Children with Special Health Care Needs Cascade Pacific Action Alliance, Pierce County and

Southwest Washington ACH Regions November 16, 2017

Regional Care Facilitator’s: Apple Martine, Kate Phillips and Anne Johnston

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Topic Notes Welcome and Introductions

Attendees: Kate Phillips, Tacoma-Pierce County & Pierce County ACH RCF Connie Callahan, Clark County Anne Johnston, Clark County & Southwest Washington ACH RCF Shannon Severeid, Mason County Sylvia Davenport, South Sound Parent 2 Parent Bonnie Peterson, Thurston County Apple Martine, Thurston County & Cascade Pacific Action Alliance ACH RCF Penny Andress, Klickitat County (phone) Michelle Kemmer, Pacific County Amber Bunker, Pacific County Jeanne Snow, Cowlitz County (phone) Ellen Silverman, DOH Christy Polking, DOH Meredith Pyle, DOH

Medical Home Neighborhood Team Call

Joined the Medical Home Neighborhood Team call to learn more about the efforts of the P-TCPi, but also to brainstorm how CSHCN and P-TCPi work intersect, and what barriers we identify for parents and children. A significant barrier identified for families is the cumbersome systems that they must navigate-specifically, the DDA. Slides attached to email.

County Updates Clark: WorkFirst referrals continue to come in, 3 to 4 per month. Jan, Office Assistant for CSHCN and myself gave a talk about the CSHCN program at DSHS Work First staff meeting. They had many good questions. Anne Johnston is moving forward with the TPCi project with identifying those who would like to support this program. The CSN nursing note format continues to evolve. We have a new IS person. Her name is Martha and I look forward to her ideas on electronic charting. I continue to see an increase in Down Syndrome babies. Many young moms. Cowlitz: Cowlitz County is using its MCHBG dollars this year to direct the work to population based health care for CYSHCN. In implementing the initial work laid out in our MCHBG Action Plan, we learned that Lewis County Autism Coalition was contracted by UW Medical Home Partnerships Project for CYSHCN, with funding from the DOH CYSHCN program to do Community Asset Mapping in the area of children w/ autism and special health care needs. A community mapping meeting had been established. So as not to be duplicative in the work, CCHHS staff joined the Community Asset Mapping meeting with 35 other community partners to identify and establish coordinated and accessible systems for families and medical provider. The purpose is to ensure timely assessment, a professional diagnosis, and evidence-based services in their community for children with suspected developmental delays. Subcommittees were formed and will meet in the future.

Children with Special Health Care Needs Cascade Pacific Action Alliance, Pierce County and

Southwest Washington ACH Regions November 16, 2017

Regional Care Facilitator’s: Apple Martine, Kate Phillips and Anne Johnston

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Topic Notes CCHHS will continue to work with the CAM group on the specific goals identified for the Lewis County Autism Coalition project, while identifying how CCHHS can enhance the work of the group to broaden the asset mapping to include other information. We drafted our MCHBG work plan and aligned the work of CAM group with the local strategies identified in the block grant to ensure there was not duplication of services. We have been working to identifying CYSHCN for population-level assessment using a variety of reporting tools, including Medicaid, CHIF, and Private Health Plans. Some of the initial information we are wanting to gather includes visit to health care provider (medical, mental health, or other health services) in the last year, prescription medication, specialized therapies, ongoing treatment or counseling, and any limiting functionality. Lauren Henricksen from our Health Communities team is working with CYSHCN Program Manager Jeanne Snow to address much of this work. In addition, we are using our Epidemiologist to assist with the more technical aspects of the epi work. Staff viewed presentation, “Identifying Children and Youth with Special Health Care Needs & Understanding Their Health and Care Coordination Needs: Real-World Methods, Models, and Strategies”. This is an excellent overview of CYSHCN from the population health care perspective that was done by Oregon’s CYSHCN Program. The link is as follow: https://www.youtube.com/watch?v=AXh08S6fTPU We have been in regular attendance at our ACH-CPAA Regional Meeting representing MCH-CYSHCN needs. In addition, our Executive Director serves as a voting member of ACH-CPAA Council. Our Community Health Outreach staff member, Gayle Reid, offers telephone consultation to families in Cowlitz County to provide information and linkages to services. She has done a great job of connecting families to existing services in the county. In addition, she maintains and updates information on the website for CYSHCN and continues to do the data collection and entry for CHIF. Grays Harbor County: Our CSHCN nurse resigned and we are now in the process of advertising for her replacement. Referrals have been slow coming in for me. I will be covering that program to the best of my ability with all the other duties, so will concentrate on phone contact a lot with any new referrals. Klickitat: In Klickitat County we are continuing to work on developing partnership with local providers to be aware of our CSHCN Program, as well as Universal Developmental Screening. We hope that they will either complete an ASQ on children at well child visits, refer the parent online to do ASQ's, or refer them to us for ASQ screening. We have also expanded our ASQ screening to three years old.

