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Medical Home Toolkit


What is the Wisconsin Statewide Medical Home Initiative (WISMHI)?

The purpose of the Wisconsin Statewide Medical Home Initiative (WiSMHI) is to promote the concepts of medical home for primary care clinicians, families, and service providers throughout Wisconsin. Training, technical assistance and resources will be provided to support Medical Home implementation with a focus in the areas of early identification of developmental concerns in the primary care practice and coordination of care and services including those for youth with special health care needs.

Collaboration is a fundamental component of this initiative, with partnerships identified with ABC for Health, Birth to Three, Family Voices, health professional organizations, Health Transition Wisconsin, Genetics Systems Integration Hub, Parent to Parent of WisconsinRegional Centers for Children and Youth with Special Health Care Needs (CYSHCN), Wisconsin Academy of Family Physicians and the Wisconsin Chapter of American Academy Pediatrics.


1. Outreach to Primary Care Clinicians

  • E-Newsletter
  • Promotion of Medical Home and WI Medical Home Toolkit
  • Promotion of early identification and intervention toolkits and programs

2. Early Identification Training and Technical Assistance

  • Recruitment of primary care practices
  • Training and Resources provided
  • Implementation of developmental screening at 9, 18 and 24 or 30 months
  • Implementation of autism specific screening at 18 and 24 months
  • Implementation of plan for notification and follow-up on Newborn Hearing results
  • Ongoing support

3. Collaboration with Professional Organizations

  • WIAAP – WI Chapter of the American Academy of Pediatrics
  • WAFP – WI Academy of Family Physicians
  • Other medical professional organizations

4. Development of a Cadre of Medical Home Champions with expertise in the following categories

  • Principles and application of Medical Home
  • Patient Centered Care
  • Developmental screening
  • Early Hearing Detection
  • Care Coordination
  • Transition to Adult services
  • Family Outreach and Advisory Committees

5. Outreach to Families

  • Trainings on Medical Home
  • Development of Family Advisory Committees and/or newsletters at Primary Care Practices
  • Identification of Medical Home Practices

More Medical Home Links

National resources

Wisconsin resources

Resources from other states

For More Information Contact:


Arianna Keil, MD, Program Administrator

Robin Mathea, Parent and Tribal Consultant

Molly McGregor, Outreach Specialist

Naomi Westerman, Outreach Specialist

Colleen Lane, Communication/Data Specialist


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WISMHI is a program funded by Children's Hospital of Wisconsin and the Wisconsin Department of Health Services, Division of Public Health, Children and Youth with Special Health Care Needs Program through the Maternal and Child Health Title V Services Block Grant.

Site last updated June 16, 2015 @ 11:16 am;