III.E.2.c. Adolescent Health: Annual Report (10/1/2021-9/30/2022)

State Priority Need:

Reduce Preventable Deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates.

National Performance Measure (2020 - 2025):

NPM 7.2- Rate of hospitalization for non-fatal injury per 100,000 children, ages 10 through 19.

Evidence-Based/Informed Strategy Measure (2020 - 2025): 

ESM 7.2.1- Reduce count of suicide related hospitalizations in adolescents, ages 10 – 19.

General Information

As children transition to adolescence, there is a critical period of cognitive, mental, social, and emotional change that can be overwhelming. Parents surveyed in the five-year needs assessment rated mental health support as the number one health need for their teens. As the transition period can lead to various mental health challenges, the risk for suicide can increase.

 

Suicide rates in youth have been increasing over the past five years and must be addressed by state agencies and partners as the leading cause of non-fatal hospitalizations in youth ages 10 – 19. Suicide rates have been steadily increasing for teens ages 10 – 14. In 2020, the rate of suicide among 10–14-year-olds per 100,000 was 4.71. The rate among 15–19-year-olds per 100,000 was 13.67. The rate for 15–19-year-olds slightly increased in 2021 to 13.97 deaths per 100,000, The 2021 rate for 10–14-year-olds is unstable but is 3.91 per 100,000. The Indiana Department of Health Maternal and Child Health (MCH) and Fatality Review and Prevention (FRP) divisions have worked together to integrate youth suicide prevention strategies into existing programs, schools, and adolescent health clinical care while also expanding our partnership with the Division of Mental Health and Addiction and the Department of Education. MCH maintains hopeful regarding it capacity to reduce these extremely concerning rates by normalizing the conversation, having better youth data through the Youth Risk Behavior Survey (YRBS) and the Pediatric Suicide Review team, and standardizing screening tools for youth mental health.

School Health Profiles and Youth Risk Behavior Survey

To better understand the behaviors and health needs of adolescents across Indiana, MCH remains committed to obtaining weighted data for the Youth Risk Behavior Survey (YRBS) and School Health Profiles. By surveying youth and school administration staff to obtain regularly weighted data, MCH will be able to see behaviors and health trends in close to real-time.

 

Beginning in October of 2020, MCH worked to obtain weighted data the Youth Risk Behavior Survey. In November 2021, the CDC informed the MCH team that Indiana would be receiving weighted data for this cycle for YRBS 2021. We also were able to obtain weighted data for the School Health Profiles Survey in 2022. Receiving these data sets was a major accomplishment as Indiana had not received weighted YRBS data since 2015 and this marks two consecutive cycles of weighted data for Profiles (2020 and 2022). Indiana now has information to better understand the current state of adolescent health, source new ideas, and improve overall programming for teens that aid in creative positive childhood experiences. This cycle also allowed for the MCH team to build and strengthen relationships with school administration to hopefully continue into future cycles.

Currently, Indiana is working to obtain weighted data for 2023. MCH has leveraged the strategies from 2021 and is hopeful for another successful cycle, despite growing resistance against school-based surveys and many topics discussed in the YRBS. There is a growing resistance from schools and school boards to ask these questions or discuss anything related to social and emotional health. Some anti-SEL parent movements have gained a lot of traction against the survey and programming.

In 2021 and 2023, the Indiana YRBS asked high schools multiple questions related to mental health and suicidal ideation. Examples include:  

• During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities,
• During the past 12 months, did you ever seriously consider attempting suicide, 
• During the past 12 months, did you make a plan about how you would attempt suicide,  
• During the past 12 months, how many times did you attempt suicide? 

The findings for each of these questions in 2021 are as follows:

• 30.7% of students reported their mental health was most of the time or always not good (including stress, anxiety, and depression) during 30 days before the survey
• 46.9% of students felt sad or hopeless (almost every day for greater than or equal to two weeks in a row so that they stopped doing some usual activities in the 12 months before the survey
• 27.7% seriously considered attempting suicide
• 22.2% made a plan about attempting suicide, and
• 11.8% attempted suicide in the 12 months before the survey.

Suicide-related findings have drastically increased from 2015 – 2021. Females, multiracial youth, and those identifying as gay, lesbian, bisexual, questioning, or other are at the highest risk of suicide. Upon the data’s initial publication, many youth-serving individuals and medical personnel questioned the accuracy of the mental health and suicide ideation data and the legitimacy of the randomized sample. However, IDOH anticipates that the release of national YRBS data will address these concerns, as comparisons mirror what Indiana would expect based on past adolescent health surveillance findings and trends. Despite this, Indiana is working to compile an adolescent suicide data report to further address stakeholder concerns. Poor mental health plagues Hoosier youth, and it is crucial that Indiana imminently addresses these issues. MCH will need to continue to work with partners to ensure everyone is on the same page regarding the importance of prioritizing youth and young adult mental health and suicidal ideation.  