Children with Special Health Care Needs Cascade Pacific Action Alliance, Pierce County and

Southwest Washington ACH Regions November 16, 2017

Regional Care Facilitator’s: Apple Martine, Kate Phillips and Anne Johnston

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Topic Notes Lewis: No update provided. Mason: Mason County Public Health is experiencing a transition in nurses. Vickie Marquina, RN has left employment as communicable disease nurse and the position has been posted this week to advertise for new talent. Audrey O'Connor, RN has been hired to work in maternal-child health block grant programs including children with special health care needs, early intervention program with children's administration and the opiate program. Audrey is also the new CSHCN Coordinator. Nurse-Family Partnership nursing positions are leaving Mason County and transferring to a regional model with Thurston and Lewis Counties to be housed in Thurston County. The Nurse-Family Partnership Program will continue to provide services in Mason County. CSHCN referrals continue to trickle in from pediatric providers in the community and the neurodevelopmental center. Audrey plans to work on continued outreach to providers as well as a process for communicating referral outcomes to sources and building linkages with services in Mason County. Pacific County: Amber Bunker BSN, RN, is now starting to work more in the CSHCN program. We will be spending some time on the orientation book and how the program works as well as how to CHIF children. We are working on a new referral form. We meet with a social worker from the pediatrician that works in our neighboring community of Astoria, Oregon. We hope that with her new role she will be able to refer more children to all of our programs at the health department. We have no work first children. We do not have a home visiting program. We currently have 29 children enrolled in the CSHCN program. Skamania: No update provided. Tacoma-Pierce County: We currently have 27 families open to nursing case management services. We have received 8 referrals for direct services this quarter, and have 281 CHIFs this quarter. We have received 6 WF referrals this quarter. Additionally, the CSHCN team continues working through our internal CSHCN processes to find efficiencies and to ensure all our workflows are compatible with our goal of serving families! Our next phase will be looking at our charting processes to ensure we are capturing the right information and using our internal database to its full potential. Thurston County: The majority of my referral come from Seattle Children’s Hospital, Mary Bridge NCP, and the NICU’s from U of WA and TG. CSHCN nurse is seeing an increase in homelessness, more client isolation, and higher risk factors that they have difficulty following through and utilizing resources. Referrals are up for initial Work First visits. Getting around 6*8 referrals per month. Had a meeting with all the Work First case managers last month. Discussed challenges with referrals and access EJAS coming soon for me. No resources for ABA in our county if on Apple Health. They are put on a waiting list

Children with Special Health Care Needs Cascade Pacific Action Alliance, Pierce County and

Southwest Washington ACH Regions November 16, 2017

Regional Care Facilitator’s: Apple Martine, Kate Phillips and Anne Johnston

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Topic Notes and is never called. Parents and the schools struggle with managing the child’s aggressive violent behavior. We see a number of the children suspended or sent home from school due to their violent behavior. All the PHN’s have finished our 20hrs+ of infant mental health training and reflective supervision with Gona Veloni over the last 12 months, that was financially supported by a grant through THRIVE. We are all seeking endorsement for being an infant mental health specialist through Washington Association for Infant Mental Health. Two PHN’s. Apple and Bonnie are involved in the Project Launch Project in our county. They alternate on attending the parent night. This is when the childcare provider and ASQ trainer presents the ASQ to the parents and hear about resources. The families are informed about the CSHCN program. Apple and Bonnie attended the Autism Conference in Lewis County. Our Maternal Child Health team is up to 9 nurses. There is also an open .6 position for NFP which the dept. has started the process to fill it. We currently we have 8 NFP and 1 CSHCN. In the very near future, our NFP team will be going regional, adding Lewis and Mason County. Wahkiakum: No updates to share.

