Bullying

Bullying is unwanted aggressive behavior, either physical or verbal, among children where there is an actual or perceived imbalance of power. True bullying involves aggression that is repeated or has the potential to be repeated. Bullying has been linked to many negative outcomes including criminal violence, mental health impacts, substance abuse, and suicide. Victims often suffer from anxiety and depression (including suicide ideation), physical ailments, and decreased academic achievement. Perpetrators often engage in violent and abusive behavior as adults, abuse drugs or alcohol, and engage in other risky behaviors. Bystanders, or those who witness acts of bullying, are also more likely to have mental health problems, suffer from depression and anxiety, and engage in substance abuse. There are three types of bulling:

Verbal bullying is saying or writing mean things. Verbal bullying includes:

•                        Teasing
•                        Name-calling
•                        Inappropriate sexual comments
•                        Taunting
•                        Threatening to cause harm

 

Social bullying, sometimes referred to as relational bullying, involves hurting someone’s reputation or relationships. Social bullying includes:

•                        Leaving someone out on purpose
•                        Telling other children not to be friends with someone
•                        Spreading rumors about someone
•                        Embarrassing someone in public

 

Physical bullying involves hurting a person’s body or possessions. Physical bullying includes:

•                        Hitting/kicking/pinching
•                        Spitting
•                        Tripping/pushing
•                        Taking or breaking someone’s things
•                        Making mean or rude hand gestures

 

Evidence-based youth violence prevention strategies have become more evident as available research has grown. Rather than just focusing solely on reducing problem behaviors, using broad and overlapping strategies that develop strengths within individuals, families, and society can reverse the culture of bullying within a community. The implementation of a combination of these strategies is likely to result in stronger and more sustainable improvements in health and safety than the implementation of a single strategy.

The Adolescent Health Initiative (AHI) is a health promotion project designed to address the State Title V agency priorities for WV’s adolescent population. Under the direction of the AHI Director, eight community-based Adolescent Health Coordinators (AHCs) facilitate collaborative efforts that increase the assets that young West Virginians need to grow into healthy and responsible adults, and functions to improve the collective health of WV’s adolescents, thus enabling them to reach their fullest potential.

Regional Adolescent Health Coordinators will utilize Search Institute’s 40 Developmental Assets framework to increase protective factors and encourage adult youth connections in schools and communities to build and maintain positive relationships between young people and caring adults, including school personnel and care givers.

In early 2020, the AHI partnered with West Virginia University-Parkersburg to conduct surveys in schools throughout Region 5 to access impact of the AHI’s asset-based positive youth development programming. Results show that youth attending AHI’s programming are more likely to feel their parents give them support when they need it (84% vs. 72%), more likely to get along with their parents (81% vs. 67%), more likely to feel they get a lot of encouragement at school (65% vs. 28%) and feel like a lot of people in their neighborhood care about them (61% vs. 39%).

To encourage these youth-adult connections, the AHI provided 144 trainings focused on positive youth development. Trainings included COVID19 focused virtual events, Connections Matter and other asset-based programs. Over 6,338 youth, parents, professionals, and community members attended the trainings.

Training highlights include (but aren’t limited to):

 

• COVID19 Virtual Facebook event with Jenny Anderson from Advocates for Youth
• Join the Asset Movement (JAM)
• Grief and Reaction Attachment
• 40 Developmental Assets
• Resilience and Adverse Child Experience's Training
• Triple "P" Parenting
• Connections Matter
• Raising Awareness During COVID-19: Child Abuse Is Your Business (Webinar)
• When the Child Trusts You (Webinar)
• A Framework for Understanding Development Assets for Online At-Risk Youth (Webinar)
• CONNECT WV: Working Together to Keep Kids Safe and Well (6-week series) (Webinar)
• The Actual Effect of Screen-Time on the Developing Brains of Children
• Darkness to Light: Stewards of Children
• I Think I'm Stressed session at the Triadelphia Middle School Health and Wellness Conference to students
• Talking to Your Children and Substance Abuse
•  Framework for Understanding Poverty in-service workshop for teachers and administrators

Adolescent Health Initiative and the WV Violence and Injury Prevention Program will utilize the WV Youth Risk Behavior Survey and the Child Fatality Review to monitor progress on bullying and suicide measures.