Indiana obtained weighted PROFILES data in 2020 and 2022. MCH has recently received its data back. PROFILES data complements YRBS by offering insight into the resources provided to students to support various positive youth development needs, including mental health resources. Examples of questions asked about suicide prevention and mental/emotional health included:  

• During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, any other kind of in-service) on each of the following topics? 
• Would you like to receive professional development on each of the following topics? 
• During this school year, have teachers in your school tried to increase student knowledge on each of the following topics in a required course in any of grades 6 through 12? (Mark yes or no for each topic.) 

The findings for each of these questions in 2021 are as follows:

• 62.7% of schools have a lead health education teacher who has received professional development on suicide prevention. 
• 60.8% of schools have a lead health education teacher who would like to receive professional development suicide prevention
• 87% of schools have teachers who tried to increase student knowledge on suicide prevention in a required course in grades 6 through 12.

Unlike YRBS, there seems to be minimal contention regarding the 2020 and 2022 PROFILES findings. Indiana has seen an increase across nearly all suicide prevention categories. Unfortunately, resources and training in many schools remain low. With the drastic spike in poor mental health and suicidal ideation found in the 2021 YRBS, it is apparent that current efforts must continue to be upscaled.  

Since receiving this data, MCH has presented it to numerous school districts, nonprofit agencies, government agencies, and other youth-serving organizations. All slides and data were published to the website and widely distributed. MCH has seen other organizations across the state utilize this data in newsletters, presentations, and flyers. The MCH team will continue to share this information whenever possible. They also look forward to seeing the creative ways it is continually leveraged by other agencies. The 2020 Profiles data is currently being presented, alongside YRBS data, to partners and stakeholders.

The 2021 YRBS findings have been disseminated across the state through various means. MCH gives a data presentation at least five times each month, discussing YRBS and PROFILES data. This presentation and a video recording can be found on the IDOH website. In addition, findings have also been shared in newsletters from the Department of Education and community-based organizations like the Indiana Youth Institute. Furthermore, MCH has created flyers for dissemination at conferences. Notably, Indiana Youth Advisory Board members have begun to present YRBS data to their high schools. This offers a unique opportunity for youth to share data reported by their peers. Most recently, YRBS data was shared in the Indiana Youth Institute’s 2023 Kids Count Data Book (Data Book). The Data Book is a resource for youth-serving agencies across the state to provide information about new and upcoming programming. 

The Division of Nutrition and Physical Activity recently leveraged this data to apply for a new grant. It has also been requested by and shared with various community-level organizations. As was successful in 2022, IDOH intends to do a joint YRBS and PROFILES data push following the completion of the 2023 YRBS cycle. This will include a new data presentation for conferences, commissions, state agencies, and local coalitions and to be posted on the IDOH website. The 2021 YRBS and 2022 PROFILES data will also be integral in creating a new Adolescent Health Strategic Plan. Once completed, the Strategic Plan will outline critical issues impacting adolescent health and offer direction as the state continues to pursue better health outcomes for these individuals. MCH anticipates beginning this project in the upcoming year.

In 2022, MCH also received their 2023 YRBS school sampling frame in May 2022 and attended YRBS training. This training was attended by the Adolescent Health Administrator and Adolescent Health Coordinator. The Adolescent Health Coordinator was hired after a summer internship in August 2022 and will act as the primary point of contact for the YRBS and Profiles. MCH is currently preparing for the 2023 YRBS cycle and does not anticipate analyzed data until late 2023.

Having YRBS and Profiles data has been incredibly beneficial to the state as MCH can more accurately describe the needs of youth by drawing from their experiences. MCH can compare what is being prioritized within schools by examining the results of the Profiles report. This information allows MCH to identify supporting and inhibiting factors. With this, they can lean into what is working and address what is not, hopefully closing disparity gaps and supporting those who are most vulnerable. MCH looks forward to hopefully receiving a second year of weighted YRBS data to utilizing this information in their continual effort to support the health and well-being of young Hoosiers.

Partnership with the Division of Mental Health and Addiction and the Indiana Youth Advisory Board

MCH has continued to grow a strong partnership with the Division of Mental Health and Addiction. DMHA continues to utilize the Garrett Lee Smith Suicide Prevention Grant to work alongside MCH and collaborate to address the mental health needs of adolescents under the Indiana Youth Advisory Board.