DOH Updates Christy reports that she is hopeful that the new CHIF Database will be in work in the next few months, and that it will be functional in 2018! She also reminds us to ensure that old ICD-9 codes are updated to ICD-10 codes—this is important when kids are getting renewed! Maria Nardella recently announced her retirement.

Case Presentation Connie shares about a family in need of additional support related to behavioral concerns & autism, which allows the group an opportunity to share information and resources that might assist. The group agrees that this is a helpful tool. Ellen recommends reaching out to Monica Meyer, of Monica Meyer Consulting, and Dawn Sidell at NW Autism Center for ideas and support for this family: Monica Meyer Consulting https://monicameyer.com/ Educational consultant in the Meadow Glade, Washington 18201 NE Cedar Dr, Battle Ground, WA 98604 Phone: (360) 904-8938 Dawn Sidell dsidell@nwautism.org 509-328-1582 http://www.nwautism.org/

Children with Special Health Care Needs Cascade Pacific Action Alliance, Pierce County and

Southwest Washington ACH Regions November 16, 2017

Regional Care Facilitator’s: Apple Martine, Kate Phillips and Anne Johnston

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Topic Notes Ben’s Fund: http://www.featwa.org/grants/ The Ben's Fund Mission is to provide grant opportunities to families across Washington state who need financial assistance with requests related specifically to their child's autism spectrum disorder treatments. From therapies to equipment, we support our local families by easing some of the financial strain associated with autism. Provail: http://www.provail.org/ PROVAIL is one of Washington State's largest, multi-service agencies dedicated to meeting the needs of children, youth, and adults with disabilities who need an integrated, complex set of services to live life according to their own choices. Serving primarily King and Snohomish Counties, PROVAIL offers a comprehensive range of services to support people, with even the most severe disabilities, in all major areas of life so they can live, work, play, and fully participate in the community of their choice.

Resources Identified in this Meeting

Contact for concerns about Medicaid Brokered transportation: HCANEMTTRANS@hca.wa.gov Online ASQ and ASQ-SE Screening for families through WithinReach: http://parenthelp123.org/child-development/child-development-screening-public To request Great MINDS training in your area: WA Chapter of the Academy of Pediatrics, Edna Madalena: EMaddalena@wcaap.org

Planning for 2018 Meetings

This group would like to continue quarterly meetings. We agree that a call-in option will always be utilized, and an in-person option will always be available—Apple and Kate will always be present in-person for those who care to join. Regular in-person meetings (May, August, November) will be 9:30 AM – 3:00 PM with a lunch break. February meeting, when most call-in, will be shorter, and likely only in the morning. The group agrees that county updates can be prepared and shared prior to the meeting, and that a template for doing so would be helpful.

Adjourn Next SW Washington Regional Meeting: February 22, 2018 2018 Meeting Dates: February 22, 2018 May 24, 2018 August 23, 2018 November 15, 2018

WA Pediatric Transforming Clinical Practice InitiativeNovember 16, 2017

Medical Home Neighborhood Team Meeting

April 2016

Medical Home Partnerships Project – Lead Support for MHNT

Kate Orville, MPH, Co-director,P-TCPI Medical Home Neighborhood Team Lead

Amy Carlsen, RN, Family-Professional Partnerships and CAM Lead

Kathy TeKolste, MD, Co-director

Today’s Meeting Goals

• Brainstorm how to help clinicians move forward in transforming their care for children as evidenced by moving the needle on child health outcomes

• Support the work of the Regional Care Facilitators

• For the SW local CSHCN and P2P coordinators to gain a practical understanding of the work of the P-TCPI MHNT and how to contribute and benefit from activities

• For all of us to benefit from the broad expertise of the local coordinators and the different sectors members of the MHNT represent

Child & Adolescent Clinic, P-TCPI Primary Care Team

• Phyllis Cavens, MD

• Julie Nye

Children’s Home Society

• Libby Hein

Family to Family Health Information and Education Center, PAVE

• Jill McCormick

Molina Healthcare of WA:

• Christi Sahlin, Manager

• Erin Darrah, Pediatric Case Manager

Swedish Medical Group-Patient-Centered Medical Home Team

• Brianne Wojtesta

Seattle Children’s

• Jacquie Stock

• Hugh Ewart

• Alexis Koutlas

• Paula Holmes

WA State Dept of Health• Maria Nardella• Ellen Silverman• Allison Templeton• Zoey Hogan• Melissa Thoemke

