This past week, my fellow Kentucky Youth Advocates team member Mahak Kalra and I had the opportunity to visit the University of Louisville Pediatrics Downtown location. Far more than your typical pediatrician’s office, this location is an integrated health care clinic. Integrated care is a model that helps meet the health needs of our children by extending services beyond primary care.
Two aspects of integrated care are particularly important for children: comprehensive care and co-location of services. Comprehensive care means that a full range of services are offered to the child, including preventive care, treatment, and connecting families to social support services if needed. Co-located services (i.e., primary care, oral health care, behavioral health, and social services offered at one site) are more convenient for families, increasing the likelihood that children will receive the care they need.
At the first stop on our tour, we were introduced to the onsite social workers. One social worker provides case management for families, while a clinical social worker provides behavioral health services. The clinical social worker is available for regularly scheduled appointments or for family consults when the pediatrician believes a child may have a behavioral health diagnosis.
In addition to the social workers, University of Louisville dental students and residents also staff an oral health clinic. Although the oral health clinic was located at this practice, it appeared that the pediatricians and oral health clinic staff did not communicate about patients. To meet all health needs of children, it would be ideal if a pediatrician screened for oral health issues and was able to walk the child down the hall to see a dentist (or dental student). Or, if a child had an appointment with the dentist, and the dentist noticed a physical or behavioral health issue, she could speak with the pediatrician or social worker about the patient so that the child’s needs could be addressed in the same visit.
A Managed Care Organization (MCO) representative is present in the office to provide case management for families covered under that MCO to ensure that they receive the maximum benefits for their children. Understanding health coverage benefits, and how to access those benefits, can be confusing. Helping families make the most of their health coverage is essential for improving child health.
Oftentimes, families accessing health care need more than medical treatment. To better help those families, this clinic also houses a legal aid office. Families who find that they are in need of legal services beyond health care can access those services in the same building.
Just down the hall from the legal aid office is another non-medical but essential program for children’s health: the Women, Infants, and Children (WIC) office. Parents or guardians can access WIC services after a pediatrician’s visit, or anytime outside of a primary care appointment. These services include supplemental foods; nutrition education for low-income women who are pregnant, nursing, or postpartum; and supports for infants and children up to age five identified as nutritionally at-risk. These services promote a child’s overall health by supporting the mother and providing nutrition resources for a child to eat healthy.
At this particular clinic, it is easy to see how integrating primary medical care, behavioral health services, oral health, and non-medical services benefit the patients and their families. The doctors, nurses, and other health care providers we spoke to explained that integration really occurs when the different providers talk to each other about a specific case to positively impact the health needs of that child and her family.
Integrated care is the best case scenario to meet the diverse health needs of children. On our visit we saw a multi-specialty practice providing multiple types of health care services, with providers communicating with one another to ensure all of a child’s particular health needs are met. Clinics like this one, particularly if they could incorporate more providers with different health care specialties, could increase access to quality, coordinated care for kids across Kentucky.
Just an FYI, The above mentioned clinic (formally known as C&Y) started in 1968 as a multidisciplinary clinic to meet the needs of the high-risk children of Louisville. It’s always had pediatricians, dentists, WIC and social workers. In the past it also had Home Health, psychology and speech therapy. The clinic is evolving as needed. It’s wonderful that after all these years it’s still going strong! Keep up the good work C&Y!