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Sa n Jo a q uin Co unty 5Cs Pro je c t Ca lifo rnia Co mmunity Ca re Co o rdina tio n Co lla b o ra tive s I I Sa n Jo a q uin Co unty 5Cs Pro je c t Go a ls e a te for y tha t Cr ma l c ha nne ls of infor ma tion a nd se r vic e

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SLIDE 1

Sa n Jo a q uin Co unty 5Cs Pro je c t

Ca lifo rnia Co mmunity Ca re Co o rdina tio n Co lla b o ra tive s I I

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SLIDE 2

Sa n Jo a q uin Co unty 5Cs

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SLIDE 3

Pro je c t Go a ls

Cr e a te for ma l c ha nne ls of infor ma tion a nd se r vic e de live r y tha t

susta in a mor

e e ffe c tive c a r e c oor dina tion syste m for c hildr e n with spe c ia l he a lth c a r e ne e ds (CSHCN) a nd me e t the ne e d s o f he a lth

c a re pro vid e rs, fa milie s a nd se rvic e o rg a niza tio ns.

Inc r e a se fa mily a nd pr

  • fe ssiona l a c c e ss to infor

ma tion a b o ut

a va ila b le re so urc e s to impro ve c a re c o nd itio ns fo r CSHCN a nd the ir fa milie s.

Impr

  • ve c ommunic a tion b e twe e n he a lth c a re pro vid e rs, fa milie s,

a nd c o mmunity pa rtne rs, inc lud ing sta ke ho ld e rs suc h a s c o mmunity-b a se d o rg a niza tio ns, fa ith-b a se d o rg a niza tio ns, a nd g o ve rnme nt a g e nc ie s.

Re duc e r e pe a t da ta g a the r ing by se r vic e pr

  • vide r

s; r e duc e duplic a tion of te sts a nd se r vic e s, misse d or unsc he dule d te sts a nd se r vic e s.

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SLIDE 4

Pro je c t Pa rtne rs

Ca lifo rnia Child re n’ s Se rvic e s

Child Ab use Pre ve ntio n Co unc il o f Sa n Jo a q uin Co unty

Co mmunity Me d ic a l Ce nte rs, Inc . (F e d e ra lly Qua lifie d He a lth Ce nte rs)

Co mmunity Pa rtne rship fo r F a milie s o f Sa n Jo a q uin (F a mily Re so urc e Ce nte rs)

F a mily Re so urc e a nd Re fe rra l Ce nte r o f Sa n Jo a q uin Co unty

F a mily Re so urc e Ne two rk – L e a d Ag e nc y

F irst 5 Sa n Jo a q uin/ He lp Me Gro w Sa n Jo a q uin Co unty

He a lth Pla n o f Sa n Jo a q uin (Ma na g e d Ca re pro vid e r)

L

  • d i Unifie d Sc ho o l Distric t/ SE

L PA

Pa re nts o f CSHCN who re sid e in Sa n Jo a q uin Co unty

  • St. Jo se ph’ s Me d ic al Ce nte r

Sa n Jo a q uin Co unty Be ha vio ra l He a lth a nd Re c o ve ry Se rvic e s

Sa n Jo a q uin Co unty Huma n Se rvic e s Ag e nc y – Child Pro te c tive Se rvic e s

Sa n Jo a q uin Ge ne ra l Ho spita l a nd Outpa tie nt Clinic s

Sa n Jo a q uin Co unty Offic e o f E d uc a tio n SE L PA

Sa n Jo a q uin Co unty Offic e o f E d uc a tio n He a d Sta rt

Sa n Jo a q uin Co unty Pub lic He a lth Se rvic e s – Ma te rna l Child a nd Ad o le sc e nt He a lth

Sto c kto n Unifie d Sc ho o l Distric t/ SE L PA

Sutte r T ra c y Co mmunity Ho spita l- T ra c y Ho spita l F

  • und a tio n

Va lle y Mo unta in Re g io na l Ce nte r

Vic to r Co mmunity Suppo rt Se rvic e s (Me nta l He a lth 0-5 pro vid e r)

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SLIDE 5

Pro je c t Wo rk Pla n: 3 Pha se s

 Pla nning Pha se (Ja nua ry 2015 – Ma y 2015): De ve lop a n

Infra struc ture for 5Cs L e a de rship T e a m, He a lth Na vig a tors, a nd Colla bora tive me mbe rs

 Imple me nta tion Pha se (Ma y 2015 - June 2016): T

ra ining a nd De ve lopme nt of He a lth Na vig a tors a nd SJC 5Cs Proje c t Colla bora tive Me e ting s

 E

va lua tion Pha se (Ja nua ry 2016 - June 2016): E va lua te Imple me nta tion, Re vie w, a nd Pla n F

  • rwa rd
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SLIDE 6

Pro je c t Pla nning Pha se

Planning Phase (Januar y 2015 – May 2015): De ve lop Infr astr uc tur e for 5Cs L e ade r ship T e am, He alth Navigator s, and Collabor ative me mbe r s

F r

  • m Januar

y to Mar c h 2015 the 5Cs L e ade r ship T e am me t monthly to de ve lop an 18- month wor k plan and e stablish the r

  • le s of par

tic ipants, inc luding the L e ade r ship T e am me mbe r ship, He alth Navigator s, and additional Collabor ative me mbe r s and par tic ipants.

