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Medical
Homes in Rhode Island
This page is designed to keep you informed about events
and activities happening in Rhode Island that will help improve
access to medical homes for children with special health care
needs (CSHCN).
Click on a topic below to learn more about what's
going on in Rhode Island
Medical Home Initiatives
This section provides information
on state medical home initiatives/programs. States that
are a part of the mentorship
network will have a "Promise to the State"
which outlines how they will achieve ensuring that all children
have a medical home by 2010. This is based on the Healthy
People 2010 goals which is a 10 year action plan to
achieve and
measure
success for all CSHCN.
Rhode Island Medical Home Contact:
Name: Deborah Garneau, MA - Office of Special Health Care Needs
Contact: Phone: 401-222-5929 | Email: Deborah.Garneau@health.ri.gov
Web Site: http://www.health.state.ri.us/family/specialneeds/
Pediatric Practice Enhancement Project (PPEP)
http://www.health.state.ri.us/family/specialneeds/ppep.php
PPEP Brochure (PDF)
Participating Practices Roster
Poster Presentation at Future of Pediatrics Conference June 2007:
PPEP, Strengthening Rhode Island's Medical Home Infrastructure (Power Point)
PPEP Newsletters: (Microsoft Word format)
April 2007
January 2007
PPEP provides parent support personnel to primary
care physician who serve a large percentage of CSHCN and
their families. Parent consultants are currently placed
in 20 primary pediatric offices statewide and assist
the physician in providing a comprehensive coordinated medical
home to more than 1400 families annually (as of 2006). Parent consultants
link families with necessary community resources, assist
physicians and families in accessing specialty services,
and identify and resolve with the PPEP Steering Committee
systems barriers to coordinated care. The PPEP is partnership
between the Rhode Island Department of Health (DOH), Department
of Human Service (DHS) and the Rhode Island Chapter of the
American Academy of Pediatrics (AAP).
The PPEP funding sources include the DOH and State and Federal
Medicaid. Oversight and monitoring of the PPEP is a collaborative
effort among the DOH, DHS, Neighborhood Health Plan of RI,
and the Rhode Island Parent Information Network (including
Family Voices), with the DOH being the lead agency.
Project Goals: The PPEP aims to fully embrace
the Medical Home model of care by fostering partnerships
among families, pediatric practices, and available community
resources, including CEDARR (Comprehensive Evaluation Diagnosis
Assessment Referral Re-evaluation) Family Centers. The outcomes
identified for the PPEP include:
- Pediatrics practices will provide coordinated and comprehensive
care to CSHCN with greater operational efficiency within
the practices
- Pediatric practices will have improved awareness and
communication with available and appropriate community
resources for their CSHCN
- Families of CSHCN will receive ongoing, comprehensive,
and coordinated care, where the family is recognized as
a critical decision maker, resulting in improved health
outcomes for the child
- Families of CSHCN will have improved understanding of
both the health care delivery system and the community
resources available to them and demonstrate the ability
to access those resources.
Project Evaluation: The evaluation plan
is a two-tiered approach that includes assessment of the
overall effectiveness of the PPEP and identification of
key system barriers that limit the families' access to appropriate
services and supports. Evaluation of the PPEP is accomplished
through pre/post intervention surveys administered to families
and practice staff. In addition, aggregate data is analyzed
based on parent consultant activities. System barriers are
identified through parent consultant documentation resulting
from their work with the families. Several state and community
agencies are anticipating this feedback from parent consultants
to direct their quality improvement efforts
Form more information on PPEP contact: Deborah Garneau
at Phone: 401-222-5929 | E-mail: Deborah.Garneau@health.ri.gov
Newport County CATCH/Medical Home Initiative
Purpose: facilitate the creation of medical homes
for all children in Newport County.
Goals:
- Develop and implement a care coordination system to
support the medical home
- Identify and reduce barriers to medical homes.
- Provide medical home training to parents, medical and
human service providers
- Evaluate the impact of our interventions
- Implement systems to sustain and ensure quality medical
homes for all children.
