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

The WCHS chose to continue to use NPM#10 (percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year) to monitor improvement with regard to Priority Need 6 (Improve access to mental/behavioral health services). Behavioral health screening is an important part of a preventive medical visit. Training has been provided to LHDs and school health centers on the use of behavioral health screening tools. Technical assistance has been provided by regional nurse consultants to connect adolescents with community-based services when needed. In addition, the C&Y Branch is partnering with DPI to increase support to adolescents through the Support Teams in each school, which includes a behavioral health specialist.

Supporting the Development of Teen Friendly Clinics

LHDs can choose to allocate Title V/351 Child Health Agreement Addenda funds to support the development of teen friendly clinics. A sample Attachment C template has been developed to assist LHDs in choosing evidence-based strategies to improve adolescent preventative care. The state and regional child health consultants and the PMC will share these strategies with LHDs as part of providing technical assistance to LHDs. The following are examples of strategies that can be used to provide more adolescent-focused preventive care:

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

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

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

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

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

Health Check Program Guide (HCPG) archived webinar trainings will continue to be required training components for LHD Public Health RNs who are enrolled in the CHTP to become CHERRNs. An onsite or virtual training regarding the current HCPG requirements/recommendations will continue to be presented to the students during Week Two of the CHTP. This training reviews the current HCPG requirements and recommendations that are based on the Bright Futures National Guidelines. Information about HCPG updates will also be provided using statewide live webinars when changes are made to the HCPG to keep Child Health clinical staff abreast of the current HCPG requirements.

The Branch Child Health Nurse Consultants (state and regional) and the PMC will continue to provide TA and training as needed to new LHD providers about the annual well adolescent visit. The Consultants and PMC will continue to provide specific TA with LHDs to improve confidentiality and share best practice strategies for interactions with adolescents and with use of LHD EHRs.

The CHTP is held once per year over a period of five months. The purpose of the CHTP is to train Public Health RNs to become CHERRNs. Once RNS are officially rostered as CHERRNs, they are considered billing providers with NC Medicaid and can provide well child preventative visits for clients from birth to twenty-one years of age. The role of the CHERRN is to improve access to care and to link children & adolescents with a medical home, if the LHD does not serve as a medical home.

The CHTP is an intense course that teaches RNs how to obtain a pediatric health history and perform a physical assessment for clients from birth to twenty-one years of age. Course content also includes CHERRN legal issues, confidentiality related to minor’s consent, adolescent health, behavioral health, nutrition assessment, and current HCPG requirements/recommendations.

One of the quarterly webinars offered to LHD staff will include an adolescent health topic. COVID-19 related webinars offered to LHDs by the Branch will include information related to adolescent emotional wellness and social connectedness. Continuing Professional Development to CHERRNs will continue to be provided for all of these webinars.

Annual School Nurse Conference

The Annual School Nurse Conference has been provided for the past 36 years and is attended by at least 50% of the state’s more than 1,300 school nurses. Participant evaluations and input from adolescents and parents support the planning and topics to be covered at the next year’s conference. The next conference will be held in the fall of 2021 depending on COVID-19 status at that time. Topics related to adolescent health are regularly included each conference year. Planning for the 2021 conference will begin in fall 2020. In addition to the Regional School Health Nurse Consultants, local school nurses and representatives from the NC Youth Health Advisory Council will participate on the planning committee.

School Health Center Credentialing

The SHU will continue to maintain credentialing/re-Credentialing processes with SHCs based on best practice guidelines. All documents submitted by SHCs scheduled for re-credentialing are reviewed by an interdisciplinary team (Behavior Health, Nutrition Services, Medical, and Preventive) within the SHU. Applicable and appropriate action is taken to evaluate SHCs for a credentialing status via a review of compliance with “Quality Assurance Standards” and a Medical Record Review of a minimum of ten random de-identified patient records for all applicable medical services provided. During FY21, SHCs will receive support/technical assistance as they plan and implement an appropriate COVID-19 prevention response with the schools where they are located.

NC Youth Public Health Advisor Program

During FY21, the Youth Public Health Advisory Team that was convened in FY20 will continue to meet quarterly to provide support to programs in the C&Y Branch that serve adolescents. This will be accomplished by designating Youth Advisors to planning teams that are developing or revising program policies and procedures. In FY21, a Youth Advisor will participate on the C&Y Opioid Action Team to make recommendations for strategies to reduce opioid use among adolescents and on the C&Y Branch Health Equity Quality Improvement Team to make recommendations about strategies to include in C&Y Branch programs to reduce health inequities in marginalized communities. In addition, the Youth Public Health Advisory Team will continue to use social media networking platforms to feature the Youth Advisors sharing pertinent and timely messages for teens such as the recent COVID-19 prevention video on YouTube and various and frequent alerts on Twitter.

Outreach Efforts to Medicaid and Health Choice Enrollees

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

Leadership Exchange for Adolescent Health Promotion

In FY21, DPH will be partnering with DPI on the first cohort of the Leadership Exchange for Adolescent Health Promotion (LEAHP), a learning collaborative aimed at building state education and health policymakers’ capacity to improve not only adolescent health, but a focus on sexual health education, sexual health services, and safe and supportive environments in schools. Participants of LEAHP benefit from peer-to-peer collaboration, in-depth training from subject matter experts, access to scientific research and data, and concentrated, state-specific technical assistance for the two-year project.

NC Telehealth Partnership for Child and Adolescent Psychiatric Access

WCHS will participate with the NC Telehealth Partnership for Child and Adolescent Psychiatric Access (NCTP-CAPA) implementation work during FY21. The purpose of the NCTP-CAPA is to support pediatric primary care providers with the timely identification, diagnosis, management, treatment, and referral as appropriate of children and youth with behavioral health concerns and conditions, with an emphasis on rural and underserved areas of the state. The four key objectives of the NCTP-CAPA are 1) Develop a multidisciplinary statewide network capable of providing mental health and telehealth support to pediatric primary care sites; 2) Enable pediatric primary care sites in every NC county access to timely and relevant mental health consultation; 3) Enable pediatric primary care providers in every NC county access to specialty care, community and/or behavioral health resources; and 4) Enable pediatric primary care sites in every NC county access to timely and relevant mental health education and training. During FY21 the project will be expanded to 21 of North Carolina’s 100 counties, although other counties may utilize the NC Psychiatric Access Line (NC-PAL).

School Mental Health Initiative and Social Emotional Learning

The C&Y Branch will continue to work with DPI and DMH/DD/SAS on mental health access and school mental health for adolescents as well as participating with DPI’s mental health initiatives for planning and implementation at the local level. In FY21, regional school nurse consultants will continue to support local school nurses as part of the School Resource Team to address behavioral issues, suicide and bullying in schools.

Triple P (Positive Parenting Program)

Triple P has been implemented in all 100 counties in NC and an adolescent component to help families manage behavioral problems is now available on-line for free for all NC residents. There is also a face-to-face adolescent component as described in the annual report. WCHS is working in partnership with other internal and external partners through the NC Triple P Partnership for Strategy and Governance (PSG) to support the continued implementation of Triple P which includes a focus on adolescents. Additionally, the PSG is convening the NC Triple P State Partners Coalition. The Coalition represents all the internal and external partners who either support and/or have a vested interest in the success of Triple P in North Carolina.

To strengthen the system of care for children and adolescents, representatives of the Children and Youth Branch and the State Title V Director and State Title V CYSHCN Director will continue to meet with the Home Visiting and Parenting Education Systems Planning group in FY21. The goal of the coalition is to provide a governance structure for family strengthening programs, survey family strengthening needs across counties in NC, and coordinate funding and data collection.