Families of children with special health care needs are painfully acquainted with the too frequent
difficulty of having access to specialty care. In California, approximately one in six children is diagnosed with a special health care need, which can range from conditions such as asthma, diabetes, and birth defects, as well as developmental disabilities such as autism and cerebral palsy, and mental illness. Children with special health care needs (CSHCN) require healthcare and other services that are either more specialized in nature or must be accessed on a more frequent basis than generally required by children. This pronounced lack of access puts CSHCN at increased risk for chronic physical, developmental, behavioral or emotional conditions. Telehealth, the use of technology to provide and coordinate healthcare at a distance, can vastly improve access and care coordination for vulnerable populations, like CSHCN.
Last month, CaliforniaHealthline shared a story about Kimberly Griffiths’ daughter, Avery, who almost lost her life at just one week of age but the availability of telehealth saved her. Avery was taken to an emergency room in rural Sonora, California, and although the nearest ediatric specialist was 100 miles away, her emergency room doctors were able to connect via online video with a neonatologist at UC Davis. The specialist viewed hi-resolution images of the infant and her vital signs and determined that Avery had a congenital heart condition and prescribed medication to stabilize her breathing. “Without telemedicine, our daughter would have died that night,” Avery’s mother said, “Nobody should be denied the health care they need because of where they live.”
Telehealth provides communities with the option to bring care to children when available providers in a given area are in short supply or difficult to access. Telehealth can also be used to help coordinate care for kids who have multiple needs for health care and support services, as is often the case for CSHCN. Families with CSHCN who utilize telehealth services are able to access the care that they may otherwise go without, while also reducing both the need to travel far distances to see healthcare providers, and the need for school and work absences in order to make these appointments.
Earlier this month, California lawmaker Sharon Quirk-Silva (D- Orange County) joined The Children’s Partnership and the Providence Speech and Hearing Center (PSHC) at an August 16th roundtable to discuss the promise of telehealth as a means of increasing access to vital services for families. The event featured a live tele-speech therapy demonstration by a speech pathologist who provides services to patients from her remote site in Mission Viejo, 20 miles from PSHC. After the demonstration, the panel – which included Assemblymember Quirk-Silva, Linda Smith, PSHC CEO, Isabel Becerra, CEO of the Coalition of Orange County Community Health Centers, and Mayra Alvarez, President of The Children’s Partnership – discussed the critical role that telehealth plays in providing services and care to children and families with access challenges and/or special needs across California.
Assemblymember Quirk-Silva mentioned that she and other state lawmakers are working to increase the resources made available to providers. However, such a task has become even more challenging as a result of attempts at the federal level to dismantle the ACA and Medicaid.
The Children’s Partnership remains committed to working with California policymakers, providers, payers, child health advocates, and families to advance telehealth and other promising solutions that will break down access barriers, improve care coordination and move us closer to achieving health equity in California.
NOTE: The event was broadcast via Facebook live, and can be viewed online at https://www.facebook.com/kidspartnership/.
“Break down boxes!” “Open up new solutions!” “Dream big!” These are some of the expressions heard during last month’s Silicon Valley Hack Foster Care Summit. The hackathon introduced youth, caregivers, social workers, child welfare agencies, advocates, service providers, and funders to “design thinking” – an approach to solving business and social problems that starts and ends with the user – in this case, children and youth in foster care. The hackathon also introduced technology specialists to the foster care experience –creating a real opportunity to understand the foster care system and the ways outdated technology burdens the system and those who are part of it. In doing so, we broke down boxes.
Then came the opportunity to “Open up new solutions!” Participants were divided into more than 20 “tracks” to look at complex child welfare issues in new ways in order to develop tangible models and prototypes to improve the lives of children and youth in care. With the “dream big” theme in mind, these “tracks” bore strong results. For example, teams developed designs for digital tools that would improve placement success by leveraging matching algorithms (a’ la eHarmony.com) and bringing children, youth, and prospective families into the placement process to find better compatibility based on strengths and interests. Another track developed a prototype for a communications platform that would connect youth to trusted peers and resources, enabling them to build their own support structure that would promote mental wellness. Other teams came up with innovative ways to: give children and youth secure input to the dependency court judge through pre-taped videos or audio files created on a phone; help foster youth evaluate and find training and employment opportunities with virtual reality and gaming technology; and, simplify the application process for becoming a foster parent through an online portal that tracks the process and provides online support. During team presentations of these models, developers worked with attendees to incorporate their feedback and really put “design thinking” to work.
