Special Needs Program

Special care for your child with complex medical needs

The Special Needs Program helps coordinate medical and non-medical services for children with medical complexity due to multiple chronic conditions. Our team works with children and families, doctors, community resources and insurers to make sure your child is getting the best care in and out of hospital.

A Special Needs Program nurse care coordinator, care coordination assistant and physician or nurse practitioner will work with your child and family, primary care physician, specialists and community providers to ensure seamless care. The Special Needs Program does not provide primary care.

Families or any health care provider can refer a child to the Special Needs Program

You or any health care provider can refer your child to the Special Needs Program. All referrals are reviewed and children who meet criteria are enrolled. If your child does not meet enrollment criteria for the Special Needs Program, we will connect you with other resources to help with your child’s care. To refer a child, call (414) 266-6943.

Criteria for enrollment in the Special Needs Program include:

  • Three or more chronic conditions involving 3 organ systems and requiring 3 or more medical specialists
  • One or more unplanned hospital stay lasting longer than five days OR at least 10 specialty clinic visits during the past year
  • Unmet care coordination needs
Many of our patients also may have:
  • An unknown diagnosis
  • Long travel to Children's Hospital of Wisconsin
  • A life change that affects their health
  • Other barriers to fully coordinated care

Managing all of your child’s special needs from a single point of care

Children’s Hospital of Wisconsin Special Needs Program:

  • Helps with communication between multiple providers and services, such as doctors, hospital staff, specialists, equipment companies, pharmacies, social workers, community agencies and schools
  • Assists with the medical management of your child’s problems
  • Help you learn how to best care for your child and coordinate care
  • Supports families’ and patients’ best interests in and out of hospital
  • Works with families to develop comprehensive, individualized care plans