Early childhood leaders in the NC DHHS established the NC Early Childhood State Leaders Collaborative in FY17 in response to legislation to coordinate early childhood services across the Department and to make recommendations for an early childhood governance structure. In FY18, this group made its recommendations to the NC DHHS and the NCGA and the work of the formal Collaborative ended, although coordination continues. In FY18 the Secretary convened a workgroup to develop an action plan for early childhood, birth to eight years. As the work of this continued, the Governor expanded the scope of the action plan to be one across all early childhood organizations in NC, now called the Early Childhood Action Plan (ECAP). The Title V Director and Title V CYSHCN Director served on workgroups who helped develop the ECAP. Using this framework, the WCHS will continue to align with and amplify the strategies included in the ECAP to collaboratively achieve the outcomes.
In FY20, the Title V Director will continue participate in the Child Well-Being Transformation Council. The purpose of the Child Well-Being Transformation Council is to serve as a means for coordination, collaboration, and communication among agencies and organizations providing public services to children. The focus of the Council is on the following initiatives:
- Mapping the network of child-serving agencies and organizations in the State
- Cataloging examples of failures in coordination, collaboration, and communication in the context of child welfare.
- Reviewing the work of bodies similar to the Children's Council operating in other states to identify promising practices and focus areas for the Children's Council's work.
- Monitoring changes in the social services and child welfare system associated with reform and regional supervision.
- Identifying gaps in coordination, collaboration, and communication related to all publicly funded child serving programs.
- Recommending changes in law, policy, or practice necessary to remedy gaps or problems impacting coordination, collaboration, and communication among publicly funded child-serving agencies.
In addition, the Title V Director and Title V CYSHCN Director will participate in the implementation of strategies developed and supported by many early childhood leaders on the Pathways to Grade-Level Reading by adopting: shared, whole child, birth-to-age-eight measures that put children on a pathway to grade-level reading; coordinating strategies to support children’s optimal development beginning at birth; and aligning policies and practices that are rooted in how children develop.
The Early Childhood Matrix Team, comprised of program staff across the WCHS, will continue to meet quarterly to share ideas, sponsor training events, align with the Early Childhood Action Plan and coordinate work to support child well-being. This Team was created during the time the C&Y Branch received the Early Childhood Comprehensive Systems formula grant. Program topics for FY20 are transitioning into Medicaid Managed Care, NCCARE360, engaging in the Perinatal Health Strategic Plan, and viewing and discussion of the film RESILENCE.
C&Y Branch Regional Child Health Nurse Consultants will routinely conduct individual site visits to review child health services and provide technical assistance and education about best practices to LHD staff. The PMC will continue to use a self-assessment tool for new advance practice providers and physicians to determine resources to support delivery of well child visits in LHDs based on Bright Futures. Branch RCHNCs will continue to review charts and electronic health records of clients seen in LHDs on the Medicaid requirement to provide, document, and discuss the results of developmental screenings with families as well as review the charts for other items. The nurse consultants, along with the PMC, will continue to train and update LHDs on changes to the Medicaid requirements and reinforce the need for ongoing developmental screenings. WCHS staff will also continue to work with the Pediatric Program at CCNC and the Assuring Better Child Health and Development program with Smart Start to increase awareness about developmental and social-emotional screenings.
The C&Y Branch will continue to refine the redesigned Child Health Agreement Addenda with LHDs to require that:1) all services supported by Title V funding will be evidence-based; 2) services will support the MCHBG domains and reflect the needs of the community; and 3) priorities established by the local communities will be data driven. The Child Health Program has:
1. Created an online process for LHDs to self-report at mid-year and end of year on the measures for the services delivered by the LHD;
2. Standardized the measures and improved the reporting mechanisms to increase accountability; and
3. Increased technical assistance to LHDs to support the use of additional evidence-based services and resources for children.
