Injuries among youth and teens, specifically teen suicide.

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 caregivers.

The Adolescent Health Initiative (AHI) is a Title V health promotion project that maintains a comprehensive and holistic view of an adolescent's health and well-being. The AHI uses a PYD framework, developed by Search Institute, to look beyond individual risk behaviors to focus on the overlap between behaviors, their underlying common causes, and successful interventions. The Search Institute’s Developmental Assets® are 40 research-based, positive experiences and qualities that influence young people’s development, helping them become caring, responsible, and productive adults. Over time, studies of more than 5 million young people consistently show that the more assets that young people have, the less likely they are to engage in a wide range of high-risk behaviors and the more likely they are to thrive.

In early 2020, the AHI partnered with West Virginia University-Parkersburg to conduct surveys in schools throughout Region 5 to access the impact of the AHI’s PYD programming. Results show that youth attending AHI’s programming are more likely to feel their parents give them support when they need it (61% vs 43% strongly agree), more likely to get along with their parents (49% vs. 36% strongly agree), more likely to feel they get a lot of encouragement at school (31% vs. 11% strongly agree) and feel their teachers push them to be the best they can be (44% vs. 15% strongly agree).

However, during the COVID19 pandemic, youth ecological systems have been in turmoil, with disruptions in daily routines, interruptions in information and communication across settings and drastic and abrupt changes in rules and processes. Throughout most of 2020 and 2021, school systems have juggled ever-changing guidelines and restrictions while bouncing to and from remote and in-school class formats. While challenging to implement with COVID19 restrictions and class setting instability, the need for PYD programming and activities is more prevalent than ever.

While many schools returned to (mostly) in-class learning in 2021, continued COVID19 restrictions and closures made implementation, at times, even more challenging than in 2020. The regional Adolescent Health Coordinators’ (AHCs) access to schools were still severely limited and for the most part, they could no longer access students remotely. Community meetings and events continued to be very limited as well. Despite these continued challenges, the AHI participated in 85 trainings, presentation and events focused on positive youth development to encourage resiliency, empowerment, leadership, tolerance, youth-adult connectedness, etc. Nearly 9000 youth, parents/families, community leaders, professionals, and school personnel attended.

Highlights include (but aren’t limited to):

• Sexual Orientation/Gender Identity 101
• Adaptive Yoga for Teens
• Social Emotional Competency
• A Framework for Understanding Poverty
• Developmental Assets
• Intentional Relationships Workshop
• Inclusive Relationships Workshop
• Trauma and Discomfort with Racial Conversations
• Welcoming Schools/Diversity
• Youth Mental Health First Aid Overview
• How to Build Developmental Assets
• I Can: Overcome by Supporting each Other (Homelessness); Have Control my managing my anger and avoid violence; Graduate by deciding to stay in school; and, Speak Series
• Developing Star Leaders
• LGBTQ Resources for Schools
• Handle with Care 1.0 and Grad Class
• Success in the New Economy
• Be An Askable Parent
• The Bright Side

The AHI also worked with youth teams to do more than 20 community service and youth focused projects. Some examples are as follows: The Giving Room to provide food, clothing, personal hygiene supplies and school supplies for students in need; wrote thank you notes to doctors WVU Medicine for their hard work during the pandemic; Calhoun County Caring Closet - constructed dress racks and shelves for clothing, shoes, food, personal hygiene, school supplies and prom dresses were donated for the girls; wrote letters to all virtual students to ensure they felt connected to the school; Backpack Blessings provided weekend food bags to student’s pre-school through 8th grade; Operation South Paw - volunteered and donated supplies and food to the Humane Society to help with the animals left at the shelter or abandoned; Youth Moves, a youth empowerment workgroup; Back to School Bash at a local mall - distributed 100 crayons, 600 single section notebooks, 600 five-section notebooks, 1,000 yellow highlighters, 5,000 pencils, 864 backpacks; and Teen Boot Camp Cooking Class.

