2024-2025 Child Health Training Program (CHTP) Information Page

Important Dates

Applications due: July 19, 2024

Required Live webinar Local Planning Document review: August 1, 2024

Registration/Payment deadline: September 13, 2024
*More information on the registration process and the application link are provided below.

Required Pre-Orientation Assignments for students and primary preceptors: September 19, 2024

Orientation: September 26, 2024

Online Pre-Training Assignments: September 27 - October 16, 2024

In person Classroom Week One: October 21 - October 25, 2024

Supervised Clinical Practicum: October 28, 2024 - March 21, 2025

In person Classroom Week Two: March 31, 2025 - April 3, 2025

Course Overview
The Child Health Training Program (CHTP) is designed to provide a standardized curriculum for registered nurses (RN) in local health departments (LHD) to perform Early and Periodic Screening and Diagnostic Treatment (EPSDT) or Health Check screenings.

The course focus is on the American Academy of Pediatrics (AAP) Bright Futures evidence-based recommendations as the clinical framework. The course addresses all required components of the Health Check screening visit, focusing on the comprehensive pediatric history and the complete physical assessment. There is a strong emphasis on identification of problems, assuring appropriate consultation, referral and/or treatment of identified problems, along with documentation to support the quality of care and billing requirements.

The course is a stand-alone training; public health nurses are not required to have completed other pediatric or physical assessment training programs prior to enrolling in the CHTP; however, six months of experience in ambulatory pediatrics is strongly recommended.

The CHTP is designed to provide nurses in local health departments with the skills they need to perform physical assessments and to function under standing orders.

The course includes a supervised clinical practicum with local agency physician(s) or advanced practice provider(s).
The course requires an application. (Must be completed with clinical preceptor information and applicant's signature.)

The CHTP course objectives include:

Increase their knowledge and skills, as evidenced by successfully demonstrating their ability to complete a history and perform a comprehensive well-child assessment including the developmental, and psychosocial status of children and adolescents independently
Provide client-focused, age-appropriate anticipatory guidance to children, adolescents, and families.
Develop an appropriate plan of care and provide appropriate consultation and/or referral for clients with identified or suspected abnormalities.
Demonstrate and follow agency-appropriate nursing standing orders and clinical policies while following RN scope of practice.
Appropriately document (according to AAP Bright Futures recommendations, North Carolina Board of Nursing (NCBON) guidelines and regulations, Health Check Program Guide requirements (HCPG), agency-appropriate standing orders, and clinical policies)

Learner Outcomes:

Participants will increase knowledge and skills, as evidenced by successfully demonstrating their ability to complete a history and perform a comprehensive well child assessment independently, appropriately documenting, appropriately consulting and/or referring patients with identified or suspected abnormal findings and developing an appropriate plan of care by end of CHTP as evidenced by a minimum score of 80% on posttests, graded classwork, check- offs and final exam.

Disclosures

NCPD Contact Hours and CPH Recertification Credits may be earned upon successful completion.
For successful completion, participants must attend 100% of the educational activity, make at least 80% passing grade on the final exam and complete the online course evaluations.
There will be no partial credit awarded.
No one with the ability to control the content of this activity has a relevant financial relationship with an ineligible company to disclose.
No commercial support has been received for this activity.
This educational activity is being jointly provided by the Public Health Nursing Institute for Continuing Excellence (PHNICE) and the North Carolina Public Health Association.

Provider Statement
The Public Health Nursing Institute for Continuing Excellence is approved as a provider of nursing continuing professional development by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Medicaid Reimbursement for the Health Department
Successful completion of this course qualifies RNs to be rostered through the Office of the North Carolina Chief Public Health Nurse (OCPHN) with the NC Division of Public Health as a Child Health Enhanced Role Registered Nurse (CHERRN). Once rostered, the CHERRN is qualified to perform comprehensive pediatric histories and EPSDT (Health Check) screenings using the American Academy of Pediatrics (AAP) Bright Futures evidence-based recommendations as the clinical framework. Rostered CHERRNs provide comprehensive pediatric preventative evaluations in compliance with agency nursing standing orders, NC Medicaid billing guidelines, and the North Carolina Nurse Practice Act.

The Division of NC Health Benefits reimburses for Health Check Screenings performed by a rostered CHERRN. The Medicaid reimbursement of Health Check visits by CHERRNs is the same as for physicians or nurse practitioners at a minimum rate of $90.00; the cost of CHERRN training can be recovered in as few as 28 billed Health Check visits. Child Health 351 Agreement Addenda (AA) funds may be used at the same rate to offset the cost of preventative visits for non-Medicaid, non-insured clients. Additionally, with Division of Child and Family Well-Being (DCFW) approval, agencies may use CH 351 AA funds to support the training of CHERRNs.

