Need 4 – Promote Safe, Stable, and Nurturing Relationships
- Work with the business community to increase employer-based family friendly workplace policies with an emphasis on industries where employers are less likely to have access to family friendly policies and benefits;
- Build public awareness at the state and local levels about the benefits of family friendly workplace policies, including paid family leave and the impact of ACEs on the health and development of young children, which may lead to norms change;
- Increase community capacity to implement paid family leave policies at the local government level;
- Focus on racial equity and the disparate ways economic policies, including family friendly workplace policies, may impact families;
- Exploration of alternative strategies for implementation of paid family leave (e.g., insurance); and
- Alignment of local plan development or implementation.
The Title V CYSHCN Director, PMC and other DCFW/WCHS staff members will continue to help with the implementation of strategies developed and supported by NC ECAP and Pathways to Grade Level Reading. NC ECAP goals include healthy babies (infant mortality and especially disparities), preventive health services (which also include developmental screening and surveillance), safe and nurturing relationships, food security, safe and secure housing, and social emotional health and resilience. Title V staff will continue to work on creating an action map that will help to identify and coordinate strategies to support children’s optimal development beginning at birth and will provide resources for ongoing supports for social emotional development and trauma informed care to try to reduce the impact of ACEs on young children.
In addition, there will continue to be participation of the Title V CYSHCN director, PMC. SCCNC, and other WCHS staff in the efforts to address Infant Early Childhood Mental Health Consultation to professionals in early childhood settings such as child care, DSS placement, early intervention, and preschool. DCFW/WCHS staff members will also continue to participate in the EarlyWell Initiative advisory committee and to help suggest changes in how providers and systems engage families and provide TA to medical homes.
Several Title V staff will continue to partner with Dr. Pretzel and Dr. Crais (UNC-CH) on the HRSA funded Navigating Pathways for Coordinated Care for Children with ASD/DD grant to increase early identification of young children with special developmental needs. The decision tree model to engage families in developmental monitoring (using LTSAE materials) will be posted on the NC Act Early web site. In addition, family navigators across the state will be trained through the grant to use the online developmental monitoring guide with families, including those from Title V, CMARC, ASNC, FSN and ECAC.
In FY23, the Early Childhood Matrix Team plans to reform and determine a meeting cadence to share ideas, sponsor training events, align with the other early childhood efforts such as NC ECAP, Think Babies, IHOPE (Integrating Healthy Opportunities for Play and Eating), and coordinate work to support child well-being, making sure the structure supports ongoing partnership with the proposed reorganization. Program topics for FY23 will align with priorities of DPH, DCFW, and NCDHHS related to and/or impacting early childhood. Potential topics include Medicaid Transformation, NCCARE360, impact of COVID-19, engaging in the Perinatal Health Strategic Plan, updates from other early childhood efforts across the state, and supporting implementation of the ECAP.
Efforts to Increase Screening for Developmental, Psychosocial, and Behavioral Health Concerns
The DCFW/WCHS SCHNC, RCHNCs, and the PMC will continue to include at updates and trainings for child health clinical staff in LHDs regarding information about the importance of developmental surveillance and screening, identification, management and referral especially with many children experiencing different environments and caregiving arrangement due to the pandemic.
The DCFW/WCHS SCHNC and RCHNCs have not been able to go onsite to LHDs due to COVID-19 restrictions and enormous demands on LHD Child Health Program staff. The SCHNC and RCHNCs will continue to utilize Microsoft Teams technology to meet with LHD Child Health Program clinical staff virtually in order to provide consultation and technical assistance. The plan is to restart individual site visits in spring of 2022 and DCFW/WCHS staff members will continue to review child health services and provide technical assistance and education regarding best practices to LHD staff about well child visits which include developmental surveillance, screening, identification, management and referral. The PMC will continue to use a self-assessment tool for new advance practice providers and physicians to determine resources to support delivery of developmental surveillance, developmental screening, social-emotional, behavioral, and psychosocial screenings during well child and sick visits and access resources for anticipatory guidance, and community partners when concerns are identified in LHDs based on Bright Futures and AAP recommendations. The DCFW/WCHS SCHNC and RCHNCs will provide technical assistance and review charts and electronic health records of clients seen in LHDs on the Medicaid requirement to provide, document, and discuss the results of developmental and behavioral health screenings with families as well as review the charts for other items. Nurse consultants, along with the PMC, will continue to train and update LHDs on content from and changes to the Medicaid requirements and reinforce the need for ongoing developmental surveillance and screenings. WCHS staff will also continue to work with the Pediatric Program at CCNC/CCPN, Clinically Integrated Network, and the EarlyWell Initiative to increase awareness about developmental, behavioral health and social-emotional screenings.
