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 to better support CYSHCN and their families. IA provides funding opportunities meant to bring together healthcare agencies, CYSHCN and their families, and community partners to improve access to healthcare and other community services.

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, Whole Child Health Section.

Services offered

North Carolina's Local Health Departments, Health Districts, Federally Qualified Health Centers, and nonprofit organizations are eligible to apply for funding 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.

Eligible organizations must serve at least three counties or one large metropolitan county and focus on at least two of the following areas:

• Community accessibility (improving access to healthcare, social services, recreation, and community events)
• Emergency preparedness
• Palliative care integration
• Transition from pediatric healthcare to adult healthcare

Family and caregiver engagement is central to IA. Grantees must either create an advisory/steering committee with at least 50% parents/caregivers or work with an existing community workgroup of parents/caregivers of CYSHCN. Grantees also must develop plans for data collection, action, and sustainability.

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 Innovations Database, which serves to highlight best practices in maternal and child health.

The Cabarrus Health Alliance in Cabarrus County received an AMCHP Replication Project 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, the 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.

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

Contact Information