CoIIN State Team Work: Alabama

Improving communication to determine the needs of children with medical complexity, beginning with identifying CMC through Medicaid and private insurer data run

Lead Organization: Alabama Department of Rehabilitation Services/Children’s Rehabilitation Services (Title V)

Family/Youth Engagement Partner: Family Voices of Alabama

Clinical Site: Children’s Rehabilitation Services

Project

The Alabama CoIIN state team, in conjunction with families and staff at the University of South Alabama (USA) Pediatric Complex Care Clinic and Children’s Rehabilitation Service, is implementing a comprehensive care coordination program to improve outcomes for CMC that focuses on patient and family quality of life. This is being accomplished through the establishment of a patient-centered medical home model and the use of Shared Plans of Care to improve communication among providers and families.

Outcomes

To date, the Alabama team has developed a shared plan of care and hired a care coordinator who is providing care coordination services to children with medical complexity and their families at the USA Strada Patient Care Center Pediatric Complex Care Clinic.


Team Alabama’s journey map illustrated by ConverSketch