Adolescent Health - Annual Report

Illinois’ priority for the Adolescent Health Domain is:

• Assure access to a system of care that is youth-friendly and youth-responsive to assist adolescents in learning and adopting healthy behaviors. (Priority #5)

Accessible and high-quality preventive care is essential to the health and well-being of Illinois’ adolescents. In 2019-2020, 78% of adolescents received a well care visit (NPM #10), ranking Illinois 17th out of the 50 states. Receipt of a well care visit varied by a young person’s insurance status and social group. Approximately 70% of adolescents insured by Medicaid received a well-child visit, compared to more 90% of adolescents with private insurance, demonstrating a need for improved access for families with Medicaid. Receipt of vaccinations is one of the important services received at preventive care visits. More than 90% of adolescents have received at least one dose of the TDaP vaccine (NOM #22.4) and 92% received at least one dose of the meningococcal conjugate vaccine (NOM #22.5). More than three quarters of all Illinois adolescents have received at least one dose of the HPV vaccine (NOM #22.3), and this rate has been steadily rising in recent years.

In terms of mortality, there are some successes and some concerns. Adolescent mortality rose significantly from 2019 to 2020; in 2020, there were 39 deaths per 100,000 population (NOM #16.1). Non-Hispanic Black adolescents have an overall mortality rate more than three times that of non-Hispanic White and Hispanic adolescents, a call for greater efforts on equity for adolescent safety. The mortality rate due to motor vehicle (NOM #16.2) has remained nearly steady, with troubling disparities evident by urbanicity. Adolescents in non-metro counties have a mortality rate due to motor vehicle that is nearly four times higher than the rate in large metro areas. Mental health and suicide prevention remain a top priority in the state. Several groups experience a high burden of suicide deaths in young people. Non-Hispanic Male adolescents are more than twice as likely to die by suicide than female teens, and the suicide rate among teens in rural communities is 80% higher than urban communities.

During FY21, Title V utilized the following strategies to address the Adolescent Health Domain priority:

5-A.  Facilitate the Illinois Adolescent Health Program (AHP) to increase adolescents’ access to preventive and primary care through adolescent-friendly clinics that provide comprehensive well- care visits, and address behavioral, social, and environmental determinants of health.

In FY21, Title V continued to support the Adolescent Health Program (AHP), which seeks to encourage adolescents to adopt healthy behaviors and to increase the rate of adolescent well-care visits. Activities supported through the program include provider training and education on the importance of adolescent well-visits, local implementation and expansion of adolescent‐friendly health care services, creation of youth-friendly atmospheres, digital and social media campaigns, inclusion of youth voices, and the establishment of youth advisories. Although the COVID-19 pandemic caused interruptions in the execution of the various activities, a total of 11,346 adolescents (ages 11-21) had a well-care visit or received a referral for services. 

To further highlight the activities of the program, below are some notable achievements of a select group of AHP grantees.

