MCH Digest

December 2024

Developmental Screening & Referral: The e-Referral Project

By: Michele Coates, MA, Early Childhood Systems Specialist, Children and Youth with Special Health Care Needs (CYSHCN) Section

Developmental Screening & Referral (DSR): The e-Referral Project is an interagency collaboration to establish a closed-loop electronic referral process between pediatric health systems and Early Intervention Colorado (EICO). This project is a Maternal Child Health funded initiative in partnership with Early Intervention Colorado at the Colorado Department of Early Childhood (CDEC) and Assuring Better Child Health & Development (ABCD). Technical support for this project is provided by Health Data Consults and Contexture; one of Colorado’s largest health information exchange (HIE) organizations.

Why e-Referral?

Young children, birth-to-three, with or at risk for developmental delays often do not successfully connect with early intervention services. Data indicates a high percentage of these referrals were closed prior to completing the evaluation process. Additionally, primary care providers, the largest referral source for early intervention, frequently report that they don’t always know the outcome of their referrals.

Primary care physicians and hospitals are the leading referral sources (65.9% of total referrals).

The e-Referral project was designed to pilot a more effective coordinated intake and referral system by enhancing accurate and timely referrals, increasing evaluation rates and successful referral outcomes, and improving workflow between systems that serve young children and their families through electronic bidirectional communication.

Project Goals

Establish a closed-loop electronic referral process between health systems and EICO to support effective referral systems and coordination of services for children (birth to three) and their families.
Provide health care professionals the ability to easily connect patients with community resources-specifically early intervention services at the point of care.
Referring providers will receive progress notes which closes the communication loop and gives the provider a better picture of the care and support the patient receives outside of the healthcare setting.

“e-Referral is a technology solution that improves referral outcomes, communication and system collaboration.”

How Does It Work?

Referrals are made through the electronic health record system (EHRs) via a direct message interface with Contexture (HIE) to share pertinent referral data with EICO’s centralized intake data system (Salesforce). Progress notes with the current status of the referral are sent back using the same process to the health system within a few days after receiving a referral. This closed bidirectional loop enhances and improves communication and workflow between the two programs.

What Health Systems Have Implemented e-Referral?

Phase One (2022-2023):
Salud Family Health Centers (piloted the e-Referral process)
Phase Two (2023-2024):
Children’s Hospital Colorado (scale pilot with a larger health system)
Phase Three (2024 -2025):
Valley Wide Health Systems, Stride Community Health Centers and the larger UCHealth System (additional health systems are in the implementation process)
Phase Four (2025-2026):
Plans are underway to continue onboarding new health systems while developing sustainable infrastructure for ongoing post-pilot implementation and technical support.

Info graphic highlighting information about the 269 e-referrals that were completed.

What We Have Learned

Notable and promising project outcomes include:

82% of families were contacted successful (vs 61% via faxed referrals)
Families were contacted in 3.9 days (on average, vs. 4.6 days via faxed referrals)
13% of families refused services (vs 16% via faxed referrals)
Evaluations were scheduled in 23 days (on average, vs 32 days via faxed referrals)
48% of families scheduled evaluations (vs. 35% via faxed referrals)

*Data is from a six month period with Children’s Hospital during Phase Two.

Progress notes shared at multiple points between referral and evaluation have improved connection and established trust between critical systems of care for young children and their families. Initial pilot evaluation results demonstrate high rates of provider satisfaction with ease of referral and the simplification and enhancement of provider workflow. EICO reports there is a decrease in closed referrals due to missing/incorrect contact information and overall better outcomes for children and families which include successful contact and completion of the evaluation process.

Pilot to Process

With five health systems and more than 40 clinics currently using or piloting e-Referral, implementation partners are currently planning for Phase Four which includes continued scaling of the e-Referral Project across the state in addition to the development of a post-implementation sustainability plan for all participating health systems. Project data collection and evaluation are ongoing as we continue to learn more about project outcomes and impact.

"This project has translatable outcomes for supporting State and Health System partnerships to enhance communication and data transfer through electronic referrals. This is relevant to families with young children at risk for developmental delay as timely and consistent communication builds trust between families and their primary care provider and trust between the systems serving families."

