MCH works closely with the LHDs, community agencies, and the KY Department of Education on many adolescent health endeavors. These include education and outreach for many adolescent health topics, including pregnancy prevention, obesity, mental health, behavioral health and preventive services, and personal safety and responsibility.

 

Primary and Preventive Services

 

LHDs with primary clinical services continue to provide care to the adolescent population as available. With LHD transformation, many LHDs with limited clinical services, continue to provide education and outreach via health fairs, social media or written media and prevention campaigns for sexually transmitted infections, family planning, or promotion of preventive exams and immunizations. As needs are identified, LHDs provide primary resource and establishment with a medical home. In KY, many adolescents are less likely to obtain annual preventive health care unless they are actively involved in sports activities that require eligibility physical exams.

 

Immunizations are among the primary and preventive services accessed by youth at LHDs. The KY Immunization Program distributes vaccines to LHDs, and private providers enrolled in the federal Vaccines for Children Program. The KY immunization program follows the Advisory Committee on Immunizations Practices (ACIP) recommendations to include the Human Papilloma Virus (HPV) series beginning at age 9 and for 6th grade entry into school: Tetantus, Diptheria, and Acelullar Pertussis (Tdap), Meningococcal, Influenza and COVID-19. During 2020, at beginning of the pandemic, administration of routine vaccines for adolescents was markedly less than pre-pandemic trends. In 2022, this rate improved dramatically. For the past two years, individual vaccine counts appear to have returned to pre-pandemic levels.

 

 

 

 

Source: Kentucky Department of Public Health, Division of Epidemiology and Health Planning, 2023

 

Obesity

 

Adolescent obesity is a priority for the adolescent health population domain identified from the 2015 Needs Assessment and continues to this day. To address this need, KY has chosen NPM # 8: Percent of children ages 6-11 and adolescents ages 12-17 who are physically active at least 60 minutes per day. According to the State Obesity Report from the Robert Wood Johnson Foundation, in 2021, KY has the highest prevalence for pediatric and adolescent obesity in the United States. Approximately 23.8% of KY children ages 10-17 years of age are considered overweight or obese according to BMI-for-age standards. Half of KY’s children in poor families are overweight or obese.

 

Data from the 2021 KY Youth Risk Behavioral Surveillance System (YRBSS) has continued reporting youth activity level is below the national average. Physical activity continues to be a focus for all programs with less than half of high school students reporting exercise for greater than 60 minutes, 5 days per week.

 

The percentage of high school students who are obese increased from 18.4% in 2019 to 19.6% in 2021. 16.2% were considered overweight. (KY YRBSS). When the data was reviewed by gender, high school males were more likely to be obese than female high school students. 26.5 % of males ages 16 to 17 years, versus 14.1% of females of the same age are considered obese. Furthermore, the 2021 data also has shown that male students in grades 11 and 12 were more likely to be obese than grades 9 and 10, while females in the 9th grade were more likely to be obese than all other grade levels. Among all high school ages, Black high school students were more likely to be obese at 20.1%.

 

To reach all populations, KY must address obesity concerns from all levels. Strategies must begin at birth with breastfeeding promotion. Early childhood should lay the framework to establish healthy behaviors related to nutrition and activity. For the school age and adolescent population, the WSCC model provides a wrap-a-round framework to continue encouraging this population to make healthy choices.

 

With the MCH Evidence Informed Strategy focusing on increasing physical activity and creating an overall healthier climate in school and community settings, local health departments have succeeded in providing outreach and supplemental health education to students in their local school districts. As previously mentioned in the Child Health Annual Report, LHDs that participated in Healthy People, Active Communities are also working to promote full community engagement with activity and nutrition.

 

MCH’s evidence informed strategy, Healthy People Active Communities Package, promotes healthy eating and physical activity safely and easily accessible. The strategy supports policies that make environmental changes that are sustainable within communities and schools. In addition, this package serves to increase community partnerships with various local organizations and community members. Together the LHD, community organizations, and community members will define the issues, address the barriers to meeting the evidence-based healthy behaviors, and engage possible solutions. In 2022, LHDs (23) reached 528,309 community members including 216,989 children, approximately 5% of whom were those with special health care needs. Some of this work involved stakeholders addressing safety in crosswalks for walking paths in urban areas, development of walking paths in the community, implementation of health education in the school system, development of farm to table initiatives, and cooking classes.

 

To increase access to physical activity, LHDs collaborated with several communities that have a pedestrian plan. A Community Physical Activity Committee has representation from the Federal Highway Administration, Foundation for a Healthy KY, KY Association for Economic Development, KDPH, KDE, KY Office of Adventure Tourism, KIPRC, KSPAN, KY Office of the Americans with Disabilities Act, KY Rails to Trails Council, KY State Parks, KY Transportation Cabinet, KY Youth Advocates, National Park Service, and UK Cooperative Extension. The committee and local stakeholders identified assets, needs, and barriers through interviews and surveys of stakeholders and community members.

 

The KDPH State Physical Activity and Nutrition (SPAN) branch and their state partners provide the training and technical assistance on access to healthy foods and physical activity, as well as resources, including community engagement, Early Care, and education.

 

Local health departments’ programs have demonstrated continued success in 2021 despite the uncertainty and lasting effects of COVID-19. Their work and partnerships supported providing access to healthy foods through Farmers Market vouchers, walking trail and exercise promotion, promotion of Diabetes Prevention Program, and outdoor literacy programs for children. Although majority of health department personnel were overwhelmed with COVID-19 response, they continued providing support to communities using the virtual platform, community care packages, grab and go educational activity bags, and by increased use of social media. These practices and resources continued throughout 2022, having proven value to prevention, promotion, and protection strategies in all the MCH packages.

 

Coordinated School Health (CSH)

 

One program that has been significantly involved with physical activity strategies in KY is the CSH program headed by the KY Healthy Schools Team (HST). This program is an effort funded by the CDC’s 1801 Improving Student Health and Academic Achievement through nutrition, physical activity, and the management of chronic conditions in schools. The program has supported this work through a five-year funding cycle ending in June 2023. As the current funding comes to an end, the newly established School Health Program along with many other staff members of MCH and other public health disciplines will continue the great work around school health. The School Health Program is using the WSCC model as the foundation for the work that will continue to focus on the student and emphasizes the collaboration between schools, communities, public health, and health care sectors to align resources in support of the whole child. The education, public health and school health sectors have each called for greater alignment that includes integration and collaboration between education leaders and heath sectors to improve each child’s cognitive, physical, social and emotional development. Public health and education serve the same children, often in the same setting. The Whole School, Whole Community, Whole Child (