III.E.2.c. State Action Plan - Child Health - Application Year - North Carolina - 2022
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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 Interim Title V CYSHCN Director and other WCHS staff will continue to participate on committees to help with the implementation of strategies developed and supported by many early childhood leaders as part of the Pathways to Grade-Level Reading efforts which helped to form the NC Early Childhood Action Plan (ECAP). NC ECAP goals include healthy babies (infant mortality and especially disparities), preventive health services, safe and nurturing relationships, food security, safe and secure housing, and social emotional health and resilience. Pathways to Grade-Level Reading committees continue to work on gathering information about shared, whole child, birth-to-age-eight measures that put children on a pathway to grade-level reading; identifying and coordinating strategies to support children’s optimal development beginning at birth through efforts such as development of a statewide Pathways Action Map; and aligning policies and practices that are rooted in how children develop.
In addition, there will continue to be participation of the Interim Title V CYSHCN director and other WCHS staff in the EarlyWell Initiative advisory committee and to help review the products from twelve work groups on strategies that use an equity lens, acknowledge the impact of racism and poverty, suggest changes in how providers and systems engage families and provide TA to medical homes. The EarlyWell Initiative began in Fall 2019 as the NC Initiative on Young Children’s Social Emotional Health. This initiative is led by NC Child, in collaboration with early childhood leaders including the NC Early Childhood Foundation, to enact recommendations from the Pathways to Grade-Level Reading Action Framework and to build a robust, evidence-based, and accessible early childhood social-emotional health system in NC. The goal of Pathways was modified to be more inclusive of children with all abilities and is not that NC children, regardless of race, ethnicity or socioeconomic status, are reading on grade level by the endo of third grade, and all children with disabilities achieve expressive and receptive communication skills commensurate with their developmental ages to that they have the greatest opportunity for life success.
Due to priorities having to shift because of COVID-19 needs, during FY21, the Early Childhood Matrix Team, which was previously convened as part of the Early Childhood Comprehensive Systems grant and comprised of program staff across the WCHS, was not able to meet. During FY22, the Early Childhood Matrix Team plans to reform and meet quarterly 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 FY22 will align with priorities of DPH 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.
One measure of the WCHS’ success at promoting safe, stable, and nurturing relationships will be the new SPM#2 (Percent of children with two or more Adverse Childhood Experiences (ACEs) as measured through the NSCH). This indicator was also selected as one of the Healthy North Carolina 2030 indicators and is part of the Early Childhood Action Plan. In FY22, programs providing direct services to clients will regularly assess infants, children, and youth for two or more ACEs. Programs and services supported by Title V and implemented at the local level include CMARC, the Child Health Program in LHDs, Title V and MIECHV supported home visiting, child care health consultation, Triple P, SHCs, the EHDI program, and school health services.
Efforts to Increase Screening for Developmental, Psychosocial, and Behavioral Health Concerns
The WCHS has chosen to continue to use NPM#6 (Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed tool in the past year) and the corresponding ESM#9 (Number of training opportunities to LHD providers on appropriate use of valid and reliable developmental, psychosocial, social determinants of health, and behavioral health screening tools for children during state fiscal year) to monitor its success at increasing appropriate developmental screenings for children.
The C&Y Branch Regional Child Health Nurse Consultants (RCHNCs) and the PMC will continue to provide at least quarterly updates and/or trainings for child health clinical staff in LHDs. The conference planned for fall 2021 was not able to be provided due to COVID-19. During FY21 almost monthly trainings were provided related to care of children related to COVID-19 with additional topics related to child health. These included technical assistance on new Medicaid requirements for well visits and newborn home visits allowed via telehealth, child care and school health and safety issues, and the need for use of developmental, psychological, social determinants of health and behavioral health assessments especially during COVID-19, based on recommendations from CDC, HRSA, and AAP.
C&Y Branch RCHNCs 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 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 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.
Several staff will continue to serve on the state stakeholder advisory committee of the EarlyWell Initiative with a focus on increasing screening, identification and management of social emotional health. The PMC will continue to serve on the Medical Home Work Group to address how to best increase the knowledge, skills and abilities of medical homes to promote relational health and screen, identify, and manage social emotional concerns and social drivers (include structural racism) using a family-centered equity lens. Additionally, the NC ITP will be implementing the ASQ-SE statewide.
