Author: manda.hufstedler@duke.edu

NC InCK Shares Insights in Recent NC Medical Journal Case Study

Posted on by manda.hufstedler@duke.edu

NC InCK executive team members, Dr. Rushina Cholera, Sarah Allin, Dr. Richard Chung, Dr. Kori Flower, Dan Kimberg, Melissa McDonald, and Dr. Mike Steiner, published a case study sharing early learnings from NC InCK’s approach to whole-child care in the North Carolina Medical Journal.  

This article highlights NC InCK’s integration of physical, mental, behavioral, and social health needs into a care management model that focuses on child and family well-being. The case study describes NC InCK’s efforts to enhance the capacity of health systems and go beyond traditional medical interventions. The authors underscore how NC InCK’s focus on the  ten core child service areas  contributes to accomplishing these goals. 

Additionally, the article emphasizes how NC InCK’s care management model offers long-term support to families while collaborating toward shared goals through the development of personalized Shared Action Plans. To do this, NC InCK trains care managers to focus on family well-being through a holistic look at the systems that impact them (e.g., Behavioral Health, Food, Housing, Early Childhood), and through collaboration with care team members like guidance counselors, school nurses, and teachers who represent those systems. 

Furthermore, the authors stress NC InCK’s collaboration with schools, highlighting the importance of in-school services, information sharing between care managers and school professionals, and the evidence-based actions healthcare practices can take to promote school readiness. NC InCK is also focusing on the care of children in foster care. NC InCK works to pair children in foster care with care managers to increase coordination between their different care providers. The authors of the case study recognize the need for additional foster care resources so that we can fully realize our vision of whole-child health. 

The authors share that, ultimately, NC InCK hopes to provide an example of how care management focused on whole-child health can lead to improved health and well-being outcomes. The model remains dedicated to advancing whole-child health care by addressing the holistic needs of Medicaid-enrolled children in North Carolina. 

Read the full story through this link. 

Behavioral Health Part 2 Integrated Care Rounds (November 2023)

Posted on by manda.hufstedler@duke.edu

Description

In this second discussion of behavioral health, the NC InCK team outlines crisis resources, whole-person care, and therapies that help better understand and support behavioral health.

Click this link for the November 2023 Behavioral Health Part 2 Integrated Care Rounds Slide Deck

Key Takeaways

  • There are many evidenced-based therapies to treat different behavioral health diagnoses. Having a basic understanding of evidence-based treatment modalities can help with identifying an appropriate treatment provider and allow Family Navigators to share knowledge of what to expect with families. Trauma focused cognitive behavioral therapy is an evidenced-based therapy that can be beneficial for children and young adults who have experienced trauma.   
  • There is a continuum of behavioral health crisis supports available to children and families in NC InCK counties. It is important for Family Navigators to be aware of available crisis supports and share them proactively with family or members that have a known or suspected behavioral health diagnosis.  
  • Tailored Care Management (TCM) provides whole-person care management to individuals who are Tailored Plan eligible. TCM providers can link individuals to enhanced supports available in the Tailored Plan to address mental health and I/DD diagnoses.  Family Navigators can assist with transitions to TCM by supporting families in reaching out to LME/MCO member services and the enrollment broker. 

Resources

Breaking Barriers and Bridging Gaps: NC InCK’s Response to Food Insecurity 

Posted on by manda.hufstedler@duke.edu

North Carolina has the ninth highest statewide level of food insecurity in the country, and one out of every six children lives with hunger. Within the NC Integrated Care for Kids (NC InCK) model, rates of childhood food insecurity in 2021 ranged from 6.6% in Orange County to 26.6% in Vance County. 

 

“Feeding every child is worth the cost because every child is priceless. They are our GREATEST investment.”    

Teresa Spruell, NC InCK Family Council Member; Parent Teacher Organization President, Butner-Stem Elementary School, Granville, NC 

 

More Than Just Hunger 

Food insecurity isn’t just about going hungry. Food insecurity means not having the food you need to stay healthy, develop, and thrive. It’s about the quality and nutritional value of the food available to you. Food insecurity is a threat to the health, development, and well-being of children across America, and it’s a problem larger than the individual challenges faced by any one family.   

Childhood food insecurity is associated with higher risks for developmental delays and poor academic outcomes, including lower reading and cognitive performance, increased long-term psychological distress and poor social-emotional health, and increased risk for chronic health conditions such as asthma. Children, particularly older children, may also experience the stress and emotional costs of food insecurity as they witness adults in their household skipping meals or struggling to afford groceries. 

