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North Carolina’s Strategies to Connect
    K-12 Students to Health Care




     Healthy and Ready to Learn Webinar Training
                  December 11, 2012
Webinar Agenda
                       Healthy and Ready to Learn Project:
       North Carolina’s Strategies to Connect K-12 Students to Health Care
11:00 am – 11:10 am: Welcome and introduction to Healthy and Ready to Learn project in 2012 -2013
                  Steve Shore, Executive Director, NC Pediatric Society;
                  Ania Boer, HRL Project Director

11:10 am – 11:25 am: Health Check (Medicaid) and NC Health Choice (SCHIP) – children’s health insurance
                  programs in North Carolina
                  Norma Martí, Public Health Minority Outreach Coordinator, NC DPH

11:25 am - 11:40 am: School outreach strategies for K-12 students, Guidelines and Ordering Materials for 2012 -13
                   Ania Boer, HLR Project Director
                  Betty Macon, India Foy, Laura Brewer, HRL Local Community Coordinators

11:40 am – 11:50 am: School nursing and public health supporting Healthy and Ready to Learn
                  Ann Nichols , School Health Nurse Consultant, NC DPH
                  Cheryl Herberg, President, School Nurse Association of NC
11:50 am – 12:00 pm: Q&A
N.C. Healthy and Ready to Learn Project:

• Funded by CHIPRA in 2009-2011
   Children’s Health Insurance Program Reauthorization Act
   – 16 high-need pilot counties outreach in 2010
   – 32 counties added in 2011 (845 schools)


• Continuation funded by NC Office of Rural Health and
  Community Care from Oct. 2011 until August 2013
   – Expansion from kindergarten to elementary schools (950 schools)
   – Expansion to middle and high schools (950 + 745 = 1,695 schools)
   – 60 LEAs in 46 counties
Healthy and Ready to Learn Initiative
                                                                               Child Health Insurance Outreach Schools
                                                                                                                                     Includes Elkin City & Mount Airy City
                                             Includes Lexington City & Thomasville City                                                                                                                          Includes Weldon City & Roanoke Rapids
                                                                                                                                                        Includes Asheboro City

                                            Includes Mooresville City                            Alleghany                                                                                                                     Northampton
                                                                                        Ashe                                                                                                                                                                      Gates        Camden
                                                                                                                  Surry            Stokes       Rockingham       Caswell       Person
                                                                                                                   11                                                                             Vance Warren                                                                             Currituck
                                                                                                                                                    17                                  Granville 10                                                   Hertford              Pasquotank
                                                                              Watauga                                                                                                                                       Halifax
                                                                                                Wilkes                                                                                                                                                                    Perquimans
                               Includes                                                                           Yadkin                                                                                                     11
                                                                                                 13
                               Asheville City                             Avery                                                   Forsyth                                  Orange                                                                                 Chowan
                                                                                                                                    42           Guilford     Alamance                                Franklin
                                                                                                                                                   69                                                                                              Bertie
                                                                   Mitchell                                                                                      21             Durham
                                                                                   Caldwell                                                                                                                       Nash
                                                          Yancey                                Alexander                 Davie                                                   29                               17       Edgecombe
                                                Madison                                                      Iredell                                                                                                           5
                                                                                                                                                                                                                                                  Martin      Washington
                                                                                                               21              Davidson                                                     Wake                                                                                 Tyrrell
                                                                    McDowell Burke                                                                                                                                                                  5                                          Dare
                                                                                                                                  22            Randolph           Chatham                                        Wilson               Pitt
                                                                              17
                                                                                               Catawba                    Rowan                 23                                                                                     20
                                                   Buncombe                                       25                        20                                                                                                                           Beaufort
                                     Haywood          26                                                                                                                                           Johnston                                                                     Hyde
                       Swain                                                                   Lincoln                                                                                                                     Greene
                                                                      Rutherford                                       Cabarrus                                          Lee      Harnett             22
             Graham                                Henderson             1o                                               24             Montgomery                       8          12                          Wayne
                                  Jackson                          Polk            Cleveland    Gaston                            Stanly     5                                                                    15
                                                                                     18          29    Mecklenburg                  16                         Moore                                                        Lenoir
                                        Transylvania                                                                                                                                                                        8                 Craven
                          Macon                                                                                                                                                                                                                              Pamlico
  Cherokee                                                                                                                                                                      Cumberland                                                      15
     7          Clay                                                                                                                                                              48
                                                                          Includes Hickory                              Union           Anson     Richmond             Hoke                                                           Jones
                                                                                                                                                                                                                 Duplin
                                                                          City & Newton                                  29               6           9                                        Sampson             8
                                                                                                                                                                                                  9
                                                                          Conover City                                                                      Scotland                                                                                        Carteret
                                                                                                                                                               9
                                                                                                                                                                                                                                     Onslow
CONTACT:                                                                                                                Includes Kannapolis City                        Robeson             Bladen
                                                                                                                                                                                                                                       19
Ania Boer, Project Director, (ania@ncpeds.org, 919-839-1156)                                                                                                             23                    7
                                                                                                                                                                                                                   Pender

Local Community Coordinators:
                                                                                                                                                                                        Columbus
Laura Brewer (laura@ncpeds.org, 910-865-5507)                                                                                                                                            10
                                                                                                                                                                                                                 New Hanover
                                                                                                                                                                                                                     24
Anson, Bladen, Brunswick, Buncombe, Cherokee, Cleveland, Columbus, Cumberl                                                                                                                           Brunswick                      Includes Clinton City
and, Davidson, Gaston, Montgomery, New                                                                                                                                                                   9
                                                                           Includes Whiteville City
Hanover, Randolph, Robeson, Rutherford, Scotland, Richmond, Union.