 

The Indiana Youth Advisory Board (IYAB) started in July of 2022 and represents a diverse group of youth between the ages of 14 and 24 and represents 22 of Indiana’s counties. The board has four subcommittees: mental health, access to care and services, sexual and reproductive health, and minority health. The mental health subcommittee will continue to work on key aspects of the Garrett Lee Smith Grant to address mental health needs of adolescents.

Suicide and Overdose Fatality Review Teams

The Suicide and Overdose Fatality Review Teams (SOFR) Program Manager co-leads two state-level subcommittees of the Indiana Child Fatality Review Committee that focus on reviews of pediatric suicide deaths. By December 2021, the first pediatric suicide subcommittee completed 2017 and 2018 case reviews (n=86). In January 2022, the first subcommittee began reviewing 2021 cases, and as of September 2022, reviewed 24 of 65 cases. The second subcommittee was established in May 2022 to increase Indiana’s capacity to obtain multi-year trend data associated with pediatric suicides. As of September 2022, the second subcommittee reviewed a total of 30 fatalities that occurred in 2020 among Indiana youth. These data and the resulting recommendations will be added to that of the State Team to create a comprehensive report on pediatric suicide in Indiana.

 

Fatality Review and Prevention (FRP) continued to analyze and share data concerning risk factors and prevention strategies for youth suicide. In April 2022, FRP staff presented at the Indiana Association for Healthcare Quality Conference about pediatric suicide fatality review findings, including case demographics, causes of death, history of suicidal behaviors, and the prevalence of other suicide risk factors such as bullying and child maltreatment. Healthcare providers and other attendees were encouraged to help prevent youth suicide by consistently using evidence-based screening tools for depression and suicide risk and making referrals to mental health service providers.

Additionally, FRP staff presented fatality review findings at the Institute for Strengthening Families conference in August 2022. Attendees, consisting of child welfare professionals, social workers, and other child and family service providers, were educated about youth suicide in Indiana, suicide warning signs, evidence-based screening tools, and existing resources. FRP will continue to look for new and innovative ways to share pediatric suicide data.

SOFR continued to provide technical assistance to local fatality review teams invested in suicide and overdose prevention. As of September 2022, there were 23 active teams across Indiana. Following their annual report meeting, the Jay County SOFR team identified steps to survey adults and youth in the community about their substance use behaviors, mental health needs, and knowledge of existing resources. The survey findings will be used to develop targeted educational campaigns. The survey is expected to conclude by the end of 2022. Additionally, as a result of their SOFR recommendations, the Dearborn County SOFR team and Hamilton County SOFR team have begun working to implement Handle with Care to support youth exposed to possible traumatic events.

Since 2019, IDOH has trained 13 individuals in conducting a psychological autopsy to improve understanding of risk factors for suicide and inform prevention efforts. During 2021, one individual actively conducted psychological autopsies and submitted them for evaluation. To further expand efforts to obtain information about a person’s life history and opportunities for prevention, SOFR collaborated with the overdose fatality review site in Utah to develop a next-of-kin family interview training to improve information received by fatality review teams. The training was given to the Institute of Intergovernmental Research who shared the training with SOFR teams across the United States in 2022. By September 2022, two FRP staff and two local SOFR coordinators had registered to be trained to conduct next-of-kin interviews.

FRP staff also provided results from two planning groups to the Division of Mental Health and Addiction to inform Indiana’s State Suicide Prevention Plan. FRP staff reviewed and provided feedback on the plan which was passed by the legislature in July 2021.With a plan in place, DMHA and MCH staff members are actively engaged in implementing the plan with a focus on facilitating the credentialing process for youth peer support specialists who provide direct assistance to young individuals grappling with mental health difficulties, including suicidal intentions.

Indiana Suicide Prevention Network Advisory Council

FRP and MCH are also members of the statewide Suicide Prevention Network Advisory Council (ISPNAC). This network is comprised of members from the public and private sector, as well as numerous state agencies, who collaborate on suicide prevention efforts. ISPNAC also hosts an annual suicide prevention conference. Caitlyn Short, who is the SOFR Program Manager in FRP, was elected as secretary in December 2021 and has worked with ISPNAC monthly throughout 2022 to plan for meetings, type and share meeting minutes, and sit on various project committees, including a committee to develop a website for the Indiana Suicide Prevention Network and the annual conference planning committee. The website is expected to go live December 9, 2022, and will contain information about existing resources, what to do in the event of a crisis, what to do following a suicide loss, and suicide prevention trainings.

