Special Needs Program
The Special Needs Program offers comprehensive care coordination for children with multiple medical needs who do not have existing care coordination services. Our goal is to ensure families have the best possible care in and out of the hospital.
We partner with patients, families, primary care and other health care providers to improve care coordination. All patients enrolled in the Special Needs Program have a nurse case manager and some also have a physician care coordinator. All program participants are encouraged to have their own pediatrician or family doctor.
Families or any caregiver may refer a child to the Special Needs Program.
Program eligibility
Individuals, age 21 and younger, with multiple medical needs may be referred to the program.
All Special Needs Program patients have:
- Ongoing chronic medical problems.
- Multiple specialists (average is eight per patient).
- Many clinic appointments and/or long hospitalizations.
Some patients may have:
- An unknown diagnosis.
- A long commute to the hospital.
- A life change that affects their health.
- Other barriers to care.
The Special Needs Program can:
- Assist with communication between providers, such as doctors, hospital staff, specialists, equipment companies, pharmacies, social workers, community agencies and schools.
- Provide patients/families with the necessary information to help make decisions.
- Support families and each patient's best interests.
- Coordinate care conferences and other health care appointments.
- Work with a family to develop a child's care plan.
Our Specialists
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