 

A Systemic Issue 

Food insecurity affects some subsets of the American population more than others. Households with children, especially children under the age of six, experience food insecurity at higher rates. Black, Latino/Latina, Native American, immigrant, and single-caregiver households are more likely to experience food insecurity, trends that reflect the impact of discrimination and structural racism. Low wages, paired with the rising costs of living, have left many families facing the dual challenges of low income and low wealth, with little or no savings to fall back on. In a recent survey (2021), one out of every three adults reported not having enough cash or savings to cover an unexpected $400 expense. 

 

NC InCK’s Ongoing Efforts to Reduce Child Food Insecurity 

Recognizing the importance of food security for families, NC InCK has identified food as one of the ten core child services areas of focus in our care model for children and young adults.  

One of our primary goals is for our partners and care managers to normalize conversations with families who need food support, allowing them to feel safe speaking candidly about their experiences and needs. Through these conversations, NC InCK care managers can work to connect families with programs and community partners that provide not just short-term solutions to food insecurity (e.g., food pantries), but a range of economic support programs. Together, these programs mean more resources each month that a family is able to put toward food and other basic needs.  

NC InCK works with our nine care management entities and Meals4Families to train and promote four important resources for meeting the nutrition needs of children engaged in the NC InCK model. Over time, these strategies can be used in tandem to reduce the harmful impacts of food insecurity.  

In addition to supporting individual families in benefit enrollment, NC InCK’s role also includes listening. The NC InCK team gathers stories from families and health partners, learning more about the barriers that make it hard for families to connect with and use food support programs. Using those shared experiences, we strive to improve the policies and programs that serve North Carolina.   

 

Learn more about NC InCK’s work and collaboration with NC Medicaid, schools, and community-based organizations to reduce food insecurity in the second part of this series on food insecurity at this link. 

 

Authors:

Kate Hanson: Kate is Executive Director for Meals4Families (M4F). M4F works to break down barriers that prevent families from accessing food, healthcare, and economic support through public benefit programs. Their work is focused on community health, community wealth, and wealth equity as pathways to ending child hunger in North Carolina.  

Melissa McDonald: Melissa McDonald serves as Deputy Director of Child and Family Services at North Carolina Integrated Care for Kids (NC InCK).  At NC InCK, Melissa works to improve coordination between systems (child welfare, food, housing, legal aid, schools, behavioral health, early childhood) and enhance services for Medicaid-insured children and their families. Before joining NC InCK, Melissa spent ten years working directly with children and families involved in the child welfare system.  

Dan Kimberg: Dan Kimberg serves as the Director of Strategy and Operations, and currently the interim Managing Director, at NC Integrated Care for Kids where he strives to improve health and well-being outcomes for Medicaid-insured children and youth through work across numerous systems (food, housing, behavioral health, schools and early childhood). Prior to joining NC InCK, Dan worked in and around schools for a decade as a part of Student U in Durham, and then supported cities around the country in developing strategies to combat housing instability through racial reconciliation and equity-based policy reform. Dan has a Master’s degree in “Social Justice and Childhood Ethics” from Union Theological Seminary and graduated from Duke with a Bachelor of Arts in a degree he created titled “Advocating for Educational Reform through Policy and Practice.”

NC Integrated Care for Kids (NC InCK) is Hiring a Managing Director

Posted on by manda.hufstedler@duke.edu

In collaboration with the Executive Director, the Managing Director will oversee the daily operations of the NC InCK model and support a team of approximately 40 staff members. In this position, the Managing Director will work closely with NC InCK’s key partners, including NC Medicaid, multiple health systems, and managed care organizations.

The Managing Director will guide strategy across NC InCK's novel pediatric data algorithm, care model, and alternative payment model in service of improving the health and well-being of children and youth insured by NC Medicaid. The Managing Director will play an integral role in determining the long-term future of NC InCK, by supporting research and evaluation processes to assess how lessons learned from implementation can inform statewide programs and policies.

The position is officially housed at the Duke University Margolis Center for Health Policy with a position title of Assistant Research Director, Child and Family Health Policy and Managing Director of NC Integrated Care for Kids. In addition to overseeing the NC InCK Model, the Managing Director will support major components of the Margolis Center’s implementation of child and family health policy, serving as a senior-level resource for enhancing policy analysis.

Competitive candidates will have a demonstrated commitment to the pursuit of health equity, knowledge of North Carolina health policy, experience utilizing research and evaluation to inform program improvement, and the ability to cultivate and maintain relationships across diverse stakeholders and partners.