The FY20 Child Health Agreement Addenda with LHDs for child health services will continue to support a variety of services for low income families which can include, but are not limited to:
1. Access to dental services and optometrists;
2. Access to asthma inhalers and spacers;
3. Direct preventive and sick visit services;
4. Reach Out and Read program support;
5. Interpreter services such as in-person interpreters and language line services;
6. Car seat and bicycle helmet purchases based on financial eligibility;
7. Classes for families in LHD and in school settings on nutrition and physical activity to reduce the risk for obesity;
8. Reproductive health services for teens based on a sliding fee scale;
9. Funding for school nurses;
10. Funding for family strengthening initiatives;
11. Accommodations to improve access to care for children with disabilities after site surveys for wheelchair scales and accessible examination tables;
12. Training related to skill development related to evidence-based services;
13. Mother-Baby Breastfeeding Friendly Outpatient Healthcare Clinics;
14. Funding for Child Care Health Consultants;
15. Nutrition and Physical Activity Coalition (new for FY19); and
16. Addressing Food Insecurity and/or Healthier Food Access (new for FY19).
The state and regional nurse consultants, along with assistance from the PMC, will coordinate the annual CHTP from March 2019 – June 2019. The PMC and state and regional child health nurse consultants plan to hold a Child Health Conference in November 2020 to provide child health programmatic updates as well as address additional topics such as Adverse Childhood Experiences (ACEs)/toxic stress, opioid/substance abuse related to children/adolescents, foster care transition, motivational interviewing, and family engagement.
The PMC and SCHNC will hold a minimum of five live webinars from June 2019 – November 2019 to provide additional CH Program Updates on topics such as food insecurity, interpersonal/domestic violence and its impacts on children & adolescents, housing, transportation, as well as other topics of interest. Child health provider web-based trainings will continue to be held quarterly. The PMC and the state and regional child health consultants, in partnership with the NC Public Health Nurse and Professional Developmental Unit consultants, will also continue to provide quarterly trainings and ongoing technical assistance to CHERRNs, physicians and advance practice practitioners in LHDs to assist with delivery of appropriate screenings based on the most current Health Check Program Guide requirements and recommendations. The plan is to have more of a focus on the interaction of developmental screening and social determinants of health in FY20.
In FY20, CC4C will be transitioning with Medicaid into Medicaid Managed Care. Regional trainings are being provided to local CC4C care managers and their supervisors. In addition, the CC4C Orientation training webinars will be revised to assure they are in line with Medicaid Managed Care. The SWYC, which was first required for use as a screening tool with all CC4C-engaged families in April 2018, will continue to be used as a required screening tool. Additional technical assistance will be provided to CC4C 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. CC4C 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 Early Intervention referrals. The CC4C staff will continue to provide the Books Build Connections and the “Learn the Sign. Act Early.” materials to promote child development and strong parent-child relationships.
Another effort for the CC4C program in FY20 will be to continue working with DHHS, DSS, DMH/DD/SAS, and hospitals, as well as other partners, in response to the Comprehensive Addiction and Recovery Act (CARA) that amends provisions of the Child Abuse Prevention and Treatment Act (CAPTA), including monthly meetings with these partners. CC4C will continue to work to implement and monitor Plans of Safe Care for infants affected by substance use, withdrawal, or FASD. A Substance Affected Infant Pathway that was introduced to CC4C staff in September 2017 will continued to be used to ensure effective and impactful service delivery. NC was selected to participate in the In-Depth Technical Assistance for Infants with Prenatal Substance Exposure and their Families sponsored by the National Center on Substance Abuse and Child Welfare to enhance communication and coordination among hospitals, prenatal providers, public health, treatment providers, child welfare representatives, and others related to infants with prenatal substance exposure. As part of the initial process, two or three hospitals have been engaged to examine how systems identify, refer, and engage pregnant women and mothers with substance use disorders and their infants. The Plan of Safe Care Interagency Collaborative will also be finalizing a framework to continue to support plan of safe care implementation in NC.
The CC4C program will continue collaboration with other agencies and program, such as Early Intervention and Pregnancy Care Managers, to ensure an effective system of care. The CC4C program 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 CC4C target population and at the individual child level for those children engaged in CC4C services, as collaboration with the medical home will ensure the healthiest outcomes for the child. The CC4C program is supporting staff in the transition to a new documentation system. New performance measures will be explored to evaluate program performance and impact. The program will continue the current performance assessment and improvement processes to ensure program expectations are met. The program continues to collaborate with the NC Division of Health Benefits in transitioning this program from the current Medicaid system to Medicaid managed care, which is scheduled to begin rollout in November 2019.
