Annual Report Fiscal Year 2020:  This section provides a summary of Federal Fiscal Year 2020 (FFY20) activities, accomplishments, and challenges related to National Performance Measures (NPMs) and State Performance Measures (SPMs) (2016-2020) for the Youth and Young Adult Health Program (YAYAHP).

Adolescence is the period following the onset of puberty during which a young person develops from a child into an adult. A number of events take place during this time, such as assuming responsibility for health habits, initiating risky behaviors, and a series of psychological, social, emotional, and physical changes. Bright Futures guidelines recommend that adolescents have an annual checkup from ages 11 to 21, as this may help adolescents adopt and maintain healthy habits and behaviors. The visit should cover a comprehensive set of preventive services, such as a physical examination, immunizations, and discussion of health‐related behaviors.

Over the last five years, the YAYAHP has made progress on improving the adolescent well-visit experience and providing information on healthy and safe relationships to adolescents in Wyoming. After participation in the Adolescent and Young Adult Health Collaborative Improvement and Innovation Network (AYAH COIIN), the YAYAHP and partners identified the Adolescent Centered Environment Assessment Process (ACE-AP) as a strategy to increase and improve adolescent well-visits. As of FFY20, six clinics have participated in the ACE-AP, and the YAYAHP plans to continue the program and offer the opportunity for participation to another round of adolescent-serving clinics. Based on the ACE-AP self assessment, the first cohort of clinics each saw improvement in at least six of the twelve indicator categories, and two of those clinics saw 50% improvement in several indicator categories. The number of sites (e.g. public middle and high schools and youth-serving community organizations) regularly implementing YAYAHP-supported sexual health curricula to adolescents doubled, from five sites in FFY16 to ten sites in FFY20. The YAYAHP experienced turnover during the last five years, and the current program manager onboarded in December 2020.

Strategy 1:  Implement adolescent-centered environment assessment process in Wyoming clinics to improve adolescent-friendly environment

To improve the quality of the adolescent clinical environment with a long-term goal of increasing the number of well visits among youth and young adults, the Youth and Young Adult Health Program (YAYAHP) continued its partnership with the University of Michigan to implement the 18-month ACE-AP within six pilot clinics between 2018 and 2020. The ACE-AP is a facilitated, comprehensive self-assessment and guided improvement process that includes customized resources, recommendations, technical assistance, and implementation plans using Plan, Do, Study, Act improvement cycles. The ACE-AP addresses 12 indicator categories of adolescent-centered care, listed below along with the number of clinics that chose to work in each category:

• Access to Care (5 of 6 clinics)
• Adolescent Appropriate Environment (6 of 6 clinics)
• Confidentiality (6 of 6 clinics)
• Best Practices and Standards of Care (6 of 6 clinics)
• Reproductive and Sexual Health (6 of 6 clinics)
• Behavioral Health (5 of 6 clinics)
• Nutritional Health (5 of 6 clinics)
• Cultural Responsiveness (4 of 6 clinics)
• Respectful Treatment (4 of 6 clinics)
• Adolescent Involvement and Empowerment (4 of 6 clinics)
• Parent Engagement (4 of 6 clinics)
• Community Engagement and Outreach (1 of 6 clinics)

In 2020 (late spring for clinic 1 and late fall for clinic 2), the second cohort of two clinics completed a baseline self-assessment of their organizations’ environment, policies, and practices related to youth-friendly services to identify opportunities for improvement. Then, they met with the University of Michigan to identify and implement quality improvement initiatives. Clinics are eligible to receive up to $2,000 to implement changes within their clinic to become more adolescent-friendly (e.g. tablets for completion of adolescent screening tools, privacy screens for check-in, youth-friendly posters and materials). To assure ongoing quality improvement and evaluation, each clinic collected staff and provider surveys assessing the extent to which the clinic provides a youth-friendly environment and adolescent-centered care. All four clinics reported up to 50% improvement in “[Using] positive body language and an approachable, warm tone in communicating with adolescents” and “[Using] sensitivity and maintain[ing] neutral language and body language with adolescents, [and] withholding judgment related to sensitive subjects, such as sexual health, substance use, interpersonal violence, gender and personal expression, and mental health.” 