The West Virginia Department of Education (WVDE) began utilizing the YRBS to collect data in 1993 and has been conducted every two years since. In 2019, the WVDE provided funding to the AHI to conduct YRBS Surveys in 116 schools across the state. The results were released in early 2020. The 2019 high school risk behavior shows a decrease in most adolescent risk behaviors since 1993, including the percentage of students who have seriously considered suicide (27% down to 21%); however, this data point did show a small increase from 19% in 2017. Students who made a plan in the past year to attempt suicide continued to decline in 2019 from 1993 (20% down to 14%). However, the high school risk behavior trend summary report shows that other measures remained basically the same or increased from 1993 (unless otherwise indicated) to 2019:

• Did not go to school because they felt unsafe (4% vs 10.5%)
• Being threatened or injured with a weapon on school property (8% vs. 7.5%)
• Feeling sad or hopeless every day for 2 weeks or more (30% in 1999 vs. 36.4%)

 

The middle school risk behavior trend summary report shows that several related measures remain the same or slightly increased:

 

• Ever carried a weapon (41% in 2001 vs. 40.4% in 2019)
• Were ever bullied on school property (47% in 2009 vs. 45.7% in 2019)
• Were ever electronically bullied on school property (25% in 2011 vs. 27.8% in 2019)
• Ever seriously thought about killing themselves (21% in 2001 vs. 24.7% in 2017)

 

The WVDE’s YRBS surveys and trend summary reports and other publications can be found at https://wvde.us/reclaimwv/resources/.

The surveys conducted by AHI and WVU-Parkersburg with students in Region 5 showed students who participated in AHI’s programs were less likely to think they are “no good at all” (26% vs. 52%), less likely to feel depressed (32% vs. 46%), more likely to say they like themselves as a whole (78% vs. 55%) and less likely to have attempted suicide (9% vs. 21%).

Lastly, to help identify students at higher risk for suicide, bullying or other negative outcomes, the AHI began conducting needs assessments and Child PTSD Symptom Screeners (CPSS) in classrooms as part of their Title V Sexual Risk Avoidance curriculum programming.  Between October 1, 2018 and September 30, 2019, 580 needs assessments and 553 trauma screeners were administered resulting in 26 referrals for necessary services. That is double the number of referrals identified last year. 

Adolescent Health Initiative will provide Green Dot and Youth Mental Health First Aid (YMHFA) trainings across the state and will work with school and community partners to facilitate program implementation.

In FY 2017, the AHI’s regional AHCs began by providing over 500 Green Dot posters and materials to schools across the state and began meeting with school personnel and administrators to introduce the idea of a bystander intervention approach and discuss program implementation, as the program is very time intensive and requires a lot of commitment by school personnel and the community. Program implementation began with 6 schools in FY2018 and has expanded to 30 schools utilizing Green Dot and other comprehensive bully prevention curriculum programs in FY2020. 

In the Fall of 2017, the AHI partnered with the DHHR’s Bureau for Behavioral Health and Health Facilities to certify all of the regional AHCs as Mental Health First Aid trainers. Mental Health First Aid is an 8-hour course that teaches you how to identify, understand, and respond to signs of mental illnesses and substance use disorders. The AHI conducted 20 trainings in FY2020, in addition to the 24 trainings conducted in FY2018 and 2019. The AHI partnered with Concord University to prepare a course syllabus and offer graduate course credits in 2019, in addition to the Continuing Education Credits (CEUs) for training participants offered previously. Over 70 participants completed the course through Concord University and received 3 graduated course hours.  Over 350 people attended the YMHFA trainings in FY2020.