Betty Macon (betty@ncpeds.org, 252-822-3340)
Craven, Duplin, Durham, Edgecombe, Halifax, Harnett, Johnston, Lee, Lenoir, Ma
                                                                                                                                                             Total of 46 counties
rtin, Nash, Onslow, Pitt, Sampson, Vance, Wayne.                                                                                                             (60 LEAs)
India Foy (india@ncpeds.org, 336-617-6628)
Alamance, Burke, Cabarrus, Catawba, Forsyth, Guilford, Iredell, Rockingham, Ro
                                                                                                                                                             1,695 schools (950 elementary, 745
wan, Stanly, Surry, Wilkes.                                                                                                                                  middle and high)
N.C. Healthy and Ready to Learn project:
•    School-targeted outreach and enrollment effort to register all
    “eligible and uninsured” children in grades K-12 into child health
    insurance programs Health Check or NC Health Choice

•   Partnership of Local Education Agencies, School
    Nurses, SHACs, State Agencies (DPI, DPH, DMA), Physicians and
    community-based organizations, supported by the Office of
    Governor and State Superintendent

• HRL Steering Committee has 49 members
•   Identifies uninsured students through school outreach,
    Kindergarten Health Assessment and other forms
Why is Healthy and Ready to Learn important?
• All children need healthcare coverage and medical home to
  stay healthy
• Because healthy children learn better!
• Students need to be healthy to learn and graduate from
  high school
• Students’ health status is linked to absenteeism and
  performance
• It supports one of the State Board of Education goals:
  “Healthy and responsible students”
• Children learn about healthcare system by experiencing it
• More children need health insurance in economic recession
HRL Grant Agreement 2012-2013
A. The XXX Schools will receive a $1,000 grant per county for LEA use at discretion to
    offset modest expenses and:
1. Designate a school representative, such as school nurse or school
    office/administrative staff, to be a contact person to assist the NC Pediatric
    Society Foundation’s outreach efforts to find uninsured school students, and to
    participate in the training Webinar to be held at 11 am on December 11, 2012
    (details will follow);

2. Use the HRL grant for: staff time to assist with tasks like distributing Health Check/
    NC Health Choice outreach materials, paying for school nurses to participate in
    professional development, organize SHAC meetings or to support activities that
    promote assistance to families who may be eligible for NC’s health insurance;

3. Provide feedback, data and lessons learned and/or suggestions to improve the
    project, report quarterly an estimate of the number of families assisted, and invite
    HRL staff to at least one of your SHAC meetings.
HRL Grant Agreement 2012-2013 – Cont.
B. The North Carolina Pediatric Society Foundation will:

1.   Provide a $1,000 grant per county for LEA(s) to use at your discretion
     as described above between Nov. 19, 2012 and August 31, 2013 to
     support HRL goals;
2. Host the Healthy and Ready to Learn Steering Committee and provide
   regular updates to all agencies and organizations represented plus
   LEA partners, and present at the SHAC meeting;
3. Inform principals in your LEA about the HRL participation after
    November 19, 2012, unless your system prefers to do so directly.
    NOTE: Please inform your principals by Nov. 19, 2012.
HRL Data Collection Form

Please enter the number of K-12 students/their families who were
provided information through brochure, envelope
stuffer, application, personal assistance or at school events about Health
Check/NC Health Choice children’s insurance. Email completed forms to
your HRL Local Community Coordinator each quarter.
 October - December 2012
 Total # of families/children assisted this quarter:
 Other/Notes:

 January - March 2013

 April – June 2013

 July - August 2013
Evaluation of Healthy and Ready to Learn in 2011-2012
UNC-G, Center for Youth, Family and Community Partnership survey results
  (113 respondents):
•   Strong to moderate support of HRL’s effectiveness
•   Success of HRL implementation:
     – benefited families,
     – educated parents and enabled children access to regular health care,
     – children coming to school with fewer health issues,
     – gave options to those with chronic illnesses or need of mental health services
     – personal gratification to HRL school partners

•   Challenges to enroll children into HC/NCHC:
     – find new ways to identify uninsured and eligible students,
     – contact and encourage parents to enroll their children,
     – increase involvement of different school staff members,
     – expand HRL outreach beyond elementary school
Evaluation of Healthy and Ready to Learn – Cont.
Distribution of outreach materials:
Year 1 (Jan. 2010-Sept. 2010), 16 pilot counties: 61,983
Year 2 (Oct. 2010 – Sept. 2011), 48 counties: 202,912
Year 3 (Oct. 2011 – Sept. 2012), 46 counties: 270,000
Total for all years: ~535,000

Number of children/families assisted by school nurses or school staff:
Year 1 – approximately 1,000 between July 2011-Sept. 2011 for 16 pilot
   counties (no data collected prior to)
Year 2 – approximately 56,300
Year 3 – 127,874
Total – approximately 185,000+
NC’s Public Programs Providing
                            Quality Health Care for Kids:
                            Health Check / NC Health Choice




                   Health Check/NC Health Choice & Medical Home
                   Healthy & Ready to Learn Webinar, December 11, 2012




Children and Youth Branch
School Outreach Strategies
How to find uninsured children?
• Review school forms with health insurance status
    –   Kindergarten Health Assessment Form,
    –   Health assessments,
    –   School Registration,
    –   Sports Physicals,
    –   Field Trip,
    –   School Health Contact,
    –   Emergency Contact forms.


• Add a question about insurance if forms don’t have it
• Follow up with outreach materials or in-person
  information, as appropriate
HRL Training Webinar_12.11.12
Example: Onslow County Schools Health Services
HEALTH CARE INFORMATION

Student’s Name ______________________________________ Grade/Teacher ___________________
Where your student gets regular health care:     Student has:
 1 Health Department                              1 Medicaid              3 No Insurance
 2 Hospital Clinic                             2 Private Insurance/HMO  4 Other: _____________
 3 Community Health Center                    Doctor/ Practice Name:
 4 Private Doctor/HMO
    _____________________________________
 5 Other __________________                   Dentist Name:
 6 No regular place
    _____________________________________

 I would like information on free/low cost health insurance for my student.
Forward to School Nurse
What can school staff and SHAC members do?