In addition to work that will take place in FY20 to formulate the 2020 policy agenda of the Child Fatality Task Force, other notable Task Force work anticipated includes working on initiatives launched at the 2018 CFP System Summit that are aimed at strengthening the state’s CFP System.
In FY20, the state CFPT Coordinator will continue to:
- Provide live and archived webinars with partners to local CFPTs on topics such as safe sleep, recruitment of new members and meeting facilitation;
- Conduct training needs assessments with all 100 local CFPTs;
- Explore the use of Survey Gizmo as an electronic reporting system for local team child death data collection;
- 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 Maternal and Infant Health to provide training on safe sleep; and
- Update the Local CFPT Review Guide.
North Carolina was one of seven states to receive funding from the CDC for State Essentials for Childhood Initiative: Implementation of Strategies and Approaches for Child Abuse and Neglect Prevention. In FY20, NC E4C will continue to support increased family-friendly work place policies and practices through Family Forward North Carolina, support Prevent Child Abuse NC (PCANC) in the implementation of Connections Matter, a public engagement campaign and evidence-informed curriculum designed to build community connections to improve well-being, and support the implementation of the NC ECAP and the development of community-level ECAPs. The CDC also provided supplemental funding to address risk and protective factors for ACEs and Opioid Misuse/Overdose prevention. Supplemental funding will be used to address inequities that result in adverse childhood experiences and adverse community environments (the Pair of ACEs) by using the Building Community Resilience (BCR) process.
In addition to continuing the services outlined in the Annual Report, in FY20, the PNC will continue to use results of the 2017 NC School Health Nurse Nutrition Needs/Interests Survey to address needs/interests of local school health nurses in coordination with School Health Unit team. The continued focus will be on messaging of health professionals to promote healthy weight among normal and overweight/obese children to promote health at all sizes and avoidance of eating disorders and working with the School Health Chronic Disease Nurse Consultant in defining nutrition-related case management protocols and procedures. She will continue work to promote awareness of the linkage between weight bias and bullying and support size diversity, acceptance, and weight normalization for adolescents in partnership with the C&Y Branch’s PMC, school nurse consultants, child health nurses, School Health Center staff, the SHU Behavioral Health Clinical Consultant/Adolescent Health Coordinator and other internal and external partners. She will also assess the need and feasibility for linking state and local nutritionists providing child and adolescent health nutrition services, especially related to preventing and treating childhood overweight and obesity. The PNC will also have a major focus in the area of Food Insecurity, which is anticipated to impact CYSHCN’s, adolescents, infants, children and most importantly families. The Department’s Medicaid Transformation also has a major focus on Food Security and a multitude of strategies including universal screening of NC Medicaid recipients, increasing SNAP and WIC participation (along with other federally funded nutrition assistance programs) and Healthy Opportunities pilots focused on innovative food security interventions will begin to be tested in FY20.
The PNC will also continue to integrate work begun in FY17 with Farm to School partners and Farm to Early Child and Education into C&Y Branch and DPH programs along with other statewide partners including the NC Farm to Preschool Network, the WK Kellogg NC Farm to Childcare Initiative, the Farm to School Coalition of NC and the I-HOPE Advisory Committee for Early Care and Education Settings. She will also mentor an MCH dietetic intern in the summer of 2019. Finally, she will strengthen and engage in new partnerships aimed at creating policy and environmental change to make the healthy choice the easy choice for nutrition and physical activity especially for women, children/adolescents, and families. Examples of this work include supporting the new CDC State Physical Activity and Nutrition funding that was awarded to the CDIS; the new CDC Improving Student Health and Academic Achievement through Nutrition, Physical Activity, and the Management of Chronic Conditions in Schools funding awarded in FY19 to the NC DPI Healthy Schools program; serving on the Eat Smart Move More NC Advisory Committee for the development of the next state obesity plan; and continued collaboration with WIC and the Child and Adult Care Food Program. Last, but not least, the PNC will be involved with the next MCH Block Grant Needs Assessment.