The full position description can be found at this link.

NC InCK Opens Referrals to Juvenile Justice Court Counselors for Juvenile Justice-Involved Youth

Posted on by manda.hufstedler@duke.edu

On May 30th, NC InCK partnered with the Division of Juvenile Justice and Delinquency Prevention (DJJDP) to open referrals to NC InCK care management services for all juvenile court counselors in NC InCK’s five counties – Alamance, Durham, Granville, Orange, and Vance. For the first time, court counselors working with juvenile justice-involved youth will be able to complete a simple referral form so that more youths can receive NC InCK care management with a guardian’s consent. 

Each month, NC InCK links data between NC Medicaid and DJJDP as part of our process of prioritizing children for care management. NC InCK hopes warm referrals from court counselors may increase the number of juvenile justice-involved youth receiving services.  

 

By the Numbers: Juvenile Justice-Involved Youth We Hope NC InCK Will Serve 

Across NC InCK’s five counties, approximately 950 youths interact with DJJDP in some form each year. About 600 of those youths have health insurance through Medicaid, making them candidates for NC InCK’s services.  

Additionally, about 50 youths per year are in an out-of-home placement in a juvenile detention center or Youth Development Center. These youths are very likely to need enhanced behavioral health supports during and after their commitment. 

NC InCK Training for Court Counselors 

NC InCK hopes that more youths involved in juvenile justice can benefit from care management services. To engage more of these individuals and their families, NC InCK is working with three juvenile justice districts-Districts 9, 14, and 15. This work is aimed at helping court counselors understand the NC InCK model, recognize families who may benefit from these resources, and easily refer families that are interested to NC InCK.  

This May, NC InCK staff traveled to all three regions where they trained 26 court counselors and leaders on the NC InCK model, examples of care, and how to make referrals. NC InCK’s Integration Consultant Judy Lawrence, who is based in the DJJDP, led these trainings and maintains coordination with the districts. After making a referral, District 15 Juvenile Court Counselor Matthew Rierson shared, “It was a very simple referral process and they were able to reach out to the family in a timely manner. I felt the training gave me enough information to confidently explain the program to the parent before making a referral.” 

Members of the NC InCK team at District 15 training From left: Judy Lawrence, Josie Hatley, Alyzia McAlmon, and Sarah Allin
Members of the NC InCK team at District 15 training From left: Judy Lawrence, Josie Hatley, Alyzia McAlmon, and Sarah Allin

Applying Lessons Learned Statewide  

NC InCK will continue to prioritize juvenile justice-involved youth and their families. Juvenile Justice is one of NC InCK’s 10 Core Child Service Areas. All Care Managers in the NC InCK model receive training on the juvenile justice process, recommendations for supporting and engaging juvenile justice-involved families, and have access to ongoing, as needed, support from Judy and fellow integration consultants while working with juvenile justice-involved youth and their families.    

We hope to share whether this new referral process increases engagement among juvenile justice-involved youth and to communicate lessons learned with our partners at NC Medicaid, Local Management Entities, and Prepaid Health Plans. With success, we can build more systems statewide that better connect youths with juvenile justice involvement to care management resources that meet their needs. NC InCK also hopes to learn if care management improves connections to health, education, and social services for juvenile justice-involved youth, potentially reducing the risk of out of home placement and preventing future interactions with the DJJDP system.  

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Judy Lawrence has served as an Integration Consultant with North Carolina Integrated Care for Kids (NC InCK) based with North Carolina Division of Juvenile Justice and Delinquency Prevention (DJJDP) since November 2021. This role focuses on integrating the supports and resources provided to DJJDP-involved youth and their families across multiple core youth service areas.

Schools Part 2 Integrated Care Rounds (September 2023)

Posted on by manda.hufstedler@duke.edu

Description

The NC InCK team discussed school supports, collaboration, and holistic care management during their second conversation about Schools in the September 2023 Integrated Care Rounds.

Click this link for the September 2023 Schools Integrated Care Rounds Slide Deck.

Key Takeaways

  • Family Navigators are Connectors: Due to the large amount of time students spend in school, collaborating with the school system can help increase access to services that address social, behavioral, and health needs. School personnel are with the student daily and can help a family accept a referral or engage in care management.  
  • Family Navigators are Advocates: School supports such as Individualized Education Program (IEP) and Section 504 Plans are underutilized in North Carolina! In the U.S., NC ranks 46th in providing appropriate in-school support and accommodations for children with mental health needs and 50th in suspending children with disabilities. These statistics disproportionally affect Black students. Effectively communicating a child’s educational needs empowers families to speak up if they are not being met. 
  • Family Navigators Understand: Asking the right questions, and listening to children and families can reveal challenges such as bullying, housing insecurity, absenteeism and more. Understanding these experiences will ensure holistic care management supports are in place. 