At the end of the two-day hackathon, participants walked away with a compelling approach to problem-solving and new ideas for tackling the challenges that pervade the foster care experience. Even before the event was over, improvements in the lives of foster youth were identified and moved forward. Among the follow-up commitments were over 1,200 laptops donated to California’s foster youth, to be distributed by iFoster and TeenForce; Santa Clara County committed to piloting the Think of Us platform with its foster youth; and a number of programs and vendors in attendance pledged to use the input from their tracks to enhance the services and tools that they offer. And there’s more coming! In the weeks following the hackathon, further significant commitments and planning have been made. It is clear that cross-sector collaboration brings new resources and opportunities to foster youth and families.
Technology is one vehicle that can empower and engage youth and enhance the support structure that is necessary for them to thrive. However, the real challenge as we develop digital tools and new processes is to “think different”, change the status quo, and transform the foster care experience. Taking this step requires child welfare agencies and service providers to work closely with those with “lived experience”— foster youth and their caregivers. The Children’s Partnership is committed to supporting hackathon partners and we are currently helping plan the next hackathon, taking place in Los Angeles on April 28-29, which will build on the momentum and exciting progress made during previous hackathons, including the most recent event in Silicon Valley.
The theme of this year’s National Hispanic Heritage Month is Honoring our Heritage, Building our Future, and it could not be more appropriate. In just 27 days, the American people, including 13.1 million Latinos expected to cast a ballot, will choose the next President of the United States, as well as officeholders at the national, state, and local levels. It is our vote that will decide the elected officials whose policy choices will shape the opportunities available to our children to build their future. As we celebrate Hispanic Heritage Month, let’s celebrate our opportunity to give voice to the needs of millions of Latino children in our country, a growing share of the country’s population and, in particular, a majority of California’s children.
Investing in children today is key to sustaining our national prosperity and making sure every person can achieve the American dream, on their own terms. Studies have found, for instance, that children who were eligible for Medicaid coverage earned more and paid more in taxes as adults than those who were not. Additionally, safety net programs were responsible for cutting the poverty rate for children last year by 10 percent, supporting children’s present needs and future success. Continuing these investments means voting for candidates who support programs that are proven to work in lifting children and families out of poverty and propelling them to opportunity, programs like Medicaid, CHIP, the Earned Income Tax Credit, and many others. In fact, many of these programs enjoy bipartisan support thanks to their record of success and their adherence to basic American principles like equality of opportunity.
The health and well-being of our Latino children is directly linked to our future as a state and as a nation. Nationally, Latino children face greater barriers to health and opportunity. Despite recent gains in health coverage, Latino children continue to represent a disproportionate share of the uninsured. In many states, undocumented children remain ineligible for publicly funded health coverage, like Medicaid coverage or subsidized health plans through the marketplaces. Health coverage is necessary to ensure access to health care and healthy growth and development, and we must elect officials who support covering all children—including the undocumented. We must also invest in robust, culturally and linguistically competent outreach and enrollment efforts to ensure Latino children who are eligible for coverage are able to enroll.
In states, like California, where Medicaid is available to all children, regardless of immigration status, fear prevents many parents from enrolling their children. Despite assurances from the federal government that information collected to enroll in health coverage is used only to determine eligibility, families understandably worry that giving their information to the government may impact their applications for legal status or, even worse, lead to deportation. This election cycle’s heated rhetoric around immigrants and immigration enforcement actions in many communities has only exacerbated these concerns.
What is more, immigration status has impacts on children’s health beyond their ability to access health coverage and care. Children in mixed status families—those in which some members are legally residing while others are undocumented—are regularly faced with the fear that a parent or loved one could be deported, and undocumented children themselves, many unaccompanied minors, worry what will happen to them and the new life they were hoping to build. Toxic stress caused by this constant fear has a dangerous and detrimental impact on these children. Supporting candidates who are committed to comprehensive immigration reform with a path to citizenship is not just a matter of American fairness and inclusion; it is vital to the health of our children and our communities.
