For Adolescent Health, New York’s Title V Program selected NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. This NPM was selected because it aligns with both population health data indicators and concerns voiced directly by adolescents in New York State (NYS). Most teens (ages 12-17) had a preventive medical (86.3%) and preventive dental (89.1%) visit in 2019, but NYS continues to work towards increasing the total number of adolescents who have obtained annual preventive medical and dental visits as well as reducing current disparities. 86.0% of Hispanic adolescents had a preventive medical visit compared to 89.3% of non-Hispanic White adolescents and only 78.2% of adolescents on Medicaid had an annual visit compared to 91.5% adolescents with private insurance.

 

In a series of adolescent focus groups conducted in 2019 by NYSDOH through the Assets Coming Together (ACT) for Youth Center for Community Action, adolescents across the state discussed that their medical providers lack compassion and respect for their young patients, and that youth would prefer visiting providers who are more affirming and reflective of the youth themselves. The importance of social support and the need for more people to talk to positive mentors were frequently mentioned by adolescents. They discussed feeling socially isolated and wanting opportunities for community engagement or building a sense of belonging. Beyond assuming responsibility for their own health care, adolescents voiced a desire for education about financial literacy, healthy cooking, navigating relationships, and other aspects of adulthood.

 

Preventive medical visits are one component of overall wellness, but data and community input point to other areas such as social emotional development and adult preparation that could assist with adolescents’ proper growth and development.  As indicated in the 2019 Youth Risk Behavior Surveillance System, over 30% of New York high school students reported feeling sad or hopeless for more than two weeks in the past year and over 10% reported that they attempted suicide. Hispanic students are more likely to report depression symptoms and suicide attempts, and there are dramatic disparities based on sexual identity as well, with 60% of students identifying as gay, lesbian, or bisexual reporting depression symptoms and 26% reporting a suicide attempt. Only 16.4% of adolescents without special health care needs received services necessary to transition to adult health care.

 

Adolescence is often a very challenging stage in a person’s life. During this time, adolescents experience growth through physical development, cognitive development, social-emotional development, identity, and sexual development. Supporting adolescents’ health and development and helping them prepare for their futures can have a lasting impact throughout the life course. The multifaceted nature of adolescent development and wellness means the selected NPM and its associated strategies are responsive to most of the priority areas, particularly health care, social support and cohesion, community services and amenities, and awareness of resources. This NPM also aligns directly with established priorities encompassed in the NYS Prevention Agenda goals to support and enhance children and adolescents’ social-emotional development and relationships, strengthen opportunities to build well-being and resilience across the lifespan, facilitate supportive environments that promote respect and dignity for people of all ages, and other Prevention Agenda goals related to mental health and substance use, including prevent underage drinking and excessive alcohol consumption by adults, prevent opioid and other substance misuse and deaths, prevent and address adverse childhood experiences (ACEs), reduce the prevalence of major depressive disorders, prevent suicides, and reduce the mortality gap between those living with serious mental illness and the general population. (New York State Prevention Agenda 2019-2024 https://www.health.ny.gov/prevention/prevention_agenda/2019-2024/docs/ship/overview.pdf) 

 

Four specific objectives were established to align with this performance measure:

 

Objective AH-1: Increase the percentage of adolescents, ages 12-17, with a preventive medical visit in the past year by 5%, from 81.3% in 2016-2017 to 85.4% in 2021-2022. (National Survey for Children’s Health (National Survey of Children’s Health)

 

Objective AH-2: Increase the percentage of children, ages 3 through 17, with a mental/behavioral condition who receive treatment or counseling by 5%, from 53.5% in 2017-2018 to 56.2% in 2021-2022 (National Survey of Children’s Health)

 

Objective AH-3: Increase the percentage of adolescents, ages 13 through 17, who have received at least one dose of the HPV vaccine by 8%, from 67.3% in 2018 to 72.7% in 2022 (National Immunization Survey-Teen [NIS-Teen])

 

Objective AH-4: Increase the percentage of NYS adolescents without special health care needs, ages 12-17, who received services necessary to make transitions to adult health care by 5%, from 16.4% in 2017-2018 to 17.2% in 2021-2022 (National Survey of Children’s Health)

 

Four strategic public health approaches were identified to accomplish these objectives over the next five years. These are presented in the State Action Plan Table, and each is described in more detail here, with specific program and policy activities that will be implemented to advance the broader strategic approach in the upcoming year.

 

Strategy AH-1: Incorporate specific activities to promote the wellness of adolescents across all Title V programs, including promoting and facilitating routine well visits, reproductive health care, oral health, and behavioral health.

