Priority 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’s five-year NCE4C initiative ends on August 31, 2023, but the Title V Office is applying for continued funding from the CDC for an additional five years of funding for NCE4C. If funding is received, the focus will include: 1) enhancing state-level surveillance infrastructure to collect, analyze and use ACE and positive childhood experiences (PCEs) data to inform prevention strategy implementation; 2) implement evidence-based ACEs primary prevention strategies and approaches; and 3) conduct data-to-action activities to inform changes or adaptations to existing prevention strategies. NCDPH will continue to leverage multi-sector partnerships.
The Title V Director and SMD will continue to be part of the leadership working on updates for the annual NC State Health Improvement Plan (NC SHIP) related to several HNC 2030 objectives related to women and children’s health. The SMD has been involved with the three groups which have met and will be voting to decide on the final action steps to address three HNC 2030 objectives related to ACEs, short term school suspensions and third grade reading. The focus for the short-term suspensions has been on addressing staff diversity and to address early care and learning suspensions. Local and state community leaders have been involved from different sectors: education, public safety, foundation, private agencies, etc.
The Title V CYSHCN Director, SMD and other DCFW/WCHS staff members will continue to help with the implementation of strategies developed and supported by the refresh of the NC ECAP and the foundational strategies from the Pathways to Grade Level Reading. The NC ECAP refresh focuses on four areas: food insecurity, permanent homes for children in foster care, high quality early learning settings, and infant mortality (addressing the racial disparity). Title V staff members will continue to add to an action map created by Pathways to Grade Level Reading 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, SMD. SCCNC, NC EHDI coordinator, Child Behavioral Health Unit staff, Infant Toddler Program Part C State Program Director, and other DCFW staff in the statewide efforts to address IECMH Consultation regarding 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.
In FY24, DCFW will reconstitute and convene an Early Childhood Matrix Team (ECMT). The ECMT will go through a strategic planning process over the next several months to determine priority area(s) internal and external to DCFW related to IECMH. A small planning group within DCFW met during FY23 to develop a strategic planning process and initial survey to start to assess the IECMH landscape that intersects with DCFW efforts. This planning group consisted of the SCHNC, SCCHC, EHDI coordinator, SMD, Title V CYSHCN director, two MIECHV program state level staff, and several behavioral health program staff. The proposed ECMT strategic planning process will include assessing the landscape by creating an inventory of internal and external data, efforts and partnerships and challenges; assessing how to address one or more elements of the IECMH priority: data, policy, work force, practice (i.e., screening, management and treatment), interface with families, and funding; determining data that needs to be collected to measure how we are achieving improvement on the identified internal and external priorities; and creating an action plan to address the priorities.
Efforts to Increase Screening for Developmental, Psychosocial, and Behavioral Health Concerns
The DCFW/WCHS SCHNC, RCHNCs, and the SMD will continue to include 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 arrangements.
The DCFW/WCHS SCHNC and RCHNCs resumed onsite monitoring and technical visits for LHDs in May 2022 while still offering the option to hold virtual visits through Microsoft Teams meetings. Prior to May 2022, onsite monitoring and technical assistance visits had been postponed for two years 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 to provide consultation and technical assistance. DCFW/WCHS staff members will continue to review child health services and provide technical assistance and education concerning best practices to LHD staff about well child visits which include developmental surveillance, screening, identification, management, and referral. The SMD 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 SMD, 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. DCFW/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 SMD, 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 holding a statewide Biennial Child Health Conference in FY25 will be explored in FY24. In the meantime, the SMD, SCHNC, and RCHNCs will continue to lead efforts to bring topics that 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 SMD, 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 FY24, 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 Child Abuse Prevention and Treatment Act 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 FY24 to promote the HOP and continue to coordinate care management efforts with 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 SMD will continue to authorize targeted case management, evaluation and management services offered by service providers at several CDSAs. The SMD 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. NC ITP management, CDSA leadership, the remaining physicians and advanced practice providers and the SMD will review the process for and content of 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 FY24, 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 FY24, 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 FY24. 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 FY24, the SCCNC will continue to work collaboratively with programs within the DCFW/WCHS and across Divisions, as well as with local and state partners, to establish and maintain links to promote and advocate for the health and safety of young children 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 83 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 early learning settings. The NC CCHSRC, 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. Three Regional CCHC coaches from the NC CCHSRC in addition to the SCCNC will continue to provide coaching services to CCHCs in FY24 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 SCCNC will partner with the Carolina Global Breastfeeding Institute and the NC CCHSRC to offer Breastfeeding Friendly Child Care train the trainer opportunities to Child Care Health Consultants and Birth-to-Three Specialists across the state to increase the number of trainers advocating, supporting, and promoting breastfeeding in the child care settings.
The CCHC Systems Workgroup, established in FY21, will continue its work in FY24. Outreach efforts by the SCCNC and regional CCHC coaches to promote and support hiring in counties that remain without local/regional coverage will continue.