Efforts to Improve Preventive, Screening, Assessment, Diagnostic, and Treatment Health and Well-Being Services
The PMC, SCHNC, and RCHNCs plan to hold monthly statewide webinars to provide child health programmatic updates which will include topics such as ACEs/toxic stress, relational health, positive childhood experiences, trauma informed care and enhanced well visits for infants, children and youth in foster care, and family engagement. The possibility of a holding a statewide Annual Child Health Conference will also be explored in FY23. In the meantime, the PMC, SCHNC, and RCHNCs will continue to provide the opportunity to earn nursing continuing professional development (NCPD) contact and Certified in Public Health (CPH) recertification hours during several of the statewide webinars. The PMC, SCHNC, and RCHNCs will continue to provide one training about developmental surveillance and screening, identification, management, and referral for the CHTP participants. The CHTP will also continue to include training on vision system assessment and lead screening and will share the archived webinars with child health clinic staff in LHDs. In addition, they will provide ongoing technical assistance to CHERRNs, physicians, and advance practice practitioners in LHDs on topics such as refugee health updates, obesity prevention and screening; oral health prevention and screening in addition to other topics as needed.
In FY23, the CMARC program will continue to collaborate with other agencies and programs, such as EI and Pregnancy Care Managers, to ensure an effective system of care. The CMARC program in conjunction with the Prepaid Health Plans will continue to require staff to collaborate with medical homes in their communities, both at the system level for effective identification of children in the CMARC target population and at the individual child level for those children engaged in CMARC services, as collaboration with the medical home will ensure the healthiest outcomes for the child. CMARC staff will also continue to support the work of NCDHHS’ Plan of Safe Care to meet CAPTA requirements for substance-affected infants. The program will continue to provide technical assistance and training per the NC Medicaid Program Guide for Management of High-Risk Pregnancies and At-Risk Children in Managed Care to enhance performance assessment and improvement processes to ensure program expectations are met. The CMARC staff will collaborate in FY 23 to promote the Healthy Opportunities Pilot. We will continue to participate in the NC InCK pilot program.
With the launch of NC Medicaid Managed Care which occurred on July 1, 2021, CMARC state staff will continue to work with NC Medicaid Division of Health Benefits to assure that care management services are maintained and enhanced for children ages zero to five who meet the program population criteria. Care management services will continue to include developmental screening using the SWYC. Additional technical assistance will be provided to CMARC staff and health care providers in LHDs and private practice on the use of the SWYC tool and on linking with resources to address concerns in the community. CMARC care managers will continue to conduct general developmental screenings using the Life Skills Progression Assessment and share the results with the appropriate medical home practitioners and facilitate EI referrals.
The PMC will authorize targeted case management, evaluation and management services offered by service providers at several CDSAs. The PMC will also work with several CDSA providers to increase outreach to medical homes about developmental screening, management and appropriate referrals to EI and other agencies. The PMC will also help with recruitment of a state level pediatrician to help with consultation and TA for the CDSAs and outreach and trainings to health care providers serving young children about general development and social emotional health. NC ITP management, CDSA leadership, the remaining physicians and advanced practice providers and the PMC will also review the established conditions list for eligibility for EI and several other EI policies and processes and explore how to create processes and policies that are consistent across all CDSAs to support billing and access to evaluation, management and treatment with developmental services and supports for eligible infants and children.
In FY23, the DCFW/WCHS will continue to support the Triple P System through Title V funding as noted in the CH Domain Annual Report. The NC Triple P System will satisfy select strategies stated in CH 4A.3 relative to statewide trainings on preventive screening, assessment, and treatment of parents and caregivers struggling with custodial child abuse and neglect issues, in coordination with its partners. This occurs via specific training, technical assistance, and through the four levels of Triple P intervention services across the state, both face to face and via the Triple P Online Program.