 

Adolescence is a critical stage of development when children grow physically, cognitively, emotionally, and socially to become adults. The lifestyle choices, behaviors, and relationships established during this time can affect an adolescent’s current and future health. Routine well visits during adolescence are recommended by the American Academy of Pediatrics and Bright Futures™ as one way to foster health in the present and build a foundation for wellness into the future. They are an opportunity to promote healthy behaviors, discuss risky behaviors, provide important vaccinations, and address conditions that can interfere with healthy development. Likewise, comprehensive, and inclusive reproductive health care and education are opportunities to help adolescents avoid or mitigate risky sexual behaviors. Title V Programs also provide enabling services to adolescents, such as referrals to and linkages with community services and social supports to holistically address health and wellness, including mental health and social determinants of health.

 

The key programs that work to support adolescent wellness and help connect adolescents to needed services include Comprehensive Adolescent Pregnancy Prevention program, Personal Responsibility Education Program, Sexual Risk Avoidance Education, Children & Youth with Special Health Care Needs, School-Based Health Centers, Family Planning Program, and Sexual Violence Prevention programs. ACT for Youth Center for Community Action at Cornell University works with the Department of Health to provide technical assistance, training, and evaluation services for the Comprehensive Adolescent Pregnancy Prevention program, Personal Responsibility Education Program, and Sexual Risk Avoidance Education programs.

 

During the height of the COVID19 pandemic, Kindergarten through 12th grade schools and youth-serving locations throughout the state experienced closures; transportation options were limited; and social distancing protocols were introduced. This reduced the ability for programs to meet the youth in a consistent manner. The ACT for Youth Center for Community Action worked with programs to ensure that the evidence-based programs they were implementing were be adapted with fidelity within the confines of a new virtual environment. Significantly less youth were served across the state compared to time periods prior to the emergence of COVID19.  

 

However, as noted by the CDC, schools and community programs play critical roles in promoting equity in learning and health, particularly for groups disproportionately affected by COVID-19. People living in rural areas, people with disabilities, immigrants, and people who identify as American Indian/Alaska Native, Black or African American, and Hispanic or Latino have been disproportionately affected by COVID-19. These disparities were also observed among children. School administrators and public health officials can promote equity in learning and health by demonstrating to families, teachers, and staff that comprehensive prevention strategies are in place to keep students, staff, families, and school communities safe and provide supportive environments for in-person learning.

 

The Title V Program established the following specific program and policy activities to advance this strategy over the 2021-22 year:

 

AH-1.1: Through the Personal Responsibility Education Program and Comprehensive Adolescent Pregnancy Prevention program, provide information to adolescents and parents on the offering and arranging of adolescent sexual health reproductive services.

 

The Comprehensive Adolescent Pregnancy Prevention program and the Personal Responsibility Education Program support the delivery of evidence-based programs to youth. These evidence-based programs are curriculums that have been rigorously tested in controlled settings, proven effective, and translated into practical models that are widely available to community-based organizations. Evidence-based programming on reproductive and sexual health was completed for 23,073 youth during this reporting period through the Comprehensive Adolescent Pregnancy Prevention program and the Personal Responsibility Education Program. 

 

The Comprehensive Adolescent Pregnancy Prevention program funds youth-serving organizations to work with adolescents, ages 10-21 that lack social and economic opportunities to develop their full potential. This includes (but is not limited to): racial/ethnic minorities, youth from socioeconomic disadvantaged communities, youth living in foster care, youth who identify as lesbian, gay, bisexual transgender and questioning, youth who are homeless, and youth involved in the juvenile justice system. The Comprehensive Adolescent Pregnancy Prevention program provides evidence-based programs to youth to reduce the adolescent pregnancy rate and the rate of unintended pregnancy by practicing health promotion and risk-reduction behaviors and ensuring access to confidential reproductive health care and family planning services for adolescents.

 

The Personal Responsibility Education Program is similar to the Comprehensive Adolescent Pregnancy Prevention program but is fully federally funded. It supports implementation of evidence-based program models and educates youth on at least three of the following six adult preparation subjects: Healthy Relationships, Adolescent Development, Financial Literacy, Parent-Child Communication, Educational and Career Success, and/or Healthy Life Skills. The Personal Responsibility Education Program also promotes activities to ensure youth access to comprehensive reproductive health care and family planning services.

 

Programs provide and arrange referrals for services identified as appropriate and outreach and education to youth and parents is reported biannually by programs. Department of Health staff review biannual reports, provide feedback and follow-up as needed. Programs use social media to promote programming, access to services, and education and programs collaborate with community partners to promote education and access to services.  Many Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program providers promote their resources on social media platforms popular with youth, such as Instagram, Snapchat, and occasionally TikTok and Facebook. For example, Community Healthcare Network’s Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program used an innovative youth-as-partners model to involve peer educators in the creation of five social media campaigns and PSAs every year on their Instagram and Facebook pages. They can provide educational content featuring authentic youth voice and connect youth to Community Healthcare Network’s programming and sexual health services via these platforms.

