L.A. Care tries to identify and serve abused or neglected children in its membership

L.A. Care, an independent entity created by the state of California to provide managed health care services to Los Angeles County residents, has started L.A. Cares for Kids in an attempt to identify abused or neglected children within its membership who are under the supervision of the Department of Children and Family Services and who live with their families under that department’s Family Maintenance program. The intent is to ensure that the children’s health care needs are assessed and met.

David Hollinger, manger for community benefits and program innovation at L.A. Care, tells State Health Watch that L.A. Cares for Kids came out of work the staff did several years ago with foster children who are carved out of the state’s Medicaid program. They realized that another subset of children who likely could benefit from special attention was those who are part of the Family Maintenance program in which they still live with their family but are under county child protection agency supervision for abuse or neglect.

Children have multiple needs

"Research shows that abused children have many health issues: mental and physical health and developmental issues," Mr. Hollinger says. State workers soon realized they had no way to identify which of the children on their membership rolls were in the Family Maintenance program. "We assumed we had some, but they were invisible. There was no system in place for care coordination, provider training, etc. We saw several holes to be filled."

One key to getting the program off the ground, he says, was early collaboration with the Department of Children and Family Services. A willingness to participate in and dedicate resources to solving health and related policy issues at the community level is part of L.A. Care’s vision for itself and something the plan says distinguishes it from most other health plans.

"Providing community benefit requires cooperation and partnership with other entities striving to improve conditions for the least advantaged in our county. L.A. Care’s approach to developing, implementing, and sustaining L.A. Cares for Kids is defined by our ambition and commitment to be accountable for the health and well-being of the members we serve and the communities where they live," Mr. Hollinger says.

The program summary says project goals are to:

• demonstrate an effective model of managed care delivery, utilizing provider training, care coordination, and patient tracking to promote the health and safety of vulnerable children;

• collect data regarding the unique health care needs of children in the Family Maintenance program, creating a baseline health profile to drive future policy development.

The goals are to be met by:

• establishing a means to identify eligible children;

• conducting provider training to improve assessments, services received, communication with families, and identification of risk factors for abuse and neglect;

• developing protocols for communication and coordination between health care providers and the child protection agency;

• designing a replicable care coordination process to ensure that each child receives prescribed health and related services and to assist parents in gaining skills to manage their children’s health needs;

• creating a data collection and evaluation system to gather baseline health data on the children and perform process and outcome bases analyses of L.A. Cares for Kids.

Identifying those eligible

Mr. Hollinger says identification of eligible children on the L.A. Care membership rolls was accomplished by close contact with the county’s Dependency Court, which issued an order allowing the child protection agency to release information on its clients to the health plan.

At any given time, he says, the county has 50,000 to 60,000 foster children, 10,000 children in the Family Maintenance program, and 2,300 to 3,300 of those children who are members of L.A. Care.

One of the initial hurdles in the project, which has been funded for three years, was the reluctance of families to be identified as participants in the Family Maintenance program. Mr. Hollinger says that during the planning process, L.A. Care conducted focus groups with families and found them to be generally very supportive, but concerned that the physicians would treat them differently if they knew about their family situation.

Concern was expressed by those whose physicians didn’t know that the family had an open case with the county child protection agency, he says. Families whose physicians did know about the situation were very supportive, he adds.

Karen Goodyear, project manager, tells SHW that she is optimistic the program can work if the recruitment barriers can be overcome. Since the children who are being identified already are L.A. Care members, their medical services continue as is, with the addition of services under the new program.

Involving the entire family

L.A. Care works with the entire family, so other family members receive benefits from participation in the program. "We have to work with the parents. That’s what’s going to make or break this program," she points out.

Ms. Goodyear says part of the case coordination work is to develop a transition plan for when families leave the Family Maintenance program. They also are working to identify needed resources such as transportation.

"We don’t want to replace any existing services," she says. "We want to coordinate and augment them."

Working with physicians

In addition to working with families, the staff also work with physicians to be sure they have a systematic way to do rough screening on developmental issues and behavioral problems in the children who are in the program.

Goodyear says her criteria for success of the program include:

• gathering needed health data;

• increasing screening at the front end for developmental and mental health issues;

• training physicians and improving their ability to screen;

• increasing services accessed through care coordinators.

"We hope we can document coming up with a system that identifies the elements of what it took to make this work so it can be replicated elsewhere," Goodyear says.

[Contact Mr. Hollinger and Ms. Goodyear at (213) 694-1250.]