Efforts to Improve Preventive, Screening, Assessment, Diagnostic, and Treatment Health and Well-Being Services
The state and regional nurse consultants, along with assistance from the PMC, will coordinate the annual CHTP which is planned to run from August 2021 to March 2022. The PMC and state and regional child health nurse consultants plan to hold statewide webinars to provide child health programmatic updates as well as address additional topics such as ACEs/toxic stress, opioid/substance abuse related to children/adolescents, foster care transition, motivational interviewing, and family engagement. A statewide Child Health Conference was not and continues not to be possible due to ongoing commitments and requirements from local health departments due to COVID-19 testing, contact tracing, and vaccination. Although a statewide Annual Child Health Conference will not be scheduled, the PMC and the state and regional child health nurse consultants will continue to provide Child Health Provider webinars with the opportunity to earn nursing continuing professional development (NCPD) contact and Certified in Public Health (CPH) recertification hours.
The PMC and SCHNC in partnership with other WCHS staff and outside stakeholders will hold a minimum of three live webinars from June 2021 – November 2021 to provide additional CH Program Updates on topics such as food insecurity, interpersonal/domestic violence and its impacts on children & adolescents, housing, transportation, child care health consultation, as well as other topics of interest. Child health provider web-based trainings and updates will continue to be held monthly. To assist with delivery of appropriate screenings based on the most current HCPG requirements and recommendations, the PMC and the state and regional child health consultants, in partnership with the NC Public Health Nurse and Professional Developmental Unit consultants, will explore providing one training to all child health staff and continue providing one training for the CHERRN CHTP program participants. In addition, they will provide ongoing technical assistance to CHERRNs, physicians, and advance practice practitioners in LHDs as needed.
The SWYC, which was first required for use as a screening tool with all CMARC-engaged families in April 2018, will continue to be used as a required screening tool. 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 CMARC staff will continue to provide LTSAE, Triple P, and the Small Moments, Big Impact materials to promote child development and strong parent-child relationships. The NC ITP also promotes the LTSAE campaign both on its website and by sharing it with families seen at the CDSAs.
The CMARC program will continue collaboration 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 Interagency Collaborative. The CMARC program will continue to support staff in the transition to Virtual Health/Care Impact documentation platform system. 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.
With the launch of NC Medicaid Managed Care occurring 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 that meeting the program population criteria
The Triple P System in NC consists of the NC State Partnership for Strategy and Governance (PSG), the NC Triple P Support System (Triple P America, The Impact Center at UNC at Chapel Hill, and Prevent Child Abuse NC), the Design Team (The Impact Center and Triple P America), the State Triple P Partners Coalition, and the Lead Implementing Agencies (LIAs). In FY20, a five-year Scale-Up Plan was developed by the Design Team to support the work of the PSG and the LIAs.
The C&Y Branch is continuing to offer maintenance (or base funding) of the program with a Triple P LIA Regional Coordinator who will lead the ten LIA regional sites. In FY22, the LIAs will begin implementation of their Year One Plan as part of the Model Scale-Up Five-Year Plan. The Support Team will be working with each LIA to assess the training and support needs of local practitioners to deliver Triple P as part of their work.
The Triple P State Learning Collaborative, consisting of all the coordinators at the LIAs, will continue to provide a learning environment in which coordinators can meet to learn, share, and plan to implement 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 will continue to support the Triple P System in NC through Title V funding by employing a State Triple P Coordinator, funding the LIAs for infrastructure and training support with Title V funding, and providing a part-time data specialist to work in conjunction with the C&Y Data Manager to support state-wide data collection and reporting and using data for local CQI projects.
The C&Y Branch will 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 as those initiatives are very compatible and integrate well with the Triple P program. The C&Y Branch will also receive funds from DSS to provide additional funding for the LIAs and provide a co-chair for the PSG.
DSS has added Triple P to their menu of approved family strengthening programs that can be supported by local DSS funds. In addition, DSS has applied for grant funding to expand Triple P into local DSS agencies. In FY22, funds will continue to be used to hire a Level IV trained practitioner in up to 20 local DSSs, plus train all the CPS case workers in Level III. CPS case workers will deliver Triple P in the home and then refer high need cases to the Level IV practitioner. This same strategy will be incorporated into DSS’s application for Family First funding.
Demonstrating ongoing strength of the Triple P program, it is important to note that two ICO4MCH project sites (covering seven counties) will continue to implement Triple P as one of their evidence-based strategies to improve health among children ages zero to five for FY22. An additional site chose to expand their Family Connects Home Visiting Program.
Child Care Health Consultants
The C&Y Branch 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 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.
