Care Coordination

Care coordination is a process that involves linking children and their families with health care and community supports and services in an effort to achieve good health.

Coordination services may be available from health care and community-based organizations. These services can address medical, social, developmental, behavioral, financial and educational aspects of health. Coordination may include sharing information with different agencies as well as active connection to health care and community services. Children and families are always at the center of the support.

The Medical Home Initiative collaborates with clinical, public health and community organizations across Wisconsin to improve support systems of coordination that promote family-centered practice. We invite you to collaboratively pursue solutions to challenges in systems of coordination that benefit all children and families.

There are three learning community projects: Shared Plan of Care, Developmental Screening and Food Insecurity and Health. These learning communities are focused on testing ways to improve systems of coordination or early intervention.

AAP policy statement: Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems (2014)

Building Capacity for Health and Food Systems to Partner

The Food Insecurity and Health pilot aims to strengthen communication between food systems and primary care providers to address food insecurity and health of children with chronic health conditions.

Health and Food Systems 2021 Learning Community

2021 Learning Community Calls

For more information on the Health and Food Systems Pilot, please contact Geeta Wadhwani.

Learn More

Clinician Resources

Family Resources

  • Pediatric Care Plan Template
    See an example of a shared plan of care from the American Academy of Pediatrics. Talk to your provider about developing a plan for your child.

Contact Our Staff

Colleen Lane
Project Manager
Medical Home
(608) 442-4177
clane@chw.org

Sign Up for Our Newsletter
Medical Home Minute

Monthly news, events and resources from the Wisconsin Medical Home Initiative.

The Wisconsin Medical Home Initiative is funded by the Wisconsin Department of Health Services’ Title V Children and Youth with Special Health Care Needs Program and the Maternal Child Health Program located in the Division of Public Health.

WAC EMSC IDC Keeping Kids Alive Wisconsin Medical Home Oral Health