WA State Parent to Parent• Susan Atkins

WithinReach• Stephanie Orrico

• AND the REGIONAL CARE FACILITATORS and SW WA Guests

P-TCPI Regional Care Facilitator (and Practice

Facilitators )Better Health Together-Sheila Masteller/Melissa Charbonneau (Reese Holford)Greater Columbia –Shelley Little (Reese and Tawn)King County- Kate Besch (Christine Stahlie)North Central- Carol McCormick (Tawn Thompson)North Sound --Paula Young (Joann Parris)Olympic- Karina Mazur (Amy Etzel)

And our Pierce, Cascade and SW WA Members and Guests!• Cascade – Apple Martine (Karen Pastori)

• Thurston, Lewis, Cowlitz, Wahkiakum, Pacific, Mason and Grays Harbor

• Pierce – Kate Phillips (Torri Veloz)• Pierce

• SW WA Regional Health Alliance –

• Anne Johnston (MacKenzie Dunham)• Clark, Skamania, Klickitat

Medical Home Neighborhood

• Based on a national concept to include the entire care continuum of multi-specialty providers along with community services and resources, social services, and state and local public health services.

• To strengthen clinical – community partnerships for comprehensive pediatric care.

• Focus on “Coordinated” Care Coordination

Medical Home Neighborhood Team• Membership reflecting Medical Home Neighborhood Partners

• Team source of expertise to advise and support P-TCPI on integrated approaches to co-management, care transitions, and communication between hospital, pediatric primary care, behavior health, and specialty care

• Provide support to Regional Care Coordination Project and other team projects. Regional asset mapping and building on local models that work, connection to ACH transformation work.

Also: • Access to behavioral health

• Family engagement

• Youth transitions from pediatric to adult care

Handouts

SW WA CSHCN Coordinators and P2P Coordinators

Cascade Pacific Action Alliance- Apple Martine (Karen Pastori)• Thurston, Mason, Grays Harbor, Pacific Wahkiakum, Cowlitz

Pierce County – Kate Phillips (Torri Veloz)

SW WA Regional Health Alliance – Anne Johnston (Mackenzie Dunham)• Clark, Skamania, Klickitat

Additional Handouts:

• Agenda

• Summary of Sept 29, 2017 PTCPI Learning Forum Breakout: External Clinic/Clinician Support. Conversation among Practice Facilitators, Regional Care Facilitators and Qualis Coaches/Connectors

DOH Updates – Ellen Silverman

1) Refocused goal of grant

2) Recruitment

Need to recruit at least 2000 clinicians by end of April, 2018• Currently about 1400

Breaking News: All SeaMar Community Health clinics joining the initiative

• Joann Parris, our North Sound PF, has just secured a memorandum of understanding with the SeaMar CEO

• Much more work needs to be done to enroll these clinics and develop a level of coordination with the larger Sea Mar organization

CMS approved Specialty Care:

• Audiologist

• Certified Speech Therapist

• Chiropractor

• Clinical Mental Health

• Clinical Nurse Specialist

• Clinical Psychologist

• Clinical Social Worker

• Dentist

• Doctor of Dental Surgery

• Doctor of Optometry

• Doctor of Oral Surgery

• Doctor of Osteopathy

• Doctor of Podiatry

• Nurse Practitioner

• Nutritional Professional

• Occupational Therapist

• Physical Therapist

• Physician’s Assistant

• Registered Dietician

RecruitmentTargeting Specialty Care Clinicians

Questions for SW CSHCN Meeting

• Have you heard of P-TCPI before?

• Do you know any clinicians who are involved? Feedback?

• How have you seen P-TCPI improving care for children?

• How can local care coordinators collaborate with Regional Care Facilitators and the P-TCPI grant to move the needle on clinical outcomes?

MHNT Members?

• Your reactions? Thoughts? Questions?

Accountable Communities of Health (ACH) Update: Dr. Phyllis Cavens

Partnering Providers”

ACHs are expected to submit a preliminary list of “partnering providers” interested in implementing project(s). (Not binding or definitive at this stage- in 2018)

• ACHs must show improvement on a number of clinical outcome metrics for the overall Medicaid population; children account for 830,000 of the 1.8 million enrolled in Apple Health (Medicaid) .