 

A new Request for Applications was issued for the Comprehensive Adolescent Pregnancy Prevention program in 2022, with an enhanced focus on health equity. The Request for Application required applicants to “[a]pply a health equity lens to activities to address social determinants of health and reduce disparities that impact adolescents’ health and well-being.” The programs work to increase the percent of youth-serving programs that engage youth, particularly youth representative of populations impacted by health disparities, (including racial and social injustice) in program planning and implementation. The Comprehensive Adolescent Pregnancy Prevention Program Request for Application asked applicants how they had engaged youth in the design of this aspect of the program and how they would continue to increase youth voice.

 

AH-1.2: Through the Sexual Risk Avoidance Education program, provide medically accurate and complete sexuality health education services to youth.

 

The Sexual Risk Avoidance Education program focuses efforts on youth ages 10-13 living in resource poor communities, and, like the Personal Responsibility Education Program, is also federally funded. The Sexual Risk Avoidance Education program has three components. The first provides sexual risk avoidance education with an evidence-based approach based on adolescent learning and developmental theories for the age group receiving the education. The education includes medically accurate and complete information and normalizes the optimal health behavior of avoiding sexual activity. The second component focuses on adult-supervised activities with the youth. These activities stimulate cognitive, social, physical and/or emotion growth and provide a context for building positive relationships.

 

Programs report on attendance, reach and dosage of the curriculum implemented biannually. The third component is evaluation. Programs also conduct entry and exit surveys with each cycle implemented. Department of Health staff review biannual program reports, provide feedback to programs, and follow up with programs as needed.

 

Evidence-based programming was completed for 391 youth during this reporting period for the Sexual Risk Avoidance Education programs.

 

AH-1.3: Through the Comprehensive Adolescent Pregnancy Prevention program, Personal Responsibility Education Program, and Sexual Risk Avoidance Education program, increase access to health care services for adolescents through a referral process that includes confirmation as permitted while ensuring confidentiality.

 

The Comprehensive Adolescent Pregnancy Prevention program, Personal Responsibility Education Program, and Sexual Risk Avoidance Education program increase access to health care services by directly referring youth internally within their organization or through a Memorandum of Understanding with clinical providers and other providers. The Comprehensive Adolescent Pregnancy Prevention program, Personal Responsibility Education Program, and Sexual Risk Avoidance Education program report biannually the number of adolescents referred for comprehensive health care services. A total of 342 comprehensive health care services were made in 2022, of which 92 referrals were from reproductive health services. Programs ensure confidentiality through continuous staff trainings and by providing education to the public, communities, and community-based organizations (CBOs). Outreach and education efforts, including community events, presentations, and social media posts.  are reported biannually. Department of Health staff review biannual reports, provide feedback to programs and follow-up as needed.

 

AH-1.4: Division of Family Health staff and community youth-serving organizations provide trauma-informed education and training on social emotional wellness and positive youth development for children and adolescents.  

 

All adolescent health programs provide programming using positive youth development and a trauma-informed approach. On-going trainings to providers on trauma-informed approach and social-emotional wellness are provided to program providers through ACT for Youth Center for Community Action. ACT for Youth Center for Community Action hosted webinars on positive youth development and trauma-informed care, including: Puberty!; Mindfulness-Based Programs for Stress and Health; Using a Trauma-Informed Approach, Positive Youth Development. ACT for Youth Center for Community Action also provided in person training at two locations on Positive Youth Development. Department of Health staff review biannual reports, provide feedback, and follow-up as needed.

 

In July 2022, the Bureau of Women, Infants and Adolescent Health, which was renamed to the Bureau of Perinatal, Reproductive, and Sexual Health, held a three-day virtual Provider Meeting. The main theme of the conference was Building on Community Strengths for Health and Justice. Keynote speakers included Dr. Rachel Hardemen, PhD, MPH, on Centering Antiracism to Achieve Reproductive Justice; Dr. Kenneth Ginsberg, MD, MSEd on Integrating Self-Care with Our Real Lives; and several providers and community advocates from Central New York on Building Trust and Community Engagement. Conference sessions focused on centering community voices and creating action; building capacity for diversity, equity, inclusion, and justice; and building organizational strengths.  All adolescent health programs were required to have staff attend. Presentations were recorded and were posted on the ACT for Youth Center for Community Action website.

 

The 2022 Comprehensive Adolescent Pregnancy Prevention Program Request for Application included an enhanced focus on social-emotional wellness. The goal of the program is to increase percentage of adolescents who live in supportive and cohesive communities, implement multi-dimensional educational, vocational, economic, and recreational opportunities for youth on multiple health and developmental related topics that introduce them to new situations, ideas and people, and challenge them to build or learn skills.