Adolescent Health Initiative and the WV VIPP will utilize the WV YRBS 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 began utilizing the AHC (Adolescent Health Coordinators) regional network to conduct YRBS surveys across the state. In late 2021, The AHCs conducted YRBS surveys in 57 in 29 of WV’s 55 counties. A total of 1,776 students were enrolled, however due to absences, quarantines, and localized closures related to COVID19 and multiple winter storms, only 883 were able to complete the surveys. Additionally, COVID19 restrictions did not permit the AHCs to conduct the surveys in the spring of 2021, delaying implementation until November 2021. Because of this delay, 2021 YRBS data is not available as of May 2022.

The 2017 high school risk behavior shows a decrease in most adolescent risk behaviors including the percentage of students who have seriously considered suicide since (27% down to 19%); however, this data point showed a small increase to 21% in 2019. 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/.

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

Beginning in FY 2017, the AHI’s regional AHCs began meeting with school personnel and administrators to introduce the idea of a bystander intervention and discuss evidence-based program implementation, as this approach requires commitment by school personnel and the community. Program implementation of the Green Dot program began with 6 schools in FY2018 and has expanded to 32 schools utilizing an array of comprehensive programs. These programs have expanded to include bullying, all forms of violence including sexual violence, suicide prevention, cyber safety, trauma, mental health, and diversity. These programs include:             

• Connections Matter

• Signs of Suicide
• Coaching Boys into Men
• Darkness to Light
• Healthy Grand Families
• 4-H Stress Management
• Teen Safety
• Positive Action
• Cyber Civics
• SafeTalk

Also in 2017, the AHI partnered with the DHHR’s Bureau for Behavioral Health and Health Facilities to certify the regional AHCs as Youth Mental Health First Aid trainers. Youth Mental Health First Aid (YMHFA) is an 8-hour course that teaches you how to identify, understand, and respond to signs of mental illnesses and substance use disorders. Since that time, the AHCs have also become certified trainers in ACEs (Adverse Childhood Experiences), Trauma Informed Schools and Handle with Care (HWC). Research shows that trauma can undermine children’s ability to learn, form relationships, and function appropriately in the classroom. HWC programs support children exposed to trauma and violence through improved communication and collaboration between law enforcement, school agencies and community agencies, and connects families, schools and communities to community services. A total of 6,338 youth and adults attended these programs, including the following:

• Teen Mental Health First Aid
• Youth Mental Health First Aid
• Mental Health Application Grad Class
• Handle With Care During COVID and The Big Transition for Kids
• Handle With Care: Responding to Child Abuse During a Pandemic
• Handle With Care: Using the Principles of Diversity, equity, and Inclusion to Protect Children and Families
• Handle with Care 1.0
• Handle with Care Grad Class
• Overcoming ACEs

In addition to the above, the AHCs provided the following trainings and presentations:

• Social Media Safety
• Diversity Resources for Schools
• Ending the Silence
• Sexual Orientation and Gender Identity 101
• I CAN Be Happy by Facing Negativity
• I CAN Be Strong by Tackling Bullying and Peer Pressure
• I CAN Find Hope: The Bully, the Bullied and the Bystander
• I CAN Find Hope by Seeking Help for Suicidal Thoughts
• Notice, Listen, and Connect
• Sensitivity Training
• Suicide Safe, Recognizing and responding on the Front Line
• Step Up; be a Leader, Make a Difference
• Strategies, Tips, and Activities for the Classroom: Building Connections and Developing Empathy
• Welcoming Schools; Preventing Bias-Based Bullying
• Welcoming Schools: Creating Schools That Welcome All Genders
• Welcoming Schools: Connect WV 3.0
• Welcoming Schools: Graduate Class

In total, 16,248 youth, parents, school staff and community members attended the AHI’s 54 trainings and workshops. The AHI also posted 287 messages, links and resources on social media; and disseminated 14,350 brochures, life-line cards, fact sheets and other literature on bullying prevention, suicide prevention, depression and mental health, violence prevention, cyber safety and ACEs.