• Becoming a partnering provider, eligible for TA and financial supports to make transformation possible

-- Liz Arjun, Health Management Associates

Announcements, Requests, Updates, Closing Thoughts….Feedback on events attended?

Next Steps

Next MHNT Meeting December 21 , 2017 9:30 -11 a.m.

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Transforming Clinical Practices Initiative – Pediatrics Medical Home Neighborhood Team Agenda

Thursday, November 16, 2017 9:30- 11 a.m.

NOTES

Invited Participants:

Child & Adolescent Clinic, P-TCPI Primary Care Team

• Phyllis Cavens • Julie Nye

Children’s Home Society

• Libby Hein

Family to Family Health Information and Education Center, PAVE

• Jill McCormick

Molina Healthcare of WA: • Christi Sahlin, Manager • Erin Darrah, Pediatric Case Manager

Parent to Parent of WA • Susan Atkins

Seattle Children’s • Jacquie Stock • Hugh Ewart • Alexis Koutlas • Paula Holmes

Swedish Medical Group, Patient Centered Medical Home Team

• Brianne Wojtesta

UW WA State Medical Home Partnerships Project

• Amy Carlsen (notetaker) • Kate Orville • Kathy TeKolste • Sophie Lu

WA State Dept of Health

• Ellen Silverman • Allison Templeton • Zoey Hogan • Maria Nardella • Melissa Thoemke

WithinReach

• Stephanie Orrico

P-TCPI Regional Care Facilitator Reps • Better Health Together- Sheila Masteller • Cascade Pacific Action Alliance- Apple Martine • Greater Columbia –Shelley Little • King County- Kate Besch • North Central- Carol McCormick • North Sound – Paula Young • Olympic- Karina Mazur • Pierce County – Kate Phillips • SW WA Regional Health Alliance – Anne Johnston

Special Guests: CSHCN & P2P Coordinators from the Pierce, Cascade and SW WA ACH regions

Clark: Connie Callaghan, CSHCN Cowlitz: Jeanne Snow, CSHCN and Lacey Cairns, P2P Klickitat: Penny Andress, CSHCN Lewis County: Donna Muller, CSHCN and Amber White, P2P

Pacific: Michelle Kemmer, CSHCN Pierce: Doreen Vandervort, P2P Thurston/Mason: Sylvia Davenport P2P Thurston: Bonnie Peterson, CSHCN

Expected Outcomes: Medical Home Neighborhood Team members will understand activities related to the team, contribute to upcoming activities and know how to access more information if desired. CSHCN Coordinators and P2P Coordinators in Pierce, Cascade and SW WA ACH regions will better understand the work of the P-TCPI MHNT and how to contribute and benefit from activities. Facilitators: Kate Orville, WA State Medical Home Partnerships Project, UW

In Olympia: RCFs, Kate Phillips, Apple Martine and Anne Johnston Presenters: Kate Orville, Phyllis Cavens MD, Ellen Silverman

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Handouts Sent prior to meeting: • Agenda • Contract forms: P-TCPI org chart, Regional Team Contact lists, and RCF Contacts • ACH regional recruitment sheets (examples of Cascade, Pierce and SW WA) • October 2016 MHNT Notes • Summary of RCF and Practice Facilitator Breakout at P-TCPI workshop (living document)

AGENDA

Welcome/Roll Call

-Welcome and Intent of today’s call -Introduction: name, role and organization -Review of today’s Agenda and Handouts -Purpose of meeting is how to help clinicians move forward in how they provide care for children. P-TCPI and The Medical Home Neighborhood Team

Overview of MHN -- see slides – Kate Orville

The P-TCPI Medical Home Neighborhood Team (MHNT) is trying to help clinics connect with their partners, close the loop, our project is to support our RCF and their communities.

• Updated org chart and other handouts, see slides • See recruitment tool-hoping that you can look and see if there are providers missing in your community that

we can reach out to. Let your Regional Care Facilitator know of any ideas you have. DOH Updates- Ellen Silverman

Ellen for Maria-remind ourselves that as we do care coordination, that we keep the P-TCPI Aims at the forefront of our mind. Make sure we are working on well child visits, reducing avoidable ER visits, immunizations, asthma as the forefront of your work. We are responsible for these measures.

• We really want to reach out to allied health professionals, tailored message reach out to allied health professions. Practice coach can really help to move this forward. We have a draft. There are others who are part of the medical home team.