•   Review school forms to check if child has health insurance

•   Remind families to complete all “Parent complete” parts
    on the KHA, emergency contact, field trip forms, etc.

•   Always share those three pieces: promotional
    materials, an application form and address of the local
    DSS with families of uninsured children

•   Parents are more likely to apply if they see income
    guidelines based on family size so keep outreach materials
    on hand

•   Promote child health insurance at school events
What can school staff and SHAC members do - cont?
• Put into operation ideas from bi-weekly HRL Outreach Hints emailed
  on Wednesdays

• Check Healthy and Ready to Learn Facebook page for updates and
  strategies

• Think of and share middle and high school outreach ideas with HRL
  staff and other LEAs

• Implement at least three school-based outreach ideas provided by
  HRL at your LEA
Guidelines to Sustaining Healthy and Ready to Learn (HRL)
               Outreach in Elementary Schools

1. Include HRL on SHAC agendas and identify a person
   responsible for updates on child health insurance outreach.
2. Include child health insurance outreach materials at
   kindergarten orientations every year.
3. Display child health insurance information during school’s
   open houses.
4. Check Kindergarten Health Assessment forms to see if a
   child has health insurance. Share Health Check/NC Health
   Choice information with those who are uninsured.
Guidelines to Sustaining Healthy and Ready to Learn (HRL)
               Outreach in Elementary Schools
5. Add health insurance status questions to current school
    forms such as emergency information cards collected at the
    beginning of school year, field trip forms, school health
    forms, etc. Share HC/NCHC information with those who
    indicate no insurance coverage.
6. Check a child’s health insurance status based on parent
   reports and Parent Policy Booklets’ signature sections.
7. Share HC/NCHC information during school registrations.
8. Include a link to child health insurance information:
   http://www.nchealthystart.org/public/childhealth/index.htm
   on your school’s webpage.
Guidelines to Sustaining Healthy and Ready to Learn (HRL)
               Outreach in Elementary Schools

9. Ask about child health insurance status during vision/dental
    screenings and 5th & 6th grade vaccination requirements.
10. Include HRL and child health insurance information during
    staff meetings, support team meetings such as principal,
    social worker, teacher, school nurse meetings.
11. Orient new school staff members about child health
    insurance and HRL.
12. Present HRL at Parent Advisory Councils, PTAs, PTOs and
    other parent groups.
13. Add HC/NCHC outreach information to health referrals.
Guidelines to Sustaining Healthy and Ready to Learn (HRL)
               Outreach in Elementary Schools
14. Display HC/NCHC poster in prominent school locations
     where parents can see it.
15. Send outreach materials with school report cards.
16. Include HC/NCHC information with free or reduced school
    lunch applications and/or acceptance letters and summer
    lunch programs.
17. Use your school’s voice system Alert Now/Connect Ed to
    share child health insurance information. For a ready-to-use
    script, go to Sept. 20, 2012 HRL Facebook post at:
    http://www.facebook.com/HealthyandReadytoLearn.
    Update the annual income guidelines every April 1.
Middle and high school outreach focus
•   Send HC/NCHC info with report cards
•   Opportunity to contact students directly, not only parents
•   Message to teens needs to be positive, informative and why they need it
•   Use social communication technologies:
      – Text messages to students (parental permission needed, come from school’s medical
          professional)
•   Peer-to-peer messages work best
•   Pick teen champion to share it with other students (video/TV club, school newspaper)
•   Include HRL in Health and Safety, Wellness, PE classes
•   School-based health centers to share information
•   Collaborations with school clubs and their Presidents and Advisors
•   Utilize school announcement system with direct message
•   Involve schools’ counselors, psychologist, PE teachers (beside social workers and school
    nurse)
•   Driver ED – add insurance status
Outreach in middle and high schools
                 What are other LEAs doing?
                                    Central region:

•   Placing brochures in the office waiting room and the visitor “sign-in” area
•   Include brochures in the “new student” packets
•   Add HC/NCHC materials and applications to the mobile unit and inquire about
    coverage during intake
•   Review health/PE forms for status of insurance
•   Send info and applications to parents when the school nurse is providing referrals
    for vision or hearing screenings
•   Send HC/NCHC envelope stuffers home with report cards
Outreach in middle and high schools
                What are other LEAs doing?
                                Southwestern region:

•   Partner with allies for teens such as:
     – TOP - Teen Outreach Programs,
     – Advocates for Teens,
     – Beta Clubs,
     – FHA clubs
•   Collaborate with Nutrition Director to obtain a list of every child, by school, in the
    LEA, who has an outstanding school cafeteria bill of over $100 and determine if
    these students are eligible for F/R Lunch and thus may also be eligible for Health
    Check or NC Health Choice
Middle and high schools
                      What are other LEAs doing?
                           Northeast region
•   Attach HC/NCH info to student athletic physical forms which are required for participation
    in middle and high school sports
•   Distribute NC health insurance information during sports physical examination clinics held
    at school sites
•   Provide NC health insurance materials to middle and high school students during 1-on-1
    health office visits and/or to class groups during health presentations
•   Attach materials to nurse referrals
•   Review annual student health information forms and follow-up as needed
•   Place NC health insurance posters and materials in school nurse office, guidance offices and
    school office
•   Provide materials at sporting events, Open Houses/Orientation, "Parent Nights"
•   Send fact sheet home with report cards
•   Use televised announcements
School Nursing and Public Health

Supporting Healthy and Ready to
         Learn Project
Ann Nichols, State School Nurse Consultant, NC Division of Public Health