Events

AMCHP March 15 - 18, 2025. Washington, D.C.

Culture of Data - Data Science for Health Justice: Addressing the Social Determinants of Health. April 24 -25, 2025. Submit an abstract.

Training

Build Your Own Compass (BYOC)

Build Your Own Compass (BYOC) is a FREE virtual leadership training program focused on retention and investment in the success and leadership skills of young people of color.

What participants will gain in this program:

Enriched cultural and self-leadership strengths to more effectively navigate public health and primary care training programs and professions.
Leadership skills necessary to negotiate and thrive in public health and primary care training programs and professions.

The program also includes 3-5 hours of one-on-one coaching per participant to support their personal and professional development.

BYOC will be offered as biweekly virtual synchronous sessions via Zoom held on Tuesdays from 6:30-8:00 PM MST starting February 11th, 2025 through May 27th, 2025.

Eligibility criteria:

Must be between the ages of 18-25.
Currently a student or a professional in the fields of primary care and public health.
Identify as African American (or Black), American Indian and Alaska Native, Hispanic (or Latino), or Native Hawaiian or other Pacific Islander.
Reside in Colorado, Montana, South Dakota, Utah, Wyoming, or New Mexico.
Participants must have access to Zoom and a working camera.

Learn more/Register for Build Your Own Compass.

News & Updates

New Child Passenger Safety Laws

Key Child Passenger Safety Law Changes Effective January 1, 2025:

Booster seats: Children must now use a car seat or booster seat until they are 9 years old (previously under 8 years old)
Rear-facing car seats: Children under 2 years old and weighing under 40 pounds must be restrained in a rear-facing car seat in the rear seat if available (previously under 1 year old and under 20 pounds). Children under 2 years old but weighing over 40 pounds may use either a rear-facing or forward-facing car seat
Seat belt or car seat requirement ages: Children under 18 years old must now be properly restrained in a seat belt or child restraint system (previously under 16 years old)
WeeCycle, Children’s Hospital Colorado and SafeKids Colorado Springs have programs through which families can get a free or low-cost car seat.

2025 Human Milk Feeding Supportive Funding Program RFP

The Colorado Breastfeeding Coalition (COBFC) and La Leche League of Mountain Plains (LLL-MP) are pleased to announce the opening of the application period for the 2025 Human Milk Feeding Supportive Funding Program. The program's goal is to improve breastfeeding support and rates, while reducing breastfeeding barriers and disparities in communities throughout Colorado.

GRANT YEAR: February 1, 2025, to January 31, 2026

Grant requests cannot exceed $2,000. Requests for any amount under $2,000 are allowed. To apply, applications MUST be completed through the online application form by January 5, 2025. Emailed or mailed submissions are not accepted.

LPHA Corner

Cross-County Grant Funds Awarded for Increasing Family Affordability through Tax Credits

The MCH teams from Adams County, Arapahoe County, and Jefferson County submitted a proposal for the Increasing Family Affordability through Tax Credits grant from Gary Community Ventures. They were awarded $80k over 18 months with work starting in November 2024. The team’s approach, informed by metro area health alliances, involves working with a handful of community-based organizations to help with outreach by being community ambassadors.

Michele Ebendick: “Our strategy involves a regional approach to promoting tax credits and outreach by collaborating with our Regional Health Connectors (RHCs) and Community Health Workers (CHWs). Thanks to the Adams County VITA team, we are expanding VITA services to include Jefferson and Arapahoe counties. We will focus specifically on reaching out to low-income parents with young children to take advantage of the Family Affordability Tax Credit and file their taxes for free.”

This joint proposal resulted from collaborative discussions at the Economic Mobility learning circles facilitated by state and local MCH teams. Contact Michele Ebendick (mebendick@arapahoegov.com) to learn about the learning circle.

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The Title V Maternal and Child Health Program (MCH) works with statewide partners and local public health agency representatives to improve the health of Coloradans using population-based and infrastructure-building strategies. Our mission is to optimize the health and well-being of mothers and children by employing primary prevention and early intervention public health strategies.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Colorado Maternal and Child Health Block Grant 6 B04MC45202. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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