T he 5Cs L e ade r ship T e am de ve lope d an agr e e d upon de sc r iption of the e xpe c tations of He alth Navigator s, re vie we d a nd se le c te d a

Me mo ra ndum o f Unde rsta nding (MOU) fo rma t, de ve lo pe d lo g istic s to disse mina te a nd c o lle c t MOU’ s a nd c o nside r ne c e ssa ry re c ruitme nt to re pre se nt se rvic e g a ps.

F

  • r

ms and te mplate s we r e c r e ate d to solidify r

  • le s and r

e sponsibilitie s inc luding MOU’s with inte ra g e nc y info rma tio n sha ring / re le a se o f

info rma tio n c o mpo ne nts, a nd sta nda rdize d re fe rra l fo rms fo r c a se c o nfe re nc ing a t Co lla b o ra tive me e ting s.

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SLIDE 7

Me mo ra ndum o f Unde rsta nding

Ag e nc y a nd Pa tie nt/ He a lth Na vig a to r Ro le s we re sta te d in the MOU, b ut ma ny a g e nc y pa rtic ipa nts wo rke d a t a n a g e nc y tha t c ho se no t to sig n the MOU. T he MOU is a va ila b le a t: http:/ / www.lpfc h.o rg / site s/ de fa ult/ file s/ me mo ra ndum-o f- unde rsta nding -sa mple -fro m- sa n-jo a q uin-c o unty.pdf

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SLIDE 8

Family Support Mental Health Health Education

Basic Moderate Extensive Basic Moderate Extensive

Care Coordination for Children with Special Health Care Needs

  • 1. California Children's Services
  • 2. Health Plan of San Joaquin
  • 3. St. Joseph’s Medical Center/Neonatal

Intensive Care Center (NICU)

  • 4. San Joaquin General Hospital/NICU
  • 1. Family Resource Network
  • 2. Child Abuse Prevention Council
  • 3. Family Resource and Referral Center/

Help Me Grow Call Center

  • 1. Child Abuse Prevention Council
  • 2. Victor Community Support Services
  • 1. Early Start: Valley Mountain Regional

Center

  • 2. Lodi Area Special Education Region

Local Planning Area (LASER SELPA)

  • 3. San Joaquin County Office of

Education (SJCOE) SELPA

  • 4. Stockton SELPA
  • 5. Stockton Unified School District

Health Services

  • 6. United Cerebral Palsy

For more information, contact Family Resource Network at (209) 472-3674 or email to: frnfamilies@aol.com

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SLIDE 9

Page 2 Agency Map of Care Coordination Agencies for Young Children with Special Health Care Needs

Family Support - Basic Family Resource Network frcn.org Child Abuse Prevention Council Nochildabuse.org Family Resource and Referral Center/ Help Me Grow Call Center Frrcsj.org Mental Health - Basic Child Abuse Prevention Council Victor Community Support Services Victor.org

Health – Extensive California Children’s Services sjcphs.org Health – Moderate Health Plan of San Joaquin hpsj.com

  • St. Joseph’s Medical Center Neonatal Intensive Care

Unit/NICU Dignityhealth.org/stjosephs/ San Joaquin General Hospital NICU sjgeneral.org Education – Extensive Early Start: Valley Mountain Regional Center vmrc.net Lodi SELPA lodiusd.net SJCOE SELPA sjcoe.org Stockton SELPA Stockton Unified School District Health Services Stocktonusd.net Education – Basic United Cerebral Palsy ucpsj.org

This resource map is primarily designed for children ages zero to five

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SLIDE 10

Pro je c t Ac tivitie s

 Imple me ntation

Phase (Ma y 2015 -

June 2016): T ra ining a nd De ve lo pme nt

  • f He a lth

Na vig a to rs a nd SJC 5Cs Pro je c t Co lla b o ra tive Me e ting s

T he 5Cs L e a de rship T e a m me t mo nthly prio r to o r fo llo wing the SJC 5Cs Co lla b o ra tive mo nthly me e ting s to a ddre ss upc o ming ta sks b a se d o n the wo rk pla n, inc luding Co lla b o ra tive Me e ting pla nning , le a rning c o mmunity a c tivitie s, me nto r c o unty a c tivitie s, re po rting re q uire me nts, a nd e va lua tio n re q uire me nts o f the 5Cs Pro je c t.

F ull Co lla b o ra tive Me e ting s we re pro vide d mo nthly, a lte rna ting c a se c o nfe re nc ing with a g e nc y in-se rvic e a nd o the r tra ining to pic s.