The Pediatric Nutrition Course will continue to be offered online to NC public health nutritionists and open to other interested parties as space allows. In addition, the Child and Adult Care Food Program will continue to work on implementation of the new meal patterns by providing training and technical assistance. The program will also continue collaborating with DPI to streamline the process for school participation in the At-Risk After School Meal Program.
In FY20, the C&Y Branch will continue working with the NFP sites to strengthen their CABs. The CABs currently focus on developing referrals for the NFP program. Having developed good referral systems in each county, the Branch staff will request that CABs focus on marketing the NFP program in the community to increase awareness, interest, and ownership within the community and developing sustainability plans that include applications for local and philanthropic funding. In addition, CABs will be encouraged to include more parents, especially parents who have graduated from the NFP program. Families have been engaged with the planning and implementation of the NFP program at the state and local levels. Families serve on the state stakeholders group and are represented on local NFP CABs. Many of the parents who become involved at the local level as mentors to parents and members of local CABs are graduates of their NFP home visiting program.
During FY20, MEICHV will be working on a needs assessment and will collaborate with the Title V needs assessment. MIECHV will also continue Continuous Quality Improvement (CQI) work with each local implementing agency, examining data to inform ongoing improvement of the program. Some of the CQI projects include breastfeeding, client enrollment, and client retention.
MIECHV will continue working with a multi-state technical assistance grant State- level Home Visiting Integration with Early Childhood Data Systems (Project SHINE) to integrate MIECHV data into the NC Early Childhood Integrated Data System (ECIDS).
The MIECHV Team developed an online learning library based on the competencies needed for home visitors. The library includes a needs assessment, training modules, and quizzes. In FY20, the MIECHV program will submit the Learning Library to DHHS Office of Communications for publication on the DPH website. When approval has been received all home visiting programs will be invited to use the resource.
The Triple P State Learning Collaborative will continue to provide a learning environment in which coordinators from the ten regional sites representing all 100 NC counties will have access to a forum where they can meet to learn, share, and plan to determine best practices, offer collective problem solving and efficiencies, determine sustainability needs, and encourage model fidelity based on the Triple P Implementation Framework. The C&Y Branch and Triple P America will continue to offer support to the Collaborative. It is anticipated that the Collaborative will work with the Branch to develop a strategic plan that includes a statewide sustainability plan, a plan for billing Medicaid for Triple P services, and a plan to produce a statewide Triple P conference for coordinators, practitioners, and parents. Consultation and technical assistance will continue to be provided by the C&Y Branch’s Triple P Coordinator, data managers, and Data/QI Specialists. There will continue to be a strong focus on the statewide data collection and reporting system and use of data for program planning and evaluation, including state and local continuous quality improvement projects. The state Triple P Coordinator will continue developing a Triple P Implementation Manual which will be used by newly funded sites. One focus for FY20 will be practitioner training for Teen Triple P, Stepping Stones (for families of CSHCN), and Transitions (for families who are experiencing separation and divorce). A member of the C&Y BFPs attends and provides technical assistance at each of the quarterly Collaborative meetings. The Triple P Family Partner is a certified Triple P practitioner and serves as the liaison between the Triple P Program and the BFP. As a trained practitioner, she also delivers Triple P to parents and promotes Triple P through local parent organizations.
The Triple P Program has several opportunities moving forward. The C&Y Branch plans to continue partnering with the NC DSS to support Incredible Years and Strengthening Families cohorts in local communities and integrate those evidence-based family strengthening programs with Triple P. These initiatives are very compatible and integrate well with the Triple P program. DSS has added Triple P to their menu of approved family strengthening programs that can be supported by local DSS funds. In addition, DSS was awarded additional state appropriations for family strengthening in FY20. It is anticipated that these funds will be recurring in FY20 to support training additional practitioners and purchasing Triple P Online codes, following up with previously trained practitioners to ensure continues engagement, and further exploration of DSS partnerships. A second opportunity will be expansion beyond the ability of Title V funding to support Triple P. The Triple P Partnership for Strategy and Governance (PSG) has been convened of all the state level funders. The PSG will focus on funding allocations for the local implementing sites, setting benchmarks for saturation and scale up of Triple in local communities, identifying funding to continue to support the purchase of Stay Positive (website and print materials). Members of the PSG are DPH, DSS, DMH/SAS/DD, NC Partnership for Children, The Duke Endowment, and Juvenile Justice/DPS. Lastly, more efficient collection of data from practitioners and local implementing sites will continue to be an opportunity as Triple P expands to additional counties. Memorandums of agreement and local coordinator site visits continue to be executed to assure that the statewide data collection and reporting system includes all Triple P services.