Community-based Adolescent Health Coordinators will identify and coordinate the implementation of research-based models for prevention of bullying and harassment in schools and other youth serving organizations.

 

Recognizing that “one size does not fit all” in terms of evidenced based interventions, the AHI worked with schools and youth groups to identify programs that fit best with their needs, schedules and staff.  They provided training, technical assistance and helped facilitate implementation for several programs in addition Green Dot and YMHFA.  These programs include (but not limited to):

 

• Too Good For Drugs and Violence- A curriculum consisting of 14 core lessons and 12 additional lessons that can be integrated into the teaching of other school subjects. The program aims to promote pro-social skills, positive character traits, and violence- and drug-free norms among high school students. It includes a staff development component and optional family and community components.[1]
• Second Step- A program rooted in social-emotional learning that helps transform schools into supportive, successful learning environments uniquely equipped to encourage children to thrive. More than just a classroom curriculum, Second Step’s holistic approach helps create a more empathetic society by providing education professionals, families, and the larger community with tools to enable them to take an active role in the social-emotional growth and safety of today’s children[2]
• Cyber Civics-The most comprehensive digital literacy curriculum available. It features 50-minute curriculum lessons on digital citizenship, information literacy and media literacy. It is adaptable for in-class or remote learning and is currently taught in schools in 44 states.[3]

 

In 2016, the AHI’s surveyed over 6,000 adolescents and their parents on the topic of bullying.  The survey data indicated adolescents felt “social” was the most prevalent type of bullying, versus physical or verbal bullying. In response to this data, the AHI and the VIPP partnered to provide Media Literacy and Digital Footprint trainings across the state. Additionally, the AHCs began promoting the three-year, online module program Cyber Civics Curriculum for Middle School Students. To date, 12 schools are implementing the program with nearly 2,400 students. After the COVID19 “stay at home” order was issued, the AHI facilitated 2 statewide webinars on online safety protocols for teachers, parents and students.

 

The AHI also examined survey data collected by WVU-Parkersburg to assess the AHI’s asset programming’s impact on bullying and violence prevention. Participants in AHI’s program were less likely to have taken part in a fight (5% vs. 15%), more likely to be perceived as caring about others’ feelings (92% vs. 78%) and more likely to be perceived as respectful of others’ values and beliefs (92% vs. 79%). AHI’s participants were more likely to be considered good at making and keeping friends (87% vs. 72%) and less likely to be afraid of being hurt at school (18% vs. 27%).

 

To assist with compliance of WV House Bill 2535, commonly referred to as “Jamie’s Law” requiring public middle and high school administrators to disseminate and provide opportunities for all middle and high schools to discuss suicide prevention awareness information, the AHI provided 4 Darkness to Light: Stewards of Children trainings. This evidence-based training utilizes bystander intervention sexual abuse prevention strategies. Additionally, Sexual Orientation and Gender Identity workshops were held for teachers and students in Kanawha and Cabell Counties. 

 

The AHI also partnered with Westbrook Health Services and Adolescent Suicide Prevention and Early Intervention program (ASPEN) to provide suicide prevention trainings to staff and students at multiple sites across the state. During the state shutdown due to COVID19, the AHI partnered with Valley Health Systems to provide educational board games, card games and activities that were focused on topics such as bullying, healthy relationships and stress and anger management for families in homeless shelters in Valley Health’s service areas.

 

Lastly, the AHI provided 102 trainings and workshops; posted 122 messages, links and resources on social media; and disseminated 5,966 brochures, posters and other information literature in bullying prevention, bystander interventions and healthy relationships.

 

Adolescent Well Visits

Facilitate Pediatric Medical Advisory Board meetings assuring the involvement of HealthCheck Program, Department of Education, CHIP, Medicaid and local health care providers.

