Care Coordination Collaborative Model

The HCCC, now known as the North Central Care Coordination Collaborative, has become the care coordination model for Children and Youth with Special Health Care Needs (CYSHCN) services in Connecticut, and has expanded to address the needs of all vulnerable children.

The model brings together the care coordinators from a variety of child serving sectors with regularly scheduled meetings to do the following:

• Learn, through presentations from area/state resource providers, about services for children and how to help families access them
• Collectively review challenging cases and develop cross sector solutions to meeting children’s and families’ needs
• Develop and advocate for policy level solutions to families’ struggles in connecting to services
• Support pediatric primary care in meeting the care coordination needs of families

The purpose of the North Central Care Coordination Collaborative is to serve families and child health care clinicians in the greater Hartford area in a holistic and efficient manner by identifying and maximizing the full range of resources available and supporting care coordinators in obtaining the care and services needed by children and their families.

In addressing the needs of families, the Collaborative also seeks to understand health and human service delivery systems in order to promote wellness, support the medical home, and assist families in negotiating these systems as well as to document the gaps and barriers that families confront when in need of assistance.

• ACCESS-Mental Health CT
• Child Health and Development Institute (CHDI)
• Children and Youth with Special Healthcare Needs (CYSHCN) Program, Department of Public Health (DPH)
• CHN – Community Support Services
• CHN – Intensive Care Management
• Community Health Network (CHN) – the ASO
• CT Behavioral Health Partnership
• CT Dental Health Partnership
• CT Family Support Network
• Connecticut Children’s Medical Center – Education and Rehabilitation Services
• Connecticut Children’s Medical Center – Center for Care Coordination
• CT United Way/2-1-1 – Child Development Infoline (CDI)
• CT United Way/2-1-1 – Health and Human Services
• CT United Way/2-1-1 – Child Development Infoline
• Department of Children and Families (DCF)
• Department of Developmental Services – Division of Autism
• Department of Social Services
• Hartford Public Schools- Health Services
• Husky Health – (DSS) Person Centered Medical Home
• InterCommunity, Inc – Child First
• The Cornerstone Foundation, Inc.
• The Medical/Legal Partnership Project, Center for Children’s Advocacy
• The Village for Children and Families
• Urban League of Greater Hartford
• Vernon Public Schools
• Wheeler Clinic

The Care Coordination Collaborative model brings together the care coordinators from a variety of child-serving sectors with regularly scheduled meetings to do the following:

• Learn, through presentations from area/state resource providers, about services for children and how to help families access them
• Collectively review challenging cases and develop cross-sector solutions to meeting children’s and families’ needs
• Develop and advocate for policy-level solutions to families’ struggles in connecting to services
• Support pediatric primary care in meeting the care coordination needs of families

As the Care Coordination Collaborative learns more about the work of member agencies and the challenges they confront in supporting families, suggestions and recommendations for improving care coordination will arise. A State Level Collaborative was convened to provide a venue for regional collaboratives to elevate systems’ issues and gaps, with the intention of developing potential policies to address these issues.

Connecticut Children’s Office for Community Child Health, along with the North Central Care Coordination Collaborative, organizes, facilitates, and provides technical assistance to four regional community care coordination collaboratives with the goal of improving the system of services for Children and Youth with Special Health Care Needs (CYSHCN) as they strengthen and formalize their infrastructure.

The North Central Care Coordination Collaborative has improved connection among child-serving sectors, increased knowledge about resources available for children and families, and maintains strong connectivity among members as well as with outside organizations.

The Collaborative has designed and tested a set of tools to measure the impact of their work. The regional sites may access the toolkit from this website.

The following regions will replicate their own regional care coordination collaborative. If interested in joining, please contact the following:

• North Central Care Coordination Collaborative –  email Allison Matthews-Wilson, LCSW

• South Central Region (Family Centered Services of CT, Inc. New Haven) –  email Denise Stevens

• Eastern Region (United Community and Family Services of Norwich, Inc. Norwich) –  email Yolanda Bowes

• Southwest Region (Stamford Hospital, Stamford) –  email Madhu Mather

• Northwest Region (St Mary’s Hospital, Waterbury) – email Maria Thomas

This is made possible with funding from the CT Department of Public Health and the Connecticut Health Foundation.