Background:

Medically vulnerable infants are a growing group of at-risk children, the majority of whom are born prematurely (< 37 weeks gestation period). Preterm infants in 2006 made up 10.7% of California’s birth population* and, according to the Institute of Medicine, in 2005 cost on average $51,600 per preterm infant at birth**. Follow up costs for undetected and untreated medically vulnerable children can run into the hundreds of thousands of dollars annually in lifelong costs. The MVI Workgroup believes medically vulnerable infants in Kern County will continue to present a long term medical priority if not addressed with a timely, coordinated response that addresses the challenging and diverse medical and social service needs they require to mitigate early challenges and measurably improve birth and life outcomes.

Emphasis on primary prevention to address underlying causes of MVI health problems. Although many MVI children (estimated at 100+ annually in Kern County) receive intensive services for many years after birth, the majority of these infants’ (estimated between 200 – 300+ annually) develop conditions that may not appear until 6 months – 2 years after birth or later, long after they have left a Kern County NICU and the support of care managers. However, well established research has shown that certain medical conditions resulting from a shorter gestation period and/or low birth weight are strong medical indicators of future problems and potentially debilitating conditions. Unnecessary delays in need identification and a lack of a coordinated response very often lead to poorer life outcomes that require even greater costs to child and family well-being, and to the county’s healthcare, social service, education, and, too often, criminal justice systems.

Contribute to seamless continuum of care. A Kern County MVI coordination initiative would use a well-defined triage model supported by existing research to coordinate services among health, education and social service partners based on each child’s medical prognosis, developmental track, support system, and other needs as determined by regular assessments. It is anticipated that a county coordination initiative would mobilize all elements of the community to serve MVI and their families. Sample outcome indicators that are anticipated to be used to track progress for MVI program participants: Better, more timely diagnoses; Health insurance; Regular assessments; Medical home; Access to specialized services; Follow up services; Advocacy activities.

Build community capacity. The MVI Workgroup is dedicated to reaching out and involving all MVI stakeholders. Since its inception in 2008, the workgroup has been composed of representatives from key organizations that have responsibility for assisting and treating Kern County’s medically vulnerable infants, children and their families. Based on the planning period results, potential roles for a county-wide MVI coordinator could include, among other duties: Advocate/Ombudsperson for MVI and their families; Referral committee coordinator, using a triage selection process based on medical, social, behavioral treatment plans; Monitoring follow up activities between families and providers based on identified needs; Alleviate backlogs that negatively impact the timely provision of services; Identification and maintenance of an online resource bank and training curriculum for families, community organizations and providers to understand the benefits of a coordinated county-wide response and prepare them to respond to the needs of MVI and their families.

Emphasize collaborative governance. As part of the planning process, the members of the workgroup will develop a governance plan that will reflect the collaborative nature of the initiative, provide accountability and transparency to its work, and result in an inclusive decision making process to achieve optimum results for children, families and the county of Kern.