Future Initiatives:
- Collaborate with the PPEP to define access barriers
and capacity issues & continue collaborative problem
solving with providers and families
- Collaborate with the RI Lung Association, Hasbro Children's
Hospital and Newport Hospital to implement community needs
assessment and training for asthma
- Develop Neighborhood Training Teams in collaboration
with the Newport Housing Authority
- Provide medical home training to school educators, FSC(s)
and health advocates as part of the Train the Trainer
Initiative
- Collaborate with mental health and special education
services to integrate care into the medical Home
- Develop a Newport County Medical Home web-site for families
and providers
- Maintain and build upon established medical home services
and products
- Obtain funding to sustain Newport County CATCH/Medical
Home Initiative
Newport County CATCH/ Medical Home Initiative
Presentation 
Newport County CATCH/Medical Home Initiative 2005
Work Plan and Action Items 
Newport County CATCH/ Medical Home Initiative Brochure
This brochure provides definitions, benefits and tips for
families about having a Medical Home for your child, and
includes a comprehensive listing of community and state
resources
Newport, Middletown, and Jamestown Medical Home
Transportation Map

Newport County CATCH/ Medical Home Initiative
"
Initiative Aims to Improve Children's Health Care"
Newspaper clip from the Newport Daily News. February 19-10,
2005 
For more Information on the Newport County CATCH/
Medical Home Initiative Contact:
James Sattel
Newport County CATCH/Medical Home Coordinator
The Triplett School
435 Broadway
Newport, RI. 02840
(401) 847-2100; ext 223 | jsattel@ebcap.org
Related Grant Initiatives
This section provides information
on current state grants that are working on medical home
initiatives. This includes the grant abstract as well as
key contacts for the grant.
Healthy Tomorrows Partnerships for Children Grant:
The Child Care Health and Mental Health Consultation Network of Rhode Island (The Network)
Project Period: 2006-2011
Program Description: A majority of Rhode Island's young children are cared for outside of the home, in regulated or non-regulated child care settings. The purpose of this project is to increase health and mental health services provided through child care settings to families, which is currently an unmet need in Rhode Island. The project will develop and implement a high-quality model of child care health and mental health consultations for child care centers and family care homes.
Projects Goals & Objectives: The goals of the project are: 1) To develop an infrastructure to support accessible and effective health and mental consultation for child care providers, 2) To increase child care provider's knowledge and ability to support young children's healthy development, 3) To identify children at risk for poor developmental outcomes and connect these children and families to the medical home and other developmental intervention services, and 4) To improve collaboration and coordination between child care providers, medical homes, and other community resources to ensure child and family access to services that promote health and development
Genetics MCHB Grant:
Abstract

Project Period: 3 years From: 6/1/2001-5/31/2004
The goals for this project focus on assuring identification
of all children with genetic conditions, access to a medical
home which coordinates primary and specialty care, improving
vehicles for informing parents and professionals about genetic
risks and tests, and strengthening HEALTH’s ability
to respond to existing and evolving genetics issues.
Partners in the State
This section provides information
on who in the state (individuals and agencies) are working
together to create medical homes for children.
American Academy of Pediatrics (AAP) Chapter:
www.riaap.org/
American Academy of Family Physicians (AAFP) Chapter:
www.riafp.org/
Title V Block Grant to States
Title V of the Social Security Act is one of the largest
Federal block grant programs. It leads the nation in ensuring
the health of all mothers, infants, children, adolescents,
and children with special health care needs (CSHCN). Title
V is administered by the Maternal and Child Health Bureau
(MCHB) as part of the Health Resources and Services Administration,
U.S. Department of Health and Human Services.
Title V and Children with Special Health Care
Needs
MCHB Objective: Support development and
implementation of comprehensive, culturally competent,
coordinated systems of care for the estimated 18 million
U.S. children who have or are at risk for chronic physical,
developmental, behavioral or emotional conditions and
who also require health and related services of a type
or amount beyond that required by children generally.
MCH Contact:
Ana Novais
Executive Director, Rhode Island Department of Health
Address: 3 Capitol Hill
Providence, RI 02908
Phone: 401-222-5117
Email: Ana.Novais@health.ri.gov
For the CSHCN Contact please view the Medical Home Contact at the top of the page.
Early Hearing Detection & Intervention (EHDI) Contact(s):
State EHDI programs promote universal
newborn hearing screening, develop effective tracking and
follow-up as a part of the public health system, promote
appropriate and timely diagnosis of the hearing loss, prompt
enrollment in appropriate Early Intervention, ensure a medical
home for all newborns and
strive to eliminate geographic and financial barriers to
service access.
