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