Full Course: Jan. 10, 2019 – May 3, 2019
In-Person Session Week One: Jan. 28-Feb. 1, 2019
In-Person Session Week Two: April 30-May 3, 2019

Applications due by Nov. 30, 2018
Registration/Payment deadline: Dec. 14, 2018

An Enhanced Role Nurse (ERRN) Course

Course Overview

The Child Health Training Program (CHTP) was designed to provide a standardized curriculum for registered nurses (RN) who 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 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.

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Medicaid Reimbursement for the Health Department

Successful completion of this course and required clinical practicum qualifies RNs to be rostered through the Public Health Nursing and Professional Development Unit (PHNPDU) with the N.C. Division of Public Health as a Child Health Enhanced Role Registered Nurse (CHERRN). Once rostered, the CHERRN is able 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. A rostered CHERRN can provide a higher level of nursing services under standing orders in compliance with Medicaid billing guidelines and the North Carolina Nurse Practice Act. The Division of Medical Assistance (DMA) reimburses for Health Check Screenings performed by rostered CHERRN.

For example, 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 34 billed Health Check visits. Activity 351 HMHC Child Health funds may be used at the same rate to offset the cost of preventative visits for children who are not Medicaid recipients. Additionally, with Branch approval, agencies may use Activity 351 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 N.C. Division of Public Health has a memorandum of understanding with Medicaid to train and roster CHERRNs.

Only rostered CHERRNs may bill Medicaid 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.

PHNPDU and the Child Health Program work collaboratively to support the CHERRN. PHNPDU consultants provide nursing scope of practice and billing and coding guidance. Regional Child Health Nurse Consultants (RCHNCs) provide Health Check Program Guide 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 agencies. 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.

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Audience

The curriculum is for registered nurses who are currently working or who are preparing to work in clinics at North Carolina local health departments and other community-based clinics. 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.

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Cosponsors

  • The North Carolina Institute for Public Health, UNC Gillings School of Global Public Health
  • Children and Youth Branch, Women’s and Children’s Health Section, Division of Public Health, North Carolina Department of Health and Human Services
  • Public Health Nursing and Professional Development Unit, Division of Public Health, North Carolina Department of Health and Human Services

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Course Format

The CHTP consists of distance learning sessions during which students must participate in Clinical Topic Webinars and successfully pass the post-test for each topic; and two weeks of on-site training, separated by a 60+ hour clinical practicum in the student’s employing agency. 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, two clinical practice scenarios completed with preceptors, and submit four detailed write-ups documenting clinical findings, assessments, and plans of care for children seen.

Course Outline

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Objectives

After completion of this course, participants will be able to:

  • Elicit a comprehensive pediatric health history, including investigation of any concerns or problems.
  • Demonstrate a comprehensive pediatric physical assessment.
  • Document a pediatric history, physical assessment, problem list and plans according to POHR, programmatic guidelines and Bright Futures Tool and Resource Kit forms.
  • Perform, score, document results and share results and implications with parents regarding pediatric developmental screenings using validated screening tools.
  • Document a clear nursing assessment of the physical, developmental and psychosocial status of children and adolescents.
  • Identify normal growth, development and psychosocial patterns for children and adolescents.
  • Complete appropriate consultation and/or referral of clients with identified or suspected abnormal findings in order to develop an appropriate plan of care.
  • Follow agency appropriate standing orders and clinical policies for positive risk factors when indicated.
  • Provide client-focused, age-appropriate anticipatory guidance to children/adolescents and families.
  • Identify appropriate schedule for comprehensive pediatric health assessment based on AAP Bright Futures recommendations and the Health Check Program Guide requirements.
  • Demonstrate RN scope of practice as it relates to the Child Health Enhanced Role Nurse role.

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Prerequisites

BSN or completion of Principles and Practices of Public Health Nursing for RNs. Agencies must provide documentation of completion of Principles and Practices of Public Health Nursing.

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Required Textbooks

The following texts are required for the course. They can be purchased from any major bookseller.

  • Bates’ Guide to Physical Examination and History Taking, Lynn S. Bickley, 12th or 11th edition.
  • Bright Futures: Guidelines for the Health Supervision of Infants, Children and Adolescents, 4th edition, American Academy of Pediatrics

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Required Pre-course Planning

Each student must arrange for an on-site clinical preceptor that will oversee and provide feedback regarding skills progression during the clinical practicum. A Local Planning Document signed by the student, clinical preceptor, nursing supervisor, and Regional Child Health Nurse Consultant (RCHNC) must be completed after application and prior to registration for the course.

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Minimum Technical Requirements

Except for two weeks of face-to-face training, this course is delivered online through a learning management system (Sakai), as well as through webinars using the web conferencing system, (Zoom). In order for you to successfully complete this course, you must have access to the following:

  • A sound card (most fairly new computers have a sound card already installed)
  • Reliable, high-speed internet access
  • An email account that can handle attachments
  • An up-to-date web browser such as:
    • Mozilla Firefox (v52 or greater)
    • Google Chrome (v 55 or later)
    • Note:  for Sakai, Mozilla Firefox or Google Chrome is the preferred browser
  • The two free plug-ins:
  • A copier/scanner or a desktop scanner for scanning non-electronic homework assignments that you will upload to Sakai.
  • For the live webinars (Orientation and Practicum Check Ins), you will need to have access to both the internet (visual) and the telephone (audio). For the archived Clinical Topic Webinars, you will need either speakers or a headset.

