Magazine article The Exceptional Parent

Vermont Parent Doctor Team Designs a Medical Home for Children with Special Healthcare Needs

Magazine article The Exceptional Parent

Vermont Parent Doctor Team Designs a Medical Home for Children with Special Healthcare Needs

Article excerpt

When parents of children with special needs arrive for office visits at Gifford Pediatrics, in Randolph, Vermont, they receive a simple, one-page questionnaire about their immediate concerns. (See below.) Parents can check off any of a dozen possible items, ranging from their child's height and weight to loneliness, falling behind in school and making and keeping friends. Parents can also write in other concerns, and they are specifically asked to indicate which two are "most on their mind today." For parent Kim Daniels the form is a welcome invitation from her son's pediatrician, Dr. Louis DiNicola, to talk with him about "the things that are on my mind--not just medicine and tests."

The questionnaire and other special features of the Randolph, Vermont practice are also meant to help parents obtain other community resources and connect to other families and professionals. For example, the questionnaire asks parents whether having a care coordinator could help in getting their child's needs met. It also asks whether they would like to be contacted about financial resources and family support by the state's Parent to Parent organization. Betsy Hannah, the nurse and care coordinator at the Gifford practice, often helps parents complete the form. If they wish, she sits in while parents discuss their concerns with their children's doctor and then she follows up later.

The questionnaire, the care coordination and an informal parents' network are designed to make the practice a "medical home" for children with special healthcare needs. Some special features are meant to minimize potential problems in office visits. Kim Daniels reports that the entire office staff knows that spending time in the waiting room is too challenging for her son, Troy, although another child "can get through any visit--so long as there's a blue balloon" waiting for him. If necessary, the staff may schedule a senior volunteer to park a family's car.

Other special services of the Gifford practice go well beyond dispensing balloons, valet parking and medical services. Parents call Betsy Hannah for help with school problems, parent contacts and, sometimes, just to talk about feeling overwhelmed by their child's needs. She also can put them in touch with a resource parent, who helps them qualify their children for SSI (Supplemental Security Income), Medicaid, personal care assistance and other forms of aid. Dr. DiNicola meets monthly with interested parents to talk about such topics as ADHD and adolescent transitions. Parents Wade equipment and experiences among themselves.

For parents, the practice has evolved into a single point of entry, a term referring to the idea of one identifiable place in a community where parents can learn about and gain access to the bewildering army of health services and therapies, financing options, special equipment, early interventions, special education classes and social supports that their children may need as they grow up.

The medical home design team. Ten years ago, the American Academy of Pediatrics (AAP) adopted a "medical home" policy recommending that a child's physician be responsible for all aspects of a child's healthcare, including "interaction with school and community agencies to be certain that special health needs of the individual child are addressed." Working with the AAP and the national parents' organization, Family Voices, the federal Maternal and Child Health Bureau (MCHB), its state offices and grantees are developing materials and testing methods for putting medical home principles into practice.

What is interesting about Gifford Pediatrics is that Dr. DiNicola and his office staff have worked with Kim Daniels and other parents to translate the medical home concept into a reality. The catalyst for this process was the Lebanon, New Hampshire Center for Medical Home Improvement, which receives MCHB and other grant support. Center co-directors Jeanne W. …

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