Adolescent Health promotion and services are present in many programs in NCDHHS, especially recognized in the School, Adolescent, and Child Health Unit. The DCFW/WCHS and Title V Office support adolescent health around the state by coordinating health initiatives, expanding the use of evidence-based programs, practices, and policies, and providing adolescent health resources for youth, parents, and providers through multiple programs across NCDHHS. Adolescents are served across the DCFW/WCHS in all programs and represent almost half of the school age population. NC is fortunate that providing comprehensive school health services remains a priority of both DPI and NCDHHS. The DCFW/WCHS houses the State, Regional and Charter School Health Nurse Consultants who are responsible for planning, training, and consulting for school nurse positions located in LHDs, schools, and hospitals throughout the state, and also houses support for school health centers. Although the school health nurse consultants are paid for by a variety of funding types, six of the school health nurse consultants are supported through Title V funding.

 

Priority Need 6 – Improve Access to Mental/Behavioral Health Services

 

The Title V Office uses NPM#10 (percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year) to monitor improvement about Priority Need 6 (Improve access to mental/behavioral health services). Behavioral health screening (as part of developmental surveillance, mental health screening, and substance use screening) is an important part of a preventive medical visit. Training has been provided to LHDs and school health centers about the importance of using behavioral health screening tools (i.e., HEEADSSS, PHQ-2/PHQ-9, CRAFFT). Technical assistance has been provided by State Child Health Nurse Consultant (SCHNC) and Regional Child Health Nurse Consultants (RCHNCs) to consult with advanced practice providers or physicians and/or follow agency policies to connect adolescents with community-based services when concerns are identified. In addition, the DCFW/WCHS partnered with DPI to increase support to adolescents through the Support Teams in each school, which includes a behavioral health specialist.

 

NPM#10 – Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year

 

Data from the 2020-21 NSCH indicate that parents report that 72.4% of adolescents in NC received a preventive medical visit in the past year which is lower than results from the 2016-17 survey (81%). NC did have a higher percentage than the nation in both the 2016-17 (78.7%) and 2020-21 (69.6%) surveys, although the confidence intervals overlap, so there is probably not a significant difference. In NC in 2020-21, YSHCN were more likely to have received a visit than those youth without a special health care need (YSCHN – 83.6% v. non-YSHCN – 67.5%).

 

In one effort to help increase this percentage, the Title V Office chose ESM 10.1 (Number of adolescents age 12 to 17 receiving a preventive medical visit in the past year at an LHD child health clinic or school health center) for this NPM. The number of adolescents receiving a preventive medical visit (CPT codes 99384 and 99394) in LHDs in FY22 was 7,122 which is a 17.6% increase from the number receiving visits in FY21 (6,054), but a 43.1% decrease from pre-COVID-19 FY19 (12,521). The decrease in the number of adolescents that received a preventative visit is correlated with the impacts of the COVID-19 pandemic. In addition, data for school year 21-22 indicate that 9,047 preventive medical visits occurred at the NC School Health Centers (SHCs). For FY and SY22, there was a combined total of 16,169 adolescents receiving preventative medical visits at the LHDs and SHCs.

 

An additional ESM chosen for this NPM is ESM 10.2 (Percent of adolescents who had a behavioral health screening at time of preventive care visit at a LHD). For FY22, 71.2% of adolescents age 12 to 17 received a behavioral health screen at the time of their preventative care visits at a LHD. Baseline data for this measure were collected in FY21 with 71.6% of adolescents who had behavioral health screenings (CPT 96127) during a preventive health visit at their LHDs during that time. In SY22, SHCs also completed 4,702 total depression screenings. The DCFW/WCHS will continue to promote integrating mental health screenings during well-child visits through regularly scheduled child health webinars.

 

Supporting the Development of Teen Friendly Clinics

 

SCHNC and RCHNCs continued to encourage LHDs to choose to allocate Title V Child Health Agreement Addenda funds to support the development of teen friendly clinics. A sample Attachment C template continued to be included on the LHD AA Resource page to assist LHDs in choosing evidence-based strategies to improve adolescent preventative care. While no LHDs chose to use funding to support the development of a teen friendly clinic in FY22, the SCHNC, RCHNCs and the DCFW SMD continued to provide TA to LHDs about the strategies from the Attachment C template with LHDs as part of providing technical assistance to LHDs. The following are examples of strategies that can be used to provide more adolescent-focused preventive care:

• Implement improvements in youth accessibility through hosting adolescent-friendly hours (later afternoon or evening hours), walk-in appointments, longer appointments, web-accessible information, and/or office space/check in space for adolescents.
• Provide information and counseling through telephone, text messaging, or email hotline(s) to increase access and engagement.
• Engage providers and staff in professional development opportunities to further support their expertise and skillset in serving the adolescent population. Suggested trainings include:

• Positive Youth Development
• Motivational interviewing
• Minors consent and confidentiality
• Screening, Brief Intervention, and Referral to Treatment (SBIRT)
•  Adolescent Health Initiative Spark Trainings
• Implicit Bias
• Social Determinants of Health
• LGBTQ-friendly care
• Trauma-informed screening and assessment
• Wellness Recovery Action Plan (WRAP)
• Youth Mental Health First Aid

• Evaluate policies and procedures for adolescent confidentiality; review may include suggestions/modifications to the Electronic Medical Record that improve adolescent confidentiality, procedures for informing adolescents and guardians of confidentiality practices and more.
• Engage in an adolescent-friendly clinic review process and develop an improvement plan based on the findings:
  • Youth Friendly Services Assessment Tool and Guide (free)
  • Youth-Led Assessment Tool (Free)
  • Adolescent Champion Model (Fee-based)

• Complete an organizational assessment tool to evaluate behavioral health integration readiness.
• Implement behavioral health service integration through universal or targeted behavioral health screening practices.
• Develop and engage with a new or existing youth advisory group with an emphasis on raising awareness of the value of preventive care. Promote evidence-based clinical preventive services for adolescents among providers in the community.
• Develop a community-based strategy/strategy to promote adolescent preventive care visits via web/electronic resources, social media, meetings and events, and/or traditional media.
  • Well-Visit Marketing Tools and Templates
  • Marketing the Adolescent and Young Adult Visit

 

Technical Assistance and Training on the Components of the Annual Well Adolescent Visit and Quality Adolescent Health Services

 

The DCFW/WCHS continued to help support the provision of preventive health services to children from birth to 21 years of age primarily through LHD clinics which follow the most current Bright Futures national recommendations for preventive pediatric health care. The Bright Futures recommendations have been incorporated into the most current version of the Health Check Program Guide (HCPG) which is used by the Medicaid program as the standard for preventive health care for children up to 21 years of age. During FY22, the DCFW SMD, SCHNC, and RCHNCs provided ongoing technical assistance to LHDs about the required and recommended components of adolescent preventive health care and the importance of following AAP best practice recommendations to provide a complete well visit for those adolescents who come into LHDs asking for pre-participation physical evaluations (sports physicals) which is limited in scope. Guidance about new recommendations from the NC High School Athletic Association was shared with LHDs and NC Pediatric Society providers to allow for safe athletic participation and clearance during COVID-19. In addition, the DCFW SMD and the SCHNC continued to promote the guidance for coding for sport physicals (Preparticipation Physical Evaluations) with the NC Office of the Chief Public Health Nurse which is posted on their website as a resource to help to adolescent well visits. LHD staff were provided information and articles about mental health, substance use, and behavioral health/psychosocial screening, and preparticipation physical evaluations for adolescents as well as links to past webinars on motivational interviewing and use of the HEEADSSS (Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, and Safety) interview tool and the CRAFFT substance use screening tool. The SMD continued to use a self-assessment tool with new providers to LHDs about their knowledge, skills, and abilities related to all the well child preventive visit components. This tool specifically asks about these skills in relation to adolescents and skills with use of specific adolescent screening tools, and during FY22 it assisted the SMD with providing targeted technical assistance to meet the needs of three individual providers.

 

Child Health Program audits of LHDs were not able to be done by the Best Practice Nurse Consultant (BPNC) due to COVID-19 travel restrictions and the continued demands on LHD staff. However, consultation and technical assistance continued to be provided by the SCHNC and RCHNCs regarding compliance with current HCPG age-appropriate requirements, billing and coding requirements and scope of practice. All the requirements for an adolescent visit continued to be included in the most current NC HCPG which was promoted and shared with LHDs by the child health nurse consultants. These requirements continued to apply to all adolescents served by the LHDs in addition to adolescents enrolled in Medicaid who were cared for in other practice settings.

