Cook Children's Health Care System - Cook Children's Homeless Initiative

Overview

In 2008, Cook Children’s Health Care System brought together representatives from multiple parts of the health system, including its neighborhood clinics, case management, transportation, the Foundation for fundraising, the medical center, and community outreach to help create a seamless continuum of care for children living in one of three homeless shelters in Tarrant County, and to make health care easily accessible. The hospital provides financial support for an RN case manager, a social worker, and other expenses for this initiative. The Cook Children’s Women’s Board donated a van to transport children to appointments. Assistance is provided when families need help navigating Medicaid. The case managers assist families in accessing primary and specialty health care and other needed services, and an array of family health classes are offered at the shelters for parents.

In 2007, of the more than 4,000 homeless in the county, more than 1,000 were children. Due to the instability of their lives, these children find it nearly impossible to establish and maintain a medical home. When they get sick, they find themselves in an emergency department or receive no treatment at all. The goal of the program is to provide a medical home to provide primary care for these children and provide case management services to minimize the negative impact of being homeless. The Cook Children’s initiative was created as a response to partner with a larger community effort focused on homelessness called “Directions Home.”

Impact

As of September 2012, primary care through a medical home at the Cook Children’s Neighborhood Clinics has been provided to 755 children while living at the shelters, which has included 1,745 patient encounters. The care provided to the children included well-visits, immunizations, and sick visits. Assistance with enrollment in Medicaid was provided to 249 children and two pregnant mothers, and 488 children were tested for TB by Tarrant County Public Health. In addition to primary care, the RN case manager has secured dental services for 252 children, vision services for 146 children, behavioral health services for 98 children, and other health care services for 327 children. A significant indication of the impact of this program is that 276 children have maintained one of Cook Children’s Neighborhood clinics as their medical home after leaving the shelters.

Challenges/success factors

The neighborhood clinics offer a wide array of classes, including disciplining your child, immunizations and nutrition, and how to feed your newborn – which gives them an edge over most pediatric practices and retail health clinics. In addition, classes on topics related to behavioral health, colds and flu, stress management, SIDS/co-sleeping, prevention of child abuse, asthma, communication, and other parenting topics are coordinated by Cook Children’s and taught at the shelters by Cook Children’s staff and other community partners. Also, Cook Children’s staff at all levels have actively participated by donating huge amounts of desperately needed coats, shoes, school supplies, bedding, and more to these families. Most important, however, Cook Children’s offers an integrated health care system for these patients, which means, for example, if a child is diagnosed with a heart condition at a neighborhood clinic, a Cook Children’s cardiologist can take over the patient’s care with a seamless transition because of the established network between the physicians.

Future direction/sustainability

In March 2010, Cook Children’s conducted a survey of shelter staff, parents whose children were receiving services from Cook Children’s, and the children themselves to determine if the program was meeting its goals and to identify opportunities for improvement. The feedback was very positive, and two new goals were added to the original work plan. Parent education classes at the shelters have been enhanced. A pilot program was established in fall 2010 to help the families moving into transitional housing maintain health care and other needed services for their children. Cook Children’s continues to fund the RN case manager position, the social work case management position, and the driver for the van. A local foundation is funding a new dimension for the project to address behavioral health needs of the children. It uses a trauma-informed care model for staff at the shelters and staff at Cook Children’s to better understand the trauma experienced by the children and their families and how best to respond. In addition, the new position that will coordinate this effort will be able to assess behavioral health needs of individual children at the shelters and provide consultation and assistance in getting further clinical treatment when needed.

Advice to others

Taking the following steps will contribute to the program’s success:

• Get support and unwavering commitment from executive leadership. The president and CEO of Cook Children’s made this program a top priority with the edict, “Treat these children like they are members of your own family.”
• Collaborate with the community. Cook Children’s created a real partnership with the city, the county, the shelters, and other health care providers and agencies.
• Use every available resource to carry out the program. This includes physicians, nurses, case managers, social workers, and community health outreach staff.
• Make sure health care staff and employees are passionate about the effort. Give them the real numbers of homeless children in the county, and then let them tour the shelters to meet some of them and meet with staff to better understand the problem.
• Engage all employees. Provide ways to donate needed items for the children.

Contact: Ginny Hickman
Assistant Vice President, Community Health Outreach
Telephone: 682-885-6804
E-mail: ginny.hickman@cookchildrens.org