• We need to be doing both-clinical measures as well as recruiting others in allied health. • Breaking News: The CEO of SeaMar has just signed a memorandum of understanding with P-TCPI to have all

of the system’s clinics join the initiative! • Phyllis Cavens-Aims statement is clinically oriented, but the medical home is part of team care. May appear as

primary care, but the way to transform it needs to be towards community services/systems • Bonnie raised a question about the wording of the medication Aim of “At least 7,939 pharmacy scrips for asthma

and psychotropic medications avoided.” She pointed out that many of the children and youth she sees and their families are resistant to taking medications, and as a result have asthma that is out of control. Hopes this aim does not undermine the work convincing families to have their children keep up with their medicines.

o Phyllis- Thanked Bonnie for raising this question. The intent of this aim was to address a problem in the foster care population where three times the number of these children were on psychotropics than in the general population. No one had the skills to manage the care. Led the state to develop the PALs line to provide phone consultation to community primary care providers serving children with mental health needs. Any prescription needs to be within the standards of care. If we write a prescription that is age inappropriate, it will be reviewed by a psychiatrist. The Asthma wording is either miswritten or there is something else that needs to be looked at. Will revisit that Aims statement. Thank you for calling this wording to our attention.

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Role of RCF on TCPI- including mapping out care coordinators and resources, supporting regional team meetings and events - How do we impact clinical measures?

Issues and suggestions from SW WA Regional Meeting participants? From MHNT members? Kate O.-Opportunity today to explore where the public health CSHCN programs and other agencies fit into the Regional Care Coordination project. Kate Phillips: Regional Care Facilitators (RCF) work includes doing regional asset mapping of community services and care coordinators in the Accountable Community of Health (ACH) region, and bring together all of the agencies that support children. What are your ideas about how you might work with the RCF, what kind of strength can CSHCN and parent support programs bring to the Regional Care Coordination Project?

• Medicaid transportation-connections to other agencies are time consuming, lots of time spent on hold. • Paratransit customer services is not always friendly • Families who are dropped off at a regional hospital (Randell) by taxi, have to call when they are ready to go

home and then may need to wait for hours for the ride home. Q: Are there things in your region that have helped you or been good resources for families? Would love if the RCFs could help with the connection/ strengthen connections. • Receiving referrals-in one area WIC, one hospital both are hard, certain PCP are good about referrals and others

not good. “Better connection between child’s medical home” would help. • Lack of PCPs who will take Medicaid in Clark County (Connie Callaghan)

o Phyllis-aware of the issue in Clark County and as a result the Child and Adolescent Clinic is expanding their staff and doubling their facility in Salmon Creek. Expected opening is Feb 2018.

• Language is another problem- o lack of interpreters especially for a couple of Spanish dialects. Takes a lot of time. Hard time scheduling

appointments on the phone. (Grays Harbor) o Similar issues- limited Spanish interpreters for WIC (Pacific County)

• Lack of resources for autism in our area (Bonnie Peterson- Thurston County) is terrible. So many people have autism, people in the area don’t take Apple Health for behavioral health support. Children wait for years to get services because the reimbursement is too low. Kids are blowing out of school and the escalation continues as they get older. The earlier we can help these children the better. When new agencies open up, their slots fill up immediately. I know families who are on the waiting list for all 5 ABA agencies.

• Apple- Was just at the Cowlitz Community Asset Mapping meeting where PCPs were talking about the need for enhanced trauma training for behavioral health services providers. What training is offered, what the integration is like, how incorporating trauma informed integration. As we are thinking about reducing psychotropic, trauma training is a big issue.

o Tory Henderson (tory.henderson@doh.wa.gov) at DOH is available for training. She collects and disseminates resources on her ACES and Resilience listserv. (Donna Muller)

o In Pierce, our ACH is thinking about how to integrate trauma informed practices, how we can make that more of a standard in our community. (Kate P)

Phyllis-the value of the RCF and team is to repeat loud and clear that we need resource for children and resources for families. Juvenile Justice cut half of the kids in a program for them. So we partnered with local Educational Services District (ESD) to create an intensive day treatment center that can support children who can’t go to school. Funding is now coming from public education instead of the juvenile justice system. Need support as early as possible.

o Carol McCormick-Likes the idea of the day treatment center.

