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Title of program/project:Starlight Pediatrics
Affiliation:Monroe County Department of Health
Web site:
Model:Medical Home
Location served:Locally-based - Rochester - NY - County health department but separate building, co-located with foster care visitation center
Funding:County funding; Health insurance - We bill Medicaid and MMC for all clinical services.  We do operate at a substantial deficit because all of our patients are in foster care/foster care alumni and covered by MA or MMC.  The county funds the deficit with local dollars.  We occasionally have grant funding to support special projects, and we do get some donations (for example, our building was built with a combination of grant, donation and local dollars.).  health care management is totally unfunded so that is the bulk of the local dollars commitment.
Services provided:Entry to care health assesment
Comprehensive health assessment
Standardized screening (developmental, mental health)
In-clinic mental health evaluation
Subspecialty referrals
Ongoing primary care/medical home
Program/Project description:Starlight Pediatrics has been the pediatric medical home for children and teens in Rochester NY since December of 1989 and provides all primary health care services, health care management services and health education services for this population, their caregivers and caseworkers.
Patient tracking:Commercial electronic medical record - e Clinical works which we actually like
Special focus:
Strengths:Specialty practice in foster care so staff is very experienced and knowledgeable about childhood trauma, its impact on children and families and the care needs of children and youth in foster care, and the needs of their caregivers.  We provide all the health care management, and are involved in educating caregivers, including training of new foster parents and caseworkers.  We have a close working relationship with child welfare, and provide them a health summary after each visit (currently print or fax) and communicate frequently via telephone, email and fax (and sometimes in person).  We have some on-site MH services, mostly diagnostic evaluations although some youth come here for services.  Pediatric staff provide universal developmental (children < 66 months) and mental health screening (12 months to 21 years).  We manage all referrals (health, MH, Early Intervention etc) in coordination with child welfare. Develop-beh pediatrics is on-site once every other month to evaluate some children.  We used to have a dentist doing screening, but that lost its funding.  We monitor and track all meds, manage home health nursing directly. 
Challenges:Funding is the key issue we face as each year at budget time we have to justify our existence.  MA/MMC only reimburses about 30% of our costs as costs have risen and payment has remained flat for about 22 years.  We lost a chunk of targeted case management dollars several years ago because of concerns by county finance that the county could not bill for 2 case managers (child welfare and health), and we also lost state deficit funding because the state decided that we were not part of the public health mission of our county DOH.  Our deficit grew from 50% of our budget to 70% with the loss of these dollars.  Other than that, we have many challenges related to the care of a special needs population (their complexity, the complexity of their families and of foster care), but we have solved many issues (consent, confidentiality, communication etc.) over time. 
Contact:Moira Szilagyi, MD, PhD
Email:mszilagyi@monroecounty.gov
Phone number:585-753-5603