The Child Health Enhanced Role Registered Nurse
The CHERRN was established to increase access to preventative care for underserved and at-risk children. The NC Division of Public Health and the Division of Child and Family Well-Being have a memorandum of understanding with NC Health Benefits to train and roster CHERRNs. Only rostered CHERRNs may bill NC Health Benefits for services or use Title V funds to support preventative services. CHERRNs practice within the North Carolina Nurse Practice Act. Training and rostering allow the CHERRN to bill for Medicaid services but does not extend the RN scope of practice.

OCPHN and the Child Health Program work collaboratively to support the CHERRN. OCPHN consultants provide nursing scope of practice and billing and coding guidance. Regional Child Health Nurse Consultants (RCHNCs) provide HCPG and programmatic guidance and training as well as quality improvement resources.

CHERRNs are jointly rostered with the agency – rostering is not transferable. If a CHERRN changes agencies, the CHERRN must reapply for rostering with the new agency. It is the responsibility of the CHERRN and the agency to assure that the CHERRN remains on the roster in order to be able to bill Medicaid for the child health screening completed by the CHERRN. The agency is responsible for assuring compliance with rostering requirements and establishing the consultation support and infrastructure, including nursing standing orders, competency assessment and policies and procedures to support safe, effective and licensure compliant practice.

Target Audience

Registered nurses who are currently working or who are preparing to work in well child clinics in North Carolina local health departments. Selection of applicant(s) is the responsibility of the local public health nurse supervisors and Directors of Nursing in cooperation with the Regional Child Health Nurse Consultants and the State Child Health Nurse Consultant. Applicants are not required to have completed other pediatric or physical assessment training programs prior to enrolling in the Child Health Enhanced Role Registered Nurse Program; however, six months of experience working in ambulatory child health services is strongly recommended.

Cosponsors

Division of Child and Family Well-Being/Whole Child Health Section, North Carolina Department of Health and Human Services
NC Office of the Chief Public Health Nurse, Division of Public Health, North Carolina Department of Health and Human Services
North Carolina Public Health Association (NCPHA)
Public Health Nursing Institute for Continuing Excellence (PHNICE)

The CHTP consists of distance learning sessions during which students must participate in clinical webinars and successfully pass the post-test for each topic. Also, two weeks of onsite classroom training, separated by 60 hours of clinical experience composed of comprehensive preventative visits for children from birth through 20 years of age.

During the practicum, students under the guidance of clinical preceptors will perform comprehensive histories and physical examinations on children and adolescents. Students must also complete additional clinical topic webinars, complete three clinical practice scenarios with their preceptors, and submit four detailed write-ups documenting clinical findings, assessments, and plans of care for children seen.

Click here to access the 2024-2025 CHTP Course Outline

Prerequisites
Completion of the North Carolina Credentialed Public Health Nurse (NCCPHN) Course for RNs. Please note: Effective May 1, 2024, all RNs applying to the Child Health Training Program must submit proof of completion of the NCCPHN Course. (Students may be dually enrolled in both courses. If dually enrolled, students must enter estimated date of NCCPHN Course completion on CHTP application.)

Required Textbooks
The following texts are required for the course.

Bright Futures: Guidelines for the Health Supervision of Infants, Children, and Adolescents, 4th Edition.
Guide to Physical Examination and History Taking. Bates, Barbara. J. B. Lippincott Company, 13th Edition.
Bates’ Pocket Guide to Physical Examination and History Taking, 9th Edition
The Clinician's Guide to Pediatric Nutrition, Natalie D. Muth MD MPH RDN, Mary Tanaka MD MS. 1st Edition
Pediatric Nutrition for Toddlers, School-aged Children, Adolescents, and Young Adults: A Clinical Support Chart, Indexed Edition
Ackley and Nursing Diagnosis Handbook, An Evidenced-Based Guide to Planning Care 13th Edition

Note: The texts are included with registration and provided to Participants for this cohort.

Minimum Technical Requirements

Webinars and faculty feedback sessions for students and preceptors are delivered using MS Teams and Adobe Connect. Students and preceptors will need MS Teams agency or individual account access and Adobe Connect for these sessions. Agency should ensure students' ability to access and utilize MS Teams and Adobe Connect before the mandatory Local Planning Document (LPD) webinar. The RCHNC can address any questions relating to access options during the LPD review.