 Cheryl Herberg, President, School Nurse Association of North Carolina




         “Working for a healthier and safer North Carolina”
Division of Public Health
• Long-term sustainability is critical
• Assuring access to care as a forethought, not
  afterthought.
• Institutionalizing the project
  – Goal of State Division of Public Health
  – Goal of Children and Youth Branch of DPH
  – Goal of School Health Unit of DPH
           “Working for a healthier and safer North Carolina”
School Nurse Association
           of North Carolina
SNANC is committed to assisting the HRL
Initiative with the following :
• MOU understanding
• Presentation of program at Executive
  Committee meetings
• Support initiative at all regional meetings in
  Fall and Spring throughout the state
Factors Influencing Health Outcomes
                                          Public Policies


                                           Community &
                                           Environment

                                          Clinical Personal
                                           Care Behavior
                                               Health




Source: Robert Wood Johnson Foundation. “Overcoming Obstacles to Health: Report from the Robert
Wood Johnson Foudnation to the Commisssion to Build a Healthier America.” February 2008.
2020 Healthy People

   Increase the proportion of adolescents who have had a
          wellness check-up in the past 12 months.

                                 68.7 percent of adolescents aged 10 to
Baseline:                        17 years had a wellness checkup in the
                                 past 12 months, as reported in 2008
Target:                          75.6 percent
Target-Setting Method:           10 percent improvement
                                 National Health Interview Survey
Data Source:
                                 (NHIS), CDC, NCHS
HRL Project Strategies:
 Focus on Middle and High Schools Students
   through School Nurse and Community

School Nurse Point of Service is a time to observe
insurance status.
• Siblings of referred students
• Teacher referrals
• Student referral teams
Adolescents are also old enough to be
aware of health insurance.
• Speak directly with student
• Include benefits of insurance in health
      promotion opportunities
School Nurse Opportunities for
        Insurance Referral

6th grade Tdap requirement
College immunizations
Acute illness
Vision screening follow up
 One-on-one
  health counseling
YOU can make a difference!
                     10 HRL Actions Steps:
1.   Share information about the Healthy and Ready to         3.   Review school forms to check
     Learn and child health insurance programs, Health             insurance status .
     Check/NC Health Choice, with school staff and all your
     SHAC members (This PowerPoint will be posted at:         4.   Hang a HC/NCHC poster so
     www.NCPedsFoundation.org ).                                   that families can see it.


2.   Order free (English/Spanish) outreach materials, i.e.
     fact sheets (D4, D4BR), envelope stuffers
     (D3), applications (D6E, D6S) and poster (D5) from
     your HRL Local Community Coordinator or
     download materials in English, Spanish and other
     languages at:
     http://www.nchealthystart.org/outreach/index.html
YOU can make a difference!
                              HRL Actions Steps:

5.   Give outreach materials to families        7.   Create or implement the Guidelines and outreach
     with uninsured children and those               ideas in your school system. For example, include
     who mark “no insurance” on KHA and               HRL on SHAC agendas and identify a person
     other school forms. Be sure to share: a          responsible for updates on child health insurance
     flier with income guidelines (fact sheet         outreach.
     or envelope stuffer), an application,
     and the address of the local DSS.               If your school has a Pre-K program, please reach out
                                                     to families of 4-year old children.
6. Consider following up with families to
   see if they need help enrolling and offer    8.   Please help us keep track of the number of families
   them resources such as                            you assist. Every quarter we will ask for an
   www.NCHealthyStart.org and the                    approximate number of K-12 families you have
   local DSS.                                        reached.
YOU can make a difference!
                           HRL Actions Steps:
9.   Call us if you need help with ordering materials, scripting a
     message, need a cover letter to send to families, or want us to
     mail you fliers with DSS addresses by county.

     Local Community Coordinators for HRL are:
     Laura H. Brewer (south/west region, office in Robeson
     County), laura@ncpeds.org, 910-865-5507, Betty Macon
     (north/east region, office in Halifax
     County), betty@ncpeds.org, 252-822-3340, and India Foy
     (central/west region, office in Guilford
     County), india@ncpeds.org,
     336-617-6628.

     Visit www.NCPedsFoundation.org and
     https://www.facebook.com/HealthyandReadytoLearn
     for outreach tools and resources!

     Like Us on Facebook and check our page often.
Healthy and Ready to Learn Project
                                                            Local Community Coordinators

Project Director
Ania Boer, ME, MA                                                           C: Central Region
1100 Wake Forest Road, Ste 200                                                                                                                                         NE: Northeast Region
                                                                            India Foy, MPH
Raleigh, NC 27604                                                           Greensboro, NC
                                                                                                                                                                       Betty Macon
919 839-1156                                                                336-617-6628                                                                               Roanoke Rapids, NC
FAX: 919-839-1158                                                           india@ncpeds.org                                                                           252-822-3340
ania@ncpeds.org                                                                                                                                                        betty@ncpeds.org


                                                                   Alleghany                                                                 Vance                     Northampton              Gates           Currituck
                                                           Ashe                  Surry                 Rockingham
                                                                                            Stokes                  Caswell          Granville   Warren
                                                                                                                              Person                                                    Hertford
                                                     Watauga        Wilkes                                                                                     Halifax
                                                                                Yadkin                           Alamance
                                        Mitchell Avery                                     Forsyth                     Orange                   Franklin                                Bertie
                                                       Caldwell                                         Guilford                                           Nash
                                     Yancey                     Alexander           Davie                                   Durham
                             Madison                                                                                                                                Edgecombe                              Tyrrell
                                                    Burke              Iredell           Davidson                                      Wake                                            Martin     Washington          Dare
                                                                                                       Randolph     Chatham                                Wilson
                               Buncombe McDowell              Catawba               Rowan                                                                                    Pitt
                                                                                                                                                                                             Beaufort
             Swain      Haywood                                   Lincoln                                                                   Johnston                Greene                                  Hyde
                                              Rutherford                           Cabarrus       Montgomery             Lee
    Graham                       Henderson                                                                                      Harnett                Wayne
                     Jackson
                             Transylvania
                                           Polk        ClevelandGaston                     Stanly          Moore
                                                                                                                                                                    Lenoir          Craven
                                                                            Mecklenburg
Cherokee     Macon
        Clay                                                                                                                   Cumberland                                                       Pamlico
                                                                                               Anson     Richmond      Hoke                 Sampson                          Jones
                                                                                   Union                                                                   Duplin
                                                                                                                  Scotland                                               Onslow          Carteret
                                                                                                                          Robeson      Bladen
                                                                                                                                                       Pender