 

Resources

  • NC Center for Afterschool Programs – Website that allows you to search for afterschool programs by zip code and filter by grades served and activities offered. 
  • Just U & Me Mentoring Program – A mentoring program that engages Vance County fifth-grade students in social-emotional intervention strategies that will help them improve classroom participation and academic success; meets weekly on Saturdays from 9am – 12pm. 
  • Durham Performance Learning Center – A program that helps high school students who aren't succeeding in traditional school get back on track for graduation in small classes with 1:15 teacher student ratio. Students may be recommended by current/ previous school, but families can apply independently as well. 
  • ICR Appendix – Several resources listed including IEP/ Special Education Guides, before and after school programs, school resources by NC InCK County, and education related Value Added Benefits offered through each PHP.

Adolescent and Young Adult Engagement and Well-Being Integrated Care Rounds (August 2023)

Posted on by manda.hufstedler@duke.edu

Description

The August 2023 Integrated Care Rounds discusses Adolescent and Young Adult (AYA) engagement in the NC InCK model. The NC InCK team and guests talk about what risks adolescents and young adults may face and how to empower families to set healthy goals together.

Click this link for the August 2023 AYA Engagement and Well-Being Integrated Care Rounds Slide Deck

Key Takeaways

  • The adolescent brain is particularly susceptible to addiction, with youth showing signs of dependance quickly. Nicotine dependance can develop within days to weeks after as few as 100 cigarettes, and before daily smoking. Nicotine impacts brain areas responsible for learning, attention, impulse control and mood. Youth-friendly resources, such as Live Vape Free (LVF), can play a crucial role in helping young people quit vaping products.  
  • It is especially important to engage Adolescents and Young Adults (AYA) in their care. Tips for this include: talking with parents/caretakers about including their adolescents in care management, discussing consent and confidentiality with AYA and answering their questions, encouraging and involving adolescents in goal planning, and focusing on proactive skill building!  
  • NC InCK has been receiving community referrals from Juvenile Justice Court Counsellors since May, 2023. If a family chooses, Family Navigators can collaborate with Juvenile Court Counselors to better support and reach the goals of Juvenile Justice involved youth and their families.  

 

Resources

Many Thanks to Our Summer 2023 Interns

Posted on by manda.hufstedler@duke.edu

During Summer 2023, the NC InCK team was supported by multiple wonderful interns. They have been involved in a variety of projects, especially with our Research and Evaluation team. NC InCK is grateful for all their important contributions. Read more about our interns, their work, and what they learned below.

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Jeylan Close is a pediatrician, child psychiatrist, and is in the National Clinician Scholars Program (NCSP at Duke University. Jeylan is passionate about NC InCK’s model of holistically addressing the needs of children and families and has been able to do some qualitative work around family engagement from the perspectives of Family Navigators. When her hands are idle, she likes to weave baby hats. Jeylan is now working on the evaluation of the manual referral process, where community partners can directly identify children who may benefit from NC InCK care management services. Jeylan is entering her final year at Duke and plans to continue to work with the NC InCK team.

“I have learned so much about care management models and the logistics of how they can be operationalized. Working with Rushina [Cholera] and the whole leadership team at NC InCK has also taught me a lot about how to effectively manage projects. I have appreciated their thoughtful approach and hope to adopt their skills and strategies in my future work.” -Jeylan Close

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Alex Gertner is a psychiatry resident at UNC-Chapel Hill. He has an MD-PhD from the UNC School of Medicine and the Gillings School of Global Public Health. Alex is interested in how social circumstances and policies affect children and adolescents' mental health. Alex is working on developing dosage and intensity measures for NC InCK services and examining how these may affect parental stress and child development. This project will help NC InCK better understand service delivery and components of services that affect child well-being. Alex hopes to continue working with the NC InCK team to improve child and adolescent well-being in North Carolina. 

 

 

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Amaris Huang is an undergraduate student at Duke University (’25) studying biomedical engineering and computer science. As a NC InCK intern, she supported a mixed-methods research study on food insecurity screening and intervention policies in pediatric clinics nationwide. Through her work on this project, Amaris assisted with performing rapid qualitative analysis on stakeholder interviews and helped with conducting a literature review of food insecurity and value-based payment models. Her work supported the development of a manuscript with collaborators from the Duke-Margolis Center for Health Policy, UNC School of Medicine, and Wake Forest School of Medicine. Amaris plans to continue working with the research team towards the full fruition of the project. 

