"It is incumbent on the physician to become familiar with each family’s natural, informal, and formal support systems and understand the impact of those systems on the family’s ability to access community resources. The physician and office staff’s ability to assess a family’s concerns, priorities, and resources, as well as a family’s ability to express their needs enables family-centered care."
Source: AAP Policy Statement
- Medical Home
Introduction - Medical Home Strategies
- Engage Families as Partners
- Identify Children & Youth with Special Health Care Needs
- Use Planned Encounters
- Improve Care Coordination:
Create Care Plans - Support Adolescent
Transitions - Collaborate with
Community Resources - Refine Coding &
Reimbursement Practices - Find Regional Centers
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Site last updated:
October 15, 2009
Wisconsin Resources
Wisconsin Regional Centers for Children and Youth with Special Health Care Needs
Wisconsin First Step
1-800-642-7837
Children's Health Alliance of Wisconsin
Wisconsin WIC Toolkit for CYSHCN
Great Lakes Intertribal Council Children/Youth with Special Health Care Needs Project
National Resources
National Center of Medical Home Initiatives for Children with Special Needs
- Medical Home Tools for Community Based Organizations (link)
The Center for Health and Health Care in Schools
Improving the Management of Family Psychosocial Problems at Low-Income Children’s Well-Child Care Visits. Pediatrics, 2007 (link)
In a Medical Home, the primary care provider coordinates a team to make sure children get all the medical and non-medical services needed. Collaboration with early intervention programs, schools, early childhood education, child care programs and other public and private community agencies help assure there is communication amongst the many providers addressing a family’s needs.
Videos
Two physicians discuss the critical role the Regional Centers play in helping identify resources for families and complete a circle of care. A Birth to 3 Director describes how a county can strengthen Medical Homes for families by creating a network to assure coordination of services for children with special needs.
Medical Home Resources
In Wisconsin, the five Regional Centers for Children and Youth with Special Health Care Needs can assist families and providers in finding local, state and federal resources – making this information readily available in the practice setting. They also provide free, confidential assistance for families connecting them with health insurance or other resources, build advocacy skills and provide emotional support. They provide linkages to family support organizations like Family Voices of Wisconsin and Parent-to-Parent of Wisconsin.
Wisconsin First Step is an information and referral hotline for children and youth with special needs. Parent Specialists offer information and assistance 24/7. They provide referrals to County Birth to 3 Programs and other resources.