Guest Post by Erin Cornell, MPH
Program Manager for Research, Innovation & Evalution

Care coordination is a longstanding element of the Help Me Grow model. But are we defining it too narrowly to measure and support it adequately? 

Since it was first established as a pilot program in 1997, Help Me Grow has leveraged care coordination, by way of a central care coordinator role, as a strategy to support family linkage to community-based programs and services. The four components of HMG reflect this central role, particularly the centralized access point, which is staffed by telephone care coordinators who effectively link children and families to community-based services and supports.

It is generally agreed upon in the field that effective care coordination helps families navigate a fragmented landscape of programs and services. It is also clear that HMG care coordination, specifically, overcomes the barriers to care coordination experienced by many other sectors, such as lack of time, competing obligations, and most importantly, difficulty in tracking children and families across poorly integrated systems of early childhood programs.

Recently, however, we’ve begun to clarify our definition of “care coordination.” We want to make sure we have the most comprehensive, accurate definition possible, so that we can precisely measure care coordination in HMG systems and speak as powerfully as possible to the value of this core component.

To the extent that we have measured connection to services as part of the Common Indicator reporting process for HMG affiliates, that metric can and should incorporate only those families who receive referral to a service. Yet it is also true that many families contact HMG with requests for information about community resources or for strategies to support them in promoting optimal development. These are specific needs, for which care coordinators respond with specific guidance or information.

Thus, an important and currently unanswered question is, ‘What proportion of families’ needs are met upon contacting HMG, either by the information provided or by a referral to a program or service?’ Broadening our definition of care coordination will allow us to strengthen our measurement framework to articulate the success of HMG systems in responding to diverse family needs.

Is care coordination more than linkage to services?

We began this effort by acknowledging that multiple contacts are required to facilitate linkage to services, and that the HMG care coordinators at the centralized access point are effective in promoting this linkage.

Yet, the reality is that HMG affiliates engage in many activities in addition to linkage to services. Some families contact HMG with requests for information about community resources. Others have specific questions about their child’s development. Vulnerable families might present with more complex needs that require additional effort and time of the care coordinator.

Though some of these interactions are one-time requests, others span much longer periods of time and facilitate a high degree of family engagement. In any of these situations, a care coordinator may make a referral to a specific program or service, and follow-up with the family to ensure linkage. Yet, in many cases, the care coordinator responds to pressing family needs without making a referral.

The second truth is that all of these interactions do two things: 1) build family trust and knowledge of child development and parenting; and 2) increase the likelihood that families will go to HMG for future needs.  In responding to needs, care coordinators promote family resilience and access to concrete support, protective factors known to promote optimal child development as defined by the Strengthening Families Framework.1

It follows that we can reasonably take a much broader view of care coordination that encompasses all interactions between a family and HMG. We present here an initial definition and visualization of care coordination in the context of HMG that reflects this broader perspective and supports our ability to articulate impact.

• CARE COORDINATION
  Any action of Help Me Grow on behalf of a child that increases knowledge of HMG as a critical community resource that can enhance family resilience and support receipt of information or referral and linkage to services. See “The Activities of HMG Care Coordinators” graphic.

Expanding our capacity to measure care coordination

A multitude of different definitions of care coordination exist in different settings, and there is a general lack of consensus regarding the core functions of care coordination. Though many agree that care coordination is a process that engages the recipient and promotes access to care, services, and/or professionals, the implication of such descriptions is that care coordination is intricately linked to the specific setting in which it is applied.

Here we’ve attempted to articulate those activities that are essential to the HMG care coordinator role – though they are distinct from the care coordination activities of the patient-centered medical home, for example, they are critical to enabling HMG to respond to the needs of the family. The competencies that support a care coordinator in linking families to information and to services are outlined in the latest addendum to the HMG Manual, which describes the attributes of an effective care coordinator, including expertise, persistence, critical reasoning, and empathy.

Further, the HMG care coordinator does not assume responsibility for longitudinal care coordination and thus must ensure that information is transferred to others to ensure ongoing support. Many providers, as well as family members, coordinate care for children, but HMG possesses a full array of resources for families of young children across several sectors.

Our intent in broadening our definition of care coordination is ultimately to enhance our ability to advocate in support of this core component of the HMG system. In measuring and reporting on the outcomes of HMG systems, we want to quantify not just the proportion of families connected to services, but also, to the extent we can, other ways in which families’ needs are met by HMG care coordinators.

Children and families stand to benefit from a centralized call center whose care coordinators embrace the broad array of activities that enable them to meet the needs of families. Care coordination through HMG provides families the appropriate level of support and guidance to enable them to access resources, programs, and services that promote children’s optimal health and development.

As always, we encourage your thoughts and reactions.

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[1] Center for the Study of Social Policy. Strengthening Families. A Protective Factors Framework. Available at: http://www.cssp.org/reform/strengtheningfamilies.