                                        S & SW: Southern & Southwestern Region                                                      Columbus                 New
                                        Laura H. Brewer                                                                                                      Hanove
                                        St. Pauls/Lumberton                                                                                    Brunswick
                                        910-865-5507
                                        laura@ncpeds.org

                                                                                                                                                                                                                     December 2010
North Carolina Pediatric Society Foundation
              Healthy and Ready to Learn project team:

           Steve Shore, MSW, Executive Director, NCPS-F
        Ania Boer, ME, MA, Project Director, ania@ncpeds.org

  Laura Brewer, Local Community Coordinator for south/western region
      (office in Robeson County), laura@ncpeds.org, (910) 865-5507
India Foy, MPH, Local Community Coordinator for central/western region
       (office in Guilford County), india@ncpeds.org, 336-617-6628
   Betty Macon, Local Community Coordinator for northeastern region
       (office in Halifax County), betty@ncpeds.org, (252) 822-3340

                  1100 Wake Forest Road, Suite 200
                        Raleigh, NC 27604
                       Phone: (919) 839-1156
                        Fax: (919) 839-1158
                    www.NCPedsFoundation.org
North Carolina Pediatric Society Foundation
 Healthy and Ready to Learn project team:

       Steve Shore, Executive Director




                                Ania Boer, Project Director




                      From Left:
                      Betty Macon, Local Community Coordinator
                      for northeastern region,
                      Laura H. Brewer, Local Community Coordinator for
                      south/western region,
                      India Foy, Local Community Coordinator for
                      central/western region
Thank you for your continued support of the
   Healthy and Ready to Learn Project!
                   Q&A

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HRL Training Webinar_12.11.12

