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Being discharged from the hospital is a vulnerable time for families and caregivers of children with special health care needs (CSHCN). Appropriate resources and support are essential for care at home and can prevent complications or readmission. The California-based Nurse-led Discharge Learning (CANDLE) Collaborative brings together interdisciplinary clinicians to improve discharge care delivery for CSHCN. Learn about two new discharge practices: closed-loop medication reconciliation and tailored medication teaching, and multidisciplinary discharge rounds with early discharge notification. Speakers share how these innovative practices can be integrated into existing clinical workflows. 

Webinar Recording


Sarah Wilkerson, MSN, RN, CPNP

Pediatric Nurse Practitioner, Monroe Carrell Jr. Children’s Hospital at Vanderbilt University

Sarah works in the Program for Children with Medically Complex Needs. She has been a nurse for the last 18 years. Sarah received her MS in nursing from Vanderbilt University.

Melissa Gustafson, MSN, RN, CPNP

Pediatric Nurse Practitioner, Lucile Packard Children’s Hospital at Stanford

Melissa cares for children with medical complexity. She began her career at Children’s Hospital of Philadelphia in the renal, adolescent, and pediatric intensive care units. Melissa holds a MS in nursing from Villanova University.

Angie Marin, MSN, RN-C

Nursing Manager, Pediatrics, UC Davis Children’s Hospital

Angie has nearly 40 years of pediatric nursing experience. She is chapter president of the Greater Sacramento Society of Pediatric Nurses and serves on the chapter development and support committee as the west coast regional lead. Angie received her MS in nursing from California State University, Sacramento.

Kevin Blaine, MAEd

Director, CANDLE Collaborative and Senior Research Associate, Institute for Nursing and Interprofessional Research at Children’s Hospital Los Angeles

Kevin manages all operational activities and is responsible for maintaining day-to-day project progress for the CANDLE Collaborative. He has extensive experience facilitating meaningful intra- and inter-institutional partnerships and developing innovative strategies to improve processes and procedures, with particular expertise in intervention development, program design and evaluation, and learning theory. Kevin’s research interests including care coordination and transitions of care for children with medical complexity, post-discharge healthcare utilization among hospitalized children, and hospital-based interprofessional team functioning.

Jennifer Baird, PhD, MPH, MSW, RN, CPN

Principal Investigator, CANDLE Collaborative and Director, Institute for Nursing and Interprofessional Research at Children’s Hospital Los Angeles

Jenni’s research focuses on the development of strategies to enhance the family-centeredness of the care environment, to promote the safe transfer of patients from the hospital to home, and to support children with medical complexity in the home environment. She has worked as a registered nurse in both acute and critical care pediatric settings and has specialized training in social work, public health, and health services research methodologies. Jenni also serves on the Board of Directors for the Society of Pediatric Nurses.

Related Grants

This policy brief by the National Alliance to Advance Adolescent Health looks at what happens when low-income youth and young adults with chronic conditions and disabilities age out of the Title V Program for Children and Youth with Special Health Care Needs and provides policy recommendations.

This fact sheet from the National Health Law Program is designed to inform families about the steps they can take to appeal decisions about their child’s CCS benefits and highlight key resources available to support the process.