 

Handle with Care

In 2020, FRP received a second funding opportunity awarded through the U.S. Department of Justice by OVC to increase direct service support for the youngest victims of crime related to the opioid epidemic in Allen and Wayne County. This project focuses on decreasing secondary trauma after a child has experienced a potentially traumatic event where first responders are called to a scene. A Handle with Care (HWC) notification is sent to the child’s school before the start of the next school day for schools to receive a “heads up” that a child may have experienced a traumatic event. The confidential notification includes the child’s name with the words, “Handle with Care,” and no information regarding the incident is ever shared through the notification.

 

When a HWC notification is received by a school, it is distributed the next day to staff who may interact with the student to ensure they are able to watch for atypical behavior and respond in a trauma-informed manner. School staff are trained to provide additional support as needed and to not ask questions or try to gather information about the event. If the student needs additional support mechanisms outside of the classroom, schools' partner with mental health providers to connect the student and their families with mental health services.

HWC funding has supported the development of programming among five school districts in Wayne County and three schools, an elementary, middle, and high school, in Allen County. Technical assistance has been provided to additional schools that choose to implement the program across the state. A bi-monthly community of practice call helps to provide further technical support while allowing for cross collaboration across the state.

Since implementation in Indiana in 2021, HWC spread from two school districts in two counties, to thirteen school districts in five counties with an additional 22 counties interested in learning more or actively planning implementation.

FRP continued to identify opportunities to streamline state-wide efforts to increase HWC participation and implementation. In 2022, the HWC project manager attended a Six State Trooper Conference in West Virginia where Indiana State Police (ISP) were present. The HWC project manager co-presented with Andrea Darr, Director at West Virginia’s Center for Children’s Justice. As a result of this opportunity, the project manager was able to connect with ISP leaders to further discuss HWC at the state-level. Conversations continue among these leaders.

FRP has also partnered with the Indiana Department of Education to increase training opportunities for Youth Mental Health First Aid and has joined a cohort to support this expansion within schools.

Funding has also allowed for support to Allen and Wayne County to implement trauma-informed practices taking a multidisciplinary approach to include health care providers, schools, first responders, courts and probation, social services, community foundations, university partners, grassroots community organizations, faith-based communities, and local business. Through this work, engaged partners work towards developing a comprehensive trauma-informed approach to decrease secondary trauma, while also increasing positive childhood experiences that have been shown to mitigate adverse childhood experiences.

Throughout 2022, HWC programming faced challenges relating to COVID-19 and schools transitioning from virtual to in-person learning. Many schools were impacted relating to attendance, transitional challenges between virtual and in-person, and shortages in educational professionals. In addition to these challenges, schools saw an increase in the need for mental health support for students. Unfortunately, professional shortages were experienced among mental health service providers, exacerbated further in rural communities. As part of HWC, schools partnered with mental health providers to provide trauma-focused cognitive behavioral therapy (TF-CBT). As a response, FRP connected with the Division of Mental Health and Addiction (DMHA) and national HWC partners to identify strategies to increase access for TF-CBT within Indiana schools. Conversations continue between state and national partners and solutions to address and alleviate this challenge will continue into 2023. 

State Priority Need:

Promote Physical Activity through policy improvements and changes to the built environment.

National Performance Measure (2020 - 2025):

NPM 8.2- Percent of adolescents, ages 12 through 17 who are physically active at least 60 minutes per day.

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM8.2- Number of schools participating in an activity (training, professional development, policy development, technical assistance, PA in-school programming, PA before and after school programming) to improve physical activity among adolescents (12-17).

ESM8.2.2- Percent of adolescents ages 12-17 impacted by improvements to the built environment.

General Information

Physical activity was a top concern identified by teens and was also a concern for parents of teens in Indiana’s most recent needs assessment. Indiana continues to fall short on the percent of adolescents meeting physical activity recommendations with only 19.2% of youth reporting getting 60 minutes of physical activity every day and only 44.5% reaching the recommendations at least five days per week as of 2021. To make the biggest impact, MCH has continued to partner with the Division of Nutrition and Physical Activity (DNPA) who has been primarily responsible for implementing strategies to increase physical activity in youth, ages 12 – 17.

To impact the greatest number of teens, DNPA gathered policy and programming information from the schools over the last year and provided a variety of technical assistance to educators and other professionals working directly with large groups of adolescents to increase activity during school hours. Professional development was conducted through a variety of platforms based on need. The DNPA continued to provide policy reviews for all school corporations who participate in the National School Lunch Program. A consultation session, including a complete review through Well-SAT 3.0, and a virtual meeting to review the findings was encouraged.

The DNPA also provided grant funding focused on providing physical activity opportunities for youth and adolescents in the classroom, during school, or within before- or after-school program settings to multiple organizations/schools during the year. These were offered to help increase physical activity and physical education knowledge among youth 6-17 years old (K-12) in Indiana. Special considerations were given to organizations and schools that prioritize inclusion and health equity in their proposed program whether that be physical, mental, or emotional health.