In FY23, LIAs will continue the implementation of the Model Scale-Up Five-Year Plan by making updates to their plans. The Model Scale-Up Five-Year Plan is a living document, subject to change based on individual LIA needs. The Triple P Support Team, including the Design Team and the PSG, will work with each LIA to assist with challenges identified through the plan and to recommend solutions to those challenges. Local practitioners are also considered in these recommendations since their buy-in is essential. The Model Scale-Up Five-Year Plan also assists in the goal of addressing strategy CH 4A.3 since the plan potentially gauges any needs related to screening, assessment, training, treatment, and prevention of child abuse/neglect.
In addition, the NC Triple P State Learning Collaborative will continue to engage all LIA Coordinators, state team members, practitioners, and partners in FY23. As a central strategic networking and training opportunity, participants engage in training, ongoing problem-solving, and learning about innovative ways to recruit and coordinate Triple P training events, as well as build their professional competencies, which satisfies some components of the CH 4A.3 strategy. The NC Triple P Program will continue partnering with the NC DSS. Funding from NC DSS enables the DCFW/WCHS to maintain its funding level to support and provide coverage of Triple P services to all 100 counties.
NC Child Care Health Consultation Resources
In FY23, the SCCNC will continue to work collaboratively with programs within the DCFW/WCHS, as well as with local and state partners, to establish and maintain links to promote health and safety in early learning environments. Specifically, the SCCNC will continue to partner closely with the NC CCHSRC to support child care health consultation across NC, supporting both local and regional based CCHCs. The CCHC Resource Library offered through the CCHSRC website will be maintained and enhanced to include training resources and materials, information on current health and safety requirements, including recommendations for meeting best practice standards for child care facilities. The Resource Center, in collaboration with the SCCNC, will continue to offer the NC CCHC Course for new CCHCs and affiliates online and in person twice a year, fall and spring. The three Regional CCHC coaches from the NC CCHSRC in addition to the SCCNC will continue to provide coaching services to CCHCs in FY23 as well as serving as instructors for the NC CCHC Course and other courses. Additionally, the SCCNC will partner with the NC CCHSRC to offer quarterly webinars for CCHCs and supervisors.
The CCHC Systems Building for Statewide Expansion Planning workgroup was established in FY21 and is continuing its work in FY23. Outreach efforts by the SCCNC and regional CCHC coaches to promote and support hiring in counties that remain without local/regional coverage will continue. In FY23, the PMC will work with the SCCNC and the NC CCHSRC to enhance professional development activities and resources for CCHC’s through Learning Collaboratives addressing health and safety topics specific to children aged birth to five years in child care settings.
Efforts to Support the Learn the Signs Act Early and Reach Out and Read Campaign
The CMARC staff will continue to provide LTSAE with additional training around the ROR Campaign, Triple P, and the Small Moments, Big Impact materials to promote child development and strong parent-child relationships. The NC ITP will continue to promote the LTSAE campaign both on its website and by sharing it with families seen at the CDSAs. The CDC Act Early grant’s second year will focus in having ITP provide training of selected Part C staff on a Level II screening tool for ASD. In addition, the PMC, SCHNC, CMARC program manager, SCCNC, and several other Title V staff will continue to work with LHDs, NC Pediatric Society Early Childhood Champion, the two LTSAE NC Ambassadors, child care health consultants, MIECHV home visitors, Healthy Social Behaviors Specialists and other early childhood professionals to increase use of the LTSAE materials and Reach Out and Read with families and medical home providers. In addition, in FY23, the NC Triple P program, both from the state office and its funded LIAs will continue to support both the LTSAE and ROR Campaign via referrals and coordinator/practitioner training updates.
Child Health Agreement Addenda
The FY23 Child Health Agreement Addenda with LHDs for child health services will continue to support a variety of services for low-income families using the Attachment C Sample Evidence Based Strategies as reported in the CH Domain Annual Report.