In addition to the C&Y SCCNC, the NC CCHSRC, with funding from the Child Development Block Grant and Title V, employees three Regional Child Care Nurse Consultants that serve as coaches for the north central, south central and western parts of NC. Together with the SCCNC providing coaching services to the eastern part of the state, these CCHC coaches provide ongoing support to local CCHCs, helping them to maintain model fidelity to the NC CCHC Service Model. The SCCNC and the Regional Child Care Nurse Consultants provide the medication administration train the trainer course, as well as serve as instructors for the NC CCHC Course.
Beginning in FY21 and continuing in FY22, a statewide work group consisting of representatives from the NC CCHSRC, DPH, DCDEE, NCPC, LHDs and local Smart Start agencies are developing a governance structure for CCHC in NC, as well as a strategic plan with short term and long term vision and goals to ensure sustainability of child care health consultation. Additionally, through Child Development Block Grant funding, DCDEE has committed to fund CCHC expansion to all 100 counties. The goal is to have a local or regional CCHC assigned to support every county in NC with sustainable funding and infrastructure support. As these local CCHCs are hired, the NC CCHSRC will add additional training sessions to assure that local CCHCs are equipped to provide appropriate consultation and technical assistance related to health and safety per NC Administrative Rules and NC Star Rating System. In FY22, the PNC will work with the SCCNC and the NC CCHSRC to enhance training and resources for CCHC’s addressing enhanced nutrition for infants and toddlers (children aged birth – three).
Child Health Agreement Addenda
The C&Y Branch will continue to refine the 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 FY22 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 Coalitions; 16. Addressing Food Insecurity and/or Healthier Food Access; and 17. Gun Safety Locks and Lock Boxes.
NC Child Fatality Prevention System
The CFTF Executive Director position, formerly in the C&Y Branch, has been moved to NCDHHS for better coordination of policy activities. The C&Y Branch through Title V continues to support the CFTF and local CFPTs as well as the state CFPT Coordinator.
In FY22, 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.
- 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 safe sleep.
- Update the Local CFPT Review Guide.
Home Visiting Parenting Education (HVPE) Collaborative
Given the complexities of the current home visiting and parenting education landscape and the multiple invested stakeholders and funding, an inclusive, structured planning process was needed to develop a comprehensive, statewide system encompassing both home visiting and parent education in NC. In FY20, a Home Visiting and Parenting Education (HVPE) Collaborative was convened to assess the current system, identify and coordinate funding sources, establish a governance system, and standardize data collection and reporting with the goal to create a family-centered, coordinated system that uses current resources effectively and includes planning and activities ensuring high quality services can be scaled up to be accessible and offered in an equitable manner. In FY22, these system planning efforts will move towards implementation with the expected hiring of a HVPE System Director. The Title V Director co-chairs the effort and the Title V CYSHCN Director are members of this coalition. The C&Y Branch uses a combination of Title V, MIECHV, and state appropriations to fund NFP and HFA home visiting and Triple P.
In FY22, the C&Y Branch will continue working with the NFP sites to strengthen their CABs. The CABs have focused on referrals for the NFP program in past years. Having developed good referral systems in each county, Branch staff will provide technical assistance to local CABs to 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.
The NFP National Service Office (NSO) has hired a Government Affairs Manager to work at the state level to identify sustainability opportunities at existing sites. All NFP sites in NC are now documenting on standardized assessment forms. This was developed in collaboration with the State Nurse Consultants and the NFP NSO.
One MIECHV funded NFP site will expand its reach by adding another county to their multi-county site.
MIECHV staff members will continue working to integrate MIECHV data in the NC Early Childhood Integrated Data System (ECIDS). A monthly email is sent out to home visitors with professional development opportunities which include webinars, journal articles, and local conferences/ trainings. Partnering agencies are in the process of adopting a set of core competencies for home visitors and parenting educators in NC.
Additional Strategies to Promote Child Health
The C&Y Branch and the EIB will continue their enduring partnerships with agencies and organizations such as NC Child, the NCPS, the NC Academy of Family Physicians, ECAC, NC Partnership for Children, Family Support Network, Carolina Institute for Developmental Disabilities, and Prevent Child Abuse NC. In FY22, they will also support and participate in initiatives such as the EarlyWell Initiative and Navigating Pathways to Coordinated Care for Children with Autism Spectrum Disorder and Developmental Disabilities. In addition, they will support the use of NCCARE360 care management to support children, birth to five years, needing community-based supports to address health and social determinants of health issues. The WCHS will also continue to work with Duke and other partners to expand the NC Telehealth Partnership for Child and Adolescent Psychiatry (NCTP-CAPA) and the use of NC-PAL to support primary care providers with private practices and child health clinics in LHDs with the timely identification, diagnosis, management, treatment and referral as appropriate for children with mental or behavioral health concerns.