Microsoft Teams Requirements:

Hardware Requirements:
To view hardware requirements for using Microsoft Teams, please see the Microsoft Teams Technical Requirements Page. It covers Apple, Android, and PC devices:
- Microsoft Teams Hardware Requirements, these hardware requirements are relatively standard across teleconferencing options, (including a USB 2.0 video camera, USB headset microphone, speakers, and sound card) but please review the list to confirm.
- Please note that computers, laptops, and tablets with larger screens typically work better when using MS Teams than smaller tablets and phones.
Software Requirement:
Microsoft Teams will also require a software download to your computer or device:

Adobe Connect Requirements:

Hardware Requirements:
- The Adobe Connect Technical Specifications and System Requirements, are hardware requirements that are generally standard across teleconferencing platforms. Please review the specific requirements on this page, based on the type of operating system you have.
- A sound card (most new computers have a sound card already installed)
- Reliable, high-speed internet access (minimum of 1.8 Mbps upload speed per person & 10 Mbps download speed per person or higher; DSL/cable option is recommended, may use Wi-Fi if you have a stable and secure connection). You can test your internet speed using this link: Internet speed test
- An email account that can handle attachments and email encryption.
- An up-to-date web browser listed on the Adobe Connect Technical Specifications page:
  - Note: Mozilla Firefox or Google Chrome are the preferred browsers. Apple Safari (latest version) and Mozilla Firefox (latest version) may work, but Firefox and Chrome are the best recommendations.
- Software Requirements:
  - To view PDFs, you will need the free version of Adobe Acrobat DC or later (do not need Pro version).
  - The recommended free Adobe Connect Desktop Application plug-in. This is not required, but will help Adobe Connect meetings function better.

To test your Adobe Connect Capabilities, you can complete a quick diagnostic test (should take 2 minutes or less) by visiting:
- Adobe Connect Meeting Support Diagnostic Test
- The diagnostic test will check:
  - Your operating system
  - Your browser
  - Connectivity (network connection)
  - Speed (upload and download speeds)
  - You will also have the option to set you your speaker & microphone settings.
  - Please note and complete any recommendations. Also note that your connectivity and speed may vary throughout the day, based on your provider and specific demands of your internet connection at the time of the test.
A copier/scanner or a desktop scanner for scanning non-electronic homework assignments is necessary as you will upload assignments during the Child Health Training Program.
For the Orientation and Practicum Check-Ins, students will need to have access to the internet. For the archived Clinical Webinars, you will need either speakers or a headset. If you do not have the latest versions of the plug-ins (Adobe Reader) or web browsers listed above, please download them before starting the course. If you have questions or need assistance in verifying that you have the necessary equipment, or MS Teams access, please contact your agency’s computer support person. This is especially true if your employer utilizes firewalls for security.

Note: Documentation assignments use data from real patients and require HIPAA review and password protection or encryption to protect Personal Health Information (PHI). Students should work with their supervisor or agency tech support to ensure they are able to password protect or encrypt assignments prior to submission of assignments.

Student Requirements:

Attend the Local Planning Document Overview Webinar.
Complete and submit 3 Self-Assessments (Pre-training, Mid-training, and Post training).
Attend Mandatory Orientation Webinar (Students, supervisors, and preceptors are required to attend.) The Orientation Webinar will review the course requirements and expectations.
Pre-Training
- Students will be given access to webinars, videos, and reading assignments during the Orientation Webinar. Students will complete all Pre-training requirements, including reading and video assignments, webinars, and obtain a minimum score of 80% on all assignments. Pre-training assignments must be completed before Week One.
Students are required to participate in the face-to-face training sessions in Chapel Hill for Weeks One and Two.
Clinical Practicum: (60 Hours of clinical experience required)
- The practicum is composed of comprehensive preventative visits for children birth through 20 years of age to include the following: Performing the history and physical assessment, formulating a problem list and plans which may include consultation, referrals, or further interaction with the family (i.e., teaching), documenting in the agency record, and completing hearing, vision, and /or developmental screenings, if done by the student as part of the complete physical examination. The estimated time spent with each child and documenting the visit is approximately two hours.
- Students must see a minimum of 30 children/youth with a minimum of five from each required age group: 0-2; 3-5; 6-10; & 11-20.
- The primary preceptor will observe the student and complete the required Clinical Assessment Tools.
- Clinical Practicum Progress reports must be submitted. Maintain and submit Clinical Logs to demonstrate progress toward meeting practicum requirements.
Archived Webinars via Adobe Connect
- Students must review all webinars and complete a post-test by due dates of the webinar with a minimum score of 80%.
Live webinars via MS Teams
- Students must attend all webinars and complete a post-test within two weeks of the webinar with a minimum score of 80%.
Practicum Check-ins with faculty
- Students, supervisors, and preceptor(s) are required to attend these live webinars to review progress and ask questions.
Assignments to be submitted include:
- One Documentation Check sheet assignment.
- Four Documentation by Exception (DBE) visit documentation assignments must be reviewed by the primary preceptor before submission. The Director of Nursing/Nurse Supervisor/or designee must review and sign off on each write-up before submission to prevent an inadvertent HIPAA breach.
- Three Clinical Practice Scenarios (CPS) will be completed with the primary preceptor to reinforce the critical thinking process.
CHTP Evaluation: An evaluation must be completed to receive the Certificate of Completion and to become rostered.
Scores:
- Must obtain a minimum score of 80% on all assignments and check offs.
- Receive a rating of "satisfactory" for Two Clinical Assessment Tool Evaluations by the student's primary preceptor.
- Obtain a minimum score of 80% on the final examination which includes two CPS and 60 multiple-choice questions.