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 Reach Out and Read (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. In addition, the SMD, 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 ROR with families and medical home providers. In addition, in FY24, 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 FY24 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
The North Carolina Partnership for Children (NCPC), which leads the statewide Smart Start Network and hosts the NC HVPE System, was awarded a $1 million grant from The Duke Endowment to support HVPE advocacy and system-building goals through 2027.
The HVPE System is led by a statewide collaborative board that includes partners who support the HVPE system in many roles – through funding, advocacy, policy, and research. The System’s goal is to ensure all families have access to a range of parenting education supports in early childhood to strengthen parent-child relationships and improve family and child well-being.
With funding from The Duke Endowment, the NC HVPE System will work to lay the foundation for creating a centralized intake system for HVPE services statewide that is based on community needs. The HVPE System will ensure decisions are coordinated across the state and are equitable, transparent, and data driven. Also, with the grant funding, the HVPE System will improve its infrastructure for coordinating across the state. Funding will also support a statewide HVPE expansion plan in collaboration with local communities. Communication tools developed with the funding will focus on equity and amplifying family and community voice.
During FY23, NC MIECHV successfully signed and completed Memorandums of Agreement (MOAs) for six of the seven LIAs for data sharing (two HFA LIAs and four NFP LIAs). The NC MIECHV CQI/Data Manager and NC MIECHV’s data partners have been working with the NC ECIDS Program Manager. Together, they have selected a subset of home visiting data to be shared and finalized the definitions and details of the data. NC MIECHV and their data partners have been granted access to NC ECIDS’ Secure File Transfer Protocol (SFTP) server for secure file transfers. The plan is to integrate home visiting data for these six LIAs by the end of FY24 before considering how to integrate the last MIECHV HFA LIA, as that process will be different due to their host agency and database system.
Nurse Family Partnership
NFP has been granted an additional $1.5 million dollars in the state budget to support sustainability and allow for expansion. This funding will enable NFP to serve at least 150 additional families across the state.
The NC NFP All-State Community of Practice will be held in November 2023. The first day will have a breakout session for all supervisors and a separate breakout session for the administrative assistants. The second day will be for all NFP staff including the nurse home visitors. These sessions will be in person with the option to participate virtually. Northeast NC NFP at Halifax Community College will be hosting the event.
NC Child Fatality Prevention System
In FY24, the state CFPT Coordinator will continue to:
- Provide opportunities for local CFPT chairs and review coordinators to collaborate and share ideas, questions, and conversation about their work.
- Provide webinars to local CFPTs on pertinent topics such as member engagement, creative approaches to prevention work, and meeting facilitation.
- Collaborate with partners to conduct interactive webinars on fatality or injury topics of interest.
- Conduct training needs assessments with all 100 local CFPTs through the annual activity survey.
- Accept quarterly reports from local CFPT and submit an annual report to the State Child Fatality Prevention Team and the CFTF.
- Provide individualized trainings to new CFPT Chairpersons and support county level staff taking on CFPT responsibilities.
- Conduct monitoring activities for 33 local teams via virtual meetings and site visits.
- Update the report form local CFPT’s use when reviewing resident child fatality cases in order to collect additional data points and distribute aggregate data state-wide.
- Onboard all local CFPTs with completion of an ‘Operating Procedures’ document to supplement the statewide CFPT procedural manual by outlining the operations of each individual team.
Additional Strategies to Promote Child Health
In FY24, 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 insurance will also be provided. On-site vision screening services will continue to occur as well as conducting multi-county trainings and certifications of vision screeners to assure qualified personnel are conducting screenings.
In FY24, 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 continue to share the revised guidelines for lead screening with a lower blood reference level. In FY24, the SMD and a RCHNC will work with the NC Childhood Lead Poisoning Prevention Program and other partners to review the materials and guidance.
As with previous action plans, the PNC will continue in FY24 to integrate breast/chest and human milk feeding 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 CYSHCN. 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.
The PNC will also continue collaborative partnerships with the NC Partnership for Children, Go NAPSACC, Integrating Healthy Opportunities for Physical activity and Eating (I-HOPE), the CDIS SPAN grant staff, the State Child Care Health Consultant, the Community and Nutrition Services Section (WIC and Child and Adult Care Food Program [CACFP]), the Food & Nutrition Services Section, 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 FY24 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.
Other work for FY24 includes work planned by the PNC for FY23 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 nutritional needs identified during preventive dental visits.
Priority Need 5. Improve immunization rates to prevent vaccine-preventable diseases
Vaccines for Children Program Strategies
In FY24, 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 FY24. Although Tele-IQIP Visits are now authorized as a permanent option for conducting IQIP, the IB plans to conduct in-person visits when applicable or necessary. 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 a custom CDC-approved strategy titled, “Address Health Disparities in Immunization Coverage” 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 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 FY24, 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 and well child visit rates.
The SMD 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 improving COVID-19, influenza and other childhood vaccination rates in children and adolescents and addressing vaccine hesitancy.
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