In FY22, 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. The CHTP will continue to include training on vision system assessment and will share the archived webinar with child health clinic staff in LHDs.
In FY22, the WCHS will continue to collaborate with the NC Childhood Lead Poisoning Prevention Program to help eliminate childhood lead poisoning. Strategies to promote elimination include the testing of water in schools and child care facilities 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. The CHTP will continue to include updated training on lead screening and prevention for students and share the archived webinar with LHDs.
As with previous action plans, the PNC will continue in FY22 to integrate breastfeeding education, family engagement and Life Course Nutrition into the Child Health program through trainings conducted as part of the 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 1 year $91K ASPHN/CDC Farm to ECE Implementation Grant (FIG) that began Nov. 1, 2020 and will end of October 31, 2021 https://asphn.org/farm-to-ece-grantees-programs/. 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 FY22, the PNC and Network partners will wrap up their 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 Coalition of NC Steering Committee, a statewide Coalition she helped form in 2014. In FY22, the PNC will serve on the interview team for hiring a full-time Coalition assistant (with funding from BCBSNC); 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 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 FY22 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.
Other worked planned by the PNC for FY22 is an emphasis on 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
The federal Vaccines for Children Program (VFC) was established after a measles epidemic in the United States and became operational in the fall of 1994 under section 1928 of the Social Security Act. VFC is an entitlement program for eligible children, age 18 and younger. Provider recruitment to maintain a strong public health infrastructure helps assure high immunization coverage levels and low incidence of vaccine-preventable diseases. The IB distributes vaccines at no charge to private and public VFC enrolled providers to vaccinate children whose parents or guardians may not be able to afford them. This helps ensure that children have a better chance of getting all the recommended vaccinations on schedule. Collaborative efforts include community engagement with existing and new partnerships are essential for increasing vaccination coverage and improving vaccine acceptance. The IB provides accurate and consistent focused training to its stakeholders about vaccination of infants, children, and adults.
The IB uses vaccine ordering data from VFC providers to determine which providers are high-volume and order both adolescent and childhood vaccines. At the state level, providers who have low coverage and high patient volume, and who see both children and adolescents, will be selected to receive Immunization Quality Improvement for Providers (IQIP) visits. Providers located in geographically underserved areas or in areas where outbreaks of vaccine preventable disease occur are prioritized and will be seen first. Immunization data from the NC Immunization Registry (NCIR), a web-based statewide-computerized immunization information system that maintains and consolidates immunization records, is used to assess provider-level vaccination coverage. Regional immunization consultants run an initial assessment report to evaluate coverage and work with providers to identify practice strengths and weaknesses and implement strategies to increase vaccine uptake to improve immunization coverage. Providers are trained to use the NCIR reports to track children who are overdue for immunizations, confirm data accuracy and completeness of records, and make any needed corrections in the NCIR. The regional immunization consultants will run assessment reports a second time after corrections are made to re-evaluate coverage. Providers are asked to monitor data quality on an ongoing basis. The IB completes a centralized statewide immunization assessment annually for all children 24 through 35 months of age from the NCIR. Immunization coverage assessment results are provided to each LHD. Quality improvement strategies are discussed to improve coverage and compliance with NC immunization laws.
National Immunization Survey
At the national level, CDC uses the National Immunization Survey (NIS) to monitor vaccination coverage among children 19-35 months and teens 13-17 years, and flu vaccinations for children 6 months to 17 years. The surveys are sponsored and conducted by the National Center for Immunization and Respiratory Diseases (NCIRD) of the CDC and authorized by the Public Health Service Act [Sections 306]. Data collection for the first survey began in April 1994 to check vaccination coverage after measles outbreaks in the early 1990s. The NIS provides current, population-based, state and local area estimates of vaccination coverage among children and teens using a standard survey methodology. Estimates of vaccination coverage are determined for child and teen vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), and children and teens are classified as being up to date based on the ACIP-recommended numbers of doses for each vaccine.
Additional WCHS Immunization Activities
The Child Health Program will promote immunizations for children and youth according to AAP/Bright Futures schedule as part of the well-child visit. Information and updates will 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 review 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 North Carolina is a marked decrease in the rates of well child visits and childhood vaccinations. In FY22, WCHS will continue to monitor vaccination rates closely and work with partners on outreach and sharing of best practices to increase vaccination rates. 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 is working again 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 COVID-19 and influenza vaccines. NCDHS will also continue to engage with diverse state and community partners 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 about COVID-19 vaccination.
