Connecticut Children’s Medical Center – Care Coordination Collaborative Model

Hartford, CT
November 2017

Overview
Connecticut Children’s Office for Community Child Health (the Office) and its Center for Care Coordination, with support from the Child Health and Development Institute, launched the Care Coordination Collaborative Model (the Model) as a pilot program in 2010. The Model improves communication among diverse programs; increases the efficiency and effectiveness of care coordination within a comprehensive child health system; and serves as a resource for primary care medical homes seeking community-based services for families. Prior to the Model, a diverse array of care coordinators helped children and families, but typically in uncoordinated ways. Too often, multiple care coordinators from different sectors served the same family at the same time, sometimes unknowingly duplicating services and increasing costs.

Through the Model, care coordinators from various sectors, such as child welfare, health, and developmental services, gather regularly to discuss what they are doing to help children and jointly problem solve. The Model increases the efficiency and effectiveness of care coordinators, thereby making care seamless for children and families so they easily receive services across multiple sectors to address their needs. Since its inception, the Model has expanded statewide through five regional collaboratives that are funded and overseen by the Connecticut Department of Public Health. It has also expanded to other states through our Help Me Grow® affiliate network.

Impact
During a six-month review of data, 85 percent of Connecticut Children’s care coordinators who are involved in the Model reported positive outcomes in linking children and families to community, medical, dental, behavioral health, education and social services. In addition, 97 percent of families they assisted reported satisfaction with the program. A recent survey of care coordinators who participate in the Model documented that their knowledge of eligible services, ability to explain the value of such services, and capacity to make referrals grew from about 30 percent to more than 90 percent.

An analysis of cost savings from the Model is ongoing and mindful of statewide Person-Centered Medical Home Plus (PCMH+) opportunities to achieve shared savings through care coordination. We expect that primary care sites participating in PCMH+, which is an initiative of the Connecticut Department of Social Services, will realize cost savings as a result of improved care coordination made possible through the Model, which has grown to include more than 30 partner agencies, including United Way of Connecticut and Medicaid.

Lessons Learned
The Model recognized the need to fully engage early childhood and mental health providers, as well as include pre-existing collaboratives that involve community-level agencies. This commitment to pursuing additional partnerships improved care coordinators’ ability to effectively link families to appropriate services. Further, the Model identified systems issues and policy gaps that were addressed within a state-level collaborative, leading to resolution of critical issues in care coordination for children. For example, care coordinators were key contributors to the Children’s Behavioral Health plan, authorized by the Connecticut General Assembly in 2013.

Future Goals
The Model plans to emphasize the role of care coordinators in building families’ protective factors throughout all regional collaboratives to better serve children and families. The Strengthening Families™ Framework is a research-informed approach that enhances protective factors in families by increasing their strengths, combating the effects of toxic stress, and reducing the likelihood of child abuse and neglect. The five protective factors are: Parental Resilience, Social Connections, Knowledge of Parenting and Child Development, Concrete Support in Times of Need, and Social and Emotional Competence of Children. Enhancing protective factors in families is a proven method to buffer risk and, when adopted by child-serving systems, can support children’s development as a population health goal.

Contact: Paul Dworkin, M.D.
Executive Vice President for Community Child Health
Telephone: 860-837-6228
Email: pdworki@connecticutchildrens.org