  • 1. North Carolina’s Strategies to Connect K-12 Students to Health Care Healthy and Ready to Learn Webinar Training December 11, 2012
  • 2. Webinar Agenda Healthy and Ready to Learn Project: North Carolina’s Strategies to Connect K-12 Students to Health Care 11:00 am – 11:10 am: Welcome and introduction to Healthy and Ready to Learn project in 2012 -2013 Steve Shore, Executive Director, NC Pediatric Society; Ania Boer, HRL Project Director 11:10 am – 11:25 am: Health Check (Medicaid) and NC Health Choice (SCHIP) – children’s health insurance programs in North Carolina Norma Martí, Public Health Minority Outreach Coordinator, NC DPH 11:25 am - 11:40 am: School outreach strategies for K-12 students, Guidelines and Ordering Materials for 2012 -13 Ania Boer, HLR Project Director Betty Macon, India Foy, Laura Brewer, HRL Local Community Coordinators 11:40 am – 11:50 am: School nursing and public health supporting Healthy and Ready to Learn Ann Nichols , School Health Nurse Consultant, NC DPH Cheryl Herberg, President, School Nurse Association of NC 11:50 am – 12:00 pm: Q&A
  • 3. N.C. Healthy and Ready to Learn Project: • Funded by CHIPRA in 2009-2011 Children’s Health Insurance Program Reauthorization Act – 16 high-need pilot counties outreach in 2010 – 32 counties added in 2011 (845 schools) • Continuation funded by NC Office of Rural Health and Community Care from Oct. 2011 until August 2013 – Expansion from kindergarten to elementary schools (950 schools) – Expansion to middle and high schools (950 + 745 = 1,695 schools) – 60 LEAs in 46 counties
  • 4. Healthy and Ready to Learn Initiative Child Health Insurance Outreach Schools Includes Elkin City & Mount Airy City Includes Lexington City & Thomasville City Includes Weldon City & Roanoke Rapids Includes Asheboro City Includes Mooresville City Alleghany Northampton Ashe Gates Camden Surry Stokes Rockingham Caswell Person 11 Vance Warren Currituck 17 Granville 10 Hertford Pasquotank Watauga Halifax Wilkes Perquimans Includes Yadkin 11 13 Asheville City Avery Forsyth Orange Chowan 42 Guilford Alamance Franklin 69 Bertie Mitchell 21 Durham Caldwell Nash Yancey Alexander Davie 29 17 Edgecombe Madison Iredell 5 Martin Washington 21 Davidson Wake Tyrrell McDowell Burke 5 Dare 22 Randolph Chatham Wilson Pitt 17 Catawba Rowan 23 20 Buncombe 25 20 Beaufort Haywood 26 Johnston Hyde Swain Lincoln Greene Rutherford Cabarrus Lee Harnett 22 Graham Henderson 1o 24 Montgomery 8 12 Wayne Jackson Polk Cleveland Gaston Stanly 5 15 18 29 Mecklenburg 16 Moore Lenoir Transylvania 8 Craven Macon Pamlico Cherokee Cumberland 15 7 Clay 48 Includes Hickory Union Anson Richmond Hoke Jones Duplin City & Newton 29 6 9 Sampson 8 9 Conover City Scotland Carteret 9 Onslow CONTACT: Includes Kannapolis City Robeson Bladen 19 Ania Boer, Project Director, (ania@ncpeds.org, 919-839-1156) 23 7 Pender Local Community Coordinators: Columbus Laura Brewer (laura@ncpeds.org, 910-865-5507) 10 New Hanover 24 Anson, Bladen, Brunswick, Buncombe, Cherokee, Cleveland, Columbus, Cumberl Brunswick Includes Clinton City and, Davidson, Gaston, Montgomery, New 9 Includes Whiteville City Hanover, Randolph, Robeson, Rutherford, Scotland, Richmond, Union. Betty Macon (betty@ncpeds.org, 252-822-3340) Craven, Duplin, Durham, Edgecombe, Halifax, Harnett, Johnston, Lee, Lenoir, Ma Total of 46 counties rtin, Nash, Onslow, Pitt, Sampson, Vance, Wayne. (60 LEAs) India Foy (india@ncpeds.org, 336-617-6628) Alamance, Burke, Cabarrus, Catawba, Forsyth, Guilford, Iredell, Rockingham, Ro 1,695 schools (950 elementary, 745 wan, Stanly, Surry, Wilkes. middle and high)
  • 5. N.C. Healthy and Ready to Learn project: • School-targeted outreach and enrollment effort to register all “eligible and uninsured” children in grades K-12 into child health insurance programs Health Check or NC Health Choice • Partnership of Local Education Agencies, School Nurses, SHACs, State Agencies (DPI, DPH, DMA), Physicians and community-based organizations, supported by the Office of Governor and State Superintendent • HRL Steering Committee has 49 members • Identifies uninsured students through school outreach, Kindergarten Health Assessment and other forms
  • 6. Why is Healthy and Ready to Learn important? • All children need healthcare coverage and medical home to stay healthy • Because healthy children learn better! • Students need to be healthy to learn and graduate from high school • Students’ health status is linked to absenteeism and performance • It supports one of the State Board of Education goals: “Healthy and responsible students” • Children learn about healthcare system by experiencing it • More children need health insurance in economic recession
  • 7. HRL Grant Agreement 2012-2013 A. The XXX Schools will receive a $1,000 grant per county for LEA use at discretion to offset modest expenses and: 1. Designate a school representative, such as school nurse or school office/administrative staff, to be a contact person to assist the NC Pediatric Society Foundation’s outreach efforts to find uninsured school students, and to participate in the training Webinar to be held at 11 am on December 11, 2012 (details will follow); 2. Use the HRL grant for: staff time to assist with tasks like distributing Health Check/ NC Health Choice outreach materials, paying for school nurses to participate in professional development, organize SHAC meetings or to support activities that promote assistance to families who may be eligible for NC’s health insurance; 3. Provide feedback, data and lessons learned and/or suggestions to improve the project, report quarterly an estimate of the number of families assisted, and invite HRL staff to at least one of your SHAC meetings.
  • 8. HRL Grant Agreement 2012-2013 – Cont. B. The North Carolina Pediatric Society Foundation will: 1. Provide a $1,000 grant per county for LEA(s) to use at your discretion as described above between Nov. 19, 2012 and August 31, 2013 to support HRL goals; 2. Host the Healthy and Ready to Learn Steering Committee and provide regular updates to all agencies and organizations represented plus LEA partners, and present at the SHAC meeting; 3. Inform principals in your LEA about the HRL participation after November 19, 2012, unless your system prefers to do so directly. NOTE: Please inform your principals by Nov. 19, 2012.
  • 9. HRL Data Collection Form Please enter the number of K-12 students/their families who were provided information through brochure, envelope stuffer, application, personal assistance or at school events about Health Check/NC Health Choice children’s insurance. Email completed forms to your HRL Local Community Coordinator each quarter. October - December 2012 Total # of families/children assisted this quarter: Other/Notes: January - March 2013 April – June 2013 July - August 2013
  • 10. Evaluation of Healthy and Ready to Learn in 2011-2012 UNC-G, Center for Youth, Family and Community Partnership survey results (113 respondents): • Strong to moderate support of HRL’s effectiveness • Success of HRL implementation: – benefited families, – educated parents and enabled children access to regular health care, – children coming to school with fewer health issues, – gave options to those with chronic illnesses or need of mental health services – personal gratification to HRL school partners • Challenges to enroll children into HC/NCHC: – find new ways to identify uninsured and eligible students, – contact and encourage parents to enroll their children, – increase involvement of different school staff members, – expand HRL outreach beyond elementary school