Several years ago, the AHI and the VIPP partnered to provide a statewide training on the Green Dot bystander program. The Green Dot strategy is a comprehensive bystander intervention that capitalizes on the power of peer and cultural influence across all levels of the socio-ecological model. Since that time, the AHI has expanded to include the implementation of several prevention programs. In the coming year the AHI will work with schools to expand evidence-based programming by identifying, providing the necessary training and implementing bystander and prevention interventions best suited for each school’s needs.

The AHI partnered with the DHHR’s Bureau for Behavioral Health and Health Facilities to certify all the regional AHCs as Youth Mental Health First Aid instructors. In addition to YMHFA, the AHCs offer trainings in Adverse Child Experiences (ACEs) and Trauma Informed Schools, and Handle with Care evidence-based models. In FY2020 and 2021, challenges with COVID19 not only changed the traditional training model but also prompted the retirement of 3 of the 8 regional AHCs.  In the coming year, the AHI will seek the necessary training for new staff and will work with existing staff to develop both in-person and virtual training programs. 

The VIPP will disseminate relevant data on the topic of non-fatal suicide trends for 12-17 year olds in the state.

The VIPP has been unable to disseminate any related data due to staffing vacancies in the VIPP program.

Transition

Provide education and resources to pediatric primary care physicians on the importance of adopting a transition policy (via MCH Workforce Development communication plan and Medical Advisory Board)

Implementation of the health care transition action plan will be a priority in the coming months as we transition from the initial PHE response and incorporate the PHE long-term response into our regular work. Our strategies for this state performance measure remain unchanged. Once approved, updated tools and procedures will be included in the education and resources to pediatric primary care physicians by the WV HealthCheck Program.

The HealthCheck Program will survey primary care providers for inclusion of a formal transition policy by their practice. These survey results will inform future provider education efforts and resource needs.

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

Once approved, WV CSHCN Program care coordinators and WV BCF staff will receive training on the updated tools and procedures. WV CSHCN Program care coordinators will begin implementing these tools and procedures with all transition age CSHCN. Data surveillance will monitor progress and ensure all transition age CSHCN receive age-appropriate transition services.

The CSHCN Program will partner with the WVU CED Paths for Parents’ Parent Network Specialists and the Family to Family Health Information Center to complete transition readiness assessments for transition age YSHCN. Youth will be referred to the Parent Network Specialists upon age 14 for completion of the transition readiness assessment. The results of the transition readiness assessment will be submitted to the CSHCN Program social worker. The results will be shared with the child’s PCP and other medical home providers. Appropriate transition services will be provided pending the results of the transition readiness assessment.

Educate transition aged foster children on their entitlement to retain Medicaid coverage until age 26.

These transition services include information on the entitlement for foster youth to retain their Medicaid coverage until age 26 if they consent to continued participation in the child welfare system after age 18.  The CSHCN Program will educate enrolled foster child before the youth turns 18 and ages out of foster care. This education will be ongoing until the young adult is discharged from the CSHCN Program at age 21. Educational forms have been developed for CSHCN Program staff to facilitate transition for foster youth.

The CSHCN Program will also educate CPS workers on this entitlement.

Substance use in youth/teens.

Partner with medical providers to align with best practices in prescribing controlled substances to ensure optimum outcomes.

Alarming trends have been observed in West Virginia with regards to the prescribing of stimulants, a first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). The 2019 estimated prevalence of ADHD in children 3-17 years of age in West Virginia was much higher than the national average at 13.2% versus 8.6% respectively. Moreover, in some counties in West Virginia up to one in four children within certain age groups were being prescribed a stimulant. While prescription stimulants may be first line therapy for ADHD where appropriate, the medications are controlled substances due to their risk for dependence, addictive properties, and potential for diversion. Likewise, these medications should only be prescribed where an appropriate corresponding diagnosis exists.

