Our Initiatives


Philadelphia Coordinated Health Care (PCHC) is involved in many health care projects on an ongoing basis. These projects grow and change to meet the changing health needs of people with an Intellectual Disability and/or Autism (ID/A), their families and others in the service system in the Southeastern Region of Pennsylvania.

Please contact us if you are interested in any of our heath care projects.


Alzheimer / Dementia Initiative

Philadelphia Coordinated Health Care (PCHC) and the SE PA Regional Dementia Task Group along with clinical support provided by Carl V. Tyler Jr, MD, MS, CA Geriatrics, CMD, Fairview Hospital/Cleveland clinic developed the Southeastern PA Dementia Screening Tool (DST). The tool was adapted from the Dementia Screening Questionnaire for individuals with an Intellectual Disability (ID) (DSQIID), August 2007 by Professor Shoumitro Deb, MBBS, FRCPsych, MD, U.K. The tool was designed to be used by non-clinical staff, families and caregivers. Included on this website is the Dementia Screening ToolDirections for the Dementia Screening Tool, and the Dementia Additional Testing List (possible testing to be considered by the physician).If there are any questions or training is needed regarding the Southeastern PA Dementia Screening Tool, instructions or testing please feel free to contact PCHC.

Philadelphia Cuidado Coordinado de Salud (PCHC) y el Grupo de Tareas Regional de Demencia del Sureste de Pensilvania, junto con apoyo clínico por el señor Carl V. Tyler Jr, MD, MS, CA Geriatría, CMD, Fairview Hospital / Clínica Cleveland desarrollaron este Instrumento de análisis para detectar demencia Sudeste de Pennsylvania (DST). El instrumento fue adaptado del Detección de Demencia Cuestionario para Personas con Discapacidad Intelectual (DSQIID), Agosto de 2007 por el profesor Shoumitro Deb, MBBS, FRCPsych, MD, Reino Unido. Este instrumento fue diseñado para ser utilizado por personas sin experiencia clínica, las familias y los cuidadores. Se incluyen en esta página web el instrumento de detección de demencia, instrucciones para el instrumento de detección de demencia, y lista de pruebas adicional de demencia (posiblemente pruebas para ser considerado por el médico).
Para cualquier pregunta o entrenamiento que seas necesaria en relación con los del Sureste PA instrumento de demencia, instrucciones o de prueba por favor no dude en ponerse en contacto PCHC.

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Behavioral Health Training for Individuals and/or Autism with ID/A

Behavioral health training is currently being piloted for individuals with an Intellectual Disability and/or Autism (ID/A). The series includes: Understanding Challenging Behaviors; Mental Illness; and, Stress. A bookmark and pocket guide on these topics are being developed. A future training on how to manage one’s own behavioral health care will be developed.

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Breast Health Initiative

PCHC staff routinely provide training on breast health and wellness throughout the Southeastern Region of Pennsylvania. An informational Breast Health and Wellness Brochure has been developed to increase information available in the Southeastern Region.

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Cancer Prevalence Survey

In 2008, the Cancer Prevalence Survey Project was initiated to determine the prevalence of cancer among individuals diagnosed with ID/A in the Southeast Pennsylvania in an effort to enhance access to quality health care and support services. PCHC currently collaborates with the American Cancer Society to outreach to people within the ID/A community to increase access to services available to people who have cancer. In addition, with the assistance of the American Cancer Society, PCHC created a Cancer Support Notification Form to help us identify those individuals who may be in need of guidance and support. 

To request assistance please see the American Cancer Society Service Referral Form and PCHC Cancer Support Notification Form.

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Community Hospital Outreach Project

The project was designed to outreach to area hospitals to educate and provide resources for supporting people with an Intellectual Disability and/or Autism (ID/A) during hospitalization. An educational presentation was developed with modules so that the presentation can be customized to meet the needs of each hospital. We can and should improve the hospital experience for those with Intellectual and Developmental Disabilities and/or Autism . For more information, please see our Community Hospital Outreach Project brochure.

