Welcome to the training on Transition Services for Children and Youth with Special Health-Care Needs provided by Texas Health and Human Services (HHS) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and others to employ transition services for children, adolescents, and young adults with chronic health conditions or disabilities at key transition points.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Formulate a strategy to address the health, education, and social needs of children and youth with special health-care needs at key transition points.
- Differentiate and integrate the functions of health-care professionals involved in transition assistance for youth with special health-care needs.
- Apply legal requirements and best practices for aiding the transition of children and youth with special health-care needs.
Please note this module expires on 6/19/2020.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This course has been designated by The Texas Department of State Health Services, Continuing Education Service for 1.50 credit(s) of education in medical ethics and/or professional responsibility.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is an accredited provider (P0180) of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
This course has been designated by The Texas Department of State Health Services for 1.50 contact hours of education in professional ethics and social work values.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
- 78th Texas Legislature. (2003). Texas Insurance Code, Title 8, Chapter 1201, Section 1201.059.
- American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, and Transitions Clinical Report Authoring Group. (2011). Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 128(1): 182-200.
- American Academy of Pediatrics, Department of Research. (2009). Survey: Transition services lacking for teens with special needs. AAP News 2009, 30(11): 12. (Log in required.)
- American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians-American Society of Internal Medicine. (2002). A Consensus Statement on Health Care Transitions for Young Adults With Special Health Care Needs. Pediatrics, 110(Supplement 3): 1304-1306.
- Betz, C. L. (2007). Facilitating the Transition of Adolescents with Developmental Disabilities: Nursing Practice Issues and Care [Abstract]. Journal of Pediatric Nursing, 22(2): 103-115.
- Blum, R. W., Garell, D., Hodgman, C. H., Jorissen, T. W., Okinow, N. A., Orr, D. P., & Slap, G. B. (1993). Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 14(7): 570-576.
- Bryant, B. R., Seok, S., & Ok, M. (2012). Individuals with Intellectual and/or Developmental Disabilities Use of Assistive Technology Devices in Support Provision. Journal of Special Education Technology, 27(2): 53.
- Cebula, R. (2005). Just the Facts: Basic eligibility while institutionalized, Supplemental Security Income. Cornell University, School of Industrial and Labor Relations, Employment and Disability Institute.
- Centers for Disease Control and Prevention. (2012). Childhood Overweight and Obesity.
- Child and Adolescent Health Measurement Initiative, Data Resource Center on Child and Adolescent Health. (2012). 2009/2010 National Survey of Children with Special Health Care Needs.
- Council on Children with Disabilities. (2009). Supplemental Security Income (SSI) for Children and Youth With Disabilities. Pediatrics, 124(6): 1702-1708. doi:10.1542/peds.2009-2557.
- Davis, A. M., Brown, R. T., Taylor, J. L., Epstein, R. A., & McPheeters, M. L. (2014). Transition Care for Children With Special Health Care Needs. Pediatrics, 134(5): 900-908.
- Disability Rights Texas. (2011). Legally Adequate Consent.
- Goldenring, J. M. & Rosen, D. S. (2004). Getting into adolescent heads: an essential update. Contemporary Pediatrics, 21(64).
- Goossens, E., Bovjin, L., Gewillig, M., Budts, W., Moons, P. (2016). Predictors of Care Gaps in Adolescents With Complex Chronic Condition Transitioning to Adulthood. Pediatrics, 137(4): 2015-2413.
- University of Massachusetts Boston, Institute for Community Inclusion. (2012).
- Institute of Medicine of the National Academies, Committee on Disability in America and Board on Health Sciences Policy. (2007). The Future of Disability in America. The National Academies Press, Washington, D.C.
- Kids as Self Advocates (KASA). (2009). How to Work with Personal Care Assistants.
- Lebensburger, J.D., Bemrich-Stolz, C. J., & Howard, T. H. (2012). Barriers in transition from pediatrics to adult medicine in sickle cell anemia. Journal of Blood Disorders, 3: 105-112.
- McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P.W., … Strickland, B. (1998). A new definition of children with special health care needs. Pediatrics, 102: 137-40.
- Minihan, P. M., Fitch, S. N., & Must, A. (2007). What Does the Epidemic of Childhood Obesity Mean for Children with Special Health Care Needs? The Journal of Law, Medicine, & Ethics, 35(1): 61-77.
- National Center for Medical Home Implementation. (2012). What has your experience as a parent of a child with special health care needs been like? - Brad Thompson [Video]. AAP Medical Home's YouTube channel.
- National Center for Medical Home Implementation (Producer). (2012). What is important for care coordinators to know about patients and their families? - Brad Thompson [Video].
- National Center for Medical Home Implementation. (2012). Example of when a care coordinator helped to navigate your child's care - Brad Thompson [Video].
- National Center for Medical Home Implementation. (n.d.). Building Your Care Notebook.