The first cohort of four clinics completed mid-year and end-of-year self-assessments in 2019. The ACE-AP offers a certification at three levels - bronze, silver and gold - if a clinic scores “Fully Implemented” in 10 (bronze), 11 (silver), or 12 (gold) pre-identified clinic measures. Clinics that do not achieve certification do so either because they are unable to achieve a “Fully Implemented” score in the necessary pre-identified measures, or because the clinic chose not to focus on implementing those pre-identified measures as part of their ACE-AP. Of the four first-cohort clinics, three achieved the following certifications:

• Bronze-Level certification: 2 clinics
• Silver-Level certification:  1 clinic
• Gold-Level certification: 0 clinics

All four first cohort clinics saw improvement in at least six areas, and three of the clinics improved in at least ten areas.

One common need identified across all six participating ACE-AP clinics was information and guidance related to adolescent consent and confidentiality. In addition to the consent and confidentiality guides developed by the Center for Adolescent Health and the Law, the University of Michigan summarized Wyoming consent and confidentiality laws to create a handout for participating clinics.

Clinics used grant funds to purchase items improving the youth friendliness of the environment, such as tablets and accessories, computer hardware, educational brochures, pamphlets, posters, and charging stations.

The COVID-19 pandemic significantly impacted the second cohort’s ability to focus on environmental improvements. The YAYAHP extended the timeline for the second cohort’s participation in the ACE-AP to accommodate clinics’ need to focus on safety modifications to continue to offer medical care in the midst of the pandemic.

The YAYAHP anticipates releasing a mini-grant Request for Application (RFA) to recruit the third cohort of clinics to implement the ACE-AP model, with a focus on improving adolescent mental health screening and care. This new focus will support one of the new priorities identified for the 2021-2025 grant cycle identified and discussed further below.

Strategy 2: Develop statewide Youth Council to assure youth voices are included in decisions related to program development, implementation, and evaluation

YAYAHP seeks to promote youth voice in the development of strategies, materials, and activities. The development of a statewide Youth Council brings youth voices and experience together with health programs, promoting success, increased youth engagement, and quality improvement. One council member shared, “I joined [the Wyoming Youth Council] because I believe this council could have an impact on the lives of youth and young adults in Wyoming. I want [the Youth Council] to develop strong community partners and to hear from other youth and young adults in Wyoming to get a grasp on the concerns they have. From there, the possibilities are endless.”

The YAYAHPM developed a framework for the Youth Council and released an RFA for the Youth Council Coordinator in May 2019. The key deliverables included:

• Establish, coordinate, and facilitate a statewide Youth Council
• Recruit members across the state
• Create supportive guidelines and documents for the council (i.e. application, agreements/expectations, code of conduct, council description/informational letter)
• Work with youth to provide feedback on WDH program materials and implementation as outlined by the YAYAHPM
• Work with YAYAHPM to provide training on public health, social determinants of health, health equity, and the social ecological model
• Promote youth involvement in relevant topics (e.g. youth suicide, bullying, eating disorders, vaping)
• Plan and create Youth Council agendas and materials
• Attend and facilitate council meetings (encourage and promote youth facilitation and involvement)
• Manage all Youth Council communication, including drafting emails to be distributed to council members on updates, clarifications, upcoming meetings and events, and data reminders (may be completed in collaboration with council members)
• Work with YAYAHPM to provide positive youth development training for youth and adults working with youth
• Regularly communicate with youth and young adults to assure ongoing collaboration and information sharing on best practices and emerging issues related to youth and young adults ages 12-24 in Wyoming and other states
• Provide leadership, professional development, and social opportunities for youth
• Coordinate ongoing recruitment to promote sustainability
• Manage member leadership roles/responsibilities (e.g. social media, secretary, chair)
• Share volunteer opportunities
• Coordinate reimbursements for Youth Council members

 A contract with the selected applicant was executed in January 2020, after which membership recruitment activities took place. The Youth Council had its first meeting in July 2020 with 14 adolescent members aged 18-24, representing a range of educational attainment; racial, ethnic, and gender identities; and socio-economic standing. The council meets virtually every other week to discuss current projects and hear from organizations and agencies across Wyoming that are currently engaging in activities to promote youth wellness, and recently launched a website to engage young adults across the state.