 

 

AH-1.5: Within the Title V program, enhance collaboration between adolescent serving programs, including the Comprehensive Adolescent Pregnancy Prevention program, the Sexual Risk Avoidance Education program, School Based Health Centers, and Children and Youth with Special Health Care Needs programs, to promote holistic adolescent health through provision of comprehensive physical exams and anticipatory guidance, including BMI, behavioral health, oral health, and reproductive health, for adolescents with and without special health care needs.

 

Title V staff working in the Children and Youth with Special Health Care Needs, Child Health and Adolescent Health exchanged resources about their programs as well as training and webinar opportunities for adolescent health topics.

 

Division of Family Health staff in the Adolescent Health and Children and Youth with Special Health Care Needs domains collaborated on a roundtable discussion for the 2022 the Bureau of Women, Infants and Adolescent Health held a Conference at which all of the programs overseen by the Bureau attended. Members of both the Adolescent Health and Children and Youth with Special Health Care Needs domains, along with Adolescent Health providers, presented “Beginning a Discussion: Delivering Sexual Health Education Programming to Youth with Special Needs.” The panel examined existing resources for youth with special needs, discussed why sexual health programming is important for this population, and shared lessons learned in delivering an evidence-based sexual health program to for youth on the autism spectrum.

Staff in the Adolescent Health domain forwarded resource information and webinar opportunities to other Title V staff when appropriate, including presentations by our federal grantors: Teaching Students with Intellectual or Developmental Disabilities (I/DD) about Sexuality and Healthy Relationships; Misinformation and Public Health - Implications, Innovative Practices for Providing Sexual Health Education and Services in Schools; and Training for Parents, Caregivers, and Families on the Mental Health of Children.

 

AH-1.6: Collaborate with internal and external stakeholders, including AIDS Institute, Bureau of Immunization, and the NYS Human Papilloma Virus (HPV) Coalition to promote HPV vaccination with clinical providers. 

 

Title V staff met with representatives of the AIDS Institute, the Bureau of Immunization, and the NYS HPV Coalition, including sharing resources and contacts among organizations. Staff supporting the Adolescent Health domain attend quarterly HPV Coalition meetings and receive informational updates. HPV vaccination information resources were also disseminated to adolescent health program providers and ACT for Youth Center for Community Action. Participation in NYS HPV Coalition and contact with other organizations is ongoing.

 

Title V staff attended quarterly NYS HPV Coalition meetings during this reporting period and emailed HPV information to adolescent-serving providers.

 

AH-1.7: Refer adolescent parents to family planning providers for contraception and birth planning, including School Based Health Centers, where available. 

 

All the Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program are required to provide access to family planning. Programs that are not located in health facilities that are regulated by NYSDOH under Article 28 of NYS Public Health Law are required to have an on-going Memorandum of Understanding with an Article-28 regulated facility to provide these services to youth. At a minimum, on a biannual basis, staff discusses with each provider their interaction and relationship with their designated family planning providers and School Based Health Centers if applicable.

 

AH-1.8: Promote access to confidential reproductive health care services and preventive medical visits for adolescents, including through School Based Health Centers, where available. Family planning providers provide counseling and services related to contraception, promotion of healthy relationships, preventive medical care, and preconception/interconception health.

 

The Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program that are not at Article-28 regulated facilities are required to have an Memorandum of Understanding in place with a family planning program to provide these services. A list of the Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program located in schools with School Based Health Centers was developed and shared with Title V staff.

 

As noted by Child Health domain staff, many School Based Health Center medical programs closed when schools closed due to COVID-19 in March 2020. However, they have reopened during this reporting period. 

 

AH-1.9: Promote healthy relationships and sexual violence prevention using policy change, protective environment strengthening, healthy social norms reinforcement, and skill-building to address individual, relationship, community, and societal risk and protective factors. Focus on groups experiencing disproportionate burden of sexual violence, including communities of color, adolescents and young adults, domestic violence victims, those experiencing low income, people affected by alcohol and drug abuse, and LGBTQ+ persons.

 

Through use of the Adolescent Sexual Health Needs Index (ASHNI), adolescent-serving programs identify priority populations – youth lacking social and economic opportunities that can enable them to develop to their full potential.