• Aunt Martha’s Health and Wellness: In addition to facilitating 12 youth council meetings, during FY21, a “We Care About What You Think” poster with a QR code that links the adolescent to the patient satisfaction survey was developed and disseminated to participating clinics. Registered nurses and medical assistants have been trained to prompt adolescents to take the survey. Site posters were displayed for a five-month period and surveys were submitted via QR Code and/ or paper.    
• Cook County Health and Hospital System (CCHHS): Provided four trainings to staff and providers regarding cultural humility. All adolescents seen at CCHHS were screened for food insecurities and provided vouchers for the Greater Chicago Food Depository that comes on site every month with fresh produce. CCHHS also facilitated four coalition meetings with existing and new key stakeholders from the south suburban area who service adolescents and shared resources.
• Hult Center for Healthy Living: Trained health teachers and school nurses to conduct quarterly focus groups with youth enrolled in the in-school health (ISH) to capture their insight on all aspects of adolescent health. Hult also developed and disseminated a social marketing campaign led by peer educators. This campaign was focused on increasing adolescents’ awareness of how to access clinics and the services available. Hult coordinated outreach and e-learning opportunities for youth served by ISH clinics and caregivers. Outreach included identifying and addressing mental health needs, as well transition care counseling and planning.
• Kankakee County Health Department (KCHD): Three electronic billboard designs were displayed in Kankakee County that included facts about adolescent wellness visits and information regarding importance and a call to action to complete an annual adolescent wellness visit. KCHD also distributed program toolkits that described the adolescent health programs available at the health department. Another noteworthy activity was the development of a committee focused on adolescent behavioral health. This committee had three meetings in FY21.
• Loyola University of Chicago (LUC): LUC updated clinic space to create a more adolescent friendly atmosphere. To make the space more inviting and educational, LUC included signs/posters that welcomed young people of all genders and sexual orientation, providers’ offices were refreshed, anatomical displays were placed in the exam rooms, and educational pamphlets on sexually transmitted diseases (STDs) and other adolescent-related health topics were laminated and displayed throughout the clinic. LUC outreach efforts consisted of virtual and in person presentations on various adolescent health topics, including signs dealing with suicide and nutrition. They also promoted vaccine clinics and explained the importance of the COVID-19 vaccine.
• Will County Health Department (WCHD): WCHD implemented a text messaging program that reminded adolescents and their parents that a well-care visit was due. WCHD sent messages to more than 2,400 adolescents and/or their parents. The system continued sending messages until an appointment was made. Other key activities included WCHD developing 10 Youth-Friendly Waiting Room Kits; educating approximately 100 medical providers about the benefits of creating a youth-centered environment; distributing 1,025 resources/services to families and youth serving organizations throughout Will County that address behavioral, social, and environmental determinants of health; and launching a digital media campaign that ran four ads and reached more than 4,000 people via Snapchat, Facebook, and other apps and websites frequently visited by 12–21 year-olds and their parents. The ads used the tagline #TBH: To Being Human; To Being Happy; To Being Healthy. The graphics in the ads represented different groups, such as young adolescents, teens, LGBTQ, and parents of adolescents.

5-B.  Collaborate with the Illinois Chapter of the American Academy of Pediatrics to encourage providers to adopt lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA), and adolescent-friendly services and spaces.

The Illinois Chapter of the American Academy of Pediatrics (ICAAP) serves as a key partner to Title V in developing and delivering educational training to health professionals. In FY21, ICAAP developed three new webinar trainings specific to adolescent health and available for ICAAP members and AHP grantees:

• Addressing Health Inequities in Adolescent Care
• Adolescents and Mental Health 
• The Social Emotional Aspect of Adolescent Health

These trainings may be found on ICAAP’s website.

As an AHP grantee itself, ICAAP also organized and led the Adolescent Health Program’s Learning Collaborative. During the collaborative learning meetings, ICAAP shared the educational tools it developed regarding adolescent well-visits. They also identified resources from Bright Futures and other adolescent resources for adolescent health that would be helpful to the participants in the learning collaborative.

In FY21, ICAAP also secured an expert consultant to begin research and development of the Adolescent Health Education Curriculum. This curriculum is a two-part toolkit comprised of a component for pediatric providers and another component for parents/caregivers and youth. The pediatric provider curriculum will feature topics that focus on the concrete needs of adolescents, such as behavioral health, substance use, nutrition, pandemic challenges, and best practices for how to serve them. It will provide both general and specific resources for providers that they can choose from based on the needs of their population. The parents/caregivers and youth curriculum will focus on utilizing effective tools to improve adolescent engagement in their health care needs. This component will include how to identify credible sources for health information, importance of confidentiality, and health education on other health related issues.

5-C.  Participate on and collaborate with the statewide Adolescent Suicide Prevention Ad Hoc Committee to develop a strategic plan to reduce suicide ideation and behavior among youth.

Title V collaborated with the IDPH Violence and Injury Prevention Section (VIPS). VIPS and Title V staff participated in bi-monthly meetings to (1) share updates on adolescent suicide data efforts, (2) provide guidance to stakeholders on how to explain the burden, (3) ensure that they used common language and shared messages when discussing adolescent suicide prevention and implementing programs, and (4) coordinate projects and reduce the risk of duplicating efforts. VIPS staff shared updates on collecting data for the State Injury Indicators Report, data book, and youth data book. Title V staff provided updates around the development of a suicide-related data report and efforts to look at trend data. In FY21, Title V Continued to support a graduate internship position in VIPS to assist with the planning and implementation of adolescent suicide prevention strategies.

