Background

Many families of children with special healthcare needs may often feel overwhelmend with navigating the complex healthcare systems on which their children depend. The Maternal and Child Health Bureau, defines children with special health care needs (CSHCN) as:

“those who have or at increase risk for a chronic physical, developmental, behavioral, or emotional condition and who also requires health and related services of a type or amount beyond that required by children generally.”

According to a 2011-2012 national survey of the Data Resource Center for Children and Adolescent Health, approximately twenty percent of children in the District of Columbia have special healthcare needs. Advocates for Justice and Edcuation Inc. (AJE); assist these families in navigating the complex local health care system and identifying community resources. With an abundance of resources available to families in the District, locating the appropriate service to meet their specific needs can be a difficult task for any caregiver. AJE provides family navigation services to link families to appropriate resources, and care coordination to ensure effective and seamless service delivery to CSHCN. AJE provides care coordination activities by collaborating with families and multiple service providers supporting families, exchanging information and sharing adequate knowledge about resources with families and providers,  and facilitating appropriate delivery of health and family support services to meet the unique needs of families. Care Coordination services ensures families receive all reccomended care and treatment for their child with special healthcare needs in a coordinated, efficient, and timely manner.

Care coordination is a collaborative process that links children and families to services and resources to maximize the potential of children with special healthcare needs and provide them with optimal healthcare.

What does care coordination look like at AJE?

At AJE, a care coordination needs assessment is first taken to assist families and their community care partners to determine what immediate needs and services should be in place. The family is provided with various support and skills to communicate and coordinate with their child’s care cooridnation team. Below are some of these supports:

  • Case management by a specific staff member with specialized knowledge and skills to coordinate care delivery
  • Utilizing a Family Navigator as a peer mentor to help families learn how to navigate the system for CSHCN
  • Supporting families with setting goals as it relates to their care coordination needs.
  • Collaboration with family and multidisciplinary teams to carry out specific activities needed to accomplish identified goals.
  • Successful teamwork and frequent communication with multidisciplinary teams until the family is able to successfully locate and utilize resources independently.

Conclusion

Care Coordination at Advocates for Justice and Education (AJE) is family-centered. We teach families skills needed to successfully coordinate care services over a lifetime. By providing families with the tools to support themeselves in this role, we are also increasing the number of families capable of mentoring others.

 

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