 

The DCFW SMD, SCHNC, and RCHNCS provided TA and training as needed to new LHD providers about the annual well adolescent visit. The Consultants and SMD provided specific TA with LHDs to improve confidentiality and share best practice strategies for interactions with adolescents and with use of LHD electronic health records (EHRs). COVID-19 related webinars offered to LHDs by the DCFW/WCHS included information about the importance of doing outreach and providing well visits to adolescents and about the toll that the pandemic has had on adolescent emotional wellness and social connectedness and the need for screening for mental health risks, strengths, and coping skills.

 

Child Health Training Program (CHTP) for Child Health Enhanced Role Nurses (CHERRNs)

 

The CHTP is an accelerated and specialized public health course that teaches RNs how to obtain a pediatric health history and perform a physical assessment for clients from birth to twenty-one years of age. The purpose of the CHTP is to train Public Health RNs to become CHERRNs. Once RNs are officially rostered as CHERRNs, they are considered billing providers with NC Medicaid and can provide and bill for well child preventative visits for clients from birth to twenty-one years of age. The role of the CHERRN is to improve access to care and to link children & adolescents with a medical home, if the LHD does not serve as a medical home. The course includes examples of specific history and physical examination techniques to help with care of adolescent patients as well as clinical practice scenarios to enhance critical thinking skills and to help with learning documentation and billing. Students are expected to see a set number of adolescent patients during their clinical practicum period and share documentation from one adolescent visit with the CHTP faculty.

 

The CHTP is usually held once per year over a period of six months. Due to the COVID-19 Pandemic, the 2021-22 CHTP was held virtually using Microsoft Teams technology.  Course content covered in FY22 as part of the remaining modules of the CHTP included CHERRN legal issues, confidentiality related to minor’s consent, adolescent health, behavioral health, nutrition assessment, and current HCPG requirements/ recommendations specific to adolescent patients. These modules included several sessions that focused on adolescents or adolescent related issues such as: Bright Futures services for adolescents; required and recommended adolescent screenings; adolescent psychosocial/behavioral health/substance use screening tools; immunizations; use of gender-neutral language; and confidentiality issues for adolescents. These trainings also included information about developing resiliency in adolescents and addressing health care transition. HCPG archived webinar trainings also continued to be required training components for the CHTP.

 

Continuing Professional Development regarding the following topics related to adolescent health was provided for CHERRNs during FY22:

• Children, Mental Health and COVID
• STI and Sudden Death in Children and Youth Updates
• Caring for Children and Adolescents in Foster Care

 

Annual School Nurse Conference

 

The Annual School Nurse Conference has been held for the past 37 years and is attended by around 50% of the state’s more than 1,600 school nurses. Participant evaluations and input from adolescents and parents support the planning and topics to be covered at the next year’s conference. The Public Health Nursing Institute for Continuing Excellence, the NC Institute for Public Health/UNC Gillings School of Global Public Health, and the DCFW/WCHS held the 37th Annual North Carolina School Nurse Conference on December 7-9, 2022.

 

School Health Nurse Consultation

 

School nurses facilitate the well-being and educational success of North Carolina’s children and youth through services directed towards keeping students healthy and ready to learn. Currently, six school nurse consultants are supported by Title V funding. During FY22, school nurses were largely dedicated to COVID-19 mitigation and response efforts. FY22 continued to bring an improvement in the average NC school nurse to student ratio, moving from 1:890 to 1:833, these positions are largely supported through temporary COVID-related funds. There was sustained difficulty to fill school nurse positions during FY22 with districts reporting 131 vacancies for longer than 6 months. Any sustainable impact on school nurse ratios and FTEs will require a permanent funding response.

 

The School Health Nurse Consultant team held Regional Lead School Nurse Update meetings biannually during FY22 to provide technical assistance for school nurses and school staff that provided care to adolescent students. The updates provided a forum for discussion related to a variety of emerging local adolescent needs and issues. Specific topics covered during the updates included COVID-19 mitigation and response, school-based testing and contact tracing for COVID-19, and case management of adolescent students with chronic health conditions, including mental/behavioral health. The School Health Chronic Condition Nurse Consultant and the Behavioral Health Clinical Consultant created a behavioral health tiered document for school nurses. The guide is intended to assist with supporting student health and chronic health condition management within a collaborative multi-tiered system structure.