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 Interim Title V CYSHCN Director and other WCHS staff will continue to participate on committees to help with the implementation of strategies developed and supported by many early childhood leaders as part of the Pathways to Grade-Level Reading efforts which helped to form the NC Early Childhood Action Plan (ECAP). NC ECAP goals include healthy babies (infant mortality and especially disparities), preventive health services, safe and nurturing relationships, food security, safe and secure housing, and social emotional health and resilience. Pathways to Grade-Level Reading committees continue to work on gathering information about shared, whole child, birth-to-age-eight measures that put children on a pathway to grade-level reading; identifying and coordinating strategies to support children’s optimal development beginning at birth through efforts such as development of a statewide Pathways Action Map; and aligning policies and practices that are rooted in how children develop.
In addition, there will continue to be participation of the Interim Title V CYSHCN director and other WCHS staff in the EarlyWell Initiative advisory committee and to help review the products from twelve work groups on strategies that use an equity lens, acknowledge the impact of racism and poverty, suggest changes in how providers and systems engage families and provide TA to medical homes. The EarlyWell Initiative began in Fall 2019 as the NC Initiative on Young Children’s Social Emotional Health. This initiative is led by NC Child, in collaboration with early childhood leaders including the NC Early Childhood Foundation, to enact recommendations from the Pathways to Grade-Level Reading Action Framework and to build a robust, evidence-based, and accessible early childhood social-emotional health system in NC. The goal of Pathways was modified to be more inclusive of children with all abilities and is not that NC children, regardless of race, ethnicity or socioeconomic status, are reading on grade level by the endo of third grade, and all children with disabilities achieve expressive and receptive communication skills commensurate with their developmental ages to that they have the greatest opportunity for life success.
Due to priorities having to shift because of COVID-19 needs, during FY21, the Early Childhood Matrix Team, which was previously convened as part of the Early Childhood Comprehensive Systems grant and comprised of program staff across the WCHS, was not able to meet. During FY22, the Early Childhood Matrix Team plans to reform and meet quarterly 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 FY22 will align with priorities of DPH 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.
One measure of the WCHS’ success at promoting safe, stable, and nurturing relationships will be the new SPM#2 (Percent of children with two or more Adverse Childhood Experiences (ACEs) as measured through the NSCH). This indicator was also selected as one of the Healthy North Carolina 2030 indicators and is part of the Early Childhood Action Plan. In FY22, programs providing direct services to clients will regularly assess infants, children, and youth for two or more ACEs. Programs and services supported by Title V and implemented at the local level include CMARC, the Child Health Program in LHDs, Title V and MIECHV supported home visiting, child care health consultation, Triple P, SHCs, the EHDI program, and school health services.
Efforts to Increase Screening for Developmental, Psychosocial, and Behavioral Health Concerns
The WCHS has chosen to continue to use NPM#6 (Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed tool in the past year) and the corresponding ESM#9 (Number of training opportunities to LHD providers on appropriate use of valid and reliable developmental, psychosocial, social determinants of health, and behavioral health screening tools for children during state fiscal year) to monitor its success at increasing appropriate developmental screenings for children.
The C&Y Branch Regional Child Health Nurse Consultants (RCHNCs) and the PMC will continue to provide at least quarterly updates and/or trainings for child health clinical staff in LHDs. The conference planned for fall 2021 was not able to be provided due to COVID-19. During FY21 almost monthly trainings were provided related to care of children related to COVID-19 with additional topics related to child health. These included technical assistance on new Medicaid requirements for well visits and newborn home visits allowed via telehealth, child care and school health and safety issues, and the need for use of developmental, psychological, social determinants of health and behavioral health assessments especially during COVID-19, based on recommendations from CDC, HRSA, and AAP.
C&Y Branch RCHNCs 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 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 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.
Several staff will continue to serve on the state stakeholder advisory committee of the EarlyWell Initiative with a focus on increasing screening, identification and management of social emotional health. The PMC will continue to serve on the Medical Home Work Group to address how to best increase the knowledge, skills and abilities of medical homes to promote relational health and screen, identify, and manage social emotional concerns and social drivers (include structural racism) using a family-centered equity lens. Additionally, the NC ITP will be implementing the ASQ-SE statewide.
