News Archives - Page 3 of 5

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

Posted on January 9, 2024March 19, 2024 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.

Supplemental Nutrition Assistance Program (SNAP)
Women Infants and Children (WIC)
School and summer meals
Emergency food assistance

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 November 6, 2023November 6, 2023 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 November 6, 2023August 27, 2024 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

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.

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.

Many Thanks to Our Summer 2023 Interns

Posted on October 16, 2023November 7, 2023 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.

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

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.

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

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

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

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

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

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!

NC InCK Featured on Public Health Informatics Institute

Posted on September 8, 2023September 8, 2023 by manda.hufstedler@duke.edu

The Public Health Informatics Institute (PHII) website recently highlighted NC InCK’s efforts in promoting collaboration between core child service areas.

The article underscores NC InCK’s focus on supporting children and families through Family Navigators and the use of cross-sectional data. Additionally, PHII’s feature outlines the implementation of the NC InCK alternative payment model and dedication to sustaining our innovative framework of integrated care throughout North Carolina.

Check out the story at this link.

NC InCK Welcomes New Executive Director Rushina Cholera

Posted on August 25, 2023August 25, 2023 by manda.hufstedler@duke.edu

NC InCK is excited to welcome Dr. Rushina Cholera as the model’s new Executive Director effective July 15. Rushina succeeds NC InCK’s founding Executive Director Charlene Wong, who transitioned to her new role as Strategic Advisor with the Centers for Disease Control and Prevention (CDC) this summer. This opportunity will allow Charlene to take lessons learned from NC InCK and apply them to families nationwide. Rushina was formally introduced to the NC InCK community and partners at our July 28 webinar, where she took the opportunity to share her hope that the model continues to build on its strong foundation of success. She named enhancing NC InCK’s focus on equity as one of her initial priorities for the model, saying:

"Our NC InCK team has so many strengths. I hope I can bring an additional focus to how we think about equity. All of us came to this work because of an interest in social justice, and we can do even more in centering equity at NC InCK."

Rushina with her husband and children Kian and Nico

For the last two years, Rushina served as a member of the NC InCK Executive Team as Research and Evaluation Director. In this previous role with NC InCK, Rushina supported the model's efforts to leverage data and perspectives learned from families and care managers in order to better design our approach to improving NC InCK services. Rushina has also supported NC InCK by mentoring students and summer interns focused on areas including nutrition and food insecurity, family engagement, and risk stratification.

Dr. Mike Steiner, NC InCK Health Director, said of Rushina, “I have known Dr. Cholera for almost ten years. She is incredibly thoughtful, insightful, caring, driven, and brilliant! She will be a great leader for this next phase of NC InCK.”

In addition to her role with NC InCK, Rushina is a practicing pediatrician in Durham County. She is also an Assistant Professor of Pediatrics and Population Health Sciences at the Duke School of Medicine, as well as a Faculty Fellow at the Duke Margolis Center for Health Policy.

Dr. Cholera completed both her MD and Ph.D. in Epidemiology at the University of North Carolina at Chapel Hill.

NC InCK: Year One in Review

Posted on August 15, 2023August 15, 2023 by manda.hufstedler@duke.edu

After launching the NC Integrated Care for Kids (NC InCK) model in our five-county service area in January 2022, we celebrated our first anniversary in 2023. More than 1,600 families have been engaged in the NC InCK model since Spring 2022, thanks to the incredible work of our partners. Among these families, 350 are children in foster care placements. In partnership with our five local Department of Social Services (DSS) offices, NC InCK works closely with foster families, as our model focuses on reducing out-of-home placements.

Area 1: Understand Needs

In 2022, NC InCK began using data and information to understand the needs of children and young adults. The model began using this same data to lift up children and young adults ages 0-20 for NC InCK’s integrated care model. NC InCK is now linking data across NC Medicaid, NC Department of Public Instruction, and NC’s Division of Juvenile Justice and Delinquency Prevention. Each month, NC InCK brings together the data across these three agencies to prioritize new children for engagement with the NC InCK model. This is the first time that data on health, education, child welfare and juvenile justice have been brought together to identify children for care management under NC Medicaid.

Area 2: Support and Bridge Services

Since 2022, 4,600 families have received outreach for NC InCK’s integrated care model, and 1,600 have chosen to engage in services. Families who engage in the model are paired with a care manager who works with their primary care practice. Setting goals for an NC InCK Shared Action Plan is one of the first steps for a care manager and family. To set these goals, the care manager will ask questions to help identify areas where the family would like support for their child. Families can ask for different kinds of support in order to meet these goals, including help scheduling appointments, connections to food resources, or help contacting a child’s school about support they need. Families can set up times to check-in and share resources with their care manager during a time that is best for them.

