Children's Health Branch
NPM 10 Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year.
ESM 10.1 Partner with the University of Alabama at Birmingham to provide training and clinical practice quality improvement on youth-centered care to clinicians and other clinic staff using the Bright Futures mode.
Data combined for 2019-2020 from the Data Resource Center for CAHMI reveals 70 percent of adolescents, ages 12 through 17, had a preventive medical visit. This number is down from 2016-2017 when 76.3 percent of Alabama’s adolescents, ages 12 through 17, had a preventive medical visit in the past year. The national average is 75.6 percent, and the range across states is 67.9 percent to 90.9 percent. The rate for Alabama’s adolescents, ages 12 through 17, ranked lower than the U.S. rate of 75.6 percent. For 2019, the latest year for which Medicaid data is available, approximately 164,401 adolescents, ages 10–14 and 110,596 adolescents, ages 15-18, were eligible for EPSDT screenings. The total number of adolescents ages 10-18 that were eligible was 274,997. According to the FY 2019 Medicaid data, 80,012 adolescents, ages 10-14, and 42,099, ages 15-18, were screened. If this data is consistent, older adolescents may be less likely to seek well visits.
The Branch Director continued working with the UAB Leadership Education in Adolescent Health (LEAH). The LEAH Director assisted with the Title V Needs Assessment by participating in the stakeholder interviews and the needs assessment prioritization meetings for both child and adolescent health. This year AAP and ACHIA are using #StayWell for their quality improvement statewide collaborative centered around adolescent well visits and adolescent vaccinations.
SPM 4- Number of school districts assessed regarding current mental health services.
According to CDC, 1 in 6 children, ages 2-8, has a mental, behavioral or developmental disorder. Mental health issues often co-occur with substance abuse, violence, anxiety, depression and child suicide. About 8 in 10 children, ages 3-17, with depression also have anxiety (59.3 percent). More than 1 in 3 children, ages 3-17, have behavioral problems; more than 1 in 3 have anxiety (36.6 percent); and about 1 in 5 also have depression (20.3 percent). In 2017, Governor Kay Ivey authorized a council to recommend strategies to increase school safety. The council recommended strategies to increase school safety emphasizing physical security, threat assessments, mental health, and coordinated training and planning by state agencies.
According to the Data Resource CAHMI, in 2018-2019, 52.4 percent of Alabama’s children and adolescents, ages 3 through 17, with a diagnosed mental/behavioral health condition received treatment or counseling. This is an improvement over 2015 when only 49.5 percent of those 3–17-year-old children and adolescents received treatment. Alabama’s children and adolescents ages 3 through 17, fared slightly below the national average of 53.2
Oral Health Office
Ongoing activities in Alabama to improve oral health:
HPV Education and Vaccine Awareness/Promotion
Year 2021 marked the third year of the #WATCHYOURMOUTH campaign. The campaign was created in collaboration with USA Mitchell Cancer Institute. It is a multi-faceted campaign that highlights the importance of the FDA approved vaccine for HPV related oropharyngeal, as well as other head and neck cancers. The pinnacle of the campaign occurs in April so as to coincide with Oral Cancer Awareness Month. The campaign attracted the attention of Merck, the only manufacturer of the 9-valent HPV vaccine. Merck, as well as the American Dental Association, has promoted the campaign nationally to other stakeholders. An ad campaign was designed with Spectrum that aired in April. The television component of the commercial was aired 9,995 times on 51 networks in 15 zones throughout Alabama. The streaming version provided 357,264 impressions with 352.180 completions for a completion rate of 98.5 percent.
ADPH Public Health District Initiative
The ADPH district MCH coordinators submitted project proposals in 2020 to address needs within the Child Health Domain. These county specific projects targeted access to oral health care, increasing Early and Periodic Screening, Diagnostic and Treatment (EPSDT) visits, and suicide prevention in FY 2021.
West Central Public Health District
In 2020, ADPH BPPS reported suicide was the 11th leading cause of death in Alabama with 823 citizens lost to suicide in 2018. Evidence showed that suicide was the 2nd leading cause of death for ages 10-34. In 2018, the suicide rate in Alabama was 16.8 per 100,000 population. The West Central District’s (WCD) goal for FY 2021 was to reduce the number of suicide attempts and suicides in the district. The plan was to increase suicide awareness in adolescents and pregnant women by implementing the evidence-based Question, Persuade, and Refer (QPR) curriculum to help better identify and refer those who were at risk for suicide. The QPR curriculum is designed for those who are of high school age and older. There were 15 in person trainings facilitated during FY 2021 within the Tuscaloosa County School System and one virtual training with social workers at a CHD. A total of 245 youth and adults participated in QPR trainings. Participants are now able to recognize and respond to suicide warning signs, have an increased knowledge of depression and suicide, and know where to refer someone for help.