- Newman, L., Wagner, M., Cameto, R., & Knokey, A. M. (2009). The Post-High School Outcomes of Youth with Disabilities up to 4 Years After High School. A Report of Findings from the National Longitudinal Transition Study-2 (NLTS2) (NCSER 2009-3017). Menlo Park, CA: SRI International.
- Olsen, D. G. & Swigonski, N. L. (2004). Transition to Adulthood: The Important Role of the Pediatrician. Pediatrics, 113(3): e159-e162.
- Texas Department of Family and Protective Services. (n.d.). Transitional Living Services.
- Texas Department of State Health Services. (2011). Adolescent Health – A Guide for Providers.
- Texas Department of State Health Services. (2012). Facts About Case Management.
- Texas Department of State Health Services, Children with Special Health Care Needs Services (CSHCN) Program. (2005, 2006). Transition from Adolescence to Adulthood What’s It All About? CSHCN Newsletter for Families. In Transition Series Articles.
- Texas Department of State Health Services, Division for Family & Community Health Services. (2015). Scientific Analysis of the Current State and Needs of the Maternal and Child Health Population in Texas, Children with Special Heath Care Needs: Stand Alone Needs Assessment.
- Texas Education Agency. (2012). Education Service Centers Map.
- Texas Foster Youth Justice Project.
- Texas Medicaid & Healthcare Partnership. (2017). Texas Medicaid Provider Procedures Manual.
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2014). Transition Care for Children With Special Health Needs, Technical Brief, No. 15.
- U.S. Department of Health and Human Services, Health Resources and Services Administration. (2013). The National Survey of Children with Special Health Care Needs Chartbook 2009–2010.
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2007). Healthy People 2020.
- University of Washington. (2003). Sarah Goes to College.
- Weissberg-Benchell, J., Wolpert, H., & Anderson, B. J. (2007). Transitioning from Pediatric to Adult Care: A New Approach to the Post-Adolescent Young Person with Type 1 Diabetes. Diabetes Care, 30(10): 2441-2446.
- Health Day: News for Healthier Living. (2014). Coordinated Care Through ‘Medical Home’ Best for Chronically Ill Kids: Study.
- Garcia-Iriarte, E., Balcazar, F., & Taylor-Ritzler, T. (2007). Analysis of case managers' support of youth with disabilities transitioning from school to work. Journal of Vocational Rehabilitation, 26(3): 129-140.
- International Fibrodysplasia Ossificans Progressiva Association.
- Rosenau, N. (2000). Do We Really Mean Families for All Children? Permanency Planning for Children with Developmental Disabilities. Policy Research Brief 11(2).
- Schor, E. L. (2015). Transition: Changing Old Habits. Pediatrics, 135(6): 958-960.
- Got Transition.
- KASA: Kids As Self Advocates.
- National Alliance for Caregiving.
- National Center for Medical Home Information, Building Your Care Notebook.
- National Collaborative on Workforce and Disability.
- National Collaborative on Workforce and Disability, The 411 on Disability Disclosure: A Workbook for Youth with Disabilities.
- National Collaborative on Workforce and Disability. Paving the Way to Work: A Guide to Career-Focused Mentoring.
- Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. It offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
- Parent Companion First Five Years, a bilingual website focusing on young children with disabilities. It was created to comfort, inspire, and connect parents to helpful disability resources.
- Seattle Children’s Hospital, The Center for Children with Special Needs. Transition resources and other helpful information about transition for children and adolescent with special health-care needs.
- Social Security Administration’s Benefits for Children with Disability brochure.
- Texas Health and Human Services Commission. Take Time Texas, a web page that provides a state inventory of respite services.
- Texas 24-Hour Residential Services.
- Texas Department of Family and Protective Services, Preparation for Adult Living (PAL) Program.
- Texas Department of Family and Protective Services, Education and Voucher Training (ETV) Program.
- Texas Department of Family and Protective Services. Circles of Support and Transition Plan Meetings web page.
- Texas Department of Family and Protective Services. Extended Foster Care web page, including a brochure for youth in English and Spanish.
- Texas Department of State Health Services. Texas Consumer Guide to Health Care.
- Texas Department of State Health Services, Children with Special Health Care Needs (CSHCN) Services Program. Family Support Services information.
- Texas Health and Human Services Commission. Independent Living Services, including a list of independent living centers in Texas.
- Texas Health and Human Services Commission. Day Activity and Health Services.
- Texas Health and Human Services Disability Services website.
- Texas Personal Care and Attendant Services.
- Texas Parent to Parent, peer support for parents of children with special health-care needs.
- Texas Project FIRST. Transition in the Individual Education Plan (IEP) website.
- Texas Workforce Commission. Vocational Rehabilitation Services.
- Think College, a national organization dedicated to developing, expanding, and improving inclusive higher education options for people with intellectual disability.
Case Management Services in TexasIntegrate case management services to support patients and families dealing with special health-care needs or chronic conditions. Includes information about eligibility for Case Management for Children and Pregnant Women.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.