WY MCH selected the Promote Healthy and Safe Relationships priority due to Wyoming’s high teen birth rate, early initiation of sexual activity, incidence of teen dating violence, and alcohol and drug use prior to sexual activity. Most of these activities were previously measured on the Youth Risk Behavior Surveillance System (YRBSS), but the Wyoming State Legislature eliminated the YRBSS in Wyoming in 2016. There is no longer an effective, statewide measure of youth sexual behavior. However, Wyoming does have a statewide survey called the Prevention Needs Assessment that includes questions about alcohol and drug use.

WY MCH has used the Collective Impact Model to frame activities for this priority. Collective Impact is the commitment of a group of individuals from different sectors to a common agenda for solving a specific problem, using a structured form of collaboration. It: 1) establishes shared agendas and shared measurement, 2) fosters mutually reinforcing activities, 3) encourages continuous communication, and 4) has a strong backbone.

The following strategies related to this priority were funded with Title V Block Grant, Rape Prevention and Education (RPE) Program grant, Preventive Health and Health Services (PHHS) Block Grant, and the State Personal Responsibility Education Program (PREP) grant. 

Strategy 1:  Complete Request for Proposal process and community selection for Rape Prevention and Education (RPE) Program pilot communities to implement strategies using a Collective Impact Model

The YAYAHPM serves as the RPE Project Director for Wyoming. WY MCH contracts with the Wyoming Coalition against Domestic Violence and Sexual Assault (WCADVSA) to support RPE-funded activities in Wyoming communities. The target audience for this work is adolescents ages 12-24. From February 2019 through December 2020, two communities were funded through this grant to conduct primary prevention in their local communities with a shared risk and protective factors approach. One of these communities implemented Coaching Boys into Men and Athletes as Leaders for at least 50 student athletes. These programs teach adolescent athletes about healthy masculinity and how to be leaders in creating cultures of safety and respect. The other funded community includes the Wind River Reservation, and has focused on supporting culturally-specific youth engagement activities.

The connected risk and protective factor approach allows the program to implement strategies that will improve the overall environments for adolescents in Wyoming rather than looking at sexual violence in a silo.

The pilot community program will continue with RPE funds, but will no longer be a primary focus of Title V funding during the FFY21-25 cycle.

Strategy 2: Build statewide capacity for sexual violence prevention among youth and young adults through the Wyoming Sexual Violence Prevention Council (WSVPC)

The YAYAHPM serves as a Steering Committee member of the WSVPC, which was developed to increase the effectiveness of violence prevention efforts statewide. In addition to the Steering Committee, the WSVPC has three workgroups: the Policy and Legislation Workgroup; the Education, Training and Outreach Workgroup; and the College Sexual Violence Prevention Workgroup. These workgroups continue to develop strategic goals and work towards statewide shared Collective Impact efforts for sexual violence prevention. In July 2020, the WSVPC met virtually with council members, key stakeholders, pilot community members, and members of the Campus Consortium (comprised of the University of Wyoming and Wyoming’s eight community colleges) and focused on supporting members in adapting to COVID-19, including ways to continue to engage in prevention work online and in socially-distanced environments.

The WSVPC will continue with RPE funds, but will no longer be a primary focus of Title V funding during the FFY21-25 cycle.

Strategy 3:  Implement comprehensive sexual education curriculum that includes content on reducing risky behaviors

The YAYAHPM serves as the Wyoming Personal Responsibility Education Program (WyPREP) Project Director. WyPREP provides training, curricula, and support for implementation of evidence-based, medically accurate curricula in school and community-based settings. Contracts with ten organizations were active in FFY20: seven school districts; two community-based, youth-serving organizations; and the Wyoming Institute for Disabilities. Starting in the 2017-2018 school year to present (2017/2018, 2018/2019, 2019/2020, and fall semester 2020), WyPREP reached over 2,250 Wyoming youth.

COVID-19 significantly impacted the provision of sexual health curricula for most of the 2020 calendar year. Many sites paused curriculum delivery entirely during the first half of 2020 while they adjusted to hybrid or remote learning schedules (for schools) or to public health orders prohibiting or severely limiting in-person gatherings (community organizations). Several sites were able to adapt their curricula to remote delivery, and other sites returned to in-person delivery late in 2020 as health mitigation measures allowed schools to return to in-person learning and community organizations to again host in-person gatherings.