Title V also participates on the Adolescent Suicide Ad Hoc Committee, which is administratively supported by VIPS. The committee leverages members’ expertise to develop a strategic plan that focused on increasing awareness, knowledge, and competency in suicide prevention, assessment, and treatment for first responders, health care workers, social service workers, clergy, law enforcement, and school personnel. The committee also promotes the utilization of suicide prevention services for victims of harassment and violence, and advocates for a comprehensive continuum of care for those at highest risk for suicide. The plan also focuses on improving suicide-related data collection and developing sustainable funding sources for the implementation of suicide prevention interventions and crisis response/aftercare programs.

During FY21, the committee was restructured to establish subcommittees, which allowed the work to be divided. Co-chairs were identified for each subcommittee. With the new structure in place, the subcommittees did the following:

• Assessed current suicide prevention mandates and developed recommendations for enhancements. The assessment included distributing a survey to schools to gather insight about the implementation of school’s suicide prevention related-mandates, existence of other suicide prevention efforts in the schools and communities, impact of COVID-19 on the mental health of students, and identification of opportunities for technical assistance to support schools.
• Drafted a flyer to inform parents about adolescent suicide and reduce the common misconception parents have that suicide could not pertain to their child. The flyer included statistics and discussed signs to look for, how to react, and where to go for more resources and information.
• Developed a toolkit on suicide prevention and awareness to be used by schools during Suicide Prevention Month (September) and throughout the school year.
• Created social media messages that can be tailored to various communities and multiple demographics across Illinois. The messages acknowledge that suicide affects more than just adolescents and teens.
• Released a proclamation for Suicide Prevention Month.
• Created a Suicide Prevention and Awareness Guidelines Webpage that provides an overview of suicide prevention efforts and identifies available resources.
• Reviewed present and past data of multiple surveys such as the Illinois Youth Survey, Youth Risk Behavior Survey, the 5 Essentials Survey, and others to determine any trends, problem areas, or areas that lack data. The subcommittee also reviewed findings from the survey to schools to gain insight into their challenges to link students to services. This information will help to determine the next steps of the subcommittee and provide areas of focus to better the screening and linking process throughout the state.

5-D.  Identify gaps in mental health programs and resources for Illinois children, develop partnerships with and within organizations focused on improving mental health among children and adolescents, and support the implementation of mental wellness programs that facilitate system level improvements as well as address social determinants of health.

See Child Health Domain strategy 4-D narrative for details.

5-E.  Certify and support school-based and school-linked health centers to expand access to primary health care, mental health, and oral health services for children and adolescents.

See Child Health Domain strategy 4-E narrative for details.

5-F.  Collaborate with organizations and programs to address the impact of adverse childhood experiences (ACE) and toxic stress on mental and physical health in children and adolescents.

See Child Health Domain strategy 4-F narrative for details.

5-G.  Support the implementation of the Chicago Healthy Adolescents and Teens (CHAT) program to improve sexual health education, sexually transmitted infections (STIs) screening, and linkage to health care services.

During FY21, CDPH facilitated youth-friendly linkages for sexual health care, including testing and contraception via the CHAT Program. Though onsite STI testing was unavailable during the reporting period, CHAT staff provided sexual health education and referrals, and health centers prioritized STI testing and other services for adolescents. CDPH supported the passage of revisions to the CPS Sexual Health Education Policy, including a provision mandating all schools serving grades 5-12 maintain a condom availability program that was approved in December 2020 by the CPS Board of Education. A working group was formed with CPS and CDPH staff, CDC assignees, and interns to plan for launch of universal condom availability in school year 2021-2022. The workgroup developed materials for school staff for fall 2022 (pre-recorded webinar to be accessible on the CPS Learning Hub portal and standalone support kit with guidance and resources). Schools that fall under this policy received condoms and support materials.

Other noteworthy activities

CDPH engaged in other activities that support Title V’s adolescent health priority. These activities included CDPH developing messaging for parents around vaccine information for flu, HPV, and COVID-19; serving on the School Health Access Collaborative convened by the Public Health Institute of Metropolitan Chicago (PHIMC) and Healthy Schools Campaign; participating in CPS-hosted committees, which included the Sexual Health Advisory Committee, and the Materials Review Committee; and collaborating with CPS to develop plans for safely re-engaging schools to provide health services.