In addition, DNPA continued to fund grants to communities for tactical urbanism demonstration projects. This funding implements temporary traffic safety improvements that lead to long term permanent changes supporting safe walking and bicycling to places for youth to be active. DNPA provides funding to organizations implementing bicycle and pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting active lifestyles and active transportation for teens and adults.

GOAL University

The DNPA also contracted with GOAL University to expand the after school, family-focused community program that encouraged healthy lifestyles for children and their families through nutrition, behavior, and physical activity education. GOAL initially began in Bloomington and expanded to Lafayette, Indianapolis, and surrounding rural cities with multiple training sites in each city. The GOAL University program utilized nursing students from universities in each location to help carry out daily lessons and reinforce positive messaging. Additionally, middle school students participated in a health education program in their homeroom and participate in GOAL University during summer camps in summer 2022.

 

Physical Activity Minutes

While the time varied slightly each week due to the unique lesson plans, students typically spend about 30 minutes (of the 60-minute program) being physically active. The breakdown of a weekly program is below:

• Goal Setting and Checking: 10 minutes (sedentary)
• Nutrition Lesson: 25 minutes (15 minutes sedentary, 10 minutes active)
• Physical Activity Lesson: 25 minutes (5 minutes sedentary, 20 minutes active)

Program Attendance/Reach

Below were the total numbers of nursing student leaders and youth that participated in the GOAL University program in summer 2022 and health education during home room class periods throughout the 2021-2022 school year.

• 198 nursing college student leaders
• 105 students (12-17 years old)

Community Mini-Grants

The DNPA supported several community mini grants impacting adolescents. The programs that these community mini-grants support range from being classroom-specific to community-wide initiatives. They provide schools, educators, and students the resources to be physically active both in and out of school. The DNPA provided the opportunity for each entity below to fund their program throughout the 2021-2022 year.

Below was the reach of each grantee’s program impacting youth ages 12-17.

• Oak Park Church & Early Learning Academy
  • Reach: 156 students 12-17 years old
  • Program: Enhanced playground environment for the church/early learning academy outdoor health and fitness park; provided youth and adolescents the opportunities for outdoor learning and physical education, expanded self-awareness, taught mindfulness, and benefited their mental health by being outside in nature. Next to the playground, an already existing vegetable garden had been planted to teach youth and adolescents of all ages about healthy eating and gardening.

• Springs Valley Community Schools Corporation
  • Reach: 135 students 12-17 years (Jr./Sr. High School)
  • Program: Provided training to teachers to implement Mindfulness in Motion program and sensory hallways in elementary schools; the school corporation also purchased new physical education equipment for their Jr./Sr. high school general physical education (PE) classes and advanced PE classes which included yoga mats, jump ropes, and resistance bands. The corporation also partnered with a locally certified strength and conditioning coach to teach students how to properly utilize equipment, ways to prevent injuries, and set S.M.A.R.T. goals.

• Evansville Trails Coalition
  • Reach: Community-based
  • Program: Story Trail signage for new story trail in a highly vulnerable area in a local park; featured stories from local authors; partners included YMCA and local library; all volunteer-based; The story trail consisted of children's books featured on permanent and durable signs, with the ability to replace stories over time. Signs also included inclusive and adaptable physical activities for youth and families to engage in along the trail. The installation of the story trail has been postponed due to back orders in materials and weather. Materials were purchased during the grant year and installation will happen once the ground is ready. More details will be available for this project in the coming months.

Built Environment Strategies

Temporary Changes to the Built Environment: Tactical Urbanism Grant Program

 

The DNPA continued to grant funds to organizations implementing pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting active lifestyles and active transportation for children and adults. Grantees were selected by a competitive application process and grant amounts ranged from $7,500 – $10,000. Grant projects included new pedestrian crosswalks, pop-up bike lanes, traffic calming installations, traffic speed reduction improvements, walking programs for schools, and pedestrian wayfinding improvements that increase safe access to everyday destinations for adolescents and adults. The following grantees were awarded Tactical Urbanism Demonstration Grants in 2022 spanning from March – September.

• City of Fort Wayne:  Fort Wayne Consolidated School Corporation
  • Reach: 12,711 ages 12-17 students
  • Program: This project implemented low-cost demonstration improvements in highly visible locations along the Pontiac Street Corridor between Hanna St. and S. Anthony Blvd. The project temporarily reconfigured the street to slow traffic and create placemaking opportunities that interact with the surrounding community. The implementation of the project showcased additional pedestrian and bicycle projects along the street corridor. Additionally, the project enabled the City’s newly created Neighborhood Planning and Activation workgroup to engage with the local community in a more personable and hands on capacity, helping to create safe access to destinations for adolescents and adults along the street corridor within the neighborhood.