Though National Hispanic Heritage Month ends this Saturday, all of us, both Latinos and non-Latinos alike, must keep the needs of our nation’s growing Latino population in mind as we head into the voting booth—for the sake of our family, friends, and communities, and the future of our nation.
In California, the registration deadline for voting in November’s election is October 24. To learn about voting in your state, or to register, visit Nonprofit VOTE.
I am so excited to join the talented staff and dedicated Board at The Children’s Partnership (TCP) to continue fulfilling both my personal and professional mission of ensuring families are healthy and have the freedom to pursue their dreams. Despite the progress we have seen, the quest to ensure every child has the opportunity to lead a healthy, fulfilling life continues. I look forward to building upon the past 22 years of work at TCP to carry this mission forward.
For the past decade, I had the privilege of working as a public servant in our nation’s capital to help ensure access to quality, affordable health care for Americans from all walks of life. In various roles at the US Department of Health and Human Services, I was part of a team dedicated to weaving sound public health policy into the fiber of our communities in order to secure a better future for families across the country. And now, I am proud to return to my home state of California and continue this work at the helm of TCP.
When tackling health is the first step to ensuring everyone can reach their full potential, what better place to start than with children.
For more than two decades, TCP has worked to improve the health and well-being of children and families across California and the country with smart solutions, using technological advances, partnering with schools, or identifying the most appropriate policy levers for change. Under the great leadership of Founders Wendy Lazarus and Laurie Lipper, TCP has recognized how California serves as a center for policy innovation with immense potential to make advancements for children. I am thrilled to have the opportunity to continue their great legacy and further the progress made to support all children.
Almost 40 years ago, my parents came to the United States from Mexico with the goal of finding a better life for themselves and their children. California was the land of opportunity. Nearly four decades later, their dreams are being realized through the work of each of their daughters. My return to California comes with the same passion, commitment, and heart that my parents brought—only this time, I have the chance to work with the great staff and Board of TCP, our partners, and supporters like you to fight for the health and well-being of all children across the state and the country.
I am incredibly honored to serve as President of TCP and to be a part of this work with you. I look forward to what we can do together and appreciate your continued support to help all children lead healthy and productive lives.
Mayra E. Alvarez, MHA
President of The Children’s Partnership
The Children’s Partnership was founded in 1993 as one century gave way to the next and the nation faced a period of extraordinary and rapid change. We recognized that the nation’s children needed a voice at the very forefront of emerging social, economic, and technological trends to ensure that children, especially those who live in underserved communities, would not be left behind. Innovation at Work for America’s Children: A Timeline provides a snapshot of 22 years making a difference for children—and previews the work ahead.
Our mission then, as now, is to scout out major emerging trends that can improve the health of children and open new doors of opportunity for them. During this period, the digital technology revolution and the health reform movement offered unforeseen ways to benefit the nation’s—and California’s—children, and also presented risks that needed to be brought to light. The Children’s Partnership has focused on these two program areas: “Improving the Health of America’s Children” and “Connecting Kids to Digital Opportunities.”
To develop practical but innovative ways to improve kids’ lives, we applied strong research and policy development skills along with a commitment to involving local communities and a broad array of partners in finding scalable solutions. This work and the results are described in the timeline.
When we began our work in 1994, 1.8 million California children were without health coverage, due in part to restrictive eligibility that excluded some children and a host of other issues that prevented others from enrolling into coverage. Today, 100 percent of California’s children are eligible for comprehensive health coverage thanks to California’s historic policy decision to provide state-funded Medi-Cal to income-eligible undocumented children. The Children’s Partnership helped lead that fight, pushing to expand coverage to all, improve the quality of care children receive in public and private health coverage programs, and find innovative solutions to make enrollment processes smooth and family friendly.
And, The Children’s Partnership was among the first to recognize that digital technology would transform the way that kids learn, play, communicate, and prepare for their future. With a seminal report in 1994, on America’s children and the information superhighway, to the first comprehensive guide for parents of children online, to a model community computer initiative and guide for creating online content for low-income and underserved communities, The Children’s Partnership helped shape solutions and guide families and communities as the world went digital.
