Nutrition for Children with Special Health Care Needs

Module 3: State and Local

Nutrition Resources

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Pacific West MCH
Distance-Learning Curricula
 Nutrition for Children with Special Health Care
Needs - 6 self-study modules
 Nutrition for Children with Special Health Care
Needs - 4 group study modules
(this presentation is one of them)
 Nutrition and Oral Health Curriculum
all available (free) on-line at
www.pacificwestmch.org

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 Group Study Curriculum
Module 1: Providing Family-Centered Care
Module 2: Participating in the
Interdisciplinary Approach to Feeding
Interventions
Module 3: State and Local Nutrition
Resources
Module 4: Improving Nutrition Interventions

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 Module 3: State and Local
Nutrition Resources
Policies and service systems
- for low-income
- for children with special needs
Case studies
Local resources and service providers

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 Learning Objectives
After completing the module, participants
will have the knowledge and skills to:
 Identify key agencies and health

professionals involved in the support

and provision of nutrition services
 Access funding sources for nutrition

services for children with special health

care needs

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 Video - Jesus
 What types of nutrition services does Jesus
need now?
- What service programs could provide the services?
 What types of nutrition services did Jesus
need as an infant (early failure-to-thrive)?
- What service programs could provide the services?

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 Programs for Low-Income
 Medicaid
 EPSDT
 SCHIP
 WIC
 Head Start
 Food Assistance

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 Medicaid
 Title XIX of the Social Security Act
 Medical care for eligible families with low incomes
 Funded by federal and state governments
 Eligibility, administration, and services vary between
states...in many states, most children with special
needs are eligible
 Nutrition services covered vary from state-to-state
? nutrition services

? supplements or enteral supplies

? services by feeding team members

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 Early and Periodic Screening, Diagnosis
and Treatment Program (EPSDT)

 Component of the Medicaid program for

persons under 21 years of age
 Medicaid eligibility = EPSDT eligibility
 Guidelines include screening for nutritional
problems and services to treat conditions
identified by the screening

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 State Children’s Health
Insurance Program (SCHIP)
 Helps states to expand Medicaid
eligibility
 Eligibility, administration, and services
vary between states that participate in
SCHIP

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 Supplemental Nutrition Program for
Women, Infants, and Children (WIC)
 Funded by the Food and Nutrition
Service, USDA
 Nutrition education and counseling,
health screening, referrals for other
services, monthly food
packages/vouchers, checks for formula

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 WIC – continued
 Eligibility varies between states and counties:
 Pregnant women
 Women with breastfeeding infant up to age 1 year
 Children up to age 5 years
 At nutritional risk
 Incomes < 185% of the federal poverty level
 Children who are eligible for Medicaid
 Some agencies:
 Provide f/u services to CSHCN and bill Medicaid
 Provide specialized nutritional formulas
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 Head Start / Early Head Start
 Overall goal: promoting school readiness
for children from low-income families
 Provides social health services (including
medical, dental and nutrition screening)
 Federal law reserves 10% of enrollment
slots for children with disabilities

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 Food Assistance Programs
 Commodity Supplemental Food
Program (USDA)
 Food Stamp Program (USDA)
 The Emergency Food Assistance
Program (USDA)
 Child and Adult Care Food Program
(CACFP)

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 Programs for special needs
 Title V - Children with Special
Needs
 State Disability Programs
 Early Intervention
 Education (Special Education IEP
and Medical Need 504 plan)
 SSI

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 Title V/CSHCN Program
 Administered to US states and jurisdictions
by MCHB/HRSA
 Federal-State partnerships to develop
systems of service for MCH, including
CSHCN
 Eligibility and services vary between states:
 Provide direct service or pay for services
 Assure services—safety net when services are not
provided by another source

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 State Disability Program
 Administration on developmental disabilities
(federal)
 States usually provide additional funds, state
disability council
 Administration may be housed in separate office at
state level, or combined with MCH programs
 Usually covers birth-death special needs, programs
vary widely in services provided