 

The Comprehensive Adolescent Pregnancy Prevention program, Personal Responsibility Education Program, and Sexual Risk Avoidance Education program incorporate healthy relationship education and skills building.  The Comprehensive Adolescent Pregnancy Prevention program programs must include youth-led, multi-dimensional (educational, social, vocational, economic, and recreational) opportunities for adolescents to provide alternatives to sexual activity and to develop skills that can support a successful transition into healthy young adults. The Personal Responsibility Education Program requires each provider to teach at least three Adulthood Preparation Subjects such as healthy relationships, including positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage, and family interactions;  adolescent development, such as the development of healthy attitudes and values; educational and career success, such as developing skills for employment preparation; and healthy life skills, such as goal-setting, decision making, negotiation, communication, interpersonal skills, and stress management. The Sexual Risk Avoidance Education program must teach youth the benefits associated with personal responsibility, self-regulation, goal setting, healthy decision-making, healthy relationships, avoiding poverty, resisting sexual coercion and dating violence, and other youth risk behaviors, such as drug and alcohol usage.

 

Adolescent Health program providers make referrals as needed for physical, social, emotional, educational, and developmental support or services, including mental health, social-emotional wellness, substance abuse counseling, interpersonal violence prevention, nutrition (e.g., food pantry), and employment services. Referrals are noted in biannual reports submitted to the Department of Health by all program providers.

 

Some providers prioritize engaging LGBTQ+ populations in their catchment area, offering educational opportunities and support resources.  All Personal Responsibility Education Programs and Comprehensive Adolescent Pregnancy Prevention programs must consider the needs of LGBTQ youth and identify how their programs will be inclusive of and non-stigmatizing toward such participants as part of the application process. In addition to this standard, some programs identify LGBTQ+ youth as a priority population. For example, the Hetrick-Martin Institute is dedicated to serving LGBTQ+ youth. Their Comprehensive Adolescent Pregnancy Prevention program ensures that LGBTQ+ youth can learn about sexual health in a safe and inclusive environment and have access to LGBTQ+ supports and services through the organization's wrap-around service model. The AIDS Community Resources Comprehensive Adolescent Pregnancy Prevention program regularly provides workshops to youth and partners on LGBTQ+ health topics. They delivered a webinar, "Affirming Puberty Conversations for Transgender and Gender Diverse Youth" at the Center for Sex Education's 2022 National Sex Ed Conference. 

 

Adolescent health program providers partner with community youth-serving organizations to share resources and collaborate on community outreach efforts. For example, the State University of New York (SUNY) Downstate Personal Responsibility Education Program is part of the Brooklyn Association of Teen Educators (BATES) Network, a collaboration of 18 community partners, which has conducted an annual conference for 29 years. In addition, in the development of the Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program applications, the respondents were asked to identify community resources and which stakeholders were involved.

 

AH-1.10: Promote adolescents’ social-emotional wellness and positive developmental assets through established Title V programs.

 

All adolescent health programs incorporate a positive youth development framework, a holistic approach to adolescent health – social-emotional wellness, youth development, engaging parents and community providers, and providing resources to youth for their health care needs within their communities.

 

Title V staff continue to stress the importance of social-emotional wellness and positive youth development during regular contact with adolescent-serving providers, this includes the 2022 Bureau of Women, Infants and Adolescent Health provider meeting described above which offered several workshops on trauma-informed care, adolescent well-being, and centering youth voices.

 

As discussed in AH 1.4, ACT for Youth Center for Community Action offered educational and training opportunities to adolescent health program providers on positive youth development throughout the reporting period.

 

Strategy AH-2: Promote supports for adolescents to gain the knowledge, self-efficacy, and resources they need to prepare for and transition to adulthood.

 

For young adults, with or without special health care needs, the transition to adulthood is a crucial time in their development. Young adults may move away from their parents, transition to adult health care, become increasingly sexually active, continue their education, and/or start a career. Navigating these transitions can be difficult for youth as their independence continues to grow. Often, an increased sense of independence can lead to an increase of unhealthy risky behaviors. Title V programs will provide youth with support to help prepare for and navigate this transition.

 

The Title V Program established the following specific program and policy activities to advance this strategy over the 2021-22 reporting period:

 

AH-2.1: Ensure adolescent providers have a mechanism in place to provide adolescent-related health care service referrals to other providers of health care services, including substance abuse (e.g., alcohol, tobacco cessation), mental health issues, and intimate partner violence.

 

Adolescent health providers are required to have a mechanism in place to refer youth for services when needs are identified. Adolescent health programs have Memoranda of Understanding in place for youth referrals to partner agencies. Referrals for services are reported biannually. A total of 342 comprehensive health care services were made in 2022, of which 92 referrals were for reproductive health services. Biannual reports are reviewed by Department of Health staff, providing feedback and follow up as needed.

 

AH-2.2: Refer adolescent parents to family planning providers or School Based Health Center for contraception and birth planning.