De live ra b le s fo llo we d tra ining to pic s to info rm the wo rk o f Na vig a to rs.

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SLIDE 11

Pro je c t De live ra b le s

 I

nte r-Ag e nc y Me mo ra nda o f Unde rsta nding

 Pa ye r o f L

a st Re so rt Wo rkb o o k

 Ag e nc y E

lig ib ility Wo rkb o o k

 T

ra nspo rta tio n Guide

 E

va lua tio n T

  • o ls

Adde d De live r able s:

 2016 He a lth F

  • rum fo r

CSHCN

 SJC 5C’ s Autho re d

T ra nspo rta tio n Me mo

 Me nta l He a lth Se rvic e s

Guide s fo r Childre n Unde r Ag e 5

 Co unty Ma p o f CSHCN

Re so urc e s

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SLIDE 12

E lig ib ility Wo rkb o o k: SE L PA’ s

E lig ib ility fo r pa rtic ipa ting a g e nc ie s wa s c o mb ine d into a wo rkb o o k, a ssuming tha t c ha ng e s a re re la tive ly ra re . Me dic a l pro fe ssio na ls, c o mmunity b a se d

  • rg a niza tio ns, sc ho o ls

a nd spe c ia lists c a n use the wo rkb o o k a s a re fe re nc e fo r re fe rra l to se rvic e s.

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SLIDE 13

Pa ye r o f L a st Re so rt

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SLIDE 14

T ra nspo rta tio n Guide fo r CSHCN

All SJC 5Cs de live ra b le s a re a t the F irst 5 we b site : sjc kids.o rg / He lp Me Gro w Sa n Jo a q uin unde r Syste m Na vig a tio n Suppo rt I nfo rma tio n

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SLIDE 15
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SLIDE 16

He a lth F

  • rum

2016 Ag e nda

A ve ry impa c tful a g e nda wa s se le c te d b y 5Cs Co lla b o ra tive me mb e rs a nd de sig ne d to info rm the me dic a l c o mmunity

  • f c o mmunity-b a se d

re so urc e s fo r Childre n with Spe c ia l He a lth Ca re Ne e ds.

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SLIDE 17

Pro je c t E va lua tio n

 E

va lua tion Pha se (Ja nua r y 2016 - June 2016): E va lua te Imple me nta tion, Re vie w, a nd Pla n F

  • r

wa r d

 5Cs L

e a de r ship T e a m imple me nte d se le c te d e va lua tion tools to ide ntify g a ps a nd ba r r ie r s in the c a r e c oor dina tion syste m for CSHCN in Sa n Joa quin County. E

va lua tio n q ue stio ns a nd to o ls use d de sc riptive da ta , tre nds o ve r time , a nd me a sure s o f o utc o me s to a rtic ula te the suc c e sse s a nd c ha lle ng e s o f the 5Cs Pro je c t.

 5Cs L

e a de r ship T e a m c r e a te d fe e dba c k tools a nd que stions tha t a g e nc ie s c ould a dd to e xisting c ustome r se r vic e sur ve y tools a ppro pria te fo r fa milie s, a g e nc ie s a nd

He a lth Na vig a to rs to a sse ss the ne e ds o f CSHCN fa milie s a nd e va lua te the impa c t o f the 5Cs Pro je c t.

 Some outc ome s we r

e be st me a sur e d by da ta pr

  • duc e d by

he a lth c a r e pr

  • vide r
  • s. So me de sire d da ta suc h a s re pe a te d

sc he duling o f spe c ia lty c a re a ppo intme nts o r le ng th o f time to a c c e ss spe c ia lty c a re wa s fo und to b e ve ry c ha lle ng ing to c o lle c t.

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SLIDE 18

L

  • c a l da ta

so urc e s we re re se a rc he d

I n o rde r to a ddre ss g a ps a nd b a rrie rs in se rvic e s fo r CSHCN, va rio us a g e nc ie s da ta wa s c o lle c te d to pre pa re a pic ture o f ne e d a c ro ss the c o unty. T his is a n e xa mple o f c hildre n se nt fro m SJC NI CU’ s a t a ha lf ye a r da ta c o lle c tio n po int.

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SLIDE 19

Pa rtne rs we re surve ye d a s E xpe rts

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SLIDE 20

Powered by

Survey Monkey Q9: Health Navigator Rating of Care Coordination Challenges

Answered: 16 Skipped: 7

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SLIDE 21

Da ta wa s summa rize d fo r pre se nta tio ns to the 5Cs a nd b e yo nd

T his da ta ha s b e e n use d with b ro a d implic a tio ns. Curre ntly 5Cs me mb e rs a re e ng a g e d with the SJC Co unc il o f Go ve rnme nts in a fo rma l re q ue st to a llo c a te lo c a l tra nspo rta tio n funding to a syste m o f o ut-o f-c o unty no n- e me rg e nc y tra nspo rta tio n to Ba y Are a ho spita ls.