North Carolina Innovative Approaches Initiative

Description

Children and youth with special healthcare needs (CYSHCN) have conditions that are expected to last more than 12 months, are often diagnosed with more than one condition, and frequently experience several functional difficulties, including respiratory issues, learning or behavior concerns, difficulty with gross or fine motor skills, or chronic pain.

The Innovative Approaches (IA) Initiative in North Carolina works to make systems changes that provide CYSHCN and their families access to better, more coordinated, and culturally competent healthcare. Of the 22 counties to date impacted by IA, 16 (73%) of the counties are classified as rural. IA specifically focuses on CYSHCN ages 0-21 and supports the development of community-based and family-focused systems of care. The IA projects address the following six Maternal and Child Health Bureau priority areas:

• Families of CYSHCN will partner in decision-making at all levels and will be satisfied with the services they receive.
• All CYSHCN will receive coordinated ongoing comprehensive care within a medical home.
• Families of CYSHCN will have adequate health insurance and financing to pay for needed services.
• All children will be screened early and continuously for special healthcare needs.
• Services for CYSHCN and their families will be organized in ways that are easy to use.
• All CYSHCN will receive the services necessary to make appropriate transitions.

The Innovative Approaches Initiative is a partnership among Local Health Departments (LHDs), local community partners and healthcare providers who serve CYSHCN, and families of CYSHCN as leaders improving the system of care for CYSHCN. The IA Initiative is funded by the Title V Maternal and Child Health Services Block Grant Program and is supported through the NC Division of Child and Family Well-Being.

Services offered

North Carolina's LHDs are eligible to apply for Innovative Approaches: Community Systems Building Grants for CYSHCN via a competitive Request for Application process from the NC Division of Child and Family Well-Being. Innovative Approaches grants are awarded for three-year funding cycles.

Innovative Approaches grants provide funding for the hiring of one full-time IA Coordinator, who leads a steering committee of community stakeholders and parents, facilitates the development and completion of an action plan, and helps with evaluation.

The steering committee works together to:

• Assess systemic issues that affect families of CYSHCN
• Assess community capacity to meet the needs of CYSHCN
• Identify areas in need of improvement
• Develop strategies for addressing those areas

Depending on the number of counties that an LHD plans to serve with the Innovative Approaches Initiative, a part-time IA Parent Outreach Coordinator (PAC) works with the IA Coordinator. The PAC conducts activities to engage and recruit parents of CYSHCN. In addition, the PAC helps with education and support projects for parents and caregivers of CYSHCN and with resource and access/navigation information and support for care providers and community agencies serving CYSHCN.

Results

Examples of IA service delivery improvements:

• There has been a positive change in practices in early identification, screening, referral, and follow-up with CYSHCN clients.
• Counties have seen improvements in systems for educating and engaging families in meeting the needs of and advocating on behalf of CYSHCN.
• Primary healthcare providers have adopted a patient-centered medical home (PCMH) model.
• New practices and capacities are created to support service coordination in partnership with families.
• Funding priorities have shifted to more specifically include CYSHCN.
• Systems are developed to increase community awareness and support of CYSHCN.
• New paths and resources support CYSHCN transitions to adulthood.
• Accessible environments, including health department clinics, community playgrounds, and walking trails, have been integrated and sustained.

Innovative Approaches projects have been honored with Local Health Department Recognition Awards from the North Carolina GlaxoSmithKline Foundation for innovative projects that have produced measurable, sustainable outcomes. Buncombe County, thanks to its IA program and other community projects, was named a 2014 RWJF Culture of Health Prize Winner by the Robert Wood Johnson Foundation.

North Carolina Innovative Approaches was honored at the 2019 Association of Maternal & Child Health Programs (AMCHP) Conference with a Best Practice Award and was previously honored at the 2017 conference with an Emerging Practice Award. IA is listed in the AMCHP Innovation Hub, which serves to highlight best practices in maternal and child health.

The Cabarrus Health Alliance in Cabarrus County received an AMCHP Replication Grant in 2017 so its IA could expand its network of community partners. This work, along with NC Division of Child and Family Well-Being, Whole Child Health Section, helped move the IA Initiative from an AMCHP Emerging Practice to a Best Practice. A comprehensive evaluation of the IA Initiative was completed in 2022 and IA Initiatives continue to be highlighted at annual AMCHP conferences.

In 2021, the Pennsylvania Department of Health, Bureau of Family Health received an AMCHP Replication Project grant to replicate the North Carolina IA Initiative. The department will focus on building capacity to implement this practice into their systems change work to meet the needs of families and CYSHCN in their state.

Henderson County Innovative Approaches received designation as an AMCHP Cutting-Edge Practice in 2022 for their TRACK Trails project, which is featured in the MCH Innovations Database. The TRACK Trails project promotes outdoor recreation for CYSHCN and their families and encourages improved accessibility of trails and outdoor spaces for use by CYSHCN.

Challenges

Effectively changing the system via policy and practice change at the local level takes time. It requires relationship-building and effectively communicating why accessibility and inclusion of CYSHCN is a priority for family-focused systems of care.

Sustainability of practice and/or policy changes must be built into the design of interventions from the onset. It is easier to sustain a practice/policy change if its logistics have been implemented, tested, and refined with genuine feedback from families of CYSHCN.

Replication

Communities in other states can request an Innovative Approaches Project Implementation Manual from the NC Division of Child and Family Well-Being, Whole Child Health Section to share resources and lessons learned in establishing successful IA initiatives across the state. While this implementation manual is written to guide IA projects funded by the NC Division of Child and Family Well-Being, Whole Child Health Section hopes that the manual can also be used to assist communities with other sources of funding in creating new Innovative Approaches sites.

Collection of Snapshots of Success stories highlighting IA strategies at work are also available by request from the NC Division of Child and Family Well-Being, Whole Child Health Section. These success stories will aid in replication in other rural sites, as they provide an overview of county-specific projects including Maternal and Child Health Bureau priority areas addressed, rationale for selected approach, project results, related community efforts, timeline/key milestones, lessons learned, and project impact on families of CYSHCN.

The NC Division of Child and Family Well-Being lists resources for families of CYSHCN.

Contact Information

Danielle Matula, Best Practices Unit Manager
NC Division of Child and Family Well-Being, Whole Child Health Section
919.219.0041
danielle.matula@dhhs.nc.gov