The North Dakota Team submits the following proposal to attend the National Medical Home Conference by answering four questions.

 We would like to see ND work on having a provider that manages all aspects of a child's care -e.g. need for referrals to specialists, interaction with schools and community agencies, etc.   We would strive to have a provider who is known to the child and family, where the relationship of mutual responsibility and trust has been established.  We would like to see some training for parents and families in how make the above aspects of a Medical Home work.

 We would use providers including pediatricians, family practitioners, PA’s and NP’s to serve as a Medical Home for the 32,000 children in this state.  We have approximately 5,000 CSHCN.  We would teach everyone the concept of the Medical Home.

 Our NDAAP state chapter is very active and strong, with board representation from the four areas of the state.  We have the cooperation, confidence and support of the pediatricians in their quadrant.  We are able to effectively use our website http://www.ndaap.org , the phone, our newsletter, fax and e-mail to communicate with our membership.  Our group is compromised of experienced, dedicated, individuals, willing to bring forth this effort to provide the medical home for CSHCN.  I am past president of the NDAAP and currently an active board member.  I have chosen a pediatric physiatrist (Dr Sobus), our state Title V CSHCN director (Sue Burns), a family representative (Donene Feist) and our ND CATCH facilitator (Dr Jean Fahey) as our team.

 From a parent perspective the team hopes to accomplish the beginning phases and supports for developing a medical home model for rural states such as North Dakota.  Because of the rural needs in the state there are many areas to consider in development of a medical home model.  With limited resources, North Dakota has been able to do much work within those limitations. (collaboration could be made with the outreach efforts utilized in the children's health insurance program).

 Question 2:  The new newborn hearing screenings grant that ND received is a collaborative effort with Minot State University, CSHS, hospitals, clinics, audiologists, physicians and parents from around the state is an example of statewide collaboration that is used to improve access to health services.  We have just started year one of a 4-year cycle.  Audiologists from eight of the larger hospitals in the state with more than 300 births have meet and have been trained.  Equipment will be provided if not available in every hospital in the state by the end of the project, with the large centers serving as sources of referral for those smaller hospitals without audiologist or ENT specialists.  A pilot telemedicine project is also being tested as a separate entity.

The CSHS Pilot Sites for Care Coordination is another good example, as well as their multidisciplinary clinics.  CSHS has initiated discussions on Medical Home with the county CSHS eligibility workers.

Statewide family coalition occurs through several programs, including Family Voices, Family to Family Network (newsletter entitled Family Ties goes out to over 1,400 families and professionals from across the state on issues such as the medical home and what it means), CSHS Family Advisory Council; ARC and State Developmental Disability division which review developmental services to families on an annual basis. A positive work relationship has resulted in a collaboration of the Department of Human Services for pilot program with Altru Health System for managed care of children with medical assistance funding.  There are only two HMO's in the state.  Additionally, Altru’s CETP and the Indian Health Service do outreach clinics; as do other large facilities with local health care providers on several reservations.  There are several citizen’s organizations active in children’s health issues including Safe Kids, March of Dimes and professional organizations including North Dakota Medial Association, Community Health Care Association, PT, OT, Speech/Language Pathology Association, MeritCare, Altru Health System and the University of ND.

 Question 3:  Children’s health assessment activities in the last three years. CSHS just participated in the Title V Block Grant 5 year Needs Assessment.  To do this a workgroup was formed to identify the five population groups within Maternal Child Health: 1) Women of childbearing age, 2) infants, 3) children, 4) adolescents and 5) CSHCN.  Four need categories were selected: 1) health status, 2) health care utilization, 3) health care access and 4) the health care system.  These categories were chosen to correspond with MCHB pyramid levels and reflect the need for direct health care services, enabling services, population-based services and infrastructure building services for the maternal and child health population.

 A number of need indicators were selected for each population group and each indicator category and data was collected for each.  Efforts were made to collect multi-year data to identify historical trends, county level data to identify geographic disparities, national data as a comparison to state level data, and data on the state’s Native American population to identify racial health disparities.  We were able to look at program level data, vital records data and health claims data for these population groups.  We also used national data from Kids Count and the Youth Risk Behavior Survey.

 Once the priority needs were identified they were presented to 30-40 participants at a planning retreat.  A facilitator led attendees through a prioritization process.  Through this prioritization and needs assessment process an Annual Plan was developed.  If you would like more detail on what was collected and which priority areas had been identified, a copy of the Annual Plan could be requested.

 Through collection of data for the needs assessment, our Title V program now has a large data bank that will continue to be updated.  This will allow us to do ad hoc reporting on this important population.

 For part of their data collection, Children’s Special Health Services sent out a family survey to all families on their program.  The three main categories that were looked at were utilization of services, financing of services and family impact.  We now have program specific data that was collected to let us know how far families have to travel to see their primary care physician, their specialist, and for their therapies.  The families reported whether the distance traveled was a burden to them or not as well as the frequency that they are seeing these providers.  We also know who is covering these services.  This was a very large and comprehensive survey that collected data on more issues then those listed here, if you would like more detail on what was collected, a copy of the results could be sent.

Question 4.

□.Active statewide family coalition with Family Voices

□The state has had a very positive political climate with the passage of laws for support of the Fetal Alcohol Center for prevention and improvement of outcome for children, the State Pathology program to review all childhood deaths and the establishment of the CHIP program.  Funding has also been available for Health Tracks with CSHS, Public Health Services and Family to Family Network.

□ Positive working relationship with leaders in managed care (only two in the state) We have a very good relationship with the Altru Care which manages the states pilot Medicaid Managed Care program.

□ Citizen's organizations active in children's health issues:  Children's Caucus, KIND (Kids are Important in North Dakota), Voices in Partnership in Healthcare Reform (which includes citizen's and professionals) Family to Family, Family Voices, CHSH Family Advisory Council, and Federation of Families

□ Support from professional organizations other than AAP ---North Dakota Medical Association, ND Academy of Family Physicians, Community Health Care Association, and the PT/OT associations

□Other: In ND we have been able do allot with minimal funding in our state.  We have a great work effort and many people believe in doing what is right for our children.

We are very interested in hearing of the success stories from around the country and the collaborations to build on what we have started.