The world in which today’s children are growing up continues to change at a rapid pace, and there is even more need for an advocate for children at the forefront of health and digital technology. In fact, history demonstrates that without strong advocacy, the benefits from new technologies and advances in health and medicine may not reach all of the nation’s children—especially those who may not have the resources to secure them on their own.
For more than 22 years, The Children’s Partnership has focused on being at the table at the right time, armed with the right information, and with the right players to place the needs of underserved communities on the map of change and to help tangibly improve the lives of and opportunities for children as evidenced in the timeline. Under the leadership of the new president, Mayra Alvarez, The Children’s Partnership will continue to break new ground and put innovation to work for America’s children—a part of the long American tradition that we believe is vital to build upon because America’s children are depending on us to do just that.
This past Monday marked the fifth anniversary of the Affordable Care Act (ACA), a significant milestone and excellent opportunity to assess the impact this historic law has had on the health of California’s families and children. Our state has led the way in implementing the reforms included in the ACA, which has helped provide health coverage to more families than ever. The uninsured rate for all Californians fell by as much as 60 percent, and we can proudly say that 93 percent of kids in California are insured.
Through the state’s health exchange, Covered California, the State is insuring more than1.8 million individuals, an estimated 101,000 of whom are children. The State also expanded Medi-Cal eligibility to more adults, resulting in 2.7 million additional enrollees. In addition, California provided state-funded Medi-Cal to individuals with Deferred Action for Childhood Arrivals (DACA) status. In the last two years alone, California enrollednearly 1 million young people in Medi-Cal. Along with other reforms, Medi-Cal now covers more than half of all children in the state.
Thanks to the ACA, Californians and millions of individuals across the country benefit from an improved health care system. Those with preexisting conditions can no longer be denied coverage due to their health. The lifetime limit on health coverage has been eliminated, meaning that those with chronic conditions or in need of costly treatment will be able to continue to reap the benefits of health coverage no matter the cost. And young adults under 26 can stay on their parents’ insurance, providing an important bridge as younger Americans transition to adulthood. Health coverage now works better for Californians.
While we’ve accomplished so much together in the last five years, our work to cover all families is not done. Many families who are eligible for coverage do not understand how to enroll; there is much work to be done in educating them about their health coverage options and helping them enroll into coverage. Additionally, certain undocumented immigrants remain ineligible for coverage through Medi-Cal or Covered California, and, as a result, an estimated 170,000 California children remain uninsured due to their immigration status.
All California children deserve a healthy start in life, and our state is stronger when everyone has access to health care, including our immigrant children and families. We hope that the current injunction against President Obama’s Immigration Executive Action is lifted so that California can continue progress on this front and that the state will continue to lead the way by passing SB 4 (Health4All), which would provide affordable coverage to all Californians regardless of immigration status.
With these eligibility barriers removed and strong community education and outreach, California can make tremendous progress toward reaching our goal of providing affordable health coverage to all. With determination, we hope to soon celebrate another important milestone: 100 percent coverage for all families.
Photos below from a Affordable Care Act 5 year anniversary celebration with our partners in Los Angeles: Health Access, Planned Parenthood Los Angeles, California Partnership, Children Now, Children’s Defense Fund-California, California Immigrant Policy Center, Young Invincibles, and more.
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With enactment of Virtual Dental Home legislation in 2014, we will be working with our partners to ensure that this innovation is implemented in a way that best reaches underserved children with needed dental care in schools and Head Starts in their communities. In addition, now that all children enrolled in Medi-Cal and Covered California are enrolled in dental coverage, we are working hard to make sure those families actually know that their children have this coverage, know how to use it, and can find dentists to take care of their children.
Finally, we are closer than ever in our work with partners to ”standing up” local electronic care coordination pilots for young people in foster care. And we continue to be the only children’s voice in promoting the use of telehealth and related technologies to bring health care to children in underserved communities, addressing transportation and other barriers families face in getting needed care.
This is just some of what we have in store in the year to come. Please take a look at our 2015 California Policy Agenda and Federal Policy Agenda to see all that we are doing. We look forward to working with you in 2015.