The OMCFH continued to facilitate semi-annual meetings of the Pediatric Medical Advisory Board and monitor involvement of various perspectives to address adolescent healthcare in WV.  The fall meeting of the board was held in Charleston in early November, while the spring meeting was cancelled due to the pandemic.  Communication with all board members continued throughout the pandemic, with periodic visits to several of the member’s medical practices.

Work with Department of Education to implement Policy 2423 requiring well visits for entry to grades seven and twelve.

In coordination with the HealthCheck Program Specialists, community-based AHCs met with 24 providers to encourage teen centered care, providing materials and trainings to providers in the Valley Health, Cabin Creek and New River Health Systems, including School-Based Health Centers, across the state. The AHCs worked with schools and providers to provide 14 events and 68 trainings aimed at increasing participation rates for adolescent well visits, including the promotion of WV Board of Education Policy 2423. This Health Promotion and Disease Prevention policy requires all students must be up to date on mandatory immunizations and requires all students entering Pre-K, Kindergarten, 2nd, 7th, and 12th grades to show proof of a HealthCheck and dental examination within 45 days of entry. Nearly 6,000 people total (not unduplicated) attended these trainings and events and over 4,000 resource materials (newsletters, brochures, posters, social media posts, etc.) were distributed throughout the year.

Work to incorporate comprehensive well childcare into sports physicals.

The AHI and HealthCheck provided education and information students athletes, parents, schools and providers to promote utilizing well-child exams versus a sports physical. The AHI worked with WVDE staff to encourage the WV Secondary School Activities Commission (WVSSAC) to make well child exams a requirement for participation in school sports. Thus far, the WVSSAC is willing discuss a formal recommendation but that discussion has yet to occur due to the COVID19 pandemic.

 

Audit and educate providers regarding teen friendly criteria.

 

Data collected across the state in 2016 indicated adolescents stated that they felt very awkward going to pediatricians and felt medical facilities were not designed to meet their needs. Many also expressed confidentiality concerns. To address this concern, a joint effort between the HealthCheck Program and the AHI created a program to recognize and promote physicians that have a desire to treat and care for older adolescent and teens. The underlying goal of this project is to boost the frequency at which teens visit their “medical home” to receive well-child services. This program teams older children with a desire for better heath to a physician in their area that has taken the pledge to treat teen patients with specialized care. Through the adoption of a Patient Bill of Rights, the physician will respect the privacy of the teen patient and seriously regard their thoughts, concerns, and questions. In addition, the physician understands that teen patients have special needs and circumstances that should be addressed through such adjustments as providing Wi-Fi in the waiting area, walk-in appointment times, teen-positive reading materials, and a commitment to honor their needs as young adults. This program has prepared materials that are designed to promote the physician for their commitment to the program. These materials include a promotions flyer that is placed in the high schools in the local service area, posters for provider waiting areas, a certificate recognizing the physician’s commitment, as well as the physician’s commitment to the rights of the teen patient. This program was launched in January of 2018 and currently has 15 physicians at locations who have received the “teen friendly” designation.

 

Transition

 

Title V Agency will develop with partners and stakeholders a Transition Improvement Charter.

 

In 2017-18, an estimated 23.8 percent of children, equaling almost 90,000, were children and youth with special health care needs (CYSHCN). Of these children, 45.2 percent received comprehensive, ongoing and coordinated care within a medical home. Of adolescents, 12 to 17 years of age, 20.2 percent reported receiving the services they needed to make transitions to adult health care (2017-18 National Survey of Children’s Health).  To increase the number of children with special health care needs receiving services necessary to make transitions to adult health care a Transition Improvement Team was developed.  The team met in October of 2019 as a subcommittee of the WV CSHCN Medical Advisory Board.   Examples of a Healthcare Transition Plan, the Got Transition Registry, qualitative -"Current Assessment of Health Care Transition Activities" and quantitative-"Health Care Transition Process Measurement Tool were reviewed and approved for use in the WV CSHCN Transition Services procedures.  The advancement of a value-based reimbursement model was discussed and it was determined more effort is needed to implement strategies to support physicians in providing transition services, especially those with special health care needs, to ensure these children have access to qualified providers, who are able to receive appropriate reimbursement for the complexity of providing and coordinating their care.