PCHC staff are available to make presentations at hospitals throughout the region as requested.

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Community Safety Booklet and Training

A Community Safety Booklet has been developed for people with an Intellectual Disability and/or Autism (ID/A) and their families. The booklet is now being used as part of training to address issues of safety on the street, dealing with bullies and strangers, safety when using money in the community, carrying necessary identification and using 911.

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Diabetes Education

PCHC staff have conducted Diabetes training for nurses in the Southeastern Region of Pennsylvania and addressed Diabetes issues in the quarterly Health Care Alert. PCHC also collaborates with the Diabetes Education Department at Pennsylvania Hospital (staff and graduate students) to educate individuals with an Intellectual Disability and/or Autism (ID/A) and their support teams on how to best control Diabetes. Efforts include the development of educational materials focused on understanding Diabetes, complications, best practices and treatment.

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Dual Diagnosis Services and Supports

PCHC has been awarded a grant by the Pennsylvania Developmental Disabilities Council to lead the statewide coalition of Health Care Quality Units (HCQUs) in identifying and addressing issues faced by individuals with dual diagnosis. Grant efforts will focus on compiling best practices, identifying promising models of support, developing tools to assist in diagnostic work and creating a curriculum for training behavioral health staff.

With the support of a grant from the PA Developmental Disabilities Council, a survey was undertaken to see what the real costs were for some of the most costly individuals. The Dual Diagnosis Cost Survey Report and  Dual Diagnosis Cost Survey Executive Summary explains the survey, methodology and significant findings.

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Dysphagia Group

The Dysphagia Group was formed as an outcome of the Dysphagia Summit held in May 2004. Members of this group include representatives of the Office of Developmental Programs, county government, provider agencies, and HCQUs. This group continues to meet periodically to review initiatives started during the Summit including developing new ideas for education and training. For more information, see our Dysphagia Resource Guide and  Eating, Drinking & Swallowing Checklist.

PCHC “Lista de Verificación de Comer, Beber y Tragar” es un instrumento creado para ayudar a los cuidadores de familiares con impedimentos a identificar potenciales signos y/o síntomas de Disfagia. El principal aporte de la “Lista de Verificación de Comer, Beber y Tragar” es ayudar a identificar indicativos de Disfagia. PCHC ayudo en la elaboración y publicación de esta lista de comprobación para el uso de cualquier persona que apoya a las personas con discapacidad intelectual (I.D.). Este formato deberá ser completado anualmente como requisito de las personas y deberá ser revisado por el doctor familiar. El Directorio de Recursos de Disfagia está disponible en Ingles y ofrece información, instrucciones, recursos, ejemplos y materiales de capacitación para apoyar a las personas que viven con Disfagia.

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Education/Outreach Program

PCHC began an Education/Outreach Program in 2012 to address professional students’ lack of experience working in the field of intellectual and developmental disabilities. PCHC is dedicated to giving students the opportunity to experience firsthand what it is like to work in the ID field by allowing them to: work with health service delivery systems, collaborate on local, regional and state level initiatives, develop training and presentation skills on various health related topics, promote access and create competency within the ID system and local medical community. For more information, please see our PCHC Internship Brochure.

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Emergency Preparedness

PCHC has worked with the Philadelphia Department of Public Health, the Philadelphia Office of Emergency Management, and Temple University’s Institute on Disabilities to develop Personal Preparedness Training on preparing provider agency staff, individuals with an Intellectual Disability and/or Autism (ID/A) and families for disasters and emergencies. Currently, we are partnering with the Philadelphia Department of Public Health to train staff and individuals with special needs how to properly prepare for emergencies. In addition, we aided in the design development and distribution of the Everybody Ready Health and Emergency Planning Handbook for Individuals, Families and Caregivers (versions 1.0 and 2.0).