 

• City of Gary: Gary Community School Corporation
  • Reach: 1,824 ages 12-17 students
  • Program: This project in Gary implemented low-cost improvements in highly visible locations including the 900 block of Broadway (downtown's southern entrance) and the Adam Benjamin Metro Center, an intermodal transportation facility on the north end of downtown Gary. It features installations of artistic crosswalks adjacent to wheelchair ramps and path-of-travel improvements at locations lacking any marked paths or ramps across a state highway, helping to create safe access to public transportation and destinations for adolescents and adults, including nearby schools.

 

• Indianapolis Community Heights Neighborhood Association: Indianapolis Public Schools School District
  • Reach: 8,948 ages 12-17 students
  • Program: This project improved safe walking and bicycling connections for students traveling to Indianapolis Public School 88 and the Irvington branch of the Indianapolis Public Library; Ellenberger Park and other amenities around the Community Heights neighborhood and Irvington. The installation calmed traffic and created safer walking and bicycling environments for adolescents and adults in the neighborhood.

 

Changes in the Built Environment

Title V funding was used to promote increased levels of physical activity at the community level through changes to the built environment. Technical assistance was provided to stakeholders and Purdue Extension Community Wellness Coordinators at the local, regional, and state level to identify opportunities to make changes to the built environment supporting physical activity. Technical assistance activities included providing guidance to stakeholders for the planning and installation of multi-use trails, safe pedestrian crossings, bikeways, safe routes to schools and parks, and complete streets. This technical assistance helped enable adolescents ages 12-17 to walk and bicycle to everyday destinations, including middle or high schools, libraries, friends’ houses, and extracurricular activities. These types of built environment changes can help adolescents and adults get to places safely, while also increasing levels of physical activity, to help set them up for lifelong health and wellness.

Bicycle and Pedestrian Master Planning

The DNPA provided matching funds for two communities to prepare and adopt community-wide bicycle and pedestrian plans. Each of the two grantees received a $20,000 grant and provided dollar for dollar matching funds. The planning and adoption of bicycle and pedestrian master plans is recognized as an effective way to implement policy, systems, and environmental changes in communities that support higher levels of physical activity. These routes create safe, active pathways to everyday destinations for adolescents and adults. The following community grantees were awarded planning grants in 2022:

• City of LaPorte: LaPorte Community School Corporation
  • Reach: 2,752 ages 12-17
  • Program: The grant provided funding to hire a consultant to help the city to prepare a Trails, Greenways, and Blueways Master Plan that contributed to achieving the community's vision by identifying specific streetscape enhancements that prioritize safety and ease of non-motorized transportation. The plan also identified opportunities to enhance the Blueways network connections between each public waterbody and the trails network. The plan identified opportunities for walking and bicycling connectivity to everyday destinations for children and adults for entertainment, retail, public institutions, recreational areas, and downtown. The main goal of the plan is to allow safe movement and access to healthy transportation options throughout the city.
• Eskenazi Health Indianapolis: Indianapolis Community School Corporation
  • Reach: 8,948 ages 12-17 students
  • Program: Eskenazi Health hired a consultant to prepare a “small area or neighborhood plan" in Indianapolis that promotes walking and bicycling to everyday destinations such as schools, parks, and shopping to include a focus on Creating Safe Routes in three neighborhoods that contain Eskenazi Health Centers. The planning effort highlighted opportunities to connect safe routes and trails more directly to health center sites. This planning effort enhanced both safe access to healthcare and facilitated programming opportunities such as Eskenazi Health Wellness Walks that encouraged physical exercise. The planning effort is part of the Health Equity Zone initiative, in which Eskenazi Health conducted in depth community engagement, facilitated focus groups with staff, patients, and neighborhood resident leaders. This outreach was complemented by Eskenazi Health’s Community Health Workers and Community Weavers, a newly created role that connects community partners to each health center location.

 

Active Living Workshops

Title V funding supported communities across Indiana in hosting a series of Active Living Workshops. These workshops enabled residents to create action plans that lead to changes in the built environment supporting higher levels of physical activity in their communities. A virtual workshop was hosted in Elkhart and in-person workshops were held in Terre Haute, Gary, and LaPorte. Over 125 community leaders attended the four active living workshops. The workshops will help adolescents, ages 12-17, travel safely to everyday destinations within their communities with their families. This process will also allow for safer walking and bicycling to school access.

