Submitted by Nadine Fisher, RD, LD -
Can you give us a little background about the nutrition services you provide, the population served, where they live, etc.
Child Health Specialty Clinics (CHSC) is Iowa’s Title V program for children with special health care needs. CHSC serves Iowa children and youth from birth to 21 years of age who have a chronic condition (physical, developmental, behavioral or emotional) or are at an increased risk for a chronic condition and need special services. Our agency is administered through the Department of Pediatrics, University of Iowa Carver College of Medicine, and our providers are located throughout the state at CHSC regional centers.
I serve as the coordinator of the Nutrition Services Program for CHSC. This position involves both direct care of children and youth with special health care needs and program planning for the nutrition needs of children served by our clinics.
As a CHSC dietitian, I provide nutrition consultation, evaluation, and follow-up nutrition services for children who are in the Early ACCESS (EA) system and require assistance from a registered dietitian (RD). Iowa’s EA nutrition system serves infants and toddlers, birth to 3 years of age. This group includes children who have or are at risk for developmental delays. Once children turn 3 years of age, they transition out of EA services.
I also provide nutrition consultation within each of our 13 regional centers in Iowa. This is done in coordination with our nurse practitioners, who provide health and developmental assessments to Iowa children and youth with special health care needs. All CHSC nutrition services are for children who need more support than a local Women, Infants, and Children (WIC) dietitian can provide. For more information on the work that our agency does in Iowa, please visit our website at http://www.chsciowa.org/.
How do you use technology to provide these services, and how did this come about?
CHSC employs three RDs who are charged with providing nutrition services to almost 200 EA children across the state. To meet these geographical challenges, CHSC uses many different technologies to connect with families. Sometimes we meet with families via webcam from their local area education agency (AEA) or one of our other regional centers, and sometimes we connect via Skype® directly to the family’s home.
We regularly coordinate with a child’s other medical and service providers, interacting with the family on camera at least four times a year. Of course, this method is not without its issues. We battle Internet connection problems, computer malfunctions and technology learning curves daily. Overall though, we feel telehealth is very helpful in allowing us to provide nutrition services to children across Iowa, especially those living in rural areas.
CHSC is the primary provider of EA Nutrition Services. Children from birth through 3 years of age who participate in EA are identified as eligible for nutrition through a screening instrument known as the Parent Nutrition/Feeding Questionnaire (or PEACH.) This tool identifies children who may benefit from expertise in the areas of feeding, growth and nutrition.
Iowa infants and toddlers enrolled in EA Nutrition Services receive monthly phone calls or e-mails and quarterly nutrition visits from a CHSC RD. Our duties may involve communicating with a child’s physician on the child’s growth; helping a family navigate food allergies and restrictions; calculating calorie, vitamin, and mineral needs for a child with a feeding tube; or helping parents address pickiness or battles over food. CHSC receives EA state funds to support three part-time RDs, who provide direct nutrition services to nearly 200 children a year.
What types of technology do you use?
We have a number of ways to connect with families via telehealth. We began by utilizing secure webcams within our offices, which connect to other CHSC and AEA offices throughout the state. We also can log in to Skype and FaceTime to “meet” a family in their home. Parents report they are able to use a wide range of devices to connect with us, including their personal computers, tablets, and phones, along with those of their service providers. Because our nutrition team is located in centers throughout the state, we connect with each other using GoToMeeting software. This allows us to see one another and share our screens, while working together on different projects.
How are you reimbursed for these services?
Nutrition services are part of EA services. Therefore, the Dept of Education provides some of the funding for these services. We receive some reimbursement from Infant and Toddler Medicaid for children who are enrolled in the EA system. CHSC uses Title V dollars to pay for nutritional assessments for children and youth 3 to 21 years of age.
What are the main advantages and barriers to using these services?
One advantage is that a doctor’s referral is not needed. Parents can self-refer, and the family does not have any cost for nutrition services at this time. The amount and type of services provided to families are based on the clinical judgment of the RDs and are not dependent on insurance payers.
Some of the barriers we face include limitations on the capacity of the RD compared to the potential need for nutrition services, limited reimbursement and the reliability of utilizing technology to see patients. Ideally, we would like to visit with every family face to face.
What tips would you give other RDs on how to proceed along this path?
In terms of training, the Association of Maternal Child Health Programs offers programs for RDs in special needs nutrition. These are available both online and in person nationwide, and are meant to prepare RDs in the area of community nutrition. In the state of Iowa, an interdisciplinary leadership training program, Iowa’s Leadership Education in Neurodevelopmental and Related Disabilities Project, is available for graduate students.
As for tips in providing nutrition services using technology, our agency has developed protocols to ensure that parents have information about the security issues that accompany Web-based technology services. These and other privacy issues are important to consider when using telehealth technologies.
CHSC is a Title V and safety net provider, so we strive to ensure that all children and youth with special health care needs receive the services they need in a family-centered, coordinated, community-based, comprehensive system of care. This system includes primary and specialty care providers, schools, community providers, and service agencies. Specifically, our use of telehealth allows children and families in Iowa to access service, no matter where they live.
In our efforts to build sustainable systems, we appreciate the Iowa Academy of Nutrition and Dietetics’ interest in understanding the needs of Iowa’s children and families.
Child Health Specialty Clinics
100 Hawkins Drive
Iowa City, IA 52242
Phone (866) 219-9119