Champions for Inclusive CommunitiesCh~rmpiar~s far
inclusive Comrnunities
Early Intervention Research Institute • 6586 Old Main Hill • Logan, UT 84322-6586 • 1-800-887-1699 • www.championsinc.org
November 2, 2009
Hello,
Dubuque, Iowa was selected for the Community Recognition Program by Champions for
Inclusive Communities because they have been successful in achieving community-based service
systems for children with special health care needs and assuring family-centered care for all
children. Champions for Inclusive Communities, an MCHB-funded national center, would like to
recognize this community from your area and share their successes!
Attached is a press release honoring their work on behalf of children, youth, and families; a fact
sheet with more information about their partnerships; and a fact sheet about Champions for
Inclusive Communities.
Thank you for your time,
~d'~2
Cora Price
Star Community Coordinator
Champions for Inclusive Communities
tel: 800-887-1699
email: cora.price a,usu.edu
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~~ UtahStateUniversity
CENTER FOR PERSONS Wf~Fi DISABILRIES
Press Release: Dubuque County, Iowa recognized as "Star Community" by
Champions For Inclusive Communities
Dubuque County, Iowa has been recognized as a "Star Community" by Champions for Inclusive
Communities, a national center designed to support communities in organizing services for families of
children and youth with special health care needs (CYSHCN). Dubuque County is an excellent model
of providing organized, easily accessible services and supports to children and youth with special needs.
ChampionsInC is a project at the Center for Persons with Disabilities (CPD's) Early Intervention
Research Institute at Utah State University, funded by the federal Maternal and Child Health Bureau.
Dubuque's key to successful community-based services is the Community Circle of Care, a
Substance Abuse and Mental Health Services Administration-funded program in partnership
with the Iowa Child Health Specialty Clinics, the University of Iowa's Center for Disabilities
and Development and the Iowa Department of Humans Services. The Community Circle of Care
provides wrap around services to children and youth with serious emotional or behavioral
challenges. Wrap around services mean the family creates a plan that is based on their unique
needs and strengths, developed in coordination with community partners. Planning includes
immediate issues and future needs, such as transitioning to independent adult living. The
Community Circle of Care is successful partly because of its focus on families. Parents serve on
the planning council and local advisory boards, and significantly contribute to the Circle of
Care's monthly newsletters that go out to the families it serves.
The Visiting Nurses Association (VNA), a local organization that provides home services, is an
important partner of the Community Circle of Care in promoting the concept of a "medical
home." A medical home is not a physical place, but a way of proving coordinated,
comprehensive, family-centered care to children and their families. The VNA connects primary
care providers with the Community Circle of Care, reminding them that the Community Circle
of Care is the local "go-to" when it comes to mental health services for children and youth. The
connections made by Community Circle of Care also lead to screening referrals from partners
such as schools, health clinics, WIC, and oral health screening programs.
One of the benefits for families in the Dubuque County community is the ability to receive wrap
around services when it comes to insurance and financing. Circle of Care assists families with
funding for services they cannot afford while simultaneously helping them find an appropriate
insurance provider.
Teens with special needs in Dubuque are provided with skills to help them prepare to transition
to adult life. Schools in the community provide many of the services through a transition
coordinator. The Community Circle of Care's Elevate program also guides youth in the process
of moving out and finding a job.
To find out more about the efforts of Dubuque County and the Community Circle of Care in
providing community-based services for CYSHCN and their families, visit the Star Communities
page on the ChampionsInC website: http://www.championsinc.or reco ign tion/ or contact:
Vickie Miene, Project Director Gloria Klinefelter, Key Family Contact
888-583-5545, ext. 602 888-583-5545, ext. 606
yckie-miene(a~uiowa.edu gloria-klinefelter(a~,uiowa.edu
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Star Community
~~
Dubuque, Iowa is a community located in the tri-state area along the banks of the Mississippi River near the Wisconsin
and lllinois borders. Over four years ago, families in the area spoke up and said they were not happy with the way
services were organized, and that they wanted a "single point of contact," or none-stop-shop to access services to meet
their children's needs. This concept of a single point of contact, or "lighthouse," was gradually turned into a reality by
the Community Circle of Care, northeast Iowa's gateway into providing coordinated services to families.
The Community Circle of Care, a partnership of the Iowa Child Health
Specialty Clinics, the University of Iowa's Center for Disabilities and
Development and the Iowa Department of Humans Services, is funded
through a Substance Abuse and Mental Health Services
Administration (SAMHSA) grant, which is now in its thix{ year. It
provides wmmuruty-based wraparoru~d services to families of children
and youth with serious emotional and behavioral challenges. This
wraparound plan is-coordinated by a team of professionals, community
supports, and, of course, the family. The plan also addresses other
health needs, iiclud'urg physical health, in order to fully address the
needs of children with multiple diagnoses and their families.
services are so comprehensive for the families' needs that the family
often feels no need to return to a medical home. However, the
community has recently made large strides to change this.
For the Visiting Nurses Association (VNA), which is one of
Community Ciele of Care's community partners, medical homes have
been a priority for some time. The VNA encowages medical homes by
performing social marketing between primary care providers and
Community Circle of Care. Essentially, the VNA works to remind
primary care providers that the Commwity Circle of Cam is the "go-
to" when it comes to mental health services for their patients who are
children and youth.
Families: The Center ofthe Grcle
Families are at the center of the Community Circle of Care in many
ways. They serve on the planning council and local advisory boards,
and contribute significantly to the Circle of Care's monthly newsletters.