To date, care managers and families have completed 950 Shared Action Plans. In year two, NC InCK plans to engage and support more families. NC InCK is especially grateful to the teams of care managers at the Prepaid Health Plans, Community Care of North Carolina, Duke Health, and UNC Health for their support of children and families in the model.

Area 3: Focus Healthcare Investments

In January 2023, NC InCK, NC Medicaid, and the state’s Prepaid Health Plans launched NC InCK’s new Alternative Payment Model (APM). The APM supports high-quality health care for children and the medical providers who deliver these services. NC InCK’s APM encourages food and housing insecurity screening and allows primary care providers to promote Kindergarten Readiness. NC InCK also launched a webpage for primary care practices explaining the details of the APM.

Our Partners are Critical to Realizing NC InCK’s Vision

We are fortunate to have collaboration and support from a broad range of partners who make it possible to continue strengthening our model. We are particularly grateful to the partners with embedded NC InCK Integration Consultants. Having staff working as part of these institutions helps us better collaborate, navigate transitions in care for children, and access services and supports across NC InCK’s core child service areas. Thank you to the following entities who house NC InCK Integration Consultants within their teams and contribute to the cross-sector, collaborative design of our NC InCK model:

Alliance Health
Durham Families and Communities Rising
Orange County Health Department
Orange County DSS
Granville Vance Health Department
Division of Juvenile Justice and Delinquency Prevention
NC’s five Prepaid Health Plans (PHP)
Community Care of North Carolina (CCNC)
Duke Health
UNC Health
Vaya Health

Looking Ahead: Strengthening Family Engagement in the NC InCK Model

NC InCK care managers call families to give them the option to participate in our service model. In year two, we aim to increase the number of families who receive these calls and accept care management services. Care managers engaged approximately 30% of the families we outreached in our first year. To strengthen outreach and engagement, NC InCK is piloting several different approaches in 2023, including:

Accepting NC InCK referrals from school nurses, juvenile justice court counselors, and care managers in health systems
Housing NC InCK care managers in one large primary care clinic (Burlington Pediatrics) to meet families and build in-person connections
Building a series of toolkits and materials for using texting and alternative communication approaches to more effectively reach families

In 2023, we plan to highlight the promising approaches, systems gaps, and learning areas from our model through regular updates like this. Stay tuned for future updates on our in-depth work to connect more children in foster care with care management services, our goals and early implementation lessons from the NC InCK Alternative Payment Model, and our strategies across service areas like food and early childhood.

NC InCK November 2024 Webinar Recording

Posted on August 10, 2023December 4, 2024 by manda.hufstedler@duke.edu

The November 7, 2024 webinar shared highlights of the model, including a general overview of NC InCK's goals and strategies, information about NC InCK's Alternative Payment and Care Models, and updates about research questions NC InCK hopes to answer. Watch the November webinar below.

NC InCK Launches New Facebook Page for Families, Partners, Health Care Providers, and More

Posted on July 19, 2023July 19, 2023 by manda.hufstedler@duke.edu

We are thrilled to announce the official launch of the North Carolina Care for Kids (NC InCK) Facebook page! Whether you’re a caregiver, a health care provider, or a community member, our page is a one-stop hub for staying connected with all things related to NC InCK!

With this page, we aim to foster a strong sense of community by keeping you informed about our latest events, model updates, and important policy changes that impact our work. We also hope to share information about events and supports offered by our partners in the five counties. We believe that by staying connected, we can create a more informed and engaged community working together to provide the best possible support for North Carolina children and families.

What to expect:

NC InCK Updates – Stay tuned for upcoming event announcements as well as model updates
Policy Changes – We’ll keep you up-to-date on legislative or healthcare-system changes, such as Medicaid Expansion in North Carolina, that have a direct impact on families in the NC InCK service area
Community Events – We’ll also promote and share events in our communities that may benefit NC InCK families and partners

If you have events or updates that you would like to share with the NC InCK community, please reach out to our team via Facebook direct message or by email at info@ncinck.org. We’d be happy to get the word out!

Join us on our journey to supporting and bridging services where children, youth, and families live, learn, and play. Like and follow our page to stay connected and up-to-date: @NC Integrated Care for Kids