  • 11. Evaluation of Healthy and Ready to Learn – Cont. Distribution of outreach materials: Year 1 (Jan. 2010-Sept. 2010), 16 pilot counties: 61,983 Year 2 (Oct. 2010 – Sept. 2011), 48 counties: 202,912 Year 3 (Oct. 2011 – Sept. 2012), 46 counties: 270,000 Total for all years: ~535,000 Number of children/families assisted by school nurses or school staff: Year 1 – approximately 1,000 between July 2011-Sept. 2011 for 16 pilot counties (no data collected prior to) Year 2 – approximately 56,300 Year 3 – 127,874 Total – approximately 185,000+
  • 12. NC’s Public Programs Providing Quality Health Care for Kids: Health Check / NC Health Choice Health Check/NC Health Choice & Medical Home Healthy & Ready to Learn Webinar, December 11, 2012 Children and Youth Branch
  • 13. School Outreach Strategies How to find uninsured children? • Review school forms with health insurance status – Kindergarten Health Assessment Form, – Health assessments, – School Registration, – Sports Physicals, – Field Trip, – School Health Contact, – Emergency Contact forms. • Add a question about insurance if forms don’t have it • Follow up with outreach materials or in-person information, as appropriate
  • 15. Example: Onslow County Schools Health Services HEALTH CARE INFORMATION Student’s Name ______________________________________ Grade/Teacher ___________________ Where your student gets regular health care: Student has:  1 Health Department  1 Medicaid  3 No Insurance  2 Hospital Clinic  2 Private Insurance/HMO  4 Other: _____________  3 Community Health Center Doctor/ Practice Name:  4 Private Doctor/HMO _____________________________________  5 Other __________________ Dentist Name:  6 No regular place _____________________________________  I would like information on free/low cost health insurance for my student. Forward to School Nurse
  • 16. What can school staff and SHAC members do? • Review school forms to check if child has health insurance • Remind families to complete all “Parent complete” parts on the KHA, emergency contact, field trip forms, etc. • Always share those three pieces: promotional materials, an application form and address of the local DSS with families of uninsured children • Parents are more likely to apply if they see income guidelines based on family size so keep outreach materials on hand • Promote child health insurance at school events
  • 17. What can school staff and SHAC members do - cont? • Put into operation ideas from bi-weekly HRL Outreach Hints emailed on Wednesdays • Check Healthy and Ready to Learn Facebook page for updates and strategies • Think of and share middle and high school outreach ideas with HRL staff and other LEAs • Implement at least three school-based outreach ideas provided by HRL at your LEA
  • 18. Guidelines to Sustaining Healthy and Ready to Learn (HRL) Outreach in Elementary Schools 1. Include HRL on SHAC agendas and identify a person responsible for updates on child health insurance outreach. 2. Include child health insurance outreach materials at kindergarten orientations every year. 3. Display child health insurance information during school’s open houses. 4. Check Kindergarten Health Assessment forms to see if a child has health insurance. Share Health Check/NC Health Choice information with those who are uninsured.
  • 19. Guidelines to Sustaining Healthy and Ready to Learn (HRL) Outreach in Elementary Schools 5. Add health insurance status questions to current school forms such as emergency information cards collected at the beginning of school year, field trip forms, school health forms, etc. Share HC/NCHC information with those who indicate no insurance coverage. 6. Check a child’s health insurance status based on parent reports and Parent Policy Booklets’ signature sections. 7. Share HC/NCHC information during school registrations. 8. Include a link to child health insurance information: http://www.nchealthystart.org/public/childhealth/index.htm on your school’s webpage.
  • 20. Guidelines to Sustaining Healthy and Ready to Learn (HRL) Outreach in Elementary Schools 9. Ask about child health insurance status during vision/dental screenings and 5th & 6th grade vaccination requirements. 10. Include HRL and child health insurance information during staff meetings, support team meetings such as principal, social worker, teacher, school nurse meetings. 11. Orient new school staff members about child health insurance and HRL. 12. Present HRL at Parent Advisory Councils, PTAs, PTOs and other parent groups. 13. Add HC/NCHC outreach information to health referrals.
  • 21. Guidelines to Sustaining Healthy and Ready to Learn (HRL) Outreach in Elementary Schools 14. Display HC/NCHC poster in prominent school locations where parents can see it. 15. Send outreach materials with school report cards. 16. Include HC/NCHC information with free or reduced school lunch applications and/or acceptance letters and summer lunch programs. 17. Use your school’s voice system Alert Now/Connect Ed to share child health insurance information. For a ready-to-use script, go to Sept. 20, 2012 HRL Facebook post at: http://www.facebook.com/HealthyandReadytoLearn. Update the annual income guidelines every April 1.
  • 22. Middle and high school outreach focus • Send HC/NCHC info with report cards • Opportunity to contact students directly, not only parents • Message to teens needs to be positive, informative and why they need it • Use social communication technologies: – Text messages to students (parental permission needed, come from school’s medical professional) • Peer-to-peer messages work best • Pick teen champion to share it with other students (video/TV club, school newspaper) • Include HRL in Health and Safety, Wellness, PE classes • School-based health centers to share information • Collaborations with school clubs and their Presidents and Advisors • Utilize school announcement system with direct message • Involve schools’ counselors, psychologist, PE teachers (beside social workers and school nurse) • Driver ED – add insurance status
  • 23. Outreach in middle and high schools What are other LEAs doing? Central region: • Placing brochures in the office waiting room and the visitor “sign-in” area • Include brochures in the “new student” packets • Add HC/NCHC materials and applications to the mobile unit and inquire about coverage during intake • Review health/PE forms for status of insurance • Send info and applications to parents when the school nurse is providing referrals for vision or hearing screenings • Send HC/NCHC envelope stuffers home with report cards
  • 24. Outreach in middle and high schools What are other LEAs doing? Southwestern region: • Partner with allies for teens such as: – TOP - Teen Outreach Programs, – Advocates for Teens, – Beta Clubs, – FHA clubs • Collaborate with Nutrition Director to obtain a list of every child, by school, in the LEA, who has an outstanding school cafeteria bill of over $100 and determine if these students are eligible for F/R Lunch and thus may also be eligible for Health Check or NC Health Choice