Home Visiting and Parenting Education (HVPE) System
A central priority at this time is investing in and further developing the critical infrastructure to support the HVPE System, including expansion of staff. In addition, the four committees (Assessment and Planning; Communications; Finance; and Programs) will develop work plans in the remainder of 2022, aligned with the HVPE State Action Plan, to attach specific tasks and potential resource needs to goals in service of the plan, and will move to implementation in 2023. Several community-based pilots (including technical assistance around assessment and planning for introduction and expansion of HVPE services; communications strategies; and fiscal modeling to determine costs of implementing a mix of HVPE models) are planned for 2023-2024. Family and community engagement and racial equity remain central to the HVPE System work, and expanded supports for these areas are planned.
NC Child Fatality Prevention System
In FY23, the state CFPT Coordinator will continue to:
- Provide live and archived webinars with partners to local CFPTs on topics such as gun safety, recruitment of new members and meeting facilitation.
- Conduct training needs assessments with all 100 local CFPTs.
- Accept quarterly reports from local CFPT and submit an annual report to the State Child Fatality Prevent Team and the CFTF.
- Provide individualized trainings to new CFPT Chairpersons and support staff.
- Conduct monitoring activities for 33 local teams via telephone conferencing and site visits.
- Collaborate with local partners such as the OCME and UNC CMIH to provide training on gun safety and storage issues and the impact of COVID-19.
- Provide training on the Identification of Problems causing child deaths, Recommendations to solve these problems and Actions taken to work to solve the problems.
Additional Strategies to Promote Child Health
In FY23, funding through Title V and state appropriations will continue to support coverage of vision screening for both school-age and preschool age children with Title V funding preschool services through a contract with Prevent Blindness North Carolina. Educational materials will be provided statewide on eye and vision health. Vouchers for services and eyeglasses for children who do not qualify for other assistance through public or private insurances will also be provided.
In FY23, the DCFW/WCHS and WICWS will continue to collaborate with the NC Childhood Lead Poisoning Prevention Program to help eliminate childhood lead poisoning and maintain lead screening in LHDs and with community. DCFW/WCHS will share the revised guidelines for lead screening with a lower blood reference level.
As with previous action plans, the PNC will continue in FY23 to integrate breastfeeding education, family engagement and Life Course Nutrition into the Child Health program through trainings conducted as part of the CHTP CHERRN course and through other Child Health programs, including work with programs that specifically target CYSHCNs. The PNC will also continue her active involvement in the Association of State Public Health Nutritionists (ASPHN) through the MCH Nutrition Council and the Fruit and Vegetable Nutrition Council. In FY21, the PNC and other Steering Workgroup members of the NC Farm to Preschool Network, applied for and were awarded a one-year $91,000 ASPHN/CDC Farm to Early Childhood and Education Implementation Grant (FIG) that began November 1, 2020 and was slated to end on October 31, 2021 (https://asphn.org/farm-to-ece-grantees-programs/). With continued funding from CDC, ASPHN offered FIG funding to NC and other states and that funding (91K) will end October 31, 2022 (unless more continuation funding from CDC/ASPHN is available). The Network has local and state level Policy, Systems, and Environmental (PSE) changes included in the FIG grant along with a racial equity focus. For FY23, the PNC and Network partners will wrap up their Year 2 grant deliverables, complete end of grant year reports, generate success stories and investigate other funding opportunities to expand their work. The PNC also serves on the Farm to School (FTS) Coalition of NC Steering Committee, a statewide coalition she helped form in 2014. In FY23, the PNC will continue to lead or serve on workgroups to expand FTS in NC and continue to promote the accomplishments of the Coalition.
The PNC will also continue collaborative partnerships with the NC Partnership for Children, GoNAPSACC, the CDIS SPAN grant staff, the State Child Care Health Consultant, the NSB (WIC and Child and Adult Care Food Program [CACFP]), the State Nutrition Action Coalition, Eat Smart, Move More NC and other internal and external partners in addressing similar nutrition and physical activity strategies by routinely communicating and partnering in a more coordinated way and pooling resources for greater impact. This could include consistent messaging related to breastfeeding & healthy eating that partners could use, especially with a diversity, equity and inclusion lens. Another activity continuing in FY23 and beyond is that the PNC monitors a special nutrition project Agreement Addendum for the Durham County Department of Public Health that furnishes medical nutrition therapy and nutrition consultation services for children referred to the LHD with no other funding source. A new strategy for FY22 and continuing into FY23 that the PNC is involved with is advising and providing technical nutrition expertise to DHB, on food and nutrition services being offered to address food insecurity and improve nutrition among high-risk “members” (which includes infants, children, adolescents, pregnant women and adults with chronic health conditions) as part of the Healthy Opportunities Pilots.