“I was drawn to NC InCK’s mission to better the health and wellness for children, and I am passionate about working for health equity initiatives.” -Amaris Huang

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Vibhav Nandagiri is an undergraduate student at Duke University ('25) majoring in Biology and International Comparative Studies with a Health Policy Certificate. As part of NC InCK's research team, he supported a mixed methods study on food insecurity screening and intervention efforts in pediatric clinics across the nation. In addition to assisting primary data collection, Vibhav also carried out rapid qualitative analysis on interviews and conducted a literature review of existing policy innovations supporting food insecurity screening and intervention efforts. This work supported the development of a manuscript with collaborators at the Duke-Margolis Center for Health Policy, UNC School of Medicine, and Wake Forest School of Medicine. After this summer, he will be taking a short break from NC InCK to study abroad, but he plans to return in 2024 to continue his work with the research team.

“NC InCK's pioneering model for care delivery centers a child's well-being above all else. As a lifelong resident of North Carolina, I was drawn to the passion of everyone on the NC InCK team to better pediatric health care in my home state.” -Vibhav Nandagiri

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Michelle Shankar is a pediatrician and former public-school teacher in the National Clinician Scholars Program (NCSP) at Yale University. She is passionate about optimizing collaboration between healthcare and education systems to improve outcomes for children. This past summer, Michelle worked on a qualitative project to understand how Family Navigators, pediatric primary care providers, and school providers support families with school attendance to develop guidance for data sharing and best practices. In her free time, Michelle has been enjoying summer fiction reads and North Carolina's beautiful mountains. 

“Through this project, I have come to understand the rich and unique perspective of each of these roles in a child's care team. I am inspired by their passion to build bridges across our disciplines and create strong networks of support for NC InCK children and families. I hope to pursue a career that blends clinical work with health services research and policy work, and I would love to continue to learn from and support NC InCK's work!” - Michelle Shankar

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Lily Suarez is a second year Internal Medicine and Pediatrics resident at Duke University originally from Columbus, OH. She worked on a national project exploring the implementation of food insecurity screening and interventions in pediatric clinical practices, which aimed to identify opportunities to leverage innovative care models, like NC InCK, to improve child and family food security. Working with collaborators at Wake Forest University and UNC-Chapel Hill, these results have been shared at two national conferences, and she is currently preparing a manuscript to share these findings. 

“I was, and am drawn, to NC InCK because of my clinical role taking care of children and families. We are so limited by what we can do within clinical care, but the way that NC InCK aims to redesign care and provide communication channels between all the sectors that take care of children gives me hope that our next generation will be happier and healthier.” -Lily Suarez

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Pearl Teiko is a recent Public Policy graduate of UNC-Chapel Hill (’23) from Greensboro, NC. She worked with NC InCK as a summer intern for the Duke University Margolis Center for Health Policy, where she devised a data collection and evaluation approach for NC InCK’s manual referral pilot. This data collection tool will help NC InCK evaluate the success and efficacy of permanently establishing a referral pathway. In August 2023, Pearl continued her work at NC InCK and started her Master of Public Policy at the Duke Sanford School of Public Policy. 

“I learned a lot about the complexities of implementation science and how its principles can be applied to policy interventions. I hope to take the knowledge I’ve gained from this experience to promote health equity in NC and nationally.” – Pearl Teiko

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Anna Zolotor was raised in Carrboro, NC and attended Duke University (’23), where she completed her B.S. in Statistical Methods and Biology with a minor in Global Health. In college, she was involved in student journalism, community service, and public health policy research which brought her to NC InCK. This summer, Anna worked on a research project related to the NC InCK algorithm that distributes children into Service Integration Levels (SILs). Her work involves both a quantitative piece as well as a more qualitative component comparing NC InCK's algorithm to traditional approaches. In September, Anna will be moving to Boston, MA where she will begin her work as a statistician in the health care sphere.

“While I've had research experiences in the health policy space, my previous work has involved considering broad applications of very widely applicable tools and metrics. My NC InCK work this summer has been my first experience doing work that directly involves an operating model with acute implications. I've loved getting to learn about how one element of NC InCK (the algorithm) was created and how it actually functions.” -Anna Zolotor

Th entire team at NC InCK wants to thank each one of our interns for their hard work and collaboration. We wish you all the best of luck in your future endeavors and look forward to continuing to work with several of you!