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Family and Children's
Resource Program

Vol. 23, No. 2
June 2018

Partnering with CC4C to Serve Substance-Affected Infants

Ensuring the safety, well-being, and permanence of children and their families is a huge job--too big for a single agency or profession. Knowing this, North Carolina's child welfare workers have long partnered with a wide range of community stakeholders, including Care Coordination for Children (CC4C).

With the passage of the Comprehensive Addiction and Recovery Act (CARA) of 2016, with its requirements related to Plans of Safe Care (POSC), the partnership between CC4C and child welfare agencies has become more necessary and frequent than ever.

CC4C is an at-risk population management program for children birth to 5 years of age administered through a partnership between Community Care of North Carolina and the NC Divisions of Public Health and Medical Assistance.

CC4C serves any child birth to 5 who meets certain risk criteria such as having special health care needs, extreme poverty, recurrent physical/emotional abuse, chronic neglect, maternal depression, parental substance use, children in foster care, infants in the NICU transitioning to community services, and children exposed to substances. CC4C program goals are to:

  • Improve children's health outcomes
  • Strengthen relationships between parents and infants
  • Promote quality care
  • Strengthen the family's relationship with the medical home, and
  • Minimize the lifelong impacts of the child's risk.

All CC4C services are voluntary and may be refused or ended by the family at any time.

Referrals Related to POSC
Under CARA, healthcare providers must share information on substance-affected infants with the local (i.e., county) DSS, which in turn must refer these children to CC4C. Importantly, all substance-affected infants must be referred to CC4C before a CPS Intake screening decision occurs. Timely referrals keep DSS in compliance with confidentiality and help CC4C get involved with the family as early as possible to provide a wide range of family support, regardless of the child welfare system's involvement.

Services, Tools, and Resources
Although CC4C's primary aim is to connect substance-affected infants and other at-risk children with a medical home, they also assess families for overall needs and provide support and referrals as needed for family needs that can impact the child. CC4C services are provided either by a registered nurse or a social worker, and can be provided in person, over the phone, or at medical appointments. Despite the large number of referrals to CC4C for substance-affected infants, they currently have no waitlist for services.

CC4C and Medical Homes

Learn more about CC4C and medical homes by taking Fostering Connections I and II, a pair of brief, self-paced, on-demand, online courses available to NC county child welfare professionals at

To assess family needs and track progress towards goals, CC4C uses the Life Skills Progression, administered at 6-month intervals. They also use other evaluations, such as the SWYC (Survey of Well-Being of Young Children), to assess for typical development and make referrals as needed.

CC4C's broad array of support and referral includes: housing, food security, parental mental health/substance use, maternal depression, domestic violence, smoking cessation, or support of the parent/child dyad. They use a family-driven and family-centered process for identifying and prioritizing family needs.

While any child meeting risk criteria can work with CC4C, children in foster care can particularly benefit. CC4C ensures each child in foster care has a medical home and meets the accelerated primary care visit schedule recommended for kids in care.

There is no defined time-line to a family's work with CC4C. The care manager and family set goals and work to meet them. When goals are met, the family can defer involvement unless or until support is needed again. CC4C works closely with Early Intervention and the Child Development Services Association to ensure services are coordinated and not duplicative.

CC4C has a statewide benchmark of interacting with 7.5% of all children age 0-5 who are Medicaid eligible. Between July and December 2017, they exceeded this benchmark by seeing 9.8% of North Carolina children in this age range. Additionally, CC4C reports that among children in foster care, those engaged with CC4C are more likely to receive routine care (e.g., dental visits, well care visits, immunizations) than those who are not.

Collaborating with CC4C

1. Complete the DSS-1404 (CC4C Referral Form):

  • Include the child's name and any known contact information
  • Include the referral source as DSS
  • Check "CPS Plan of Safe Care"
  • Complete page 2

2. Have a follow up conversation with the CC4C care manager to offer any further information that might help CC4C assess and engage the family

References for this and other articles in this issue