SummaryThe Arlington Pediatric Center provides comprehensive, coordinated services within a primary care medical home for low-income and immigrant children. This program identifies and tracks children who are severely affected by special health care needs, assigns the children to a care coordinator, and uses a multidisciplinary team to provide culturally appropriate services. The program has increased access to comprehensive care for children with special health care needs and helped families to develop a better understanding of their child's medical conditions and treatment plans, thus improving adherence to treatment regimens.Suggestive: The evidence consists of post-implementation data on the number of children served by the program, along with informal anecdotal feedback from staff and families.
Developing OrganizationsArlington Pediatric Center
Date First Implemented2005
Vulnerable Populations > Children; Immigrants; Impoverished; Medically or socially complex
Problem AddressedMany children have special health care needs, especially those in low-income families. These children require multiple health care services, and low-income and immigrant families face significant barriers to accessing these services, negotiating the health care system, and coordinating care.1-5
- A common problem, especially in low-income families: Approximately 10.2 million children (13.9 percent) in the United States have special health care needs, such as an increased risk for chronic physical, developmental, behavioral, or emotional conditions that require services beyond that generally needed by children.1,2 Low-income families are more likely to have a child with special needs; for example, in Virginia, 22 percent of children who live in families with incomes below the Federal poverty level have special health care needs.3
- Multifaceted and intensive care needs: A 2006 national survey showed many children with special health care needs require broad, intensive care, including specialty medical care (52 percent), prescription medications (86 percent), vision care (33 percent), mental health services (25 percent), specialized therapies (23 percent), and medical equipment (11 percent).4
- Barriers for low-income and immigrant families: Low-income and immigrant families are more likely to be uninsured or rely on public insurance. A 2006 national survey showed that 45 percent of uninsured parents with special needs children and 22 percent of parents who have public insurance reported not receiving at least one needed service for their child. In addition, limited English proficiency, illiteracy, transportation, and other barriers make it difficult for low-income and immigrant families to access needed services, negotiate the health care system, and coordinate care.5
Description of the Innovative ActivityArlington Pediatric Center provides comprehensive, coordinated services within a primary care medical home for low-income and immigrant children. This program identifies and tracks children who are severely affected by special health care needs, assigns the children to a care coordinator, and uses a multidisciplinary team to provide culturally appropriate services. Key program components include the following:
- Ongoing patient identification and tracking: Care coordinators use a data management system to identify and routinely track children who are severely affected with special health care needs and who need the most help. The coordinators track their diagnoses and the services they receive.
- Designated care coordinator: These patients with special health care needs are assigned to a care coordinator who provides the following services:
- Help families access care from specialists by scheduling appointments, arranging transportation, and attending appointments as needed
- Assist with hospital admissions and discharges
- Obtain medications, durable medical equipment, and other personal care items (e.g., eye glasses)
- Coordinate care with schools and early intervention services
- Refer families for financial assistance and social services as needed
- Team approach to comprehensive, culturally appropriate care: Teams include pediatricians, care coordinators, medical assistants, nurses, an intake and eligibility worker, a case manager, and a mental health provider. Team members identify unmet medical needs and design comprehensive treatment plans, providing the following kinds of services:
- Patient education: Team members educate patients and parents to ensure that they understand their medical conditions and the services they are receiving.
- Culturally appropriate services: For families with limited English proficiency, bilingual (English and Spanish) care coordinators support families in all contacts with the health system to ensure clear communication of critical information. For example, staff accompany families to specialist appointments, facilitate communication with home health equipment companies, and translate information regarding prescriptions and treatment.
- Benefits counseling: Families work with an intake and eligibility worker to apply for programs such as Medicaid and Virginia’s health insurance program for children.
Context of the InnovationArlington Pediatric Center is a not-for-profit, outpatient health care center located in Arlington, VA. In 2007, the center served more than 2,400 children, providing approximately 11,000 clinical visits, including 2,546 well-child visits, and 5,915 vaccines. Serving primarily children from families living at or below 200 percent of Federal poverty level, center leaders recognized the complex needs that children with significant special health care needs and their parents face. Because many children had unmet health care needs (as a result of delaying or not seeking care), visits often took more time, with providers treating illnesses and/or injuries that required immediate attention. In addition, families often were coping with the social and emotional issues of poverty, limited education, and acculturation. This program was developed in response to these issues, and out of a belief that families should not have to choose between medical care for their children and food or shelter for the family.
ResultsPost-implementation data suggest that the program increased access to comprehensive care for children with severe special health care needs. Anecdotal reports from staff and families indicate that the program has helped families to develop a better understanding of their child's medical conditions and treatment plans and, consequently, improved compliance with treatment regimens.