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 Early Intervention
 Funding mandated by IDEA, Part C (federal)
 Provides assessment and intervention services
(including nutrition) for infants and children 0-3
years old with developmental delay or other
special health care needs, or at risk for delays
 Services guided by interagency coordinating
council (ICC) - state and local
 May be administered through school system or
disability services system
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 Educational System
 Federal regulations require that the public school
system accommodate children with special
health care needs…including nutrition-related
issues that support learning/school attendance:
 Individuals with Disabilities in Education Act (IDEA)
(1990)
 Section 504 of the Rehabilitation Act of 1973
 Americans with Disabilities Act (ADA) of 1990
 Nutrition goals can be incorporated into a child’s
educational plan

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 Educational System
 IFSP (Individualized Family Service Plan)
 For 0-3 year olds in Early Intervention programs
 IEP (Individualized Education Plan)
 For 3-21 year olds who receive Special Education
 Interdisciplinary agreements between
family, teachers, and therapists
 Revised at least once per year
 Specify how each goal to be accomplished

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 Educational System: Michael’s IEP
 Given a cup filled ¼ to ½ full,
Michael will take in the proper
amount of liquid and return the
cup without spilling in 4 out of 5
opportunities by September 15.
 Given a developmentally-
appropriate meal/snack, Michael
will remain seated during the
meal/snack time (or until
excused) in 4 out of 5
opportunities by September 15.

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 Educational System: 504 Plan
504 Accommodation plan
 For a child who does not receive special

education services, but who needs special,

health-related services during the school day
Example of nutrition services in a 504 Plan:
 11-year old with type 1 diabetes

 504 Plan: Cheryl will be permitted to eat a mid-

morning and afternoon snack (brought from

home) during recess

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 Supplemental Security Income
(SSI)
 Administered by the social security
administration
 Monthly payment for some CSHCN
(dependent upon family income)
 Often “gateway” to other services…
eligibility for SSI = eligibility for WIC,
Medicaid, and/or title V program

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 Case Study 1: Sarah
 22-month old, new to the community
 Born at 32 weeks, had BPD
 Eats soft table foods, some junior meats
 Lost 1 pound over past 6 months, length
continues “in channel”
 From low-income family with few resources
 Enrolled in early intervention program; Staff is
concerned re: lack of weight gain, but no RD with
program

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 Case Study 1: Sarah
What services might be available to
Sarah?
 Medical care?

 Food/formula?

 Nutrition services?

 Care coordination?

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 Case Study 1: Sarah
What services might be available to Sarah?
 Community referrals:
 Medicaid
 Title V / Children with Special Health Care Needs
 WIC (services, specialized food package)
 Need for formula? …WIC, Other funding source?
Rx from PCP, EI coordinate appointments?
 Coordinate with WIC RD to develop
goals/outcomes and objectives for IFSP

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 Case Study 2: Alex
 8-year old with spina bifida and learning
disabilities; in special education program
 Short stature, gained 10 pounds in last 6 mo
 Has outgrown wheelchair
 Participates in school lunch and breakfast
 Followed by RD in Title V Program/ Spina
Bifida Clinic
 Has Medicaid benefits

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 Case Study 2: Alex
What services might be available for
Alex?
 Medical care?

 Food/formula?

 Nutrition services?

 Care coordination?

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 Case Study 2: Alex
What services might be available for Alex?
 School nutrition services to provide appropriate

meals…e.g., lower energy to maintain weight and

support continued linear growth
 IEP could include physical activity goal to include

adaptive PE program, increasing exercise

 Referral to PT for evaluation for new wheelchair

 Coordination between school nutrition manager,

teachers, therapists, RD at Spina bifida clinic

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 Further thought…
 What is one resource discussed today that
you were not previously aware of?
 How have you collaborated with other
agencies to provide nutrition services?
 Think of one instance where access to one
of the services discussed today would have
improved a nutrition intervention.

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 Conclusion
 National resources
(handout- websites)
 Local resources
 Post-test and evaluation

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