17731)

• Developed by the child's physician or his or her designee

• Can be the hospital discharge plan

• It is convened by the county social worker or regional center worker

• Way to discuss the specific responsibilities of the person or persons specified under

Section 17710 (h) for provision of in-home health care in accordance with the IHCP

• May include the identification of any available and funded medical services that are

to be provided to the child in the home

• Delineate the coordination of health and related services for the child

WIC 17731 (c) (1)

IHCP Meetings

– Intended to promote a safe transition for the child.

– A brief medical history is given, future medical needs/ appointments of the child are discussed, as well as who will be responsible for completing the different parts of the plan.

– Placement paperwork is completed by the Social Worker. A signed medical consent and straight Medi-Cal must be provided to caretaker.

– Held on the day that the child is discharged from the hospital (Initial IHCP), every six months, when a child’s needs change and at every placement change.

– Count as a CFT meeting for class and sub-class. Meetings include informal supports, mental health and schools when indicated, providing a holistic approach.

Who are the team members?

– Primary care physician or other health care professional designated

by the physician

– Any involved medical team

– Health care professionals designated to monitor the child’s IHCP

– If the child is in a certified home, the registered nurse employed by

or under contract with the agency to supervise and monitor the child

– Representatives from the California Children’s Services Program or

the Child Health & Disability Prevention Program, or regional centers

Team Members (continued)

– the county social worker or regional center worker

– a public health nurse

– county mental health representative

– the prospective specialized foster parents, who shall not

participate in any team decision per WIC

– and where reunification is the goal, the parent or parents, if

available and appropriate

WIC 17731; WIC 17732 & WIC 17710

PLACEMENTS

Options / Steps

SHCN Placement Options

– Specialized Resource Families

– Foster Family Agencies

– Small Family Homes

– Intermediate Care Facility Developmentally Disabled-N – nursing component

– Intermediate Care Facility Developmentally Disabled-H – habilitative

component

– Sub-acute/Rehabilitation Centers (one step down from a hospital)

– Short-Term Residential Therapeutic Centers (STRTC) that care for SHCN children

Specialized Resource Families (SRF)

– (a) The capacity of a SRF may not exceed six children as specified in Section 10-03(a)(1).

– (b) May not care for more than two children or nonminor dependents with or without special health care needs except as provided in subsection (c).

– (c) May accept a third child or nonminor dependent with or without special health care needs under the following conditions:

Conditions

– the capacity is not exceeded

– there is no other specialized home in the county or regional service

area in which the SRF Is located

– the psychological and social needs of the child or nonminor

dependent.

– The individualized health care plan team for each child with SHCN

placed with the SRF has considered the number of children in the

home and determined that placement of a third child or nonminor

dependent will not jeopardize their health and safety

*Note- this criteria also applies to Foster Family Agencies

Small Family Homes

ICFDD

– Paid by Medi-Cal/Inland Regional Center

– Take Non-Ambulatory Children

– No more than 6 children can be placed in the home

ICFDD-N Intermediate Care Facility Developmentally Disabled with Nursing

– Paid by Medi-Cal/Inland Regional Center; if no open IRC case 100% county pay

– Take Non-Ambulatory Children

– Provide 24-hour personal care

– Developmental services

ICFDD-H

– Some take Non-Ambulatory Children

– Must have IRC case

– Paid by Medi-Cal

– Provide 24-hour personal care, habilitation, developmental, and supportive

health services to developmentally disabled persons.

Sub-acute/Rehabilitation

Centers

– Paid by Medi-Cal

– Must have IRC/CCS in place

– Used for children who’s medical needs are more than what can be serviced by

any other provider

– Once medical condition stabilizes the child must be moved

STRTP that care for SHCN

Children

– May have a nurse or nurse consultant on staff

– a residential facility that provides integrated program of specialized and

intensive care and supervision, services and supports, treatment, and short-

term 24-hour care and supervision to children

– Effective January 1, 2017, the new STRTP rate is $12,036. For all out-of-state

group home placements, the rate the county pays is based on the out-of-state

group homes rate; however, the rate paid cannot exceed the new STRTP rate.

PLACEMENT

STEPS

PRE AND POST

Medically Urgent or Emergency

– Remember the role of the PHN is that of a consultant- a resource for the SSP

through her/his knowledge and assessment skills. PHNs cannot diagnose or

treat a client.

– If the situation appears to be medically urgent or an emergency call 911. Ask

yourself: Will the child’s condition rapidly deteriorate? Err on the side of

caution, be safe not sorry.

– Examples of emergent care: shortness of breath, respiratory distress, altered

state , significant injuries, etc.

Pre-Placement Steps

– Have the child medically evaluated by a medical professional

– Obtain as much medical information as possible (if the child is in the hospital contact

the hospital,) review Health & Education Passport

– Determine the level of care needed

– Contact the local Regional Center to determine if the child is a consumer

– Search for placement

– Schedule an IHCP/CFT Meeting

Post Placement

All SHCN placements are to be re-assessed every six months (IHCP/CFT)

– If the child no longer meets criteria

– End project code in CMS

– E-mail the assigned Social Worker, assigned Supervisor, and Public Health

Nurse

Contact Information

– SHCN Coordinator : Corina Chavez (909) 388-4733

– SHCN OAIII: Irma Romero (909) 388-4716

– SHCN SSSP: Marjorie Yanez (909) 388-0400

– SrSSP: Karen Quinn (909) 388-4744

– Office located at 1094 South “E” Street, SB 92415