Efforts to Improve Preventive, Screening, Assessment, Diagnostic, and Treatment Health and Well-Being Services
The state and regional nurse consultants, along with assistance from the PMC, will coordinate the annual CHTP which is planned to run from August 2021 to March 2022. The PMC and state and regional child health nurse consultants plan to hold statewide webinars to provide child health programmatic updates as well as address additional topics such as ACEs/toxic stress, opioid/substance abuse related to children/adolescents, foster care transition, motivational interviewing, and family engagement. A statewide Child Health Conference was not and continues not to be possible due to ongoing commitments and requirements from local health departments due to COVID-19 testing, contact tracing, and vaccination. Although a statewide Annual Child Health Conference will not be scheduled, the PMC and the state and regional child health nurse consultants will continue to provide Child Health Provider webinars with the opportunity to earn nursing continuing professional development (NCPD) contact and Certified in Public Health (CPH) recertification hours.
The PMC and SCHNC in partnership with other WCHS staff and outside stakeholders will hold a minimum of three live webinars from June 2021 – November 2021 to provide additional CH Program Updates on topics such as food insecurity, interpersonal/domestic violence and its impacts on children & adolescents, housing, transportation, child care health consultation, as well as other topics of interest. Child health provider web-based trainings and updates will continue to be held monthly. To assist with delivery of appropriate screenings based on the most current HCPG requirements and recommendations, the PMC and the state and regional child health consultants, in partnership with the NC Public Health Nurse and Professional Developmental Unit consultants, will explore providing one training to all child health staff and continue providing one training for the CHERRN CHTP program participants. In addition, they will provide ongoing technical assistance to CHERRNs, physicians, and advance practice practitioners in LHDs as needed.
The SWYC, which was first required for use as a screening tool with all CMARC-engaged families in April 2018, will continue to be used as a required screening tool. 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 CMARC staff will continue to provide LTSAE, Triple P, and the Small Moments, Big Impact materials to promote child development and strong parent-child relationships. The NC ITP also promotes the LTSAE campaign both on its website and by sharing it with families seen at the CDSAs.
The CMARC program will continue collaboration 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 Interagency Collaborative. The CMARC program will continue to support staff in the transition to Virtual Health/Care Impact documentation platform system. 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.
With the launch of NC Medicaid Managed Care occurring 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 that meeting the program population criteria
The Triple P System in NC consists of the NC State Partnership for Strategy and Governance (PSG), the NC Triple P Support System (Triple P America, The Impact Center at UNC at Chapel Hill, and Prevent Child Abuse NC), the Design Team (The Impact Center and Triple P America), the State Triple P Partners Coalition, and the Lead Implementing Agencies (LIAs). In FY20, a five-year Scale-Up Plan was developed by the Design Team to support the work of the PSG and the LIAs.
The C&Y Branch is continuing to offer maintenance (or base funding) of the program with a Triple P LIA Regional Coordinator who will lead the ten LIA regional sites. In FY22, the LIAs will begin implementation of their Year One Plan as part of the Model Scale-Up Five-Year Plan. The Support Team will be working with each LIA to assess the training and support needs of local practitioners to deliver Triple P as part of their work.
The Triple P State Learning Collaborative, consisting of all the coordinators at the LIAs, will continue to provide a learning environment in which coordinators can meet to learn, share, and plan to implement 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 will continue to support the Triple P System in NC through Title V funding by employing a State Triple P Coordinator, funding the LIAs for infrastructure and training support with Title V funding, and providing a part-time data specialist to work in conjunction with the C&Y Data Manager to support state-wide data collection and reporting and using data for local CQI projects.
The C&Y Branch will 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 as those initiatives are very compatible and integrate well with the Triple P program. The C&Y Branch will also receive funds from DSS to provide additional funding for the LIAs and provide a co-chair for the PSG.
DSS has added Triple P to their menu of approved family strengthening programs that can be supported by local DSS funds. In addition, DSS has applied for grant funding to expand Triple P into local DSS agencies. In FY22, funds will continue to be used to hire a Level IV trained practitioner in up to 20 local DSSs, plus train all the CPS case workers in Level III. CPS case workers will deliver Triple P in the home and then refer high need cases to the Level IV practitioner. This same strategy will be incorporated into DSS’s application for Family First funding.
Demonstrating ongoing strength of the Triple P program, it is important to note that two ICO4MCH project sites (covering seven counties) will continue to implement Triple P as one of their evidence-based strategies to improve health among children ages zero to five for FY22. An additional site chose to expand their Family Connects Home Visiting Program.
Child Care Health Consultants
The C&Y Branch 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 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.