Other worked for FY23 includes work planned by the PNC for FY22 related to Oral Health and Nutrition that was put on hold due to a vacancy in the Oral Health Section and specifically their Perinatal Health Coordinator. The emphasis on this work will be to explore nutrition and dietary aspects directly linked with Oral Health (promotion of breastfeeding, decreasing sugar-sweetened beverages, etc.). This work will focus on providing resources and possibly ensuring referrals for nutrition needs identified during preventive dental visits.
Priority Need 5. Improve immunization rates to prevent vaccine-preventable diseases
Vaccines for Children Program Strategies
In FY23, the NCIP will continue to implement the strategies described both in the CH Domain Annual Report and below to recruit and maintain public and private providers in the VFC program and strengthen the program.
NCIP Partnerships
One IB staff member is designated as liaison to the NCIC and will continue serving as an ad hoc member on the steering committee and a committee member on NCIC’s HPV subcommittee.
IB leadership and communications staff plans to continue partnering with the N.C. Pediatric Society on joint messaging and promotion of childhood immunizations, with a particular focus on the time period prior to the start of the new school year and during the annual observance of Adolescent Immunization Awareness Month in North Carolina in the month of July.
Immunization Quality Improvement for Providers
The Immunization Branch will continue to provide IQIP visits in FY23. Although Tele-IQIP Visits may still be needed, the IB plans to gradually return to in-person visits if COVID-19 cases remain at a safe level. Regional Immunization Consultants will focus on CDC’s four core strategies (scheduling the next immunization visit before the patient leaves the provider site; leveraging immunization information system (IIS) functionality to improve immunization practice; giving a strong vaccine recommendation for patients; and optional strategies as defined by the needs of state and local communities) when conducting IQIP visits, and will work with each provider to implement at least two of those strategies. Subsequent follow up and re-assessment of rates will track provider progress through each 12 month IQIP cycle.
Additional Title V Immunization Activities
The Child Health Program will continue to promote immunizations for children and youth according to AAP/Bright Futures schedule as part of the well-child visit. Information and updates will continue to be shared with LHD staff through provider webinar updates, child health clinical staff webinar updates, and through the annual CHTP. In addition, the Best Practice Nurse Consultant will restart the process of reviewing clinical charts to assure that program and clinical guidelines are met.
The CMARC Program will encourage parents to adhere to the AAP/Bright Futures guidelines for well-child visits, including receiving appropriate immunizations. CMARC care managers are often embedded in pediatrician or family practice settings or work in close collaboration with the child’s medical home.
In addition, well visits with the medical home that follow AAP/Bright Futures guidelines will be encouraged by nurse home visitors. Often the nurse home visitor goes with the parent to the medical appointments to assure coordination between the provider and community-based services. Nurse home visitors will often go to the medical appointment with the family to reassure the family and to discuss needed community-based services.
Among the many impacts of COVID-19 on NC is a marked decrease in the rates of well child visits and childhood vaccinations. In FY23, the Title V Office will continue to monitor vaccination rates closely and work with partners on outreach and sharing of best practices to increase vaccination rates. The Title V Office and DCFW/WCHS worked with NC Medicaid, NC AHEC and Community Care of North Carolina (CCNC) on the Keeping Kids Well initiative to work with practices experiencing greater care gaps to increase well child visits and immunization rates across the state. NCDHHS will continue to work on an expanded influenza media campaign to ensure maximum coverage this year during the COVID-19 pandemic and leverage COVID-19 messaging and the importance of “layering up this winter” with both COVID-19 and influenza vaccines. NCDHHS will also continue to engage with diverse state and community partners who interact with and care for children and adolescents to implement COVID-19 vaccination in NC, ensuring fast and fair vaccination that is easy and everywhere, especially in anticipation of the availability of booster doses.
The PMC will continue to do outreach and presentations to child health providers at LHDs and in other practice settings and to agency representatives about the need to address decreased rates of well child visits and vaccinations as well as clinical guidance and NCDHHS materials related to increasing COVID-19 vaccination rates in children and adolescents.
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