Supervisor’s Requirements:

Submit agency policies (Refer to CH Policy Checklist)
Review and utilize the Key Dates Calendar throughout the course to ensure time availability.
Agree to facilitate the learning experience during the training period (time for assignments and accessibility); see student and preceptor time commitment estimation in Section II of the Local Planning Document. See CHTP Course Outline and CHTP Key Dates Calendar for suggestions on assuring time available for primary preceptor participation and review of assignments before student submission.
Agree to assess student learning requirements and make appropriate accommodations to support successful completion of course requirements, for example, providing a quiet environment in the agency to complete assignments or allowing student to work from home.
Schedule an initial planning session with the student and preceptor(s). This is to coordinate calendars to ensure the completion of course assignments.
Required attendance: LPD Overview Live Webinar, Orientation Live Webinar, and three Practicum Check-in Webinars with faculty.
Facilitate application of skills during practicum, including arranging for 60 hours of clinical practicum time during which the student is relieved of other duties, and ensuring the primary preceptor is available to support the learning process.
(See student and preceptor time commitment estimation in LPD)
Facilitate regular check-ins with the preceptor(s) and student to ensure successful completion of practicum requirements.
Review or designate a reviewer and sign off on each write-up before submission to prevent an inadvertent HIPAA breach.
Periodic check-ins with the student and preceptor(s) to assess the student’s progress toward meeting the CHTP Course requirements.
If applicable, schedule periodic check-in conference calls with the partnering agency that has agreed to provide and serve as the clinical practicum experience to assess the progress of the student’s course requirements and to address any identified questions or concerns.
Review and sign Clinical Practicum Hours and Patient Log form prior to Week Two.
Clarify agency CHERRN role expectations for the student before and once the course is completed including initial and annual competency assessments.
Ensure appropriate, consistent consultative support and policy and procedures are in place to support the RN after completion of the course.

Primary Preceptor Requirements:

Serve as clinical faculty during the clinical practicum, provide oversight and mentorship for the student including consistent accessibility for consultation and re-assessment of the client. Primary preceptor must have a face-to-face consultation with the patient in order to bill.
Complete a Self-Assessment to assist faculty in identifying areas for improved support to preceptors during the practicum.
Complete the CHERRN Role and Clinical Assessment Process, Clinical Practice Scenario Process and Grading Overview and Healthcare Documentation archived webinar and submit the Attestation of Completion forms
At the beginning of the clinical practicum, the primary preceptor must observe and evaluate a minimum of two complete pediatric assessments utilizing the Clinical Assessment Tool for each age group prior to the student performing the assessments independently. Document the students’ performance of one assessment utilizing the Clinical Assessment Tool at the beginning and end of the course.
Review the four DBE assignments before the student submits them to the training program for comprehensiveness and ensure it meets agency policy and procedures, regulatory HCPG, and licensure NCBON requirements.
NOTE: A detailed plan of care is required for all parental concerns, risk factors, clinical findings, previous diagnoses, and health conditions.
Collaborate with the student to complete the three Clinical Practice Scenarios (CPS).
Participate in faculty feedback sessions for each assignment and work with the student to ensure understanding of the feedback.
Participate in Practicum Check-in meetings with students and supervisors.
Review and sign Clinical Practicum Hours and Patient Log form prior to Week Two.

