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Gabriel Park Family Medicine Center Becomes Medical Home for Children with Special Health Care Needs

   Portland, Ore.

Arlene Jones, mother of Briana, says she feels a great sense of ease when she walks into Oregon Health & Science University Family Medicine at Gabriel Park.

"I get a comfortable feeling. I know there's help there. They know who we are and they know my child has special health care needs. Office visits and referrals go a lot smoother," said Jones. Her daughter, Briana, 17, has a developmental disability and attention deficit disorder.

The Family Medicine Center at Gabriel Park, located in the southwest Portland neighborhood of Vermont Hills, recently became the first Oregon Medical Home Project in Portland. The project is coordinated through the OHSU Child Development and Rehabilitation Center (CDRC) and is directed by Robert Nickel, M.D., professor of pediatrics, OHSU School of Medicine. Nickel also is the director of the CDRC in Eugene.

Being a medical home means that the Gabriel Park clinic has a professional/family relationship team whose members have agreed to learn about the concept of a medical home for children with special health care needs and make changes in the primary care office to better serve children and their families. Children and youth with special health care needs are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition, and who also require health and related services of a type or amount beyond that generally required by children.

A medical home is an innovative approach to care for children with special health care needs in a high quality, cost-effective way. The parents and their physician work as partners to identify and connect with the medical and non-medical care available in the community that may be needed to help them reach their maximum potential. The medical home approach calls for continuity of care, prenatal to adulthood, and coordination of care, whether it is a speech therapist, psychologist or a hearing test that is needed. "It is a family-centered, proactive approach to health care," said Pat Tangeman, M.A., M.Ed., P.T., Oregon Medical Home project coordinator.

Physicians and other health care providers often aren't aware of all the resources available to help a special child. Their focus traditionally has been treating illnesses. Times have changed, however. According to a 2000 national Health Resources Services Administration Maternal and Child Health Bureau survey taken of Oregon primary care clinics, 15 percent to 18 percent of their pediatric patients have developmental, behavioral or mental health problems, as well as complex chronic health conditions, or all of the above.

Tangeman has guided the staff of the medical center to help them make clinic changes so that care is easier for the child and family. Now even the receptionist who answers is aware of what is needed for that visit. Parents and children also are given a special half-page questionnaire that asks about concerns and current issues at each visit to better help the health care team serve that patient.

"Already we've seen an increased awareness of what is out there for patients with special needs. For some parents, it's a relief to know they're not alone and others understand their needs and have looked at solving the same problems," said Mark Bajorek, M.D., assistant professor of family medicine, OHSU School of Medicine, and medical consultant for the Gabriel Park Medical Home.

In the medical home, parents play an important part. Jones is a parent member of the Medical Home Project Team at Gabriel Park. Physicians asked her to help because she is involved locally and regionally in advocating for children, youth and adults with developmental disabilities, she said. For Gabriel Park, she has compiled a book of community resources in Multnomah, Washington and Clackamas counties for children with special health care needs, their families, practitioners, nursing staff and others to be used at the family practice. She also is available as a direct contact for families to consult on a parent-to-parent basis.

"The need has been for a collective memory. Some of the resources are really great and others may not be as great. When we get more parent feedback, it'll help us know who or what agency to contact first," Bajorek said.

The $300,000 three-year grant for the Medical Home Project is from the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, and the American Academy of Pediatrics. The grant is coming to an end, but the Medical Home Network will continue to receive support from the CDRC through its Title V public health program. Additional grant funds will help develop a cost-effective way to expand the medical home program approach in primary care offices within communities in Oregon.

The members of the Oregon Medical Home Network of primary care offices who have participated in this CDRC project include: the Mid Valley Children's Clinic, Albany; Central Oregon Pediatric Association, Bend; Southern Oregon Pediatrics, Medford; Treasure Valley Pediatric, Ontario; and Childhood Health Associates of Salem.

It is a national goal that "all children with special health care needs will receive regular, on-going comprehensive care within a medical home and multiple federal programs require that all children have access to an ongoing source of health care," according to the U.S. Department of Health and Human Services Healthy People 2010 program.

Interested parents have only to ask to use the services of the Oregon Medical Home Project, Bajorek said.

On April 24 the Oregon Medical Home Project is expected to receive a community service award from the Oregon Pediatric Society for developing and expanding the medical home approach in Oregon.

If you are interested in learning more about the Medical Home Approach, please call Pat Tangeman at 503 494-3232.

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