Learning Communities

A collaborative approach that encourages participants to share their work, discuss ways to improve, and learn from one another. The Medical Home Initiative provides support and technical assistance to two quality improvement projects, or learning communities. Within the communities there are structured goals that guide the work. Individual teams have the ability to take unique approaches within the community to best meet their needs and achieve desired outcomes.

2023 Advancing Family-Centered Care Coordination for CYSHCN

The Medical Home Initiative is supporting implementation of quality improvement processes designed to support work with Wisconsin health care teams and Tribal Health Centers to advance medical home care provision for children and youth with special health care needs. There are multiple tools available to help with care coordination such as care maps and care notebooks (see our Family Engagement page). Another way of doing so is by the use of a Shared Plan of Care.

A Shared Plan of Care is a living document created by parents and health care providers. It includes information that ensures issues affecting a child’s health are identified and accessible across systems, and that activities and accountability for addressing those activities are documented. Key components of a Shared Plan of Care include:

  • Medical summary
  • Family strengths and preferences
  • Negotiated plan of action (including clinical and family goals, actions to address goals, responsible partners, and timelines)
  • Other necessary attachments (such as emergency plans, chronic condition protocols, and relevant legal documents such as IEPs or 504 plans)

Shared Plan of Care Samples:

2023 Learning Community Calls

  • January/February: Individual Team calls
  • April 26 Learning Call: Agenda
  • June/July/August: Individual Team calls
  • October 18 Learning Call: Agenda coming soon
2023 Project Team Map

2023 Project Team Map

Wisconsin Clinics and Tribal Health Centers participating in the project.

Shared Plan of Care Project Summary 2016-2017

Shared Plan of Care Project Summary 2016-2017

A brief summary of the work in Wisconsin from 2016 and 2017.

    For more information about Advancing Family-Centered Care Coordination, please contact Colleen Lane.

    2022 Project Team Map

    2022 Learning Community Calls

    • February/March: Individual Team calls
    • April 27 Learning Call: Agenda
    • July 13 Learning Call: Agenda | Slides
    • September/October: Individual Team calls
    • December 7 Learning Call: Agenda

    2021 Project Team Map
    2021 Driver Diagram

    2021 Learning Community Calls

      • February 23 Learning Call: Agenda
      • April/May: Individual team calls
      • June 22 Learning Call: Agenda | Slides
      • September: Individual team calls

    2020 Project Team Map
    2020 Driver Diagram

    2020 Learning Community Calls

    2023 Developmental Screening Project

    Developmental Screening National Performance Measure

    The Medical Home Initiative is supporting local public health departments and tribal agencies focusing on the developmental screening national performance measure. Agencies have the option of selecting one or more of the following focus areas: medical providers, child care providers or community groups.

    2023 Learning Community Calls
    All calls are from 9 a.m. – 10 a.m.

    • May 17: Agenda coming soon
    • August 23: Agenda coming soon
    • November 15: Agenda coming soon

    For more information about the Developmental Screening Project, please contact Morgan Conti.

    2022 MCH Objective Map

    2022 Learning Community Calls

    2021 Driver Diagram
    2021 MCH Objective Map

    2021 Learning Community Calls

    2020 MCH Objective Map
    2020 Driver Diagram

    2020 Learning Community Calls

    2019 MCH Objective Map
    2019 Driver Diagram

    2019 Learning Community Calls

    2018 MCH Objective Map
    2018 Driver Diagram

    2018 Learning Community Calls

    Contact Our Staff

    Morgan Conti
    Program Manager
    Medical Home
    (414) 337-4566

    Colleen Lane
    Program Manager
    Medical Home
    (608) 442-4177

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    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.

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