  • 25. Middle and high schools What are other LEAs doing? Northeast region • Attach HC/NCH info to student athletic physical forms which are required for participation in middle and high school sports • Distribute NC health insurance information during sports physical examination clinics held at school sites • Provide NC health insurance materials to middle and high school students during 1-on-1 health office visits and/or to class groups during health presentations • Attach materials to nurse referrals • Review annual student health information forms and follow-up as needed • Place NC health insurance posters and materials in school nurse office, guidance offices and school office • Provide materials at sporting events, Open Houses/Orientation, "Parent Nights" • Send fact sheet home with report cards • Use televised announcements
  • 26. School Nursing and Public Health Supporting Healthy and Ready to Learn Project Ann Nichols, State School Nurse Consultant, NC Division of Public Health Cheryl Herberg, President, School Nurse Association of North Carolina “Working for a healthier and safer North Carolina”
  • 27. Division of Public Health • Long-term sustainability is critical • Assuring access to care as a forethought, not afterthought. • Institutionalizing the project – Goal of State Division of Public Health – Goal of Children and Youth Branch of DPH – Goal of School Health Unit of DPH “Working for a healthier and safer North Carolina”
  • 28. School Nurse Association of North Carolina SNANC is committed to assisting the HRL Initiative with the following : • MOU understanding • Presentation of program at Executive Committee meetings • Support initiative at all regional meetings in Fall and Spring throughout the state
  • 29. Factors Influencing Health Outcomes Public Policies Community & Environment Clinical Personal Care Behavior Health Source: Robert Wood Johnson Foundation. “Overcoming Obstacles to Health: Report from the Robert Wood Johnson Foudnation to the Commisssion to Build a Healthier America.” February 2008.
  • 30. 2020 Healthy People Increase the proportion of adolescents who have had a wellness check-up in the past 12 months. 68.7 percent of adolescents aged 10 to Baseline: 17 years had a wellness checkup in the past 12 months, as reported in 2008 Target: 75.6 percent Target-Setting Method: 10 percent improvement National Health Interview Survey Data Source: (NHIS), CDC, NCHS
  • 31. HRL Project Strategies: Focus on Middle and High Schools Students through School Nurse and Community School Nurse Point of Service is a time to observe insurance status. • Siblings of referred students • Teacher referrals • Student referral teams Adolescents are also old enough to be aware of health insurance. • Speak directly with student • Include benefits of insurance in health promotion opportunities
  • 32. School Nurse Opportunities for Insurance Referral 6th grade Tdap requirement College immunizations Acute illness Vision screening follow up  One-on-one health counseling
  • 33. YOU can make a difference! 10 HRL Actions Steps: 1. Share information about the Healthy and Ready to 3. Review school forms to check Learn and child health insurance programs, Health insurance status . Check/NC Health Choice, with school staff and all your SHAC members (This PowerPoint will be posted at: 4. Hang a HC/NCHC poster so www.NCPedsFoundation.org ). that families can see it. 2. Order free (English/Spanish) outreach materials, i.e. fact sheets (D4, D4BR), envelope stuffers (D3), applications (D6E, D6S) and poster (D5) from your HRL Local Community Coordinator or download materials in English, Spanish and other languages at: http://www.nchealthystart.org/outreach/index.html
  • 34. YOU can make a difference! HRL Actions Steps: 5. Give outreach materials to families 7. Create or implement the Guidelines and outreach with uninsured children and those ideas in your school system. For example, include who mark “no insurance” on KHA and HRL on SHAC agendas and identify a person other school forms. Be sure to share: a responsible for updates on child health insurance flier with income guidelines (fact sheet outreach. or envelope stuffer), an application, and the address of the local DSS. If your school has a Pre-K program, please reach out to families of 4-year old children. 6. Consider following up with families to see if they need help enrolling and offer 8. Please help us keep track of the number of families them resources such as you assist. Every quarter we will ask for an www.NCHealthyStart.org and the approximate number of K-12 families you have local DSS. reached.
  • 35. YOU can make a difference! HRL Actions Steps: 9. Call us if you need help with ordering materials, scripting a message, need a cover letter to send to families, or want us to mail you fliers with DSS addresses by county. Local Community Coordinators for HRL are: Laura H. Brewer (south/west region, office in Robeson County), laura@ncpeds.org, 910-865-5507, Betty Macon (north/east region, office in Halifax County), betty@ncpeds.org, 252-822-3340, and India Foy (central/west region, office in Guilford County), india@ncpeds.org, 336-617-6628. Visit www.NCPedsFoundation.org and https://www.facebook.com/HealthyandReadytoLearn for outreach tools and resources! Like Us on Facebook and check our page often.
  • 36. Healthy and Ready to Learn Project Local Community Coordinators Project Director Ania Boer, ME, MA C: Central Region 1100 Wake Forest Road, Ste 200 NE: Northeast Region India Foy, MPH Raleigh, NC 27604 Greensboro, NC Betty Macon 919 839-1156 336-617-6628 Roanoke Rapids, NC FAX: 919-839-1158 india@ncpeds.org 252-822-3340 ania@ncpeds.org betty@ncpeds.org Alleghany Vance Northampton Gates Currituck Ashe Surry Rockingham Stokes Caswell Granville Warren Person Hertford Watauga Wilkes Halifax Yadkin Alamance Mitchell Avery Forsyth Orange Franklin Bertie Caldwell Guilford Nash Yancey Alexander Davie Durham Madison Edgecombe Tyrrell Burke Iredell Davidson Wake Martin Washington Dare Randolph Chatham Wilson Buncombe McDowell Catawba Rowan Pitt Beaufort Swain Haywood Lincoln Johnston Greene Hyde Rutherford Cabarrus Montgomery Lee Graham Henderson Harnett Wayne Jackson Transylvania Polk ClevelandGaston Stanly Moore Lenoir Craven Mecklenburg Cherokee Macon Clay Cumberland Pamlico Anson Richmond Hoke Sampson Jones Union Duplin Scotland Onslow Carteret Robeson Bladen Pender S & SW: Southern & Southwestern Region Columbus New Laura H. Brewer Hanove St. Pauls/Lumberton Brunswick 910-865-5507 laura@ncpeds.org December 2010
  • 37. North Carolina Pediatric Society Foundation Healthy and Ready to Learn project team: Steve Shore, MSW, Executive Director, NCPS-F Ania Boer, ME, MA, Project Director, ania@ncpeds.org Laura Brewer, Local Community Coordinator for south/western region (office in Robeson County), laura@ncpeds.org, (910) 865-5507 India Foy, MPH, Local Community Coordinator for central/western region (office in Guilford County), india@ncpeds.org, 336-617-6628 Betty Macon, Local Community Coordinator for northeastern region (office in Halifax County), betty@ncpeds.org, (252) 822-3340 1100 Wake Forest Road, Suite 200 Raleigh, NC 27604 Phone: (919) 839-1156 Fax: (919) 839-1158 www.NCPedsFoundation.org
  • 38. North Carolina Pediatric Society Foundation Healthy and Ready to Learn project team: Steve Shore, Executive Director Ania Boer, Project Director From Left: Betty Macon, Local Community Coordinator for northeastern region, Laura H. Brewer, Local Community Coordinator for south/western region, India Foy, Local Community Coordinator for central/western region
  • 39. Thank you for your continued support of the Healthy and Ready to Learn Project! Q&A