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Carol: In our area (North Central ACH), even if there are services, our siloed doctors are pretty good about referring to medical services but less so to ancillary services or statewide services. There doesn’t seem to be a system they could plug into and get all the resources for their families. How can they plug in to these other services and refer to them? WIN 211 isn’t really working in our region.

o Kate P-WIN 211 isn’t as robust resource in some areas of the state as others. Can RCFs have conversations with 211 that can be reliable for everyone?

o Kate O-difference between WR and 211 – my understanding in at least King County, is that WithinReach focuses on children and family health and 211 (the Crisis Clinic in King) focuses on more of the economic issues like eviction. WR staff have told me that do warm handoffs between the two organizations (at least again in King County).

o Kate Besch-is working on how we can work on a better feedback loop, getting back to who refers, making sure that the referral is available to the family.

o Kathy TeKolste-pilot with Odessa Brown, more openness at WR to work on feedback with primary care. This is a common topic. How do we get a feedback loop and a data system within the WithinReach/HelpMeGrow system. Huge issue that we need to continue to work on.

o Penny Andress – Klickitat is very rural. Whatever issues there are in other parts of the state, are magnified in our rural county.

o Paula Young-Whatcom Taking Action Single Entry Access to Services (SEAS) is a nice model. A central person who helps people know where to go.

Susan Atkins- At the coordinator training in Yakima in Sept., one of the things that came up was to find some training parents could attend around behavior supports and de-escalation. Susan called Linda Gill at DDA and Sandra Miller. Linda suggested that parent should call DDA case manager. DDA does do training with staff around behavior…parents may be able to attend. Trainings are in all the different regions. See more info below. Susan sent additional information on the trainings from Sandra Miller- follow up with Sandra if you have questions. Sandra Miller, 360.407.1537

o “The training series on supporting individuals with Autism Spectrum Disorder can be found on our website here and includes a module on teaching functional communication strategies, which I recall is one thing you mentioned people are wanting.

o The on-line series on Positive Behavioral Supports can be found on our website here. Modules 1a & 1b provide information an overview about the principles and application of Positive Behavioral Supports; the remainder focus more on how to develop and write Functional Assessments and Positive Behavioral Support Plans – so those aren’t likely to be of much interest to most parents.

o Finally, the Provider Training Opportunities calendar can be found on our website here and includes a variety of trainings hosted by both DDA and Residential providers. The information for each training and a contact person should be included with each training. There may be some trainings that aren’t open beyond the intended audience, but it never hurts to ask!

o I believe that Linda will be following up with the list of trainers contracted with Service Alternatives to provide training and technical assistance as well.”

Susan and Bonnie: Discussion about issues getting mental health/behavioral supports paid for. Understand that DDA is cutting back on behavior supports. Client may need to be declined by Mental health system before getting these services from DDA. <?> Erin Darrah: Dealing with same issues at Molina. Many providers are not willing to contract with Medicaid. We are slowly trying to work on this. Still running into issues with subspecialists. Our biggest barrier is not knowing where to go and the lack of providers. We let the internet be our friend for finding resources. Since we cover the whole state, we aren’t familiar with all of the local resources.

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Phyllis-the other arm of P-TCPI, is to obtain value based payment to cover the cost of care to eliminate this barrier of care. To that end, TCPI is also working with the MCOs and the Health Care Authority (HCA invest in children. We can’t underfund the insurance that covers half of the children in our state and expect to have healthy children. Alexis Koutlas- Dr. Cavens hit the nail on the head. There aren’t enough resources to go around. Becomes an opportunity for advocacy at the state, is this a care coordination issue or a resources issue-we need to push back on this in a different way. Carol-we need to advocate, the idea around autism, if our providers who are giving a diagnosis don’t qualify as one of the official clinician types under the Washington Administrative Code (WAC), then DDA doesn’t pay. This can be compounded by our work with Autism Centers of Excellence (COE’s).

o Alexis-I agree with that. There is a very small pool of providers who can diagnose patients and get DDA. There are some practices, like Hope Central in South Seattle that has expanded the capability.

o Phyllis-we do have one pediatrician with developmental behavioral pediatrics training and brought in training from the UW/Seattle Children’s to become a COE. As a result of being able to now locally diagnose children with autism, we have been able to find an ABA therapist who is willing to come provide services in Cowlitz.

o Carol-the Washington Administrative Code (WAC) dictates who can diagnose. o KO-if a primary care practice can do all of the pre-work and can have a licensed clinical psychologist, then

they can get DDA. See WAC 388-823-0500 o Let Amy Carlsen (carlsa@uw.edu) know if PCPs are interested in COE training. Amy is working with the

HCA to identify local clinicians who want COE training. Also working with communities developing new School Medical Autism Review Teams.

o Kathy-the issue around whether or not we change the WAC-put together workgroup that can bring this forward?

o Doreen-is working on how to reframe the WAC to move towards the functional abilities. Will share this with us.

