Ideas for Communication/Collaboration Between Medical Homes and Part C

Channels for concise bidirectional, “minimum effort” communication needs to be in place and familiar to both the medical home and the regional Part C Program. Tools such as the AAP Referral Form for Early Intervention should be deemed acceptable (with modifications as needed) and readily available (
Professionals at both the medical home and the Part C program need continual update in medical records as the child is seen and changes are noted.
To best sustain the process of information sharing, the individuals at each program should know who one another are and how to contact directly when needed.
Information from the medical home should be available to the Part C assessment team before its evaluation and information, and recommendations on intervention should be forwarded to the medical home as the individualized family service plan is developed and modified.
When the child is seen by subspecialists, their input to both the medical home and the Part C program is valuable.
Timely and ongoing flow of information between the medical home and the Part C program reassures the family of coordinated, family-centered care; it relieves the family of the burden of having to interpret and transport the information.
  • Modified from Stille CJ. Communication, comanagement, and collaborative care for children and youth with special healthcare needs. Pediatr Ann. 2009;38(9):498–504.110