Children and Youth with Special Health Needs (CYSHN)
Programs
- Birth Defects Monitoring and Analysis
- Early Hearing Detection and Intervention
- Follow Along Program
- Longitudinal Follow-up for Newborn Screening Conditions
Related Sites
Contact Info
Care Coordination in Minnesota
Care coordination is an essential component of integrated care, which is the "seamless provision of health care services, from the perspective of the patient and family, across the entire care continuum." Data on care coordination from the 2016 National Survey of Children's Health shows that 13.5% of families of Children and Youth with Special Health Needs (CYSHN) in Minnesota that needed effective coordination did not receive it. This suggests opportunity for improvement in ensuring families receive appropriate, comprehensive care coordination services.
Care coordination is an important function of the patient and family-centered medical home, and care teams can provide optimal coordination and integration of services needed by the child and family. Relationships between the health care provider, the care coordination team, and the patient and family facilitate effective information sharing, goal setting, care planning and follow-up support.
Providing care coordination is both challenging and rewarding. Please join us in strengthening a community of practice for all who manage care for children and youth with special needs (CYSHN).
The Minnesota statewide Pediatric Care Coordination: Community of Practice provides a way for professionals who manage care to network, collaborate, share, and learn from each other.
The Pediatric Care Coordination: Community of Practice website offers:
- Upcoming events and trainings
- Resources (from materials to a list of community organizations
- A directory of members
- Open funding opportunities through the Grant Alert
As professionals who manage care for CYSHN connect, share, and learn from each other, they can improve positive health outcomes by building the capacity of all systems that serve families of CYSHN.
Through this website, we are strengthening a statewide network of people who are actively working in this area. We also host a number of trainings, webinars, and other events with opportunities to connect virtually and in-person with colleagues from across the state of MN.
Who should register:
- Care coordinators or care navigators
- Case managers (including waiver)
- Social workers (i.e. county, non-profit, contracted)
- Early childhood educators
- Special education staff
- Patient advocates and referral liaisons
- Nurses (i.e. school, clinic, hospital, public health)
- Community health workers
- Mental and behavioral health professionals
- Health coaches
- Supervisors/directors for above roles
- Anyone managing care for children and youth with special needs!
Any questions please contact info@acetinc.com.
In Minnesota, a systems mapping process, which gathered input from stakeholders from across the state, was undertaken to assess strengths, challenges, gaps, and redundancies that are occurring around care coordination.
Background Information:
Children and youth with special health needs and their families often need a wide variety of medical, psychosocial, educational, and support services. Without effective care coordination, CYSHN can receive fragmented or duplicative services - ultimately receiving less than optimal care and causing unnecessary stress and frustration for families. In order to improve care coordination for CYSHCN, stakeholders need to have a better understanding of current cross-system care coordination efforts.
What did we do in Minnesota?
During 2015 - 2016, we conducted a series of regional meetings across the state with stakeholders involved in providing or receiving care coordination. The specific objectives for these regional meetings included:
- Discuss greatest opportunities and challenges in coordinating care;
- Gain understanding of the complexity of care coordination from the family's perspective;
- Complete system mapping to identify current organizations and initiatives supporting the care coordination system, identify current gaps and redundancies in the system, and guide systems improvement efforts;
- Develop and prioritize recommendations to improve care coordination;
- Brainstorm ideas on ways each participant can improve how they practice care coordination;
- Discuss and plan for ways that care coordinators can collaborate and/or continue working with each other to improve care coordination in their region.
What were our findings?
Regional and state-level findings from our systems assessment are included in the reports linked below:
- Statewide Summary Report (PDF): In addition to statewide findings, the statewide summary includes background information on the project, details on the methodology and assessment tools.
- Northeast Region Report (PDF)
- Northwest Region Report (PDF)
- Southwest / South Central Region Report (PDF)
- Twin Cities Metro Region Report (PDF)
- Southeast Region Report (PDF)
- Central Region Report (PDF)