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

Healthy and Ready to Learn Webinar Training

December 11, 2012

Webinar AgendaHealthy 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 2009-2011Children’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 InitiativeChild Health Insurance Outreach Schools

Harnett 12

Pitt20

Alamance21

Alexander

Alleghany

Anson6

Ashe

Avery

Beaufort

Bertie

Bladen7

Brunswick9

Buncombe 26

Burke17

Cabarrus24

Caldwell

Camden

Carteret

Caswell

Catawba25

Cherokee7

Chowan

Clay

Cleveland 18

Columbus 10

Cumberland 48

Currituck

DareDavidson 22

Davie

Duplin8

Durham29 Edgecombe

5

Forsyth42 Franklin

Gaston 29

Gates

Graham

Granville

Greene

Guilford69

Halifax 11

Haywood

Henderson

Hertford

Hyde

Jackson

Jones

Lenoir8

Lincoln

McDowell

Macon

MadisonMartin

5

Mecklenburg

Mitchell

Montgomery5

Moore

Nash17

New Hanover24

Northampton

Onslow19

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Polk

Randolph23

Richmond9

Robeson 23

Rockingham17

Rowan20

Rutherford 1o

Scotland9

Stanly16

StokesSurry11

Swain

Transylvania

Tyrrell

Union29

Vance 10

Warren

Washington

Watauga

Wayne 15

Wilkes13

Wilson

Yadkin

Yancey

Lee8

Chatham

Wake

Hoke

Sampson9

Johnston22

Craven15

Iredell21

Includes Lexington City & Thomasville City Includes Weldon City & Roanoke Rapids

Includes Whiteville City

Includes Asheboro City

CONTACT:Ania Boer, Project Director, (ania@ncpeds.org, 919-839-1156)

Local Community Coordinators: Laura Brewer (laura@ncpeds.org, 910-865-5507) Anson, Bladen, Brunswick, Buncombe, Cherokee, Cleveland, Columbus, Cumberland, Davidson, Gaston, Montgomery, New Hanover, Randolph, Robeson, Rutherford, Scotland, Richmond, Union.

Betty Macon (betty@ncpeds.org, 252-822-3340) Craven, Duplin, Durham, Edgecombe, Halifax, Harnett, Johnston, Lee, Lenoir, Martin, Nash, Onslow, Pitt, Sampson, Vance, Wayne.

India Foy (india@ncpeds.org, 336-617-6628)Alamance, Burke, Cabarrus, Catawba, Forsyth, Guilford, Iredell, Rockingham, Rowan, Stanly, Surry, Wilkes.

Total of 46 counties (60 LEAs) 1,695 schools (950 elementary, 745 middle and high)

Includes Hickory City & Newton Conover City

Includes Asheville City

Includes Mooresville City

Includes Elkin City & Mount Airy City

Includes Clinton City

Includes Kannapolis City

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: 61,983Year 2 (Oct. 2010 – Sept. 2011), 48 counties: 202,912Year 3 (Oct. 2011 – Sept. 2012), 46 counties: 270,000Total 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 56,300Year 3 – 127,874Total – 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

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 schoolsWhat 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 schoolsWhat 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 schoolsWhat 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

“Working for a healthier and safer North Carolina”

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

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 Care

Personal 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.

Baseline:

68.7 percent of adolescents aged 10 to 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

Data Source: National Health Interview Survey (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 requirementCollege 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 Learn and child health insurance programs, Health Check/NC Health Choice, with school staff and all your SHAC members (This PowerPoint will be posted at: www.NCPedsFoundation.org ).

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

3. Review school forms to check insurance status .

4. Hang a HC/NCHC poster so that families can see it.

YOU can make a difference!HRL Actions Steps:

5. Give outreach materials to families with uninsured children and those who mark “no insurance” on KHA and other school forms. Be sure to share: a flier with income guidelines (fact sheet or envelope stuffer), an application, and the address of the local DSS.

6. Consider following up with families to see if they need help enrolling and offer them resources such as www.NCHealthyStart.org and the local DSS.

7. Create or implement the Guidelines and outreach ideas in your school system. For example, include HRL on SHAC agendas and identify a person responsible for updates on child health insurance outreach. If your school has a Pre-K program, please reach out to families of 4-year old children.

8. Please help us keep track of the number of families you assist. Every quarter we will ask for an approximate number of K-12 families you have 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.

10. Share your success stories with us!

December 2010

C: Central RegionIndia Foy, MPHGreensboro, NC336-617-6628india@ncpeds.org

S & SW: Southern & Southwestern RegionLaura H. BrewerSt. Pauls/Lumberton910-865-5507laura@ncpeds.org

NE: Northeast RegionBetty MaconRoanoke Rapids, NC252-822-3340betty@ncpeds.org

Project Director Ania Boer, ME, MA1100 Wake Forest Road, Ste 200Raleigh, NC 27604919 839-1156FAX: 919-839-1158ania@ncpeds.org

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Burke

Caldwell

Carteret

Caswell

CatawbaChatham

Cherokee Clay

Columbus

DareDavidsonDavie

Duplin

Forsyth Franklin

Gaston

Gates

GrahamGreene

Guilford

Halifax

Harnett

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

McDowell

Macon

MadisonMartin

Mitchell

Moore

Nash

NewHanove

Northampton

Onslow

Orange

Pamlico

Pender

Person

Pitt

Polk

Randolph

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

Yancey

Chowan

PasquotankPerquimans

Camden

Currituck

MontgomeryHenderson

GranvilleVance

Alamance

Durham

Mecklenburg

Lincoln Cabarrus

RichmondCumberland

Alexander Edgecombe

Craven

Haywood

Cleveland

Alleghany

Buncombe

Healthy and Ready to Learn ProjectLocal Community Coordinators

North Carolina Pediatric Society FoundationHealthy and Ready to Learn project team:

Steve Shore, MSW, Executive Director, NCPS-FAnia 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 200Raleigh, NC 27604

Phone: (919) 839-1156Fax: (919) 839-1158

www.NCPedsFoundation.org

North Carolina Pediatric Society FoundationHealthy 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