If you do not have the latest versions of the plug-ins (Adobe Reader, Adobe Flash Player) or web browsers listed above, please download them before starting the course. You can also test your system to see if you have the minimum technical requirements by completing the online skills test. If you have questions or need assistance in verifying that you have the necessary equipment, please contact your agency’s computer support person. This is especially true if your employer utilizes firewalls for security.

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Expectations of Students

For successful completion, participants must:

  • Participate in ALL webinars and face-to-face sessions in Week One and Week Two.
  • Complete all assignments with a score of “satisfactory” on all visit write-ups during the clinical practicum and obtain a minimum score of 80% on all Clinical Topic Webinar post-tests
  • Two Clinical Practice Scenarios will be completed with the preceptor during the practicum.
  • Participate in CHTP check-in webinars. The participant, preceptor, and nurse supervisor are expected to participate in the check-in webinars.
  • Complete at least 60 hours during the clinical practicum providing comprehensive histories and physicals (includes seeing 30 children/youth with a minimum of five from each required age group: 0-2; 3-5; 6-10; and 11-20).
  • Maintain and submit Clinical Logs to demonstrate progress towards meeting practicum requirements.
  • Receive a rating of “satisfactory” on the final clinical evaluation by the student’s advisor/preceptor.
  • Receive a rating of “satisfactory” on the final clinical check-off by faculty.
  • Score at least 80% on the final examination.

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Expectations of Agency

For successful completion, the agency must:

  • Assure time to complete course assignments and provide experienced preceptor with designated time to spend with the student.
    • 50% of FTE should be focused on the CHTP beginning two weeks prior to Week 1 (prep requirements) through the end of Week 2
    • The primary preceptor is responsible for ongoing mentoring and review of the participants assignments; it is estimated that this time commitment would average an hour per day.

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Expectations of Supervisors

For successful completion, the supervisor must:

  • Agree to facilitate learning experience during training period (time for assignments and preceptor accessibility); see time commitment estimation above. RECOMMENDATION: see Spring 2019 CHTP Key Dates Calendar for suggestions on assuring time available for preceptor review of assignments prior to 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.
  • Facilitate application of skills during practicum, including arranging for 60 hours of clinical practicum time during which student is relieved of other duties, and assuring consistent clinical preceptor is available to support the learning process (see time recommendations above). Facilitates regular check-ins with the preceptor and student to assure successful completion of practicum requirements.
  • Clarify agency ERRN role expectations for student prior to and once course is completed. Assures appropriate consultative support, and policy and procedures are in place to support the RN after completion of the course.

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Credits

Continuing Education Units (CEUs) have been applied for through the William and Ida Friday Center for Continuing Education at the University of North Carolina at Chapel Hill. A certificate of CEUs will be provided for each student upon successful completion of the course and clinical practicum. Registration information will be sent to the CEU Office at the Friday Center for Continuing Education at UNC CH where a permanent transcript of all CEU courses taken from UNC CH are maintained.

Clinical and continuing education credit earned for this course MAY NOT be used towards clinical hours and CE for rostering purposes.

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Location and Accommodations

It is strongly recommended that participants stay at the hotel during the face-to-face sessions in Chapel Hill. Students are assigned approximately two hours of hands on skills practice, homework or study each night. Staying at the hotel facilitates this practice, study time and interaction with the faculty.

Location and Overnight Accommodations:  The training will be held at the Hampton Inn & Suites, 6121 Farrington Rd, Chapel Hill NC. A block of rooms has been set up at the Hampton Inn & Suites Chapel Hill with a special rate of $92 plus tax per night. The rate includes a full deluxe hot breakfast and Wi-Fi.

Week One:

To reserve a room online please visit this page to get the special rate. To reserve a room by phone call the hotel @ 919-403-8700, press 0 and provide the meeting name Child Health Training Program. To receive the special rate reservations must be made no later than Jan. 15, 2019.

Week Two:

To reserve a room online please visit this page to get the special rate. To reserve a room by phone call the hotel @ 919-403 -8700, press 0 and provide the meeting name Child Health Training Program. To receive the special rate reservations must be made no later than April 13, 2019.

Participants are responsible for reserving and paying for their own hotel rooms.

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Application

Applications due 5:00 p.m. Nov. 30, 2018

To register, you must complete and email an Application for PHN Enrollment in the Child Health Training Program to your Regional Child Health Nurse Consultant (RCHNC) (see the link below). In addition to emailing, you may print and mail the application to your RCHNC. Faxed applications will not be accepted. Your RCHNC will review the course requirements with your agency, verify that you have completed the necessary prerequisites, assure that an appropriate clinical advisor is available and understands his or her role in the practicum, assure adequate time and resources are made available by the agency, and if approved, refer you to register for the program.

View and print application for Child Health Enhanced Role Registered Nurse Training Program (required)

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Course Registration Fees

After your application is approved, you will receive a link to the online registration form. You must submit your registration and payment on or before Dec. 14, 2018.

Course Fee: $3,000 for full course including clinical practicum

Checks should be made out to the University of North Carolina at Chapel Hill and sent to NCIPH, Campus Box 8165, UNC, Chapel Hill, NC 27599-8165.

Important: The registration fee must be received or postmarked no later than Dec. 14, 2018 or your registration will be CANCELLED.

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Challenge Exam

For more information about the challenge exam or to see if you meet the requirements to challenge this course, please visit the Child Health Enhanced Role Nurse Challenge Process.

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For More Information

For more information, contact Jackie McIver by email at jkeith@email.unc.edu or by phone at 919-966-3309.

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