In addition to the C&Y SCCNC, the NC CCHSRC, with funding from the Child Development Block Grant and Title V, employees three Regional Child Care Nurse Consultants that serve as coaches for the north central, south central and western parts of NC. Together with the SCCNC providing coaching services to the eastern part of the state, these CCHC coaches provide ongoing support to local CCHCs, helping them to maintain model fidelity to the NC CCHC Service Model. The SCCNC and the Regional Child Care Nurse Consultants provide the medication administration train the trainer course, as well as serve as instructors for the NC CCHC Course.
Beginning in FY21 and continuing in FY22, a statewide work group consisting of representatives from the NC CCHSRC, DPH, DCDEE, NCPC, LHDs and local Smart Start agencies are developing a governance structure for CCHC in NC, as well as a strategic plan with short term and long term vision and goals to ensure sustainability of child care health consultation. Additionally, through Child Development Block Grant funding, DCDEE has committed to fund CCHC expansion to all 100 counties. The goal is to have a local or regional CCHC assigned to support every county in NC with sustainable funding and infrastructure support. As these local CCHCs are hired, the NC CCHSRC will add additional training sessions to assure that local CCHCs are equipped to provide appropriate consultation and technical assistance related to health and safety per NC Administrative Rules and NC Star Rating System. In FY22, the PNC will work with the SCCNC and the NC CCHSRC to enhance training and resources for CCHC’s addressing enhanced nutrition for infants and toddlers (children aged birth – three).
Child Health Agreement Addenda
The C&Y Branch will continue to refine the 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 FY22 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 Coalitions; 16. Addressing Food Insecurity and/or Healthier Food Access; and 17. Gun Safety Locks and Lock Boxes.
NC Child Fatality Prevention System
The CFTF Executive Director position, formerly in the C&Y Branch, has been moved to NCDHHS for better coordination of policy activities. The C&Y Branch through Title V continues to support the CFTF and local CFPTs as well as the state CFPT Coordinator.
In FY22, 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.
- 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 safe sleep.
- Update the Local CFPT Review Guide.
Home Visiting Parenting Education (HVPE) Collaborative
Given the complexities of the current home visiting and parenting education landscape and the multiple invested stakeholders and funding, an inclusive, structured planning process was needed to develop a comprehensive, statewide system encompassing both home visiting and parent education in NC. In FY20, a Home Visiting and Parenting Education (HVPE) Collaborative was convened to assess the current system, identify and coordinate funding sources, establish a governance system, and standardize data collection and reporting with the goal to create a family-centered, coordinated system that uses current resources effectively and includes planning and activities ensuring high quality services can be scaled up to be accessible and offered in an equitable manner. In FY22, these system planning efforts will move towards implementation with the expected hiring of a HVPE System Director. The Title V Director co-chairs the effort and the Title V CYSHCN Director are members of this coalition. The C&Y Branch uses a combination of Title V, MIECHV, and state appropriations to fund NFP and HFA home visiting and Triple P.
In FY22, the C&Y Branch will continue working with the NFP sites to strengthen their CABs. The CABs have focused on referrals for the NFP program in past years. Having developed good referral systems in each county, Branch staff will provide technical assistance to local CABs to 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.
The NFP National Service Office (NSO) has hired a Government Affairs Manager to work at the state level to identify sustainability opportunities at existing sites. All NFP sites in NC are now documenting on standardized assessment forms. This was developed in collaboration with the State Nurse Consultants and the NFP NSO.
One MIECHV funded NFP site will expand its reach by adding another county to their multi-county site.
MIECHV staff members will continue working to integrate MIECHV data in the NC Early Childhood Integrated Data System (ECIDS). A monthly email is sent out to home visitors with professional development opportunities which include webinars, journal articles, and local conferences/ trainings. Partnering agencies are in the process of adopting a set of core competencies for home visitors and parenting educators in NC.
Additional Strategies to Promote Child Health
The C&Y Branch and the EIB will continue their enduring partnerships with agencies and organizations such as NC Child, the NCPS, the NC Academy of Family Physicians, ECAC, NC Partnership for Children, Family Support Network, Carolina Institute for Developmental Disabilities, and Prevent Child Abuse NC. In FY22, they will also support and participate in initiatives such as the EarlyWell Initiative and Navigating Pathways to Coordinated Care for Children with Autism Spectrum Disorder and Developmental Disabilities. In addition, they will support the use of NCCARE360 care management to support children, birth to five years, needing community-based supports to address health and social determinants of health issues. The WCHS will also continue to work with Duke and other partners to expand the NC Telehealth Partnership for Child and Adolescent Psychiatry (NCTP-CAPA) and the use of NC-PAL to support primary care providers with private practices and child health clinics in LHDs with the timely identification, diagnosis, management, treatment and referral as appropriate for children with mental or behavioral health concerns.