WCD also planned to increase suicide awareness in adolescents by implementing the evidence-based RESPONSE curriculum. This curriculum is designed for middle school age children and teens. It works to increase a student’s awareness about what they can do to provide support and hope if a student or friend is thinking about suicide. This awareness is vital to any suicide prevention effort, as it is often peers who first notice or are told about a person’s thoughts or intent to end their life. COVID-19 continued to cause numerous disruptions and delays during FY 2021; therefore, QPR trainings were not completely implemented as planned and the RESPONSE trainings were not implemented at all. Throughout the year suicide prevention incentive items were purchased and distributed to participants of QPR trainings. The coordinator managed a display table in the lobby of the TCHD to promote suicide awareness by making available informational pamphlets, resource cards, and incentive items to the public. The coordinator also participated in several limited community events in Greene, Hale, Perry, Pickens, and Tuscaloosa counties and provided suicide information and promotional items.
Northern Public Health District
The district MCH coordinator fostered relationships with local agencies, such as the Youth Service Council of Madison County, Community Service Planning Council of Morgan County, Colbert County Children’s Policy Council, Lawrence County Interagency Council, and regional nursing staff. The coordinator was also interviewed by a local newspaper, The Journal Record, regarding QPR and suicide. QPR training was presented to over 100 individuals and suicide prevention resources were provided to the community. Additionally, the coordinator maintained the MCH Northern District Advisory Council, hosting quarterly meetings throughout the year. The district MCH project was frequently disrupted due to having to change, cancel, or reschedule presentations and events due to COVID-19.
Southwestern Public Health District
The EPSDT program, mandated by Medicaid, is designed to identify children with actual or potential health problems and to screen, diagnose, and treat the problems before they become permanent, lifelong disabilities. Prevention can help ensure the early identification, diagnosis, and treatment of conditions before they become more complex and costly to treat. EPSDT visits ensure that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services. The district’s goal was an increase in the number of completed EPSDT visits in Marengo and Wilcox counties. ADPH staff worked to partner with local doctors that were willing to share their Medicaid clients who were behind or needed EPSDT visits. A past due EPSDT list was also provided by Medicaid. Nursing and clerical staff called patients with past due EPSDT visits and scheduled visits for these patients at CHDs.
Other ADPH Adolescent Health Programs
Adolescent Pregnancy Prevention Branch
The Adolescent Pregnancy Prevention Branch (APPB) works to reduce the incidence of unplanned pregnancies and sexually transmitted infections (STIs) among Alabama youth ages 10-19. APPB's work is made possible through federal grants awarded to the ADPH from the Department of Health and Human Services, Administration on Children, Youth, and Families. APPB works at the community level to provide opportunities and resources that promote the overall health and well-being of youth, which includes abstinence education, personal responsibility education, and overall positive youth development.
The Alabama Sexual Risk Avoidance Education Program (ASRAE) provides evidence-based abstinence education to middle and high school aged youth in school and community settings. The purpose of ASRAE is to support decisions to abstain from or delay sexual activity. Four community-based organizations that are supported with ASRAE funds deliver evidence-based education programming to youth in Alabama. The evidence-based curricula used were Making a Difference and HealthSmarts: Abstinence Puberty & Personal Health. This programming equips youth with the tools needed to resist sexual risk behaviors and to make healthy relationship choices.
The Alabama Personal Responsibility Education Program (APREP) provides abstinence and contraceptive education to high-risk youth in community settings. The goal of APREP is to reduce pregnancy and STIs, including HIV, among teens by using effective evidence-based programming. Two community-based organizations funded through APREP continued to identify and partner with community organizations through which the personal responsibility programming could be delivered. The project reaches youth in foster care, group homes, detention facilities, schools, and community organizations in Alabama. The project utilizes the evidence-based curricula, Making Proud Choices: An Adaptation for Youth in Out-of-Home Care, Wise Guys and Seventeen Days, plus adulthood preparation lessons taken from Love Notes and Money Habitudes 2 for At-Risk Youth. Adulthood preparation programming is designed to promote successful transition to young adulthood.
The COVID-19 pandemic had an adverse effect on programming this grant year due to restrictions of limited face-to-face interactions with the target population.
Rape Prevention and Education Program
The Rape Prevention and Education Program, a CDC-funded program, provides prevention of sexual violence (SV) perpetration and victimization by decreasing SV risk factors and increasing SV protective factors for the general population in 34 Alabama counties through grants to the Alabama Coalition Against Rape (ACAR) and 10 rape crisis centers. Funded centers focused efforts on activities around changing social norms, creating protective environments, and empowering young girls and women. The Public Health and Human Services Block Grant provides prevention education and awareness to the public and support through the promotion of public awareness and general assistance to victims of sex offenses within the state in 23 counties through grants to ACAR and seven rape crisis centers.
Youth Suicide Prevention Program
During the 5-year grant period, program partners provided two different curricula: Hazelden’s Lifelines training and Response Suicide Prevention Program. Difficulty securing training resources for Lifelines trainers, and high turnover in prevention educators at partner crisis centers in Year 2, led to the program seeking an alternative training program. Response Suicide Prevention Program was selected and used in Years 3 - 5. In total, 16,833 individuals were trained in Hazelden’s Lifelines, and 7,775 individuals were trained in Response Suicide Prevention, for a total of 24,608 individuals trained.
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