 

 

Develop a transition policy.

 

The Transition Improvement Team met in October of 2019 as a subcommittee of the WV CSHCN Medical Advisory Board and developed and approved two sample transition policies to be facilitated by the CSHCN Health Care Coordinator with the pediatric provider.  Additionally, an example of the quantitative-"Health Care Transition Process Measurement Tool” from Got Transition was reviewed and approved for use by the CSHCN Health Care Coordinators to facilitate with the pediatric provider to determine what or all of the implementation steps have been completed. For example, developing and publicly displaying a written transition and care policy/guide has a possible score of five; that is, if this step is completed with the appropriate documentation.  The sample transition policies and the measurement tool are components of an education curriculum/packet for pediatric providers.

 

Share transition policy among pediatric primary care physicians.

 

The tools required to introduce the Six Core Elements to pediatric providers and Project DOCC programs and to collect baseline data for said services are developed and approved by the WV CSHCN Medical Advisory Board. However, in preparation for implementation, the public health response to COVID-19 required physical and social distancing and required rapid adaptation of service delivery approaches in close partnership with public health and pediatric providers. It was also noted that CSHCN staff responsible for planning and providing transition services were also personally affected by the direct and indirect effects of the COVID-19 outbreak and efforts to slow transmission (such as physical and social distancing measures, temporary school closures, and travel advisories and restrictions).  New ways of organizing services while maintaining capacity is ongoing.

 

Complete transition readiness assessment for all enrolled CSHCN starting at age 14.

 

CSHCN Health Care Coordinators can request from the CSHCN CTS System or the CSHCN Program Epidemiologist a report indicating the required parameters to identify children of transition age per program procedure.  This grant year 545 children were eligible to receive transition services. However, the public health response to COVID-19 required physical and social distancing and required rapid adaptation of service delivery approaches in close partnership with public health and pediatric providers. It was also noted that CSHCN staff responsible for planning and providing transition services were also personally affected by the direct and indirect effects of the COVID-19 outbreak and efforts to slow transmission (such as physical and social distancing measures, temporary school closures, and travel advisories and restrictions).  New ways of organizing services while maintaining capacity is ongoing.

 

 

Obesity

Increase the number of after-school and community based physical activity and health promotion activities.

During the fall of 2016, the Adolescent Health Coordinators (AHCs) began meeting with school personnel to discuss and promote shared use activities. Those interactions are documented on a tracking tool developed by the AHI Director. To date, the AHCs have met with 181 schools.  While most schools have an open, accessible playground and/or other amenity (such as a walking track or football field), many barriers were identified and included lack of funding, lack of necessary equipment, lack of available space or facilities, and lack of staff or volunteers to supervise. Staff also expressed other barriers such as being in a rural location and vandalism. If facilities are left open, the staff needs to check playgrounds for drug paraphernalia (such as used needles), broken bottles, etc. before they can be used by the school children. The AHCs worked to address some of these concerns and increase opportunities for physical activity and health promotion in schools and communities. The AHCs engage and interact with communities by initiating or participating in local committees such as the Valley Health Systems Health and Wellness Team, Healthy Berkley and Active Southern WV. These groups have worked to develop activities like weekly walking clubs in Ansted, Valley, and Collins Middle Schools, a “healthy” community dinner provided by cooking students at Huntington High and facilitated fitness events at Summersville Lake, Town Park in Fayette County and “Healthy Berkeley” in Berkeley, WV. The AHCs also partnered with local restaurants and community centers to provide dinner while educating youth on restaurant etiquette and making healthier menu choices. Over 200 youth attended these dinners across the state.  Many other school and community events were planned for the Spring of 2020, however they were canceled due to COVID19.