 

School Nurse Chronic Conditions Case Management

 

An average of 17% to 19% of the North Carolina student population receives services in school each year related to chronic health conditions such as asthma, diabetes, seizures, severe allergies, and behavioral health conditions. Optimal control of health conditions supports student wellness and access to education. Learning self-management is also a goal for students who may often live with these conditions for many years. School nurses work with students, families, staff, and providers to assure that needed care and support are in place, often through providing case management services directed to individual student needs. School nurse case management is defined as the intentional use and documentation of the nursing process in a manner that achieves individualized health and educational goals for students. Case management services by school nurses has been a priority focus since 2006. The number of school districts implementing a standards-based program, used by all district nurses, has improved over time. Growth in standards-based case management programs in NC LEAs continued progressively throughout FY22.

 

School Health Nutrition Consultation

 

The PNC serves on the DPI Healthy Schools “Choir” team (along with School Nurse Consultants) which meets monthly to share information among nutrition and physical activity partners in the state whose focus is the school setting.  In FY 21, the PNC collaborated with DPI Healthy Schools and Nutrition Services staff, along with the Alliance for a Healthier Generation to present a 3-part series on School Wellness Policies.

 

School Health Centers (SHCs)

 

DCFW/WCHS funds 31 of the state’s 90 plus SHCs in order to increase access to primary and preventive health care for older children and adolescents, ages 10 to 19 years old, living in underserved and high-risk communities across the state. For many SHCs, this includes nutrition and mental health services. SHCs are considered to be one of the most effective and efficient ways to provide preventive health care to adolescents. Few programs are as successful in delivering health care to adolescents at low or no cost to the patient, particularly on-site or near school campuses. These centers provide primary and preventive care for the purpose of improving adolescents’ and pre-adolescents’ health and academic success, which directly contribute to the effort by DCFW/WCHS to meet NPM #10. During FY22, the SHC’s began to recover from the effects of the pandemic, as SHCs began returning to normal capacity and normal operating hours.  By the end of FY22 all schools began transitioning to full-time attendance and full-time staffing. SHC staff members were fully employed and continued to provide telehealth when necessary and fully available for all students attending school.  

 

School Health Center Credentialing

 

The DCFW/WCHS School Health Unit (SHU) continues to maintain credentialing/re-credentialing processes with SHCs based on best practice guidelines. All documents submitted by SHCs scheduled for re-credentialing are reviewed by an interdisciplinary team (Behavior Health, Nutrition Services, Medical, and Preventive) within the SHU. Applicable and appropriate action is taken to evaluate SHCs for a credentialing status via a review of compliance with “Quality Assurance Standards” and a Medical Record Review of a minimum of ten random de-identified patient records for all applicable medical services provided. During FY22, SHCs continued to receive support/technical assistance as schools began to return to normal operating hours. SHCs noted a marked increase in the number of students needing behavioral health services since the onset of the pandemic. In collaboration with school nurses, counselors, and teachers, SHCs worked to provide a safety net by providing high quality health care where youth spend most of their time.

 

Normal credentialing processes resumed as students returned to school and COVID restrictions were lifted. Monitoring assistance and advising has remained consistent for all SHC’s. Scheduling changes due to employment vacancies and transition as well effected re-credentialing delays. Mental health services remained relatively consistent with a minimal reduction in the number of behavioral/mental health procedures. SHCs reported 12,171 behavioral health procedures during FY22. This reduction was minimal and fairly consistent while SHCs began to transition to normal operation despite the challenges that the pandemic presented.

 

Youth Leadership and Partnership

 

During FY22, the Youth Health Advisor (YHA) Team convened virtually twice monthly to provide support to programs in the DCFW/WCHS that serve adolescents. This year, the team engaged in a process of Youth Participatory Action Research (YPAR), a research and intervention process led by principles of positive youth development and social justice. Throughout the year team members identified a youth health problem within their school or community, developed a research question, collected and analyzed data, and came up with data-driven solutions. Team member topics included mental health care access in schools, pre-teen nutrition education, mental health stigma in Latinx communities, youth physical activity and safe spaces to be active, youth environmental stewardship and more. Team members developed presentations of their findings and shared them within their respective schools or communities.

 

The YHA Team also continued to extend their expertise to DCFW/WCHS partners in DPI, DMH, and other divisions in NCDHHS throughout FY22 in matters of social and emotional learning, adolescent preventive care and education, and reproductive health programming. The team served as subject matter experts in effective youth engagement and the development of youth advisory council structures for several other states and organizations throughout FY22. The Adolescent Health Coordinator and two NC youth continued to serve on AMCHP’s Youth Voice Amplified Committee, committing to ensure the inclusion of diverse and inclusive youth experiences in AMCHPs programs and policies as well as the broader MCH field.