Secondary Preceptor Requirements: Provide oversight and mentorship for the student during the practicum, including consistent accessibility for consultation and reassessment of the client. Must have a face-to-face consultation with the patient in order to bill.

Expectations of Agency

For successful completion, the agency must:

The agency agrees to provide a primary preceptor experienced in pediatric well-child assessments and agency clinical and documentation policies and ensure the primary preceptor has designated time to provide clinical mentoring while the student completes the preventative visit, review and provide feedback on assignments prior to submission, and complete required webinars.
- primary preceptor qualifications require them to be either a physician or advanced practice provider.
- Rostered CHERRNs with a minimum of two years of experience may serve as secondary preceptor. The purpose of the secondary preceptor is to serve as a backup to the primary preceptor.
Assure time to complete course assignments and provide experienced preceptor with designated time to spend with the student.
- 50% of the FTE should be focused on the CHTP beginning two weeks prior to Week One (prep requirements) through the end of Week Two.
- The primary preceptor is responsible for ongoing mentoring and review of the participants assignments; it is estimated that this time commitment would average 2 hours per day, or 10 hours per week.

Requirements for the 60-hour Clinical Practicum
The practicum is composed of visits to children in need of a comprehensive assessment. The estimated time spent with each child and documenting the visit is approximately two hours. The 60-hour clinical is composed of time spent:

Performing the history and physical assessment
Formulating a problem list and plans which may include consultation, referrals, or further interaction with the family (i.e., teaching)
Documenting in the agency record
Completing Hearing, Vision and/or Developmental Screenings, if done by the student as part of the complete physical examination

Requirements for Initial Rostering: Completion of CHTP and receipt of the official initial rostering letter from the NC DPH Office of the Chief Public Health Nurse. CHERRNs may not independently see patients or bill for services until they receive the official rostering letter from the Office of the Chief Public Health Nurse.

Maintaining status as a Rostered Child Health Enhanced Role Registered Nurse: CHERRNs are not rostered independently. The CHERRN must be employed with an agency that is responsible for providing the infrastructure to support practice; Both the agency and the CHERRN are required to notify the Office of the Chief Public Health Nurse if there is a change in employment with the agency. Your RCHNC will provide and review the current Policy on Remaining Rostered as a Child Health Enhanced Role Registered Nurse.

Annual Re-rostering requirements:

100 clinical hours and a minimum of 50 preventative visits (clinical hours include completion of history and physical assessment).
10 approved continuing education contact hours

Application and Registration
You must complete and submit the Application for the Child Health Training Program. (See the link below for access to the application) After application submission and review by your RCHNC, the student, primary preceptor, and supervisor must participate in the LPD Review on August 1, 2024. You will meet with your RCHNC for any last minute questions, review of and signing of the LPD by August 23, 2024. You will then be provided the link to register for the program.

Click here to access a PDF version of the application. Applicant may utilize this document to gather necessary information to assist completion of the application.

Click here to access the application

Course Registration Fees
Course Fee: $2500 for full course including clinical practicum. After your application is approved, you will receive a link to the online registration form from your Regional Child Health Nurse Consultant. Checks will be made payable to NCPHA. *Important: The registration fee must be received or postmarked no later than September 13, 2024 or your registration will be CANCELLED.

Hotel Accommodations
The Child Health Training Program will be held at the Aloft Hotel in the conference room Weeks One and Two. A block of rooms is being held for students for each of the two weeks that training will be face-to-face. Students should contact the hotel and make reservations once you receive your registration confirmation. Contact information is as follows.

Aloft Chapel Hill
1001 South Hamilton Road
Chapel Hill, NC 27517

Link for Reservations:
Click here to book your group rate for NC Department of Health and Human Services or call for reservations at 1-844-631-0595 for Week One

Last date to book reservations for Week One at the group rate of $98.00 (plus state and local tax) per night is September 20, 2024

Click here to book your group rate for NC Department of Health and Human Services or call for reservations at 1-844-631-0595 for Week Two

Last date to book reservations for Week Two at the group rate of $98.00 (plus state and local tax) per night is February 28, 2025

Contact Information for questions regarding hotel accommodations:
Angie Moody RCHNC
Angie.moody@dhhs.nc.gov

If you have any questions regarding the CHTP, you can contact Tara Lucas, State Child Health Nurse Consultant by email at Tara.Lucas@dhhs.nc.gov or by phone at 919-624-6652 or your RCHNC.