1. Introduction
Program Background
The Nebraska Department of Health and Human Services (HHS) received a grant from the Centers for Medicare and Medicaid Services (CMS) beginning 10/1/04 to improve the medical transition process for young adults with special health care needs who are preparing to move from pediatric to adult-based health care. It was anticipated that the outcome of this project would be an amendment to the Nebraska Home and Community-Based Aged and Disabled (A & D) Medicaid Waiver to formally include medical transition planning and benefits analysis in preparation for employment. Nebraska was one of only two states selected to pilot the development of this new waiver service that could ultimately serve as a national model.
Project Activities
Nebraska Health and Human Services contracted with the Munroe-Meyer Institute to complete three components of the Portals Transition Project including development of a health care transition clinic, videoconference series for A & D Waiver Services Coordinators, and an education component for family medicine physicians. The purpose of each of these three components is briefly described below:
Clinic Model. A primary component of this project was to design and implement a transition clinic staffed by physicians and specialists from the Munroe-Meyer Institute (MMI). The first clinic was held 9/9/05. An interdisciplinary core team, including a developmental pediatrician, physician in internal medicine-pediatrics, adult psychiatrist, nurse, youth/family advocate, and navigator completes the assessment of the youth during the first visit. A summary report and initial transition plan is provided to the youth and family as an outcome of the assessment process. During the second clinic visit the youth, their family, and team review any additional assessment information completed as recommended from the first visit. The initial transition plan is finalized to support the youth and their family in their transition to adult based health care.
Physician Training. The second project component was on physician education with the expectation that training could increase family practice physicians’ acceptance of youth with special health care needs into their services. The clinic activities served as a site for family practice physicians to participate in an orientation and observe the clinic. A notebook of Physicians Training Curriculum and Resources on Transition from Pediatric to Adult-Based Health Care for Youth with Special Health Care Needs was provided as part of the orientation, education and discussion. A total of eight physicians participated in this component of the project, beginning 7/06 through 9/07, with the two remaining UNMC Family Medicine Faculty having met with Dr. Schaefer individually.
Services Coordinator Training. The project and HHS staff identified the importance of increasing the awareness and skills of the services coordinators regarding the clinic and health care issues of the youth with special health care needs as they were targeted to serve as one of the primary referral sources for the clinic. This grant sponsored a monthly statewide videoconference educational series led by Dr. Brad Schaefer and presented for Child and Adult Aged & Disabled Medicaid Waiver Services Coordinators. Beginning 5/17/06, the series focused on disseminating information on the clinics and transition issues for children with special health care needs. A total of 15 videoconferences were held beginning 5/06 and continuing through the end of this grant year.