 

Outreach Efforts to Medicaid and Health Choice Enrollees

 

Through partnerships with the Division of Health Benefits (NC Medicaid), the Prepaid Health Plans for NC Medicaid Managed Care, LHDs, and SHCs, the DCFW/WCHS staff continue to provide quarterly training events for clinical staff in promoting well care for adolescents, including use of screening tools for social emotional assessments to expand outreach to increase both the number of visits and the quality of the care provided during the adolescent preventative visits provided to Medicaid and Health Choice enrollees.

 

SCHNC, RCHNCs, SMD, and other WCHS staff continued to work with parents, adolescents, health care providers, LHDs, and health care professional agencies to promote the importance of the well visit to youth and parents when youth come in for visits that are not well visits such as when receiving a sports physical (preparticipation physical evaluation) which is best done as part of the well visit. DCFW continued to do outreach under the MOU with NC Medicaid to increase enrollment of CYSHCN into Medicaid and Health Choice and linkage to a medical home for ongoing care which includes adolescent well visits. Outreach efforts that were conducted during FY22 are described in the CYSHCN Domain Annual Report.

 

NC Psychiatric Access Line (NC-PAL)

 

The NC Title V Director, CYSHCN Director, Adolescent/Behavioral Health Coordinator, SMD, and other DCFW/WCHS staff, particularly those in the Child Behavioral Health Unit, continued to advise and participate in NC Psychiatry Access Line (NC-PAL) implementation work during FY22. The purpose of NC-PAL, formerly known as the NC Telehealth Partnership for Child and Adolescent Psychiatric Access (NCTP-CAPA), is a free telephone consultation and education program to help health care providers address the behavioral health needs of pediatric and perinatal patients, with an emphasis on rural and underserved areas of the state. Behavioral Health Consultants can respond to questions about behavioral health and local resources and can connect providers to one of our on-call psychiatrists to assist with diagnostic clarification and medication management questions. The four key objectives of NC-PAL for pediatric primary care centers are: 1) Develop a multidisciplinary statewide network capable of providing mental health and telehealth support to pediatric primary care sites; 2) Enable pediatric primary care sites in every NC county access to timely and relevant mental health consultation; 3) Enable pediatric primary care providers in every NC county access to specialty care, community and/or behavioral health resources; and 4) Enable pediatric primary care sites in every NC county access to timely and relevant mental health education and training. The Title V Director and DCFW/WCHS staff members continued to meet virtually every other month with NC-PAL staff and HRSA teams to provide updates. During FY22 NC-PAL was available to all of North Carolina’s 100 counties. Direct assessment of patients through telehealth was made available on a limited basis to providers for specific consultations. To date, the program has taken over 3,000 provider calls from 54 of North Carolina’s 100 counties.

 

Funding for NC-PAL expanded significantly through the blending of funds from multiple sources. Prior to 2021, NC-PAL was primarily funded through HRSA grants, and the program’s focus was on the development of the call center. In FY22, NCDHHS more than doubled the investment in this program by dedicating more funding through the Mental Health Block Grant and Medicaid. With the increased funding, NC-PAL has been able to expand offerings to include the following supports:

• Participation in daily clinical staffing calls with NCDHHS, county DSS, and pre-paid health plan staff to focus on children in Emergency Departments or DSS offices awaiting medically recommended behavioral health services. They provide recommendations on services, needed assessments, and medication reviews.
• Development of pilot program with four county DSS offices, working with social services staff to support better permanency planning for children with significant behavioral health needs.
• Implementation of a training initiative for psychiatrists and other practitioners to support behavioral health needs of children in their practices and local communities.

 

During FY22, the program began planning to expand its offerings, including additional resources for clinician training, complex consultation services, and school-based consultation services. The NC-PAL advisory committee continued meetings with partners from public health, mental health, academic centers, pediatrics, family medicine, psychiatry, rural health, and other disciplines. REACH (Resource for Advancing Children’s Health) training was held four times which trained 104 clinicians serving youth in North Carolina. Thirteen pediatric and family medicine residents were trained at Duke University through a curriculum adapted by the NC-PAL program called Behavioral Health Expansion in Pediatric Residency Training (Be ExPeRT).

