The KidsPeace FCCP offices in New York offer a variety of services to kids and families in need – including Health Homes, a Medicaid-based care coordination program.
The New York Health Homes Program provides comprehensive care management and care coordination for youth and their families in need of support and service coordination to address areas such as mental and behavioral health needs and other chronic and acute medical issues that create functional limitations in youth. Families receiving medical coverage through Medicaid and HMO Managed Medicaid qualify for such services.
Health Homes creates connections between providers, the family, and the care manager to create a hub of family support and service provision. The program works closely with service providers to reduce episodes of crisis and prevent the need for hospitalization or placement in out-of-home care, and to address unmet medical needs and gaps in care.
Service coordination and care management involve coordinating between an individual’s caregivers and service providers to make sure that all youth and family needs are met. Care Managers work closely with youth, family members, and providers to develop a Plan of Care through completion of the Child and Adolescent Needs and Strengths-New York (CANS-NY) assessment, as well as completing a Comprehensive Assessment, and meeting as part of an interdisciplinary team. This process helps care managers and families identify the most significant areas of need so that each Plan of Care is tailored to the individual needs of each participating youth and their families.
The program can assist with addressing and resolving immediate needs such as housing, food support, and transportation for families by working with and partnering with community agencies. Other areas of focus include addressing social supports such as locating and registering for after-school programs, sports, and community-based extracurricular activities, educational advocacy and support through attending Special Education and other school meetings, or assisting with finding educational support programs. The program ensures that each family has access to the medical and mental healthcare they need, including finding specialty providers for families, making those appointments and facilitating communication between providers to ensure collaboration and timely care. Health Homes is also able to give each family access to transportation support in several forms.
By creating this hub of support, coordination and collaboration, the program strives to improve and support increased family and individual functioning, and create a network for family success.
Rebecca Ruger is Supervisor of NY Health Home Care Management
Jennifer Udvardi-Morris is Program Manager in KidsPeace FCCP’s office in Kingston, New York.
