BIG SIX SCREENING QUESTIONS

1. Do you have enough food to eat in the house?
2. Are your housing conditions safe (internal/external)?
3. Do you have enough money to pay for basic necessities?
4. Do you have any problems getting your health insurance to pay for accessing medical services and medications?
5. Is your child receiving an appropriate education.
6. Are you or your child a victim of domestic violence?

How to Refer a Patient Who Needs Services

Identify the problem, using Resource Card categories. For assistance, call appropriate clinical social worker or
CCMC Family Support 545-9700
Charter Oak Health Center 550-7500
Community Health Services 249-9625
St Francis Pediatrics Social Worker 714-4514

GENERAL TIPS TO HELP PATIENTS

1. Help de-stigmatize use of government benefits such as food stamps and other resources by encouraging patients to access such services.
2. Document patients need for services in the chart.
3. Encourage families to reapply or appeal if they were denied services. Appeals are time-sensitive: appeal first, then search for an attorney.
4. Help families think about maximizing income by using alternative sources of income support (food stamps, fuel subsidies, housing vouchers, etc.)
5. Make a telephone call or write a letter to the landlord or caseworker. Use the agency's chain of command to ask questions for the patient.

TIPS FOR IMMIGRANT FAMILIES

1. Food stamps eligibility if they're citizens or eligible non-citizens and meet the income/resource guidelines. This includes undocumented family members.
2. Receipt of food stamps and health insurance will not affect a family's immigration status.
3. All families <185%FPL (Federal Poverty Level) are eligible for WIC regardless of immigration status.
4. Legal immigration Children with mental retardation or victims of domestic violence are elibible for HUSKY immediately, without the 6 month waiting period.

2008 Annual Federal Poverty Level (FPL) Guidelines

Family Unit Size 100% FPL 150% FPL 185% FPL 235% FPL 300% FPL             1 $10,400 $15,600 $19,240 $24,400 $31,200 2 14,000 21,000 25,900 32,900 42,000 3 17,600 26,400 32,560 41,360 52,800 4 22,200 33,300 41,070 52,170 66,600 5 24,800 37,200 45,880 58,280 74,400 6 28,400 42,600 52,540 66,740 85,200 7 32,000 48,000 59,200 75,200 96,000 8 35,600 53,400 65,860 83,660 106,800 * 3,600 5,400 6,600 8,460 10,800

*for family units over 8, add amount shown

SAMPLE LETTER REQUESTING EDUCATIONAL SERVICES

A letter requesting services should contain the following elements:

1. Specific nature of the problem.
2. The rule, law or requirement that applies to the problem.
3. How (1) and (2) relate to the patient's condition.
4. Request for action.

Dear Principal Overwhelmed:
I am writing to request that you address the education needs of
Patricia Patient, daughter of Mother Patient, who is a fourth grade
student at the Can't Educate Our Students Elementary School.

According to my review of Patricia's records, her educational
performance has fallen far below the expected level for a child in
the fourth grade, and as a result, we believe that Patricia is a student
who requires intensive educational and academic supports. We
kindly request that the school institute a Planning and Placement
(PPT) meeting to begin the process of testing and evaluating Patricia
for eligibility for special education services. In addition (if applicable),
we request that the school conduct a functional behavioral assessment (FBA)
and institute a behavioral intervention plan (BIP) to formally address the
recent behavioral and conduct issues that have manifested in recent weeks.

We look forward to working with you and we are happy to provide the
school with any medical records necessary to support the goal of providing
appropriate educational services to Patricia at this time.

Please contact me at # if you have any questions. Thank you in advance for
your time and consideration.

Sincerely,
Pat Pediatrician

RESOURCES
Remember: INFOLINE 211

Legal Services

AIDS Legal Network for CT ................. 541-5000 / 888-380-3646
Center for Children's Advocacy.................................... 570-5327
CT Fair Housing Center ............................................... 247-4400
CT Legal Rights Project ................................................ 262-5030
Greater Hartford Legal Aid ............................................ 541-5000
Medical-Legal Partnership Project ............... 714-1412 / 545-8581
Statewide Legal Services ..................... 334-0380 / 800-453-3320
UCONN Law School Asylum & Human Rights Clinic .... 570-5165

Advocacy Services

CCMC Government Relations Department .................... 545-8577
CCMC Advocacy Coordinator ...................................... 545-8561
Office of the Child Advocate .................. 566-2106 / 800-994-0939
Office of the Victim Advocate ................. 550-6632 / 888-771-3126

Asthma and Lead

CCMC Healthy Homes - Primary Care ......................... 545-9300
CCMC Easy Breathing ................................................. 545-9442
Saint Francis Regional Lead/Asthma Treatment ............ 714-4792
Hartford Environmental Health (resources) ................... 543-8815

Child Abuse and Trauma

Aetna Foundation Children's Center (Saint Francis) ...... 714-5052
CCMC SCAN Program ................................................ 545-9995
CCMC Child Protection Team ....................................... 545-9700
Medical-Legal Partnership Project ............... 714-1412 / 545-8581
DCF Child Abuse Hotline ....................................... 800-842-2288
Emergency Mobil Crisis ................ 866-261-0893 / 877-884-3571
Interval House (DV Services/Shelter) .................... 888-774-2900
Local............................................................................. 860-527-0550
Prevent Child Abuse of CT ....................................800-244-5973 (800-Children)
Local..............................................................................860-793-3375
Village for Families and Children (counseling) ............... 236-4511

Child Care (Resource and Referral)Education

Care-4-Kids ............................................... 888-214-5437 (KIDS)
CT Dept of Social Services Child Care Team ......... 800-811-6141
Child Care Info Line (United Way) ......................... 800-505-1000

Child Support

CT DSS Bureau of Child Supp. Enf. .... 723-1000 / 800-647-8872
(information and problem resolution) ........ 800-228-5437 (KIDS)
CT Women's Education and Legal Fund ....................... 247-6090
State of CT Attorney General ........................................ 808-5318
Superior Court- Family Clerk.........................................706-5100

_{Disability / Developmental Delay}

African-Caribbean American Parents of Children with Disabilities
(AFCAMP) ................................................................... 297-4307
^{Center for Children's Advocacy}
CCMC: Child Development Center ........................... 545-8680
CCMC Family Center / Family Voices of CT ........... 545-9023
CCMC Pro-Kids (Infants exposed to drugs) ........... 545-9330
CCMCSpecial Kids Support Center .......................... 545-9230
SFH Jaycees Center for Develop. & Behav. Health ..... 714-4931
Hartford Health Department (Child Development) .......... 543-8816
Help Me Grow - Child Development Hotline ........... 800-505-7000