The initial plan was to develop an assessment, evaluation, and treatment guideline for ADHD in children and adolescents to be disseminated via academic detailing (educational outreach to medical providers) throughout the state. After additional analyses of stimulant prescribing trends in West Virginia, it has become evident that stimulant use in West Virginia is higher than national averages in children, adolescents, and adults. Harms are associated with the abuse potential of prescription stimulants without an appropriate diagnosis, and without appropriate assessment or follow-up; cardiac effects, growth impacts, and tic disorders may go unaddressed. Therefore, as a necessary preventive measure to ensure appropriate diagnoses are occurring and safe stimulant prescribing habits are implemented in the state with the highest rate of overdose deaths in the U.S., this educational effort was expanded to also target West Virginia’s adult population. Braided Title V and Centers for Disease Control and Prevention (CDC) now support this endeavor.

Facilitated by the West Virginia University School of Pharmacy with support from the OMCFH, a panel of experts from across the state first convened in November 2021 for the purpose of creating a statewide resource, i.e., treatment guideline, for managing attention-deficit/hyperactivity disorder (ADHD) in West Virginia. Comprising four practicing Psychiatrists, four practicing Licensed Psychologists, four practicing Pediatricians, three practicing Family Physicians, three practicing Pharmacists, three professional educators (two from the north and one from the southern part of the state), one Licensed Social Worker, the Medical Director and Pharmacy Director for West Virginia Medicaid, the West Virginia State Health Officer, the Executive Director of the West Virginia Board of Pharmacy (the state’s PDMP authority), and the OMCFH Director and Physician Director, this expert panel convened again in January, February and March 2022. To date, drafting of the West Virginia ADHD treatment guideline is approximately 80% complete. 

Provide educational information and resources to youth, parents, schools and the community about the harmful affects of drug abuse and misuse, safe storage and disposal of prescription medications and prescription monitoring in the home.

In 2017, West Virginia began collecting data on adolescent prescription misuse on the Youth Risk Behavior Surveillance (YRBS) survey. When compared to the 2017 YRBS, the survey in 2019 (the most recent available) shows a very small and statistically insignificant decrease in prescription misuse among high school students (12.5% down to 11.7%). However, the data shows prescription misuse nearly doubled for middle school students from 2017 to 2019 (3.6% to 6.7%).  While this is not enough data to be considered a trend, it is concerning.

Educating adolescents and their parents about the risks of drug misuse and abuse is a major component to combating the problem. Research shows 1 in 4 teenagers believe that prescription drugs can be used as a study aid and nearly one-third of parents believe that attention-deficit/hyperactivity disorder (ADHD) medication can improve a child’s academic or testing performance, even if that child does not have ADHD. This type of misuse is even more prevalent among older adolescents and young adults. A study by Johns Hopkins Bloomberg School of Public Health suggests that stimulant misuse by adolescents 12 and up, as much as 60% is by young adults aged 18-25. The study found it’s common for college students to use stimulants to deal with academic pressures and “cram” for tests. (https://publichealth.jhu.edu/2016/adderall-misuse-rising-among-young-adults)

Prescription monitoring is also an important factor in preventing abuse. Two-thirds of teens who report abusing prescription medication get it from friends, family and acquaintances, including their home medicine cabinets. Providing education on proper storage and disposal is important to prevent misuse, not only in the home but in the community.  (https://drugfree.org/prescription-over-the-counter-medicine/)

To address these concerns and misconceptions, the AHI provided education and information to a total of 3,451 youth, parents, school staff and staff from other community or youth serving organizations. Trainings and programs included (but not limited to):

• Healthy Grand Families
• Making Smart Choices
• Botvin Life Skills
• 4-H Stress Management
• I CAN Be Healthy: Choosing Balance in Life
• Connections Matter
• Adaptive Yoga
• Search Institute’s Intentional Relationships
• The Bright Side
• Be An Askable Parent

In addition, the AHI participated in events such as;

• Red Ribbon Week activities across the state, including a video contest
• Art Mural Contest; the theme was HOPE for substance misuse prevention
• Recovery Center Fall Fest
• Reaching for Recovery
• Partnered with 14 students to build and distribute “recovery benches” that were placed around the county in memory of loved ones lost to addiction and overdose

The AHI also coordinated peer support groups to help students cope with stress, trauma, and grief; and distributed 1,452 pieces of literature and information on the harmful effects of substance misuse.