 

Professional Development Trainings
The DNPA provided three Coordinated Approach to Child Health (CATCH) professional development trainings to all K-12 physical education (PE) teachers and before and after school professionals in Bedford, Indianapolis, and Warsaw. The DNPA offered a diverse group of professional development trainings. One training focused on grades 6th-8th physical education, physical activity, and social emotional learning (SEL) activities and curriculum. Two training courses focused on grades K-5th physical education, physical activity, and SEL activities and curriculum. These activity-based trainings included teaching easy ways to engage students and inspire movement and healthy lifestyle habits, as well as introducing SEL into lesson plans.

A total of 38 participants attended and interacted in the three training courses from all over the state of Indiana.

Wellness Policies
The DNPA offered a free opportunity for school corporations to submit their district wellness policy for DNPA’s Child Wellness Coordinator and Youth Physical Activity Coordinator to review. They utilized the WellSAT 3.0 Quantitative Assessment Tool to score and provided an in-depth feedback letter including strengths and suggested ways to improve their wellness policy language. 

In FY 2021-2022, the DNPA reviewed, scored, and provided feedback to 15 school corporations.

Schools Mini Grants

The DNPA supported five school mini grants, three of which implemented physical activity programming at the middle school and high school level. The activities performed under this grant program included various physical activity initiatives targeting areas such as physical education, physical activity breaks, and after-school physical activity. See below for additional details and the final reach of each school serving this age group:

• Huntington County Community School Corporation

• Reach: 2,162 students in grades 7-12
• Program:
  • Created an after-school table tennis club for middle schoolers to increase after-school physical activity minutes for students who do not participate in traditional school sports.
  • Sent high school skate club students on a field trip to the local skatepark to increase physical activity minutes among students who are interested in alternative sports.

• Invent Learning Hub

• Reach: 31 students in grades 7-12

• Program:
  • Provided students with classes from Kids Dance Outreach to encourage physical activity during the school day.
  • Created sensory stations throughout the school to encourage student movement during the school day.
  • Provided families with sensory kits to encourage child movement at home.

• Metropolitan School District of Warren Township

• Reach: 5,548 students in grades 7-12
• Program:
  • Hired a wellness intern to conduct the School Health Index in order to assess physical activity practices and gaps in each school environment.
  • Created a physical activity resource library for teachers to check out supplies for temporary use that promote physical activity in the classroom.

State Priority Need:

Access to High-quality, family-centered, trusted care is available to all Hoosiers.

National Performance Measure (2020 - 2025):

NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year.

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM 10.1: Knowledge, Behavior, and Confidence Change in Physicians managing Adolescent Health Concerns.

 

General Information

Assessing physical, emotional, and social development is important at every stage of life, especially during adolescence. Well-care visits for teens reduce the chances of missed opportunities to screen, provide recommendations, and offer support that could considerably influence the health and development of young people. MCH has worked to implement a model to health address some of the barriers that physicians, office environments, and youth face in receiving services.

 

Adolescent Champion Model

MCH partnered with the University of Michigan’s Adolescent Health Initiative (AHI) in early 2021 to bring its implementation of the Adolescent Champion Model (ACM). The model has been implemented and replicated in many states throughout the U.S. with an aim to create teen-friendly health care. It helps to ensure providers feel comfortable and confident when seeing adolescent patients while also encouraging clinics to implement changes to the physical office space and staff behavior to be more welcoming and engaging with youth. Healthcare providers and staff are trained over an 18-month span in a variety of adolescent topics such as consent laws for the state, confidentiality best practices, adolescent brain development, non-verbal communication bias, and cultural responsiveness.

Since October 1, 2021, our first cohort continued with its 18-month long implementation. Our AHI staff members were able to complete their second summit and their midway check in calls to review the clinics progress. The first ACM’s cohort currently has three participating clinics located around the state and has the potential to impact 441 adolescents and young adults. This first cohort also had 26 staff and providers impacted by the training and surveys with 19 sitting on the core teams for the model.

Clinics are:

•      Adult and Child Health Clinic – Indianapolis, IN
•      Ascension St. Vincent – Salem, IN
•      Clinton County Family Planning – Frankfort, IN

During the implementation clinics were able to add murals, phone charging stations, and bike racks to help make their spaces more inclusive to teens. Staff were also able to learn more about nonverbal communication, being youth-friendly, and confidentiality trainings.

In order to select clinics for our second cohort, MCH released a letter of intent and sent to our internal and external partners to be shared out. With this letter of intent, we were able to select 6 clinic sites, with one site having two clinics. Currently four clinics are implementing with one site having two clinics. This second cohort began in March 2022 and have held their first summit and check-in call.