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End of Life Committee

End of Life issues for people with Intellectual/Developmental Disabilities and/or Autism can sometimes be challenging. A Work Group was formed in the Spring of 2012 to assist people with End of Life Planning. It consisted of representatives from various professions and venues – hospice coordinators, hospital social workers, nurses, residential provider agency representatives, supports coordinators, public health students, advocates, and administrative entity (county) representatives. Each member of the Work Group has had experience with end of life situations. Their experiences have provided education and information; however each experience was unique with interventions specific to that situation. It is clear that people are being educated about end of life through their involvement in end of life situations. What is lacking in our field of ID/A is pre-planning. There is a wealth of information and guidance available on this topic, both nationally and internationally. Members of the Work Group agreed that it would be beneficial to guide people to those resources and provide products from their meetings and work. It is hoped that these resources can make a difference in the life or death of someone with ID/A and those providing supports and services.

Click here to go to our End of Life Planning page.

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Fall Prevention Forum

Raising awareness and prevention of illnesses, incidents and accidents to people with an Intellectual Disability and/or Autism (ID/A) is a vital part of Philadelphia Coordinated Health Care’s education program. PCHC works closely with agencies, counties and the Office of Developmental Program’s regional risk management group on these issues. In 2008 we sponsored an all-day education session regarding falls which included: clinical risk factors, environmental modifications, fall prevention and a forum panel. In 2012, the Falls: Considerations for Risk Management document was created to assist risk managers when reviewing incidents regarding falls. This list is not all inclusive but was created to stimulate further discussion.

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Feeding Tube Resource Packet

PCHC developed a resource packet on information about Feeding Tubes. The packet, which includes information for staff, individuals with an Intellectual Disability and/or Autism (ID/A) and families, was developed after conducting a Feeding Tube Survey in 2006. It is hoped that the resources included in the packet will be useful to individuals facing decisions about the use of a feeding tube and for those who already use a feeding tube. For additional notes, important contacts and questions that you should ask your doctor, please see our  Feeding Tube Brochure.

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Healthy Eating & Exercise Initiative

The Healthy Eating & Exercise Initiative educational session was presented on Friday, April 20,2012. The session was geared towards men and women and their caregivers to broaden their knowledge on physical fitness and healthy living. You can download our training and handouts for the Healthy Eating & Exercise Initiative:

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The Health Information Recording System (HIRS) provides hard copy health records in residential programs for people with an Intellectual Disability and/or Autism (ID/A). The HIRS provides a paper record of important health information.

The Family HIRS and bilingual (Spanish) Family HIRS was developed for use by families providing services for their family member at home. The more complex the medical needs of someone living at home, the greater the need to organize the person's health information. The Family HIRS utilizes many of the same forms used in the HIRS, but has additional forms and information to meet the specific needs of families.

El HIRS familiar y el HIRS familiar bilingüe (español) se desarrolló para ser utilizado por las familias que proveen servicios o cuidan la persona en el hogar. Más complejas sean las necesidades médicas de la persona que vive en casa, mayor será la necesidad de organizar la información de salud de la persona. El HIRS Familiar utiliza muchos de los mismos formularios utilizados en HIRS, pero tiene formularios e información adicionales para satisfacer las necesidades específicas de las familias.

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Health Risk Screening Tool (HRST)

Telemedicine and Infection Control
This document provides a link to HRST's webinar on infection and also provides a telemedicine resource.

HRST Health Passport
This fillable document was designed as a repositoory for important information in the event of receiving medical, dental, or other care.

FAQ and Overview Document
This resource is intended to assist providers with their understanding of the HRST. Included in this one page document are the names and contact information for the PCHC HRST Gatekeeper and Lead Nurse, as well as HRST technical and clinical support contact information.

Tips for Best Practice Sheet
This resource is intended to assist the person who is completing the Health Risk Screening. Included in this one page document are tips for medication entry, diagnosis entry and considerations for comments in each rating area.

Expanded Scoring Descriptors
The document is intended to assist nurses with the clinical review. This document describes the different scores an individual can have in each of the rating sections so the nurse can make sure that the comment/note contains the correct information showing that the score is appropriate.