In FY22, 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. The CHTP will continue to include training on vision system assessment and will share the archived webinar with child health clinic staff in LHDs.
In FY22, the WCHS will continue to collaborate with the NC Childhood Lead Poisoning Prevention Program to help eliminate childhood lead poisoning. Strategies to promote elimination include the testing of water in schools and child care facilities 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. The CHTP will continue to include updated training on lead screening and prevention for students and share the archived webinar with LHDs.
As with previous action plans, the PNC will continue in FY22 to integrate breastfeeding education, family engagement and Life Course Nutrition into the Child Health program through trainings conducted as part of the 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 1 year $91K ASPHN/CDC Farm to ECE Implementation Grant (FIG) that began Nov. 1, 2020 and will end of October 31, 2021 https://asphn.org/farm-to-ece-grantees-programs/. 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 FY22, the PNC and Network partners will wrap up their 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 Coalition of NC Steering Committee, a statewide Coalition she helped form in 2014. In FY22, the PNC will serve on the interview team for hiring a full-time Coalition assistant (with funding from BCBSNC); 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 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 FY22 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.
Other worked planned by the PNC for FY22 is an emphasis on 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
The federal Vaccines for Children Program (VFC) was established after a measles epidemic in the United States and became operational in the fall of 1994 under section 1928 of the Social Security Act. VFC is an entitlement program for eligible children, age 18 and younger. Provider recruitment to maintain a strong public health infrastructure helps assure high immunization coverage levels and low incidence of vaccine-preventable diseases. The IB distributes vaccines at no charge to private and public VFC enrolled providers to vaccinate children whose parents or guardians may not be able to afford them. This helps ensure that children have a better chance of getting all the recommended vaccinations on schedule. Collaborative efforts include community engagement with existing and new partnerships are essential for increasing vaccination coverage and improving vaccine acceptance. The IB provides accurate and consistent focused training to its stakeholders about vaccination of infants, children, and adults.
The IB uses vaccine ordering data from VFC providers to determine which providers are high-volume and order both adolescent and childhood vaccines. At the state level, providers who have low coverage and high patient volume, and who see both children and adolescents, will be selected to receive Immunization Quality Improvement for Providers (IQIP) visits. Providers located in geographically underserved areas or in areas where outbreaks of vaccine preventable disease occur are prioritized and will be seen first. Immunization data from the NC Immunization Registry (NCIR), a web-based statewide-computerized immunization information system that maintains and consolidates immunization records, is used to assess provider-level vaccination coverage. Regional immunization consultants run an initial assessment report to evaluate coverage and work with providers to identify practice strengths and weaknesses and implement strategies to increase vaccine uptake to improve immunization coverage. Providers are trained to use the NCIR reports to track children who are overdue for immunizations, confirm data accuracy and completeness of records, and make any needed corrections in the NCIR. The regional immunization consultants will run assessment reports a second time after corrections are made to re-evaluate coverage. Providers are asked to monitor data quality on an ongoing basis. The IB completes a centralized statewide immunization assessment annually for all children 24 through 35 months of age from the NCIR. Immunization coverage assessment results are provided to each LHD. Quality improvement strategies are discussed to improve coverage and compliance with NC immunization laws.
National Immunization Survey
At the national level, CDC uses the National Immunization Survey (NIS) to monitor vaccination coverage among children 19-35 months and teens 13-17 years, and flu vaccinations for children 6 months to 17 years. The surveys are sponsored and conducted by the National Center for Immunization and Respiratory Diseases (NCIRD) of the CDC and authorized by the Public Health Service Act [Sections 306]. Data collection for the first survey began in April 1994 to check vaccination coverage after measles outbreaks in the early 1990s. The NIS provides current, population-based, state and local area estimates of vaccination coverage among children and teens using a standard survey methodology. Estimates of vaccination coverage are determined for child and teen vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), and children and teens are classified as being up to date based on the ACIP-recommended numbers of doses for each vaccine.
Additional WCHS Immunization Activities
The Child Health Program will promote immunizations for children and youth according to AAP/Bright Futures schedule as part of the well-child visit. Information and updates will 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 review 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 North Carolina is a marked decrease in the rates of well child visits and childhood vaccinations. In FY22, WCHS will continue to monitor vaccination rates closely and work with partners on outreach and sharing of best practices to increase vaccination rates. 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 is working again 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 COVID-19 and influenza vaccines. NCDHS will also continue to engage with diverse state and community partners 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 about COVID-19 vaccination.
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