1. Early On System Update Michigan Department of Community Health Updates

2. MDCH Across the Lifespan • The Michigan Department of Community Health is concerned with the health of all Michiganders across the lifespan. • Within Public Health Administration are: • Reproductive Health Unit • Perinatal Health (MIHP located in this unit) • Infant Health Unit • Child Health Unit • Adolescent and School Health Unit

3. Maternal Infant Health Program (MIHP) • Formerly known as the Maternal and Infant Support Services (MSS/ISS). • Redesign, effective in 2005, became MIHP. • Redesigned to improve program outcomes. • Currently being evaluated to become an evidence-based home visiting practice.

4. MIHP • Goal of MIHP: • Promote healthy pregnancies • Positive birth outcomes • Infant health and development • Supplement medical care. • Circumvent barriers to obtaining prenatal care. • Make changes that increase likelihood that the infant will be healthy at birth.

5. MIHP • Administered in rural, urban and native communities throughout the state. • For pregnant women and their infants up to one year. • Provider teams include an RN and Licensed Social Worker. • Infant Mental Health Workers and Registered Dietitians can also provide interventions based on the plan of care.

6. MIHPMaternal Risk Assessment: • Family Planning • Prenatal Care • Food • Housing • Transportation • Social Support • Smoking/2nd hand smoke exposure • Alcohol • Drugs • Stress/Depression/Mental Health • Abuse/Violence • Asthma • Diabetes • Hypertension • Interconception Care

7. MIHPInfant Risk Assessment • Health • Safety • Feeding and Nutrition • General Infant Development • Family Social Support, Parenting and Child Care • Maternal Considerations • Additional Domains

8. MIHP • Each infant is required to be screened using the ASQ:3 and ASQ-SE at least once during the enrollment. • Requirement to refer a child who is identified as needing further evaluation to Early On.

9. MIHP • MIHP/Early On Referral Form • Designed to: • Provide common referral form for MIHP providers. • Information about the status of the child’s referral can be shared easily with MIHP.

10. MIHP VIEW FORM

11. Referral Form • Form is designed to act as both a referral form for MIHP and a fax-back form for Early On. • MIHP providers complete the top portion. • Early On completes the bottom portion, obtains authorization from parents/guardian and sends to MIHP provider.

12. MIHPBenefit of the Form • Allows Early On to easily share information about the child with the MIHP provider. • MIHP will be able to document that the referral was made and action taken. • Early On provider and MIHP provider may need to coordinate services for a family. • Encourage the partnership that is possible between MIHP and Early On.

13. Questions about MIHP For more information about MIHP, please visit: www.michigan.gov/mihp

14. Developmental Screening • MDCH has received funding from the Early Childhood Investment Corporation to train physician practices to implement standardized developmental screening. • Efforts to train physicians began in 2007 here in Michigan, although many physicians have been screening for much longer.

15. Developmental Screening • Physicians are trained in the implementation of standardized screening in their practices. • Physicians who utilize developmental screening and refer to services are very interested in knowing the results of the referral. • Physicians particularly want to know the types and frequencies of services the child is receiving.

16. Developmental Screening • Physicians in our project are provided with the ASQ:3 and ASQ – SE, as well as a copy of the MCHAT. • They are encouraged to screen at the specified points of 9, 18, and 24 or 30 months as recommended by the AAP. • We also encourage additional screening instruments at each well-child visit, to make screening an everyday, consistent practice.

17. Developmental Screening • Referral to Early On is a focus of our training. • Early On Coordinators are invited to each practice training. • Because our project is statewide, we train physicians to refer using the state referral line. • Physicians may refer locally, but many have expressed that they prefer the state referral line because they can also refer children over the age of three.

18. Developmental ScreeningChild Referral Status/Fax Back Form • A group of stakeholders developed a Child Referral Status/Fax Back form. • Similar to the MIHP referral form. • Physicians requested more information. • Physicians are encouraged to refer to the statewide referral line. • Physicians have found the state referral line easier when they serve patients from many counties.

19. Developmental Screening • View Form

20. Child Referral Status/Fax Back Form • At this point, is a one page document, but it is an electronically fillable form. • If handwritten, please be legible. Space is small. • Physicians obtain signed authorizations from parents, complete the top portion and are trained to include all pertinent information (health status, vision/hearing, etc.) • Not all physicians send the requested information.

21. Child Referral Status/Fax Back Form • The bottom section is for Early On. • Form designed to be easy to complete with a series of boxes to check. • Physicians are very interested in the outcome of the referral. • We encourage inclusion of the Primary Care Physician as an entity to whom the parent authorizes therelease of information.

22. Outcomes • We have gotten feedback that although it seems overwhelming at first, the feedback loop can be completed easily. • Physicians and local Early On personnel appreciate the opportunity to become more familiar with one another. • Physicians particularly, develop a level of trust with Early On that may not have been there previously.

23. Questions? Tiffany Kostelec kostelect@michigan.gov 517-335-4663