Rating Preparation Checklist
This document provides details on the type of information to have when completing the HRST for an individual.

Monthly Data Tracker
This document is designed to allow those who support the person most directly to easily track changes related to the 22 rating items of the HRST.

Data Worksheet
This document allows support staff to collect information that can be used to determine a score in the HRST web-based application by a trained HRST rater.

Common Diagnosis and Medication Entry Errors
This document provides information to help avoid some of the more common diagnoses and medication entry errors.

Process Map for using Service and Training Considerations
This document provides a visual representation of best practices when using the HRST Service and Training Considerations.

Best Practices for Updating the HRST
This document provides best practices for when HRST should be updated, including episodic updates and annual updates.

A Rater’s Guide to Responding to a Clinical Review
This document is intended to assist a rater on the process of responding to a clinical review. It explains the clinical review process and lists the steps to take when responding to a clinical review.

The HRST Considerations: Definitions
This document provides information regarding HRST’s Service and Training Considerations. It provides definitions of terms used in these considerations that can be helpful to a team when responding to Service and Training Considerations.

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Men's Health Initiative

The Men's Health Initiative educational session was presented on Friday, August 5, 2011. The session was geared towards male individuals and their caregivers to broaden their knowledge on men’s health and wellness in the following areas: Prostate HealthCommunicationExercise & NutritionHygiene and Relationships. Here are the handouts for the Men's Health Initiative:

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Nursing Forum Workgroup

The Nursing Forum Task Force was formed in 2007 and included not only nurses, but county staff and provider agency representatives. The Task Force was instrumental in developing General Guidelines for Nurses in Community Residential Programs Supporting People with Intellectual/Developmental Disabilities. PCHC continues to support nurses in this specialized field in any way possible, including nursing school experiences and mentorship of nurses who are new to developmental disabilities nursing.

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Prostate Health Initiative

Prostate cancer is a prevalent and deadly form of cancer for men. Other prostate problems include Benign Prostatic Hypertrophy (BPH) and Prostatitis. Any of these conditions can have a significant impact on health and quality of life for the person experiencing them. As part of the Prostate Health Initiative, the prevalence of prostate health problems and health outcomes for people with an Intellectual Disability and/or Autism (ID/A) will be identified. In addition, useful information about prostate conditions and treatment options will be shared throughout the Southeastern Region.

Here are the handouts for the Prostate Health Initiative:

- Prostate Cancer Initiative
- Prostate Health Initiative Brochure
- Prostate Health for Men Brochure
- Benefits of Eating Yogurt 

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Special Needs Unit Collaborative

The Special Needs Unit (SNU) meeting meets quarterly and is comprised of individuals from diverse backgrounds with the same goal in mind – to share information about health insurance relevant to the special needs population. The SNU meeting provides a venue to discuss and exchange pertinent updates and changes about the current health insurance system including Medicare, Medicaid and MCOs. Typically, the Centers for Medicare and Medicaid Services as well as the Special Needs Unit Representatives of all 5 counties in the Southeastern Region of PA are in attendance at the meetings. For more information, please see our Special Needs Unit Brochure.

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Victims of Abuse Initiative

PCHC continues to work collaboratively with various agencies that support individuals who have been victims of abuse. For more information, please see Let's Talk About Sexual Abuse and  Sexual Abuse Brochure.

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Women's Health Initiative

The Women's Health Initiative educational session was presented on Friday, December 2, 2011. The session was geared towards female individuals and their caregivers to broaden their knowledge on women’s health and wellness in the following areas: Physical HealthHealth Risk Factors of the FemaleScreenings & Health MaintenanceExercise & NutritionHygiene and Relationships

Here are the handouts from this educational session:

- Women's Health Initiative Presentation
- Women's Health Brochure
- Screening Tests for Women 

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Contact Us to Learn More

Disclaimer: Information and education provided by PCHC is intended as general information only and is not all inclusive or intended to replace physical, dental or behavioral health advice. If you believe that you, or someone you support, have physical, dental or behavioral health issues, please seek professional advice.