Strategy 4:  Develop and maintain statewide Youth Council to assure youth voices are included in program development, implementation, and evaluation

See the Promote Preventive and Quality Care for Adolescents priority, Strategy 2 above.

Annual Report Fiscal Year 2020 Supplement:  This section provides an interim update for Federal Fiscal Year 2021 (FFY21) activities currently in process for the YAYAHP.

After the summer 2020 needs assessment, the YAYAHP identified new priorities for the adolescent domain:

• Promote Adolescent Motor Vehicle Safety
  • Measures include NPM 7.2: Rate of hospitalization for non-fatal injury per 100,000 adolescents ages 10-19.
  • New strategies include collaborating on evidence-based strategies for adolescent motor vehicle safety promotion; implementing Teens in the Driver’s Seat, a peer-to-peer traffic safety education program; and developing motor vehicle safety guidelines to provide to patients and parents at adolescent well-visits.
• Prevent Adolescent Suicide
  • Measures include NPM 10: % of adolescents ages 12-17 with a preventive medical visit in the past year.
  • New strategies include improving adolescent mental health screening and care in clinical settings and implementing Sources of Strength, a social-emotional learning program, in Wyoming middle and high schools.

Work on these new priorities combine new strategies and continuing strategies with an updated focus. Continuing strategies include:

• Implement adolescent-centered environment assessment process (ACE-AP) in Wyoming clinics to improve adolescent-friendly environment
  • The ACE-AP, coupled with new strategies to increase adolescent well visits, will support the Prevent Adolescent Suicide priority. Two clinics currently mid-process will complete the program, and the YAYAHPM will release a new RFA to solicit new clinics to complete the ACE-AP as well as engage in additional activities to increase adolescent well visits and mental health screening.
• Develop statewide Youth Council to assure youth voices are included in decisions related to program development, implementation, and evaluation
  • The Youth Council convened for the first time in the summer of 2020, and is currently meeting biweekly to learn about and discuss a range of issues impacting adolescent health and wellness. The Youth Council will support both the Promote Adolescent Motor Vehicle Safety and the Prevent Adolescent Suicide priorities, and the YAYAHP will also support the expansion of the Youth Council to engage adolescents between the ages of 12 and 17. Youth council members have connected to statewide initiatives on priorities identified by the Youth Council, to provide the youth voice to those initiatives and council members and the facilitator have participated in professional development opportunities as attendees and presenters.
• Participate in the Child Safety Learning Collaborative
  • In spring 2020, the Wyoming team decided to participate in the second cohort of the Child Safety Learning Collaborative (CSLC), a program of the Child Safety Network. The CSLC provides support to Title V programs to reducing fatal and serious injuries among infants, children, and adolescents by building and improving partnerships and implementing and spreading best practice and evidence-based approaches, especially among the most vulnerable populations. The YAYAHP will utilize membership in the CSLC to support both the Promote Adolescent Motor Vehicle Safety and the Prevent Adolescent Suicide priorities.

In addition to the new priorities, the YAYAHP will continue activities from the FY19 priority Promote Healthy and Safe Relationships for Adolescents under the Personal Responsibility Education Program (PREP) and the Rape Prevention Education Program (RPE).

Other YAYAHP Activities:

New Program Manager 

WY MCH hired and onboarded a new Program Manager for the Adolescent domain in December 2020.

YAYAHP Partnership Development

The YAYAHPM continued to develop and build partnerships with many youth-serving organizations, other WDH programs, and other agencies to increase the effectiveness of YAYAHP programming. Partnerships include:

• Wyoming Equality
• Wyoming Primary Care Association
• Strong Families Strong Wyoming
• Wyoming Health Council
• Students Against Destructive Decisions (SADD)
• Wyoming Children’s Trust Fund
• Wyoming Department of Education
• Wyoming Highway Patrol
• Wyoming Department of Transportation
• Wyoming Medicaid
• UPLIFT
• Wyoming County Prevention Specialists
• Office of Health Equity of WDH
• Injury and Violence Prevention Program of WDH
• Communicable Disease Unit of WDH
• Immunization Unit of WDH
• Wyoming Division of Victim Services

Campus Consortium

The Campus Consortium (comprised of the University of Wyoming and Wyoming’s eight community colleges), YAYAHP, WSVPC, and WCADVSA have worked to assure primary sexual violence prevention information is shared and technical assistance is provided. PHHS Block Grant funds were used to support the “Be the Solution” statewide media campaign and dissemination of campaign materials to all institutions of higher learning in Wyoming. The campaign encourages change in community norms. 