 

School Mental Health and Social Emotional Learning

 

The DCFW/WCHS worked with DPI and DMH/DD/SAS on mental health access and school mental health for adolescents as well as participating with DPI’s mental health initiatives for planning and implementation at the local level. These efforts include engagement on the statewide implementation team for social and emotional learning standards. During FY22, the Adolescent Health Coordinator began work to integrate a youth and parent partner component to this work with an emphasis on educating parent and community members on the fundamentals of social and emotional learning and how to integrate youth and parent perspective in state team objectives. Regional school nurse consultants and the Adolescent Health Coordinator also engage in the state School Mental Health Initiative, a multi-disciplinary partnership of stakeholders providing support to promote healthy social and emotional wellbeing and address the continuum of supports and services for student mental health and substance use. Regional school nurse consultants also continued to support local school nurses as part of the Specialized Instructional Support Personnel to address behavioral issues, suicide and bullying in schools.

 

School behavioral health services play a pivotal role in addressing the needs of youth. During FY22, DCFW staff began engagement in a School Behavioral Health Learning Community comprised of state health, education, and Medicaid leadership. The learning community set to building capacity to expand school behavioral health policies through learning evidence-based and evidence-informed strategies to address youth behavioral health outcomes through the school system. DCFW engaged with a state team and cross-sector partners and cross-state teams to improve coordination. The state team developed a landscape template intended as a resource providing information on current school behavioral health policy, funding, and agency leadership. The template offered insights into policy and funding gaps for a state school behavioral health program and helped shape the development of a unified school behavioral health plan (carried into FY23).

 

Additionally, during FY22, Title V and other DCFW staff submitted a plan to expand activities supported by COVID-19 testing funding to include mental and behavioral health wraparound supports for school-age children impacted by COVID. This plan detailed the impact of disruption on educational routine and environment, loss or parent or guardian, pandemic-induced anxiety and stress, and stigma of positive results. This plan was approved at the end of FY22 with implementation beginning shortly thereafter.

 

The Adolescent Health Coordinator served as a planning member for a youth suicide prevention academy in partnership with Injury and Violence Prevention Branch staff members. The academy included both prevention and postvention educational content for teams of school personnel across the state as well as other youth serving professionals.

 

Triple P (Positive Parenting Program)

 

Triple P has been implemented in all 100 counties in NC. A free online evidence-based adolescent component to help families manage behavioral problems is available for all NC residents, along with the face-to-face adolescent component. As described in the CH Domain Annual Report, DCFW/WCHS continued working in partnership with other internal and external partners through the NC PSG and the Triple P State Learning Collaborative to support the continued implementation of Triple P which includes a focus on adolescents. Additionally, the PSG convened the NC Triple P State Partners Coalition which represents all the internal and external partners who either support and/or have a vested interest in the success of Triple P in NC.

 

To strengthen the system of care for children and adolescents, representatives of the DCFW/WCHS and the State Title V Director and State Title V CYSHCN Director continued to meet with the Home Visiting and Parenting Education Systems Planning group in FY22.

 

Promote Importance of Adolescent Preventive Care Including Behavioral Health Risk Assessment

 

DCFW/WHS continued to raise awareness with LHDs, other health care providers, and professional agencies about the NC DSS recommendations for the frequency and content of the visits for adolescents who come into care. These recommendations, which have been aligned for several years with the majority of the AAP recommendations, include: an acute visit within the first week of placement in care; a comprehensive visit within 30 days of placements in care; and then well visits (which include a behavioral health risk and strengths assessment and mental health screening) every six months. During FY22, the SMD and Title V Director worked with Fostering Health NC and DSS to promote guidance during the pandemic for social workers and foster parents involved with caring for children and adolescents in foster care to continue receiving enhanced preventive health care visits in person and/or via telehealth according to these established DSS recommendations.  This means following the national AAP recommendations for visits every 6 months and visits that include mental health screenings at each visit and other behavioral health risks.  See here for more resources from AAP in addition to those from the Fostering Health NC Library. Title V staff members have worked closely with Fostering Health NC Transition Age Youth Work Group and Fostering Health NC staff to review and develop several of these resources.

 

Reduce Weight Bias/Stigma and Promote Weight Inclusive Care for Children and Adolescents

 

In FY22, the PNC began work to ensure trainings for health professionals, supported through programs through DCFW and with outside partners, included appropriate messaging to promote Health at Every Size® and Weight Inclusive principles and practices in order to reduce weight bias especially for kids in larger bodies who can be at greater risk for bullying, eating disorders and other trauma that can affect their mental health. The PNC shared nutrition and physical activity resources with the Adolescent/Behavioral Health Coordinator, Regional School Nurse Consultants, and also within the Child Health Program. This work will continue in FY23 and beyond.