To support the state level infrastructure and local implementation, the DSS will continue to fund The Impact Center at UNC-CH and Prevent Child Abuse NC to work with Triple P America as the state support system. The DSS has applied for and received notification that they will receive $10M to support the expansion of Triple P in local social service agencies. This funding will support a Level 4 LCSW and train all CPS workers in Level 3 in up to 40 counties in NC. As these local service agencies incorporate Triple P in their workplan in FY 20 and 21, it is hoped that this work will continue to be funded through ACF Families First dollars, which will also allow for the expansion into addition local social service agencies.
Triple P sites funded by Title V for implementation in FY14 will continue to use Title V funds as base funding to operate on a reduced maintenance level in FY20, with the funding being rolled forward to support maintenance of Triple P work in all the currently funded counties. The C&Y Branch is continuing to offer maintenance (or base funding) of the program with a regional coordinator who will lead regional sites. The regional sites will continue to consist of two or three previous sites combined to form ten regions across the state.
With the addition of state appropriations transferred from DSS, the DPH has been able to expand coverage to all 100 counties in NC. The focus for FY20 will be to reconnect with all the practitioners trained in the Triple P model to determine their status for continuing to provide Triple P services to families of children and teens. In addition, local Triple P coordinators will be reaching out to local DSS directors to determine how Triple P can best be used by DSS staff.
Title V funds will continue to provide support to the local implementing agencies, along with additional support from DSS, to maintain 3 local coordinators, support additional training for practitioners and purchase outreach and media materials to promote Triple P in their service area. The partnership between DPH, DSS and The Duke Endowment has supported the state-wide implementation of Triple P.
Two ICO4MCH project sites (covering seven counties) selected Triple P as one of their evidence-based strategies to improve health among children ages zero to five for FY20. An additional site chose to expand their Family Connects Home Visiting Program.
The SCCNC will continue to work collaboratively with programs within the C&Y Branch, as well as local and state partners, to establish and maintain links to promote health and safety in early learning environments. Specifically, the SCCNC will partner with the NC CCHSRC to support child care health consultation across NC supporting both local and regional based CCHCs. Two cohorts of approximately twelve newly hired local CCHCs will be trained and qualified in FY20. The CCHC Resource Library offered through Fabrik One will be maintained and enhanced to include information on current health and safety requirements, including recommendations for meeting best practice standards for child care facilities. The Resource Center will continue to offer trainings for CCHCs and affiliates online and in person. Measures will be initiated to reduce turnover and increase job stability of the CCHCs serving child care facilities. Furthermore, relationships will be built with local non-CCHC counties to establish these services. The Resource Center, with funding from the Child Development Block Grant, employees a Regional Child Care Nurse Consultant that serves as a coach for the western part of NC. Together these two positions will provide technical assistance and training opportunities across the state including, but not limited to, medication administration, emergency preparedness and response, vaccine preventable diseases, asthma, and allergies. A hiring/supervision manual has been developed for agencies and supervisors of CCHCs to be used by the NC Partnership for Children, local Smart Start partnerships, Resource and Referral Centers, and LHDs who directly fund local CCHCs.
In FY20, 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 the preschool services. 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 FY20, the WCHS will continue to collaborate with the North Carolina Childhood Lead Poisoning Prevention Program to help eliminated childhood lead poisoning. Strategies to promote elimination include the testing of water in schools and child cares statewide; a renewed emphasis on current testing and surveillance of children exposed to lead paint; and regulatory requirements for lead-free certification to be part of house transfers and apartment rentals.
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