Their voices are heard through swveys and phone calls asking their
opinion. Clinics have a paid family consultant on staff and a social
worker to provide care coordination. And, perhaps most helpful of all,
they participate in the local parent support groups and family activities.
Parents who attend these support groups share their struggles, learn
about what services are available in the community, and leans how to
be a good advocate for their child One parent of a son with epilepsy
and a variety of mental health diagnoses tells of feeling slightly out-of-
touch upon moving to the Dubuque area She says, "I had a need to
connect with other parents who were going through the same thing as
me." When a staff member from the Community Circle of Care
referred this mother to the parent support group, it was a breath of flesh
air and "hugely helpful."
Community Partners
One of Commwity Circle of Care's keys to success is its array of
community partners. Local businesses have been known to donate
space for events like parent support group mcetings and provide
discounted services to families.
The planning council also partners with non-business entities such as
schools, local agencies that serve families and youth, and the juvenile
court system. This committee meets quarterly arnd also involves parents
and youth indecision-making.
Communication in the Medical Home
The Community Ciele of Care has experienced challenges with the
medical home concept simply because thei• individualized wraparound
The VNA also acts as the informant for medical home providers who
need someone to fill them in on what is happening in the Dubuque.
One way she keeps these providers connected is by forvvardu1g them
resources such as the Circle of Care newsletters.
Screening
Communication between the primary care providers, the VNA, and
Community Circle of Care is important because in Dubuque, the
primary care provider often does much of the screening. Knowing
What makes a Star Community?
ChampionsInC has created the Star Communities program to
recognize exceptional communities.
Star Communities will show excellence in 6 Performance
Measures:
• Families are partners
• A "Medical Home" provides coordinated care-
s Children receive early and conkinuous screening
• Families have adequate funding/insurance to pay for
services
• Services are organized so families can use them easily and
are satisfied
• Youth receive necessary services to make the transition to
adult life
read about other Star Communities at
www.ChampionslnCorg
www.Cha m pions) nC.org
Champions For Inclusive Communities (ChampionslnC) is a national leadership and
resource center designed to support states and communities in organizing services so families of children and
youth with special health care needs (CYSHCN) can use them easily and families are satisfied. The implementation
of community-based service systems is a key component of Healthy People 2010 as stated in its Objective 16.23:
To increase the states and territories that have service systems for children with special health care needs.
ChampionslnC can help your state and/or community in achieving this national goal.
What ChampionslnC offers Contact Us:
Early Intervention Research
A variety of technical and web-based resources are available from ChampionslnC to assist states institute, Utah State university
and communities in their community-building efforts: 6580 Old Main Hill
Logan, UT 84322-6580
• Technical Assistance -States and/orcommunities that need support in building partnerships,
developing and implementing an action plan, and measuring outcomes can contact ~_gp0-887-1699
ChampionslnC staff for guidance and assistance.
Richard Roberts:
• www.ChampionslnC.org - Our website provides resources for policymakers, providers, and richard.robertsC~usu.edu
families interested in improving services for CYSHCN. A Discussion Forum is being developed
to provide a way for those involved in community building to share challenges and solutions. Diane Behl:
diane.behlC~usu.edu
• Champions E-newsletter - This bi-monthly newsletter provides an exchange of Ginger Payant:
information about resources and opportunities related to integrated community services. g;nger.payantC~usu.edu
Links to community-based initiatives, such as funding and technical assistance opportunities,
serve as a resource to support and sustain community efforts.
• Community Tool Box -This interactive, web-based tool provides step-by-step instructions
for community teams interested in developing action plans and organizing services.
• Evidence-Based Practices -Reviews of the literature in areas such as care coordination,
community coalition building, and racial disparities are available to help communities
implement effective strategies.
• Community Recognition Program -This recognition process will acknowledge the efforts
of communities across the U.S. that are developing sustainable mechanisms to organize
services so families can use them easily.
Champions for
Inclusive Communities
How Communities Organize Services
The goal, "Community-based service systems are organized so that families
can use them easily and are satisfied with what they receive;' has multiple
key components
• Families can access culturally competent, comprehensive services and
supports for their child and family, including specialty care, in their
community.
• Families are satisfied with services and supports they receive.
• Services are coordinated among all providers, and families receive
supports such as a coordinated service plan and a care coordinator.
• Families are connected to a variety of services and resources via a
streamlined enrollment process.
• Public-private partnerships work to develop service systems at the
community level.
' From Measuring and Monitoring CommunityBased Systems of Core for CSHCN (2003), Early
Intervention Research Institute, Utah State University, Logan.
Strategies to Organize Services for Individual Families:
• Cultural brokers who help reach families from diverse cultures
• Coordinated service plans that are developed across multiple providers
and agencies with family members as the lead
• A single care coordinator, often associated with the child's medical
home
• Wrap-around service teams to fill gaps in needed services
Strategies to Improve Policies and Practices:
• Community coalitions comprised of providers and diverse family
representatives to oversee systems development
• Co-location of multiple services under one roof
• Blended funding to fill financial gaps
• Electronic application systems to access multiple programs
www.Cha m pions) nC.org
According to the
2005/2006 National
Survey of CSHCN:
• One out of five families who needed a
referral reported problems.
• Two major problems were getting
needed information and services.
• Families of CYSHCN more likely to
have unmet needs were those:
Whose child had emotional, behavioral,
or developmental challenges;
Whose child had functional limitations;
Who had inconsistent or no health
insurance;
Who had income below the federal
poverty level; and/or
Who were headed by a single mother.
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