Name: Ellen Amore
Contact: Phone: 401-222-4601| Fax: 401-222-1442
| E-mail: ellena@doh.state.ri.us
State Genetics Program: www.health.ri.gov/genetics/screening.php
Early Intervention/Part C Coordinator:
The Program for Infants and Toddlers with Disabilities (Part
C of IDEA) is a federal grant program that assists states
in operating a comprehensive statewide program of early
intervention services for infants and toddlers with disabilities,
ages birth through age 2 years, and their families.
Name: Brenda DuHamel
Center for Child & Family Health, RI Department of Human Services
Contact: Phone: (401) 462-0318
Email: BDuhamel@dhs.ri.gov
Web Site http://www.dhs.state.ri.us/
Section 619/Special Education for ages 3-5 Coordinators:
This program provides free appropriate public education
(FAPE) for children, ages 3 through 5 years, with disabilities:
Name: Amy Cohen, Preschool Grant Coordinator
Contact: Phone: (401) 222-4600 x2408
| Fax: (401) 222-4979 | Email: abcohen@ride.ri.net
Web site: www.ridoe.net/child_family/earlychild/default.htm
State Interagency Coordinating Council (ICC) Chairs:
The ICC advises appropriate agencies on the unmet needs
in early childhood special education and early intervention
programs for children with disabilities, assists in the
development and implementation of policies that constitute
a statewide system, and assists all appropriate agencies
in achieving full participation, coordination, and cooperation
for implementation of statewide system.
Name: Dawn Wardyga, ICC Chair
Contact: Phone: (401) 727-4144 x58 |
Fax: (401) 727-4040 | Email: familyvoices@ripin.org
Web site: www.ripin.org/
Resources/Funding
State Waiver Information: www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/08_WavMap.asp
Waivers are the result of a process that allows state Medicaid
agencies to apply for and receive permission from HCFA to
provide services not otherwise covered by Medicaid and/or
to do so in ways not described by the Social Security Act.
Most Medicaid managed care programs require Waivers. The
Waivers, which can differ greatly, are known by their numbers
(1115, 1119), or as home-and community-based, or as Katie
Beckett Waivers.
KIDSNET: www.health.ri.gov/family/kidsnet
Rhode Island's child health integrated system houses
data from several public health programs, and for the last
two years, has provided online access to pediatric providers
and other users. The new public-facing site offers information
for parents, providers, and other users, answers to frequently
asked questions, our confidentiality policies, and program
highlights. The KIDSNET system is available to Head Start,
the home visiting nurses agencies, WIC, Comprehensive Child
Care Service Programs, school nurses, Lead Centers, and
Early Intervention sites. KIDSNET provides the immunization
schedule for each child in the system.
Textron Charitable Trust Supports Rhode Island Community With Grant Program
Deadline: September 1, 2006
Textron, Inc. ( www.textron.com/ ), a multi-industry company operating in thirty-three countries with aircraft, industrial, and finance businesses, has announced the Rhode Island-based recipients of the company's 2006 grant program. Grants are awarded two times each year via the Textron Charitable Trust, a nonprofit, private foundation sponsored by Textron.
The foundation provides grants to organizations that focus on workforce development, education, community revitalization, arts and culture, and health and human services programs benefiting
Rhode Islanders throughout the state.
Applicant organizations must have 501(c)(3) tax-exempt status under the Internal Revenue Code.
The company accepts grant applications twice a year, in the spring and fall. The deadline for the next grant cycle is September 1, 2006.
For more information, guidelines, and an application form, visit the Textron Web site.
RFP Link:
http://fconline.foundationcenter.org/pnd/10003523/textron
For additional RFPs in Community Improvement/Development, visit:
http://foundationcenter.org/pnd/rfp/cat_community.jhtml
Educational Initiatives
This section provides information on training initiatives
on the medical home. Some states will discuss their outreach
projects in relation to physicians, families, and the community.
No information is currently available for this category.
Screening
Initiatives
This section provides information on surveillance
and screening initiatives in the state.
State Newborn Screening & Genetics Programs:
genes-r-us.uthscsa.edu/resources.htm
- State Newborn Screening Program Links
- State Genetics Program Links
- Regional Genetics and Newborn Screening Collaborative
Links
- Newborn Screening State Contact Fact Sheet
State Resources on the Internet
Note: The information provided on the state pages was submitted
by the state medical home teams.As this is not an exhaustive
list, please let us know if you have additions for your
state resource page. You can contact us at: medical
home@aap.org.
Last Updated April 9, 2009
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