The second ACM’s cohort currently has four participating clinics located around the state and the potential to impact 4200 adolescents and young adults. It also impacted 113 providers and clinic staff with 26 on the core teams.

Clinics are:

• Columbus Pediatrics – Columbus, IN
• Health Net Arsenal Tech – Indianapolis, IN
• Refresh 5 – Austin, IN
• Reid Health OBGYN – Richmond, IN

While this program has had some great success with educating clinic staff, there have also been some challenges. During this time the Adolescent Health Initiative (AHI) had staff turnover with our immediate staff member assigned. Our new staff member was able to learn quickly and continue with the program timeline. Our next challenge has been in maintaining clinics. While the letter of intent process was successful in selecting clinics, outside factors have caused two clinics to have to bow out of the program. These have included not having enough staff, staff turnover, or not having enough time to implement due to the ongoing pandemic, other illnesses, or other programs.

State Priority Need:

Strengthen Mental, Social, and Emotional Well-being through partnerships and programs that build capacity and reduce stigma.

State Performance Measure (2020 - 2025):

SPM 4: Number of youths served with a Positive Youth Development curriculum, ages 12 – 17.

 

General Information

The Title V Needs Assessment emphasized the importance of prioritizing optimal health and well-being for adolescents and young adults (AYAs) in Indiana. As AYAs transition into adulthood, they are tasked with more responsibilities and must prepare to navigate relationships, consequences, technology, and more. Integrating a Positive Youth Development Framework in all programs equip AYAs with tools to thrive in an increasingly competitive and multi-faceted society. Through these efforts, Indiana teens feel greater support to make more positive, healthier decisions while simultaneously building their social, emotional, self-management, advocacy, and coping skills that detract from the urge to engage in risky behaviors. Teens learn ways to effectively ease anxiety, participate in healthy relationships, and focus on long-term goals by understanding the consequences of their actions. As more youth engage in PYD-focused programming, more youth in Indiana will be closer to maximizing their full potential.

 

Currently, MCH is implementing PYD-focused programming through two grant programs: Sexual Risk Avoidance Education and Teen Pregnancy Prevention: Tier One Grant program.

Teen Pregnancy Prevention

To further serve youth, MCH is implementing a Teen Pregnancy Prevention (TPP) program funded by the Office of Public Affairs. MCH is partnering with six implementing organizations to deliver the Botvin LifeSkills Training program. LifeSkills is a peer reviewed, evidence-based program that focuses on teaching youth healthy decision making in all aspects of life while also creating healthy relationships. This program is currently being implemented in school, after school, and in probationary settings. The grant year for this project ran July 2021- June 2022 and the third year started July 2022.

During the second year of the project's implementation, our partners had the following reach of 1,890 youths for Botvin LifeSkills across twenty-six counties. These programs are run in-school, after-school, or within the communities each partner serves. MCH was able to reach more youth in the projects second year than in the first, but still faced barriers due to COVID-19. MCH anticipates reaching more youth in year three.

In addition to LifeSkills, partners are also facilitating Parent and Teen Cafés. The Café Model from Be Strong Families is aimed at building resilience among both youth and parents in a group setting. Together, groups of parents discuss and share experiences about raising teens and young adults based on the protective factor framework. The youth cafés allow teens to empower, inform, and energize their journey to adulthood through conversation and expectations. MCH’s implementing partners provided 157 WoW Talk Teen Cafés reaching 1,411 youth. They also hosted 20 Parent Cafés reaching 129 parent, guardian, or champion adult for teens.

Sexual Risk Avoidance Education Program

The Adolescent Health Administrator and MCH Programs Director continued to provide guidance and oversight to the Sexual Risk Avoidance Education Program (SRAE) sub-grantees. This grant program, which is funded by the Family and Youth Services Bureau, has six sub-grantee organizations that continue to implement positive youth development programming around the state. Sub-grantee programming, which is focused on healthy relationships, communication skills, negotiating skills, and more, reaches nearly 15,000 youth per year.

Programs are implemented both during and after school and serve youth in many locations across Indiana. The Family and Youth Services Bureau is continuing to conduct a National Evaluation and has a data portal that collects information for each sub grantee twice a year. Each grantee is also able to use their own entry and exit survey data to track and understand program reach, dosage, and behavior change. Grantees have been able to utilize this data to obtain challenges and successes and help improve their programs.

MCH will continue its partnership with Health Care Education and Training (HCET), who provides training and technical assistance, evaluation, and fidelity monitoring services to grantees. HCET has worked to improve programs through curricula review for medical accuracy, inclusion, and relevance to population.