Evidence-based programs such as GoNoodle were implemented in elementary afterschool programs until schools were closed in March 2020 due to COVID19. GoNoodle helps teachers and parents get kids moving with short interactive activities and helps kids achieve more by keeping them engaged and motivated throughout the day. South Preston Elementary began utilizing MyPlate food guide as part of their after-school farmers market program. More information about MyPlate can be found at https://www.choosemyplate.gov.

The OMCFH’s HealthCheck Program continued the Coordinated Approach to Child Health (CATCH) program. The initial program began in partnership with three summer camps to offer organized, supervised physical activity for a minimum of 60 minutes per day. Activities include volleyball, basketball, softball, “ultimate frisbee” and dance, with leadership comprised from staff volunteers. Program included under this objective include, Mountaineer Boys State, American Baptist Youth Camps and the day activity program at the Marshall County Fair.  Because of the COVID pandemic, all of these programs were cancelled for the 2020 summer season.

Assist the WVDE in the facilitation of evidence-based professional development opportunities for schools and administrators.

The AHCs provided trainings and workshops to encourage increased physical activity, healthier eating, and the implementation of WVDE Policy 2510 activities. Trainings included MyPlate, Sports Medicine and Prevention, Minds-in-Motion, GoNoodle, Walking Classroom, and PA (physical activity) in the Classroom plus many general health and wellness informational sessions and workshops. In total, the AHCs provided 20 trainings, workshops, wellness events, and health fairs to 397 teachers, administrators and community leaders and distributed over 3,600 brochures, posters, and other educational materials across WV.

 

Work with school personnel to provide technical assistance to increase physical activity throughout the day as outlined in Policy 2510.

 

The AHI Director is an active member of the WVDE Health and Wellness Leadership Committee. This committee serves as an advisory board for various grants and initiatives for student wellness such as Project AWARE, Stop the Violence, School Based HIV/STD Prevention, Reclaim WV, Lets Move WV, etc. As part of this partnership, the WVDE provides funding to the 8 regional AHCs to administer Youth Risk Behavior Surveillance (YRBS) Surveys and assist with the promotion and distribution of the resulting data to schools across the state. The AHCs capitalize on the relationships formed with schools during the 2019 YRBS process. Before schools were shut down due to COVID19, the AHCs were able to connect with school administrators and staff in 78 schools to discuss needs, as well as provide resources and offer training.

 

Oral Health

Continue oral health surveillance of adolescents through the Basic Screening Survey (BSS) to inform program and policy development.

The Oral Health Program reconvened its surveillance system for children.  Although the State Oral Health Surveillance Plan does not currently include a BSS for the adolescent population, the OHP will plans to include eighth-grade BSS. Due to Covid, the 2020/2021 BSS may be delayed. If so, the 2021/2022 BSS will be conducted for two targeted populations.  The OHP is also in transition to completing state surveillance as an internal activity and will be building this capacity over the next year.

Promote and educate pediatric care providers on importance of establishing a dental home for adolescents.

In order to increase the number of children with preventive visits, the Program encouraged its colleagues and partners to intervene with children at multiple points.  The OHP has continued to work with the state AAP chapter, WV Association of School Nurses, the WV Primary Care Association and internal partners (HealthCheck and CYSCHN) to educate non-dental providers on the importance of oral disease prevention in the medical setting and referral to a dental home. The OHP has presented information regarding the importance of establishing a dental home to non-dental providers at meetings and conferences. 

Support implementation of West Virginia Board of Education (WVBE) Policy 2423 requiring a dental examination for students at school entry and grades 2, 7 and 12.

Maintained the Oral Health Services Module in collaboration with the West Virginia Department of Education and the West Virginia Statewide Immunization Information System. This module is utilized by dental and school health professionals to document dental examinations for school children at school entry, 2nd, 7th and 12th grades in alignment with West Virginia Board of Education Policy 2423: Health Promotion and Disease Prevention.

[1] https://toogoodprograms.org/

[2] https://www.secondstep.org/

[3] http://www.cybercivics.com/