 

All Comprehensive Adolescent Pregnancy Prevention programs and Personal Responsibility Education Programs are required to provide access to family planning. Programs that are not located in an Article-28 regulated facility are required to have an on-going Memorandum of Understanding with an Article 28 regulated facility to provide these services to youth. At a minimum, Department of Health staff will discuss with each provider biannually their interaction and relationship with their designated Family Planning Program providers and School Based Health Centers if applicable. In addition, several Comprehensive Adolescent Pregnancy Prevention programs implement an adult role model parent/parent peer education program designed to provide parents with the information and skills they need to become the primary sexuality educators of their children. This education includes information regarding family planning services. Support pregnant and birthing adolescent parents in attending prenatal, postpartum, and well-baby appointments.

 

AH-2.3: Support pregnant and birthing adolescent parents in attending prenatal, postpartum, and well-baby appointments.

 

Where available, adolescent health programs will refer pregnant and birthing adolescents to Perinatal and Infant Community Health Collaborative programs, Home Visiting programs including Nurse Family Partnership, Healthy Families NY, and Community Health Worker Programs. Adolescent health programs are aware of the supporting programs available within their catchment area.

 

AH-2.4: Promote access to confidential reproductive health care services and preventive medical visits for adolescents. Family planning providers provide counseling and services related to contraception, promotion of healthy relationships, preventive medical care, and preconception/interconception health.

 

All Comprehensive Adolescent Pregnancy Prevention programs and Personal Responsibility Education Programs are required to provide access to family planning. Programs that are not located in an Article-28 regulated facility are required to have an on-going Memorandum of Understanding with an Article-28 regulated facility to provide these services to youth. At a minimum, Department of Health staff will discuss with each provider biannually their interaction and relationship with their designated Family Planning Program providers and School Based Health Center if applicable.

 

AH-2.5: Ensure adolescent-serving programs provide training on adulthood preparation subjects, such as healthy relationships, effective communication, career and education opportunities, health care transition, and financial literacy for adolescents with and without special health care needs to prepare them for a transition into adulthood.

 

All Personal Responsibility Education Programs and several Comprehensive Adolescent Pregnancy Prevention programs include adult preparation topics, which are meant to help build youth capacity to understand their own development, form healthy relationships, and navigate adolescence successfully. ACT for Youth Center for Community Action provides training, webinars, and workgroups to programs in support of delivering adult preparation subjects. In addition to delivery of evidence-based program course curriculum, adolescent health program providers offer workshops and other events that address adult preparation topics. During this reporting period, programs have moved to more in-person delivery of programming, but some continue to offer education virtually through websites and online meeting platforms (e.g., Zoom).

 

Some Personal Responsibility Education Program providers delivered individually designed summer programs, separate from evidence-based practice courses. Specifically, programs included job training, a conference on bias and working with people from diverse backgrounds, and education on civic participation and community advocacy. 

 

Transitioning to adulthood resources available from Got Transition® were identified through collaboration with Title V CYSCHN staff. Got Transition® is a federally funded national resource center on health care transition from pediatric to adult health care providers.

 

Strategy AH-3: Apply public health surveillance and data analysis findings to improve services and systems related to children's health and health care.

 

Data-driven, evidence-based practice is essential to achieving public health goals for Maternal and Child Health. Across all Title V programs, continuous effort is needed to enhance the collection, analysis, and sharing of data to inform the planning and implementation of Maternal and Child Health programs and policy work. Sharing data with stakeholders, including providers and community members, is critical to raise awareness, empower community action, and facilitate quality improvement efforts at all levels. 

 

The combination of public survey data gleaned from sources such as the National Survey of Children’s Health and the Youth Risk Behavior Surveillance System with data from the AHSNI, vital Statistics and other data systems provide information to identify areas throughout the state with the most pressing health needs for youth.

 

The Title V Program established the following specific program and policy activities to advance this strategy over the 2021-22 year:

 

AH-3.1: Collaborate with the U.S. Census Bureau and the Health Resources and Services Administration to conduct an over-sample of NYS 2021 National Survey of Children’s Health for NYS to allow for enhanced sampling of Black/African-American, Hispanic, and Children and Youth with Special Health Care Needs populations. 

 

Department of Health staff collaborated with Children and Youth with Special Health Care Needs to discuss this oversampling initiative. Implementation of this project is scheduled to begin in the Spring of 2022. The survey has been completed but data are not anticipated to be ready and available for review until the second half of 2024.

 

AH-3.2: Division staff will continue to use publicly available and internal surveillance data to identify adolescent needs and/or health behavior trends to support optimum adolescent health and development and determine funding areas for NYSDOH adolescent health procurements.