Phyllis-in pediatric practice, for children 0-3 we try to partner with the family and work with the child. The primary thing is how do we address the family and child with the behaviors. Then children aged 3-5. We have a paper trail that we can share with the provider who is diagnosing. Things get sorted out. Important thing to get them hooked up with a center. Lacey Cairns (Via Chat): Hi this is Lacey Cairns from Cowlitz County. The barriers we see here at The Arc are child care for kids with significant-highly aggressive-self injurious behaviors and for children over the age of 12. Transportation and parent engagement are also barriers to supports and services. We also have a lot of families that are currently homeless. I feel in the past 7 years that I have been with The Arc the barriers have increased in intensity. On a positive note, we are doing a lot of wraparound type support and partnering-communicating with other agencies in order to serving individuals and families. ACH Update

• ACH Update: “Partnering Providers” – Extra Value for clinicians becoming involved in Accountable Communities of Health and Medicaid Transformation work

Phyllis Cavens, MD. Really excited that we have RCFs. o Another activity is regional Accountable Communities of Health and the Medicaid Demonstration Projects.

The 9 ACHs have until Nov 18 to submit proposals for what they are working on. Sent out logic models on what they are trying to achieve. Need to submit a list of “partnering providers”. Will receive dollars-go out to partnering providers. Important for providers to get involved with ACH so they are eligible to participate in and receive funding from the Medicaid Demonstration projects

o Same regional model in P-TCPI grant. As P-TCPI and ACH, that we will be fully aligned and be partners…send liaison staff to us and vice versa. ACH is addressing all of the same issues, if we aren’t at the table we won’t get these issues addressed in children. The RCFs are our voice.

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Kate B- our ACH is at a really high level, haven’t picked pediatric issues to work on. Will try to meet and bring the voice of children. Phyllis-each one of the domains that ACH have to look at, does have a child component. Carol-think there will be other points that we can get these ideas in. If anyone has ideas of where they would like to see this work happen, helpful to set up a phone call to help develop a list…use the monthly check-in meeting. To talk about. We could think about target populations for each project area so we know what some solutions are and can share them with ACHS. See email from HCA 11/21/2017 with links to the projects each ACH is choosing below. Next Steps If you are interested in developing a list of pediatric “tweaks” to selected projects, review the project areas in the ACH links on page 7 of these notes and let Kate know of your interest (Carol McCormick- you are signed up!) Kate will follow up the week after Thanksgiving. Next MHNT Meeting: Thursday, December 21, 2017 9:30-11 a.m Go-To-Meeting through December for MHNT meetings, then consider using Zoom

Addendum: From 11/21/2017 email from Healthier WA:

Accountable Communities of Health take major step toward Medicaid Transformation All nine Accountable Communities of Health (ACHs) have submitted Project Plan portfolios to the state’s independent assessor, marking an important milestone in Washington’s Medicaid Transformation Demonstration. The portfolios identify the projects each ACH will undertake, and describe in detail how projects will be implemented.

Each ACH chose a minimum of four projects, selected from a list of eight statewide priorities. State leaders - along with many health care experts, researchers, and practitioners - believe that success in these eight priority areas will dramatically improve population health throughout Washington. Links to project plans can be found on our website, under Initiative 1.

From mid-November through January 2018, the independent assessor, Myers and Stauffer, will conduct two rounds of documents review, interspersed with two write-back periods. The write-back process is designed to answer ACHs’ questions, resolve problems and, ultimately, support successful Project Plans. The process wraps up in early February and kicks off Project Plan implementation. See assessment timeline.

Part of the state’s Healthier Washington initiative, the Medicaid Transformation Demonstration ends January 2021.

• Read a summary of project plans submitted • Learn more about the Medicaid Transformation Demonstration • Learn more about ACHs