Assessing Care for Special Needs Children

February 2, 2012

When the Texas Health and Human Services Commission needed an assessment tool to help determine the amount of Medicaid home care families with special needs children might require, they called on a team of researchers at the Texas A&M University Health Science (TAMHSC) Center School of Rural Public Health and Texas A&M University for help.

The team has developed, tested and assisted in the implementation of assessment instruments to determine some of the requirements of families with children who have special needs participating in the Medicaid Early Prevention, Screening, Diagnostic and Treatment (EPSDT) program and receive Medicaid Personal Care Services (PCS) in their homes. Its goal was to develop and test a set of assessment instruments that would assist Department of State Health Services (DSHS) case managers effectively and fairly determine how many hours of PCS a family needed.

Dr. Charles D. Phillips, Regents Professor

“All of these children have one or more chronic illnesses and live in lower-income households across the state of Texas,” says Dr. Charles D. Phillips, Regents Professor with the TAMHSC-School of Rural Public Health. “Personal Care Services involve home health personnel assisting the family with care for the child in performing activities of daily living.”

Dr. Phillips, principal investigator and project manager, adds that PCS includes assistance with daily living skills such as help with bathing, locomotion, toileting, eating, dressing and personal hygiene, taking medications and preparing meals. The Personal Care Assessment Form (PCAF) developed by the research team is now used to assess all children in the EPSDT program who seek Personal Care Services. Dr. Phillips also indicated that this very vulnerable population includes between eight and 10 thousand children across the state with serious, chronic health problems, the majority of them suffer from both a medical condition and a psychological or developmental problem.

“In combining the creativity and diverse expertise of the team (e.g., counseling psychology, health policy, political science, developmental psychology and research methods), we are able to help children with special needs and their families receive services that can improve their quality of life,” says Dr. Constance Fournier, a clinical professor in Texas A&M’s Department of Educational Psychology.

The researchers found the average annual expenditure for a child receiving health care covered by Medicaid totals less than $2,000 a year; the special needs children in the population on which this project focused average more than $33,000 a year in Medicaid expenditures. In such cases, properly assessing each child’s needs also becomes financially important.

The PCAF developed by the research team is now used to assess all children in the EPSDT program who seek Personal Care Services.

Dr. Catherine Hawes, Regents Professor

Thomas Miller, Ph.D., M.B.A.

In addition to Dr. Fournier and Dr. Phillips, the team that developed the form includes Dr. Catherine Hawes, Regents Professor; Dr. Darcy Moudouni; and Dr. Thomas Miller, all with the TAMHSC-School of Rural Public Health, as well as Dr. Timothy Elliott, Department of Educational Psychology in the College of Education and Human Development at Texas A&M, and Dr. James Dyer, Ms. Emily Naiser and Ms. Ashweeta Patnaik, all with the university’s Public Policy Research Institute.

The team’s findings have been published in the American Psychological Association journal, Rehabilitation Psychology, in the Health Research and Educational Trust Health Services Research and the American Public Health Association’s Disability and Heath Journal.
Because of the success of the assessment tool the team developed, the researchers say the Health and Human Services Commission recently tasked the team with the development of an assessment instrument called the Nursing Care Assessment Form (NCAF), to be used with all children receiving any type of Medicaid home care, not just PCS.

Dr. Phillips says the instrument will be used by DSHS and home health agencies to develop a plan of care that will address each child’s need for nursing care, therapy, assistive devices and personal care.

“When implemented, this tool will be used to assess the care needs and improve the quality of life of tens of thousands of children in Texas who have special health care needs and live in lower-income households,” he adds.
He says the successful project has also gained international recognition. The instruments developed by the research team are being revised and integrated into a suite of assessment tools distributed by interRAI, a not-for-profit organization composed of researchers or policymakers from almost 30 countries around the world. Inquiries about the instruments developed by the team have come from government agencies as far away as New Zealand and South Africa and as near as the state of New York and the province of Ontario, Canada.

— Rae Lynn Mitchell

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