 

The Adolescent Sexual Health Needs Index (ASHNI) was updated in September 2021. The ASHNI is an indicator, calculated at the ZIP code level, to provide a single, multidimensional measure related to adolescent pregnancy and Sexually Transmitted Infections (STIs). ASHNI takes into consideration of key factors related to these outcomes, including size of the adolescent population, actual number of adolescent pregnancies and number of adolescents diagnosed with an STI, and specific of demographic and community factors (education, economic, race/ethnicity) associated with sexual health outcomes. ASHNI supports the State’s ability to prioritize public health resources to areas with the poorest health outcomes and with the least access to services with the goal of reducing disparities. The ASHNI was used for development of the new Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program procurements in 2022. Introductory information about the new ASHNI was shared with broader Title V staff and with ACT for Youth Center for Community Action to explore additional ways the ASHNI can be used throughout Title V programs.

 

AH-3.3: Through ACT for Youth Center for Community Action trainings, webinars, and web posts, provide information and education to youth-serving organizations.

 

ACT for Youth Center for Community Action provided training and informational opportunities to adolescent health program providers throughout this period. In addition to training on evidence-based programs (EBPs), webinars addressed positive youth development, trauma and trauma-Informed approaches, STI education and prevention, youth mental health, diversity and cultural differences, provider collaboration forums, civic engagement, social media, healthy relationships, and a variety of trainings on working virtually. ACT for Youth Center for Community Action hosted webinars on positive youth development and trauma-informed care, including: Puberty!; Mindfulness-Based Programs for Stress and Health; Using a Trauma-Informed Approach, Positive Youth Development.

 

ACT for Youth Center for Community Action offers monthly webinars focusing on a myriad of adolescent health-related topics. Through their website, ACT for Youth Center for Community Action maintains an on-going blog/discussion group that addresses additional focus areas regarding today’s youth. The ACT for Youth Center for Community Action website includes resources such as: Adolescent Development Toolkit: Youth Mental Health: Understanding Positive Youth Development; Adolescent Health and Development.

 

AH-3.4: Explore collaborative opportunities with Division of Chronic Disease Prevention’s Bureau of Chronic Disease Evaluation and Research to review and share information gathered through the Youth Risk Behavior Surveillance System.

 

Title V data staff attended Bureau of Chronic Disease Evaluation and Research surveillance meetings to discuss 2019 Youth Risk Behavior Surveillance System data, and staff will continue to attend future meetings.

 

Strategy AH-4: Apply a health equity lens to Title V activities to address social determinants of health and reduce disparities that impact adolescents’ health and well-being.

 

Maternal and Child Health outcomes are impacted by the social determinants of health, or the conditions in which people are born, live, work, play, learn, and age. The social determinants of health include factors like socioeconomic status, education, community environment, employment, social supports, and access to health care services. Systematic differences in the distribution of power and resources due to racism and other biases are root causes of inequities in access, availability of services, and quality of care. All ten priorities that emerged from community members' input during the Needs Assessment revolve around the social determinants of health and inequities. These factors and inequities impact the health outcomes of both individuals and entire communities. Adolescents who participated in the listening sessions and focus groups were aware of how things such as quality housing, safe communities, employment, and community services affect their health and well-being and that of their families and were aware of the inequities in the access and quality for their communities. They discussed seeing their parents struggle and wanting change for their parents and for themselves as they near adulthood. Strategies focus on involving stakeholders who represent the populations impacted by health inequities, particularly engaging and collaborating with youth, to inform program planning and implementation and policy development.

 

The Title V Program established the following specific program and policy activities to advance this strategy over the 2021-22 year: 

 

AH-4.1: Collaborate with other state agencies and youth-serving organizations on adolescent-centered priorities through the Youth Development Team. The Youth Development Teams includes representation from NYSDOH, NYS Office of Children and Family Services, the NYS Council on Children and Families, and the NYS Developmental Disabilities Planning Council in coordination with youth-led organizations.

 

Reestablishing the Youth Development Team has been delayed due to the ongoing COVID-19 pandemic.

 

AH-4.2: Ensure that NYSDOH health equity teams review materials before being widely disseminated to youth and youth-serving organizations

 

Currently the Division of Family Health’s cross-division Racial Justice and Health Equity Team reviews Request for Applications through a Health Equity lens. As a result, both the Comprehensive Adolescent Pregnancy Prevention program and Personal Responsibility Education Program Request for Applications included language that indicated NYSDOH’s dedication to improving health outcomes and advancing health equity, directly asking applicants to focus on the health and racial disparities among youth in their communities, placing an emphasis on the inequities of historically marginalized populations, such as Black, Indigenous, and People of Color and LGBTQ+ populations) and how they plan to address through our programming.  In addition, applicants were asked to account for the disproportionate numbers of youth affected by issues of systemic racism within their communities (i.e., lack of transportation, inadequate healthcare, and food deserts) and ways to collaborate with partner agencies to meet the needs of the impacted youth.  The Request for Application for Comprehensive Adolescent Pregnancy Prevention program was issued on September 30, 2022, and the Personal Responsibility Education Program Request for Application was released in early 2023. 