MCH Community Mini-Grant Program

In FFY20, the YAYAHP closed out two community mini-grants focused on adolescent injury prevention. In collaboration with the Child Health Program, YAYAHP funded seven community mini-grants with a focus on childhood injury prevention in summer 2019; two of these mini-grants specifically focused on adolescent needs.

Youth Emergency Services, Inc. (Y.E.S. House) is a regional hub for youth-based preventive, intervention, and treatment services in northeast Wyoming. Y.E.S. House offers training in adverse childhood experiences (ACEs) to their own staff and volunteers. With mini-grant funds in the amount of $7,000, Y.E.S. House was able to expand ACEs training, conducting thirteen training sessions for 491 participants across Campbell County. Sessions were provided to over ten agencies/organizations, including local schools and prevention councils.

Campbell County School District (CCSD) implemented school HOPE Squads as an adolescent suicide prevention strategy. With mini-grant funds in the amount of $4,615, CCSD established a new HOPE Squad at a local middle school and two new squads at three elementary schools. Eight new school advisors and one master advisor were also trained. CCSD conducted branding, marketing, and other events/activities in the community and within schools to promote the HOPE Squads and create a safe and non-threatening environment for all students.

WYOMING CAN Mini-Grant

With funding from the CDC to help advance the RPE goal of preventing sexual violence perpetration and victimization, the YAYAHP developed and released an RFA for Wyoming organizations to support the implementation of community/societal-level primary sexual violence prevention strategies.

Mini-grant recipients were strongly encouraged to consider shared risk and protective factors that impact youth and young adults ages 12-24 and can be addressed at the community/societal level. Recipients were also required to use the Sexual Assault and Domestic Violence Prevention Assessment Tool. The tool, which was developed because Wyoming no longer participates in the YRBSS, is informed by the CDC’s “Connecting the Dots” strategic vision to include shared risk and protective factors consistently associated with both sexual assault and domestic violence. When selecting measures/items to assess established risk/protective factors, validity and brevity were guiding considerations. It contains modular content that can be tailored, and can anonymously link respondents’ surveys over time. The tool has eight domains:

1. Hypermasculinity in relationships - Adolescent Masculinity in Relationships Scale
2. Delinquency - alcohol consumption content from YRBSS
3. Perceived Peer Support for Sexual Aggression - Family Life and Sexual Health Sexual Attitudes survey
4. Rape myth acceptance
5. Intimate partner violence/relationship control myths - dating and social norms items validated
6. Connectedness - school/teacher/families connectedness scales
7. Sexual assault and intimate partner violence perpetration - YRBSS victimization and perpetration items
8. Bystander intent and behavior - Coaching Boys Into Men items

In April 2020, two applicants were selected to receive funding; they used a public health approach to implement and evaluate identified sexual violence primary prevention strategies based on the best available evidence at all levels of the Social Ecological Model. One applicant funded an evidence-based bystander intervention program targeted at college students and was able to offer that program online as a COVID-19 adaptation. The other applicant expanded access to an evidence-based parent-teen communication and support program.

YAYAHPM Memberships

The YAYAHPM has remained an active member of AMCHP. As a member of PHD’s Health Equity Workgroup (HEW), the YAYAHPM participates in HEW activities and meetings, identifies inclusive strategies for capturing data and gaps in service due to disparities, and participates in WY MCH discussions related to the 6th domain priority. The YAYAHPM is an active participant in the National Network of State Adolescent Health Coordinators (NNSAHC).

COVID-19 Response

The YAYAHP launched a social media campaign during summer (June-August) 2021 to inform adolescents of available intervention and support resources for adolescents who are experiencing suicidal ideation or suffering from other mental health concerns, including depression and anxiety.