Suggestive: The evidence consists of post-implementation data on the number of children served by the program, along with informal anecdotal feedback from staff and families.
- More children receiving comprehensive care: In 2005, Arlington Pediatric Center served 58 children with special health care needs. By 2006, the program served 120 children, and currently, 300 children participate. Given the barriers that these families face, it is reasonable to assume that many of these families would not have received this care in the absence of the program.
- Improved understanding and adherence: Anecdotal reports from staff and family suggest that participating families have a better understanding of their child's medical conditions and treatment plans as a result of participating in the program, and consequently have achieved high levels of adherence to their treatment regimens.
Planning and Development ProcessKey steps in the planning and development process included the following:
- Model development: The program was developed using the principles of care coordination for children with special health care needs and the medical home model, as articulated by the American Academy of Pediatrics.1,6
- Patient identification: Through a medical record review, the center initially identified 58 children with special health care needs who could benefit from the program. Identified patients included children with cerebral palsy, congenital blindness, fetal alcohol syndrome, genetic disorders, paralysis, cancer, asthma, musculoskeletal anomalies, and other conditions. Many of these children were profoundly affected by their condition.
- Applying for funding: Arlington Pediatric Center sought grant funding from local charitable foundations to cover program development, hiring of a care coordinator, and prescription medications and medical equipment (e.g., eyeglasses) for uninsured children.
Resources Used and Skills Needed
- Staffing: Across the center, there are 2.7 full-time equivalent (FTE) pediatricians, 3 FTE medical assistants, 1 FTE nurse, and a full-time intake and eligibility worker, case manager, and mental health provider. Two care coordinators (2 FTE as of September 2010) who are licensed practical nurses (LPNs) are dedicated to the program. The medical director also devotes time to supervise the program and review progress.
- Costs: The annual operating budget is approximately $110,000. Of this amount, $10,000 per year is used for transportation, medical equipment, or prescription medications. The remainder is used for operational costs, primarily the salaries for the two LPN care coordinators.
Funding SourcesKaiser Permanente; Virginia Hospital Center; Vicky Collins Charitable Foundation
Virginia Hospital Center has been a primary supporter of all Arlington Pediatric Center programs, contributing nearly $5 million since 2001. Support from the Vicky Collins Charitable Foundation covers the salary of the care coordinators. In 2007, the center received $420,296 in donations to support the center's overall activities.
Getting Started with This Innovation
- Assess staff commitment: The program requires pediatricians and staff who are dedicated to the medical home model and who recognize the importance of providing comprehensive, culturally competent care. Discuss the core principles of the program with staff to determine their level of commitment to the program.
- Identify and track patients: Establish procedures to identify and track children with special health care needs.
- Secure community support: This program cannot be successfully launched without local community support. Develop a clear mission that relates to the particular needs of the surrounding community and build support by communicating it in a wide array of community forums.
Sustaining This Innovation
- Maintain a diverse team: A range of skills and expertise is needed to sustain this program. Continually monitor patient needs and adjust staffing to ensure the team is able to address them.
- Secure ongoing financial support: Because the program does not generate fees to cover costs, it requires an ongoing financial commitment from funders. Develop and maintain relationships with local foundations and other potential sponsors to secure long-term funding.
Contact the InnovatorGonzalo Paz-Soldan, MD, FAAP
Arlington Pediatric Center
601 South Carlin Springs Road
Arlington, VA 22204
Phone: (703) 271-8109
Fax: (703) 271-8585
Innovator DisclosuresDr. Paz-Soldan has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.
McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics. 1998;102(1):137-9. [PubMed]
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children with Special Health Care Needs Chartbook 2005-2006. Rockville, MD: HHS, 2008. Prevalence of children with special health care needs. Available at: http://mchb.hrsa.gov/cshcn05/NF/1prevalence/individuals.htm
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children with Special Health Care Needs Chartbook 2005-2006. Rockville, MD: HHS, 2008. State data: Virginia. Available at: http://mchb.hrsa.gov/cshcn05/SD/virginia.htm
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children with Special Health Care Needs Chartbook 2005-2006. Rockville, MD: HHS, 2008. Specific health care needs. Available at: http://mchb.hrsa.gov/cshcn05/NF/4healthcna/specific.htm
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children with Special Health Care Needs Chartbook 2005-2006. Rockville, MD: HHS, 2008. Services needed but not received. Available at: http://mchb.hrsa.gov/cshcn05/NF/4healthcna/services.htm
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Original publication: July 06, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: October 23, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: July 29, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.