 

AH-4.3: Collaborate with youth through focus groups and community forums for direct input with state initiatives and special projects.

 

NYSDOH is exploring the formation of a Youth Advisory Council to provide youth from across NYS an opportunity to weigh in on NYSDOH policies and programs, including an adolescent mental health campaign for the new pediatric mental health grant, with plans for an ongoing partnership to advise Division of Family Health on other Adolescent Health topics.

 

NYSDOH will ensure that the council will be geographically and demographically diverse to ensure that youth from communities impacted by health inequities are represented. The goal is to improve equity by ensuring that youth have a voice in regard to sexual and reproductive health issues.

 

NYSDOH is developing a multimedia Mental Health Campaign to promote the availability of School Based Health Center mental health services for underserved youth while addressing the stigma associated with needing and accessing care. Materials developed will be culturally sensitive and available in English and Spanish to ensure the messaging reaches important high-need populations.

 

AH-4.4: Involve stakeholders, who represent the populations most impacted by racism and health inequities, in programmatic decisions.

 

The upcoming procurement for the Comprehensive Adolescent Pregnancy Prevention program will incorporate youth stakeholder input to identify program opportunities for social-emotional wellness. The Comprehensive Adolescent Pregnancy Prevention program providers increase the percent of youth-serving programs that engage youth, particularly youth representative of populations impacted by health disparities, (including racial and social injustice) in program planning and implementation Increase the percent of youth-serving programs that engage youth, particularly youth representative of populations impacted by health disparities, (including racial and social injustice) in program planning and implementation.

 

AH-4.5: Through NYSDOH adolescent providers, issue information on locally available resources and provide referrals specific to addressing the social determinants of health with adolescents from populations impacted by disparities.

 

In collaboration with our Perinatal Regionalization Unit the Adolescent Health Unit participated in the development of adolescent health pamphlets on pelvic exam and heavy menstrual bleeding. These health promotion initiatives will educate female adolescents on the importance of self-monitoring as it relates to vaginal health and checkups with a health care provider.

 

The Jewish Organization of Women’s Medical Association (JOWMA) created and designed a pamphlet on puberty for adolescent females of all races to inform this young and growing population on things to look for, who to talk to, and what to do during this stage of life. The Department of Health supports this organizations initiative by providing printing and translation services for pamphlet distribution.

 

All members of the Division of Family Health’s cross-division Racial Justice and Health Equity Team were assigned to COVID-19 activities during 2020 and 2021. During that time many of the members were conducting health equity activities as it relates to COVID-19. They were in involved in the contact tracing community support response, vaccine equity task force, training of the contact tracing workforce on equity and diversity, New York State Birth Equity improvement project and the Together We Can Inclusion project. During this time the Health Equity Team reviewed the Perinatal and Infant Community Health Collaboratives, and Dental Fluoridation Request for Applications to ensure a health equity lens was incorporated during development. In the beginning of this reporting period in October 2021, the Division’s Racial Justice and Health Equity Team reconvened, collectively to resume efforts within the Division and is currently re-establishing itself after staff transitioned out of the Division and NYSDOH and will be recruiting new members. With so many new staff, the Team’s first focus was training to ensure staff understand health equity, health disparities and social determinants of health. Early in 2022 several Health Equity Team members left the Division; new members joined the Team later in the reporting period.  Title V staff are currently seeking to work with the NYSDOH AIDS Institute Health Equity Coordinator to collaborate efforts and learn from one another.

 

It is important to note, the NYS Title V Program established two Evidence-Based Strategy Measures (ESMs) to track the programmatic investments and inputs designed to impact NPM 10.

 

ESM AH-1: Percent of youth-serving programs that provide training on adult preparation subjects, such as healthy relationships, effective communication, financial literacy, and adult health care for adolescents with and without special health care needs to prepare them for a transition into adulthood.

 

Data for this measure will be obtained from biannual reports and annual data requests submitted by local adolescent health providers. The baseline value for this measure, taken from a six-month program period of 7/1/2020 – 12/31/2020, is 96.3%. The program has set an improvement target of 75% by 2025. For the period of 1/1/2021 – 12/31/2021, the value of this measure was 100% (with data for 2 of 54 programs missing).

 

ESM AH-2: Percent of youth-serving programs that engage youth, particularly youth representative of populations impacted by health disparities, in program planning and implementation.

 

Data for this measure will be obtained from biannual reports and annual data requests submitted by adolescent health providers. The baseline value for this measure, taken from a six-month program period of 7/1/2020 – 12/31/2020, is 68.7%. The program has set an improvement target of 75% by 2025. For the period of 1/1/2021 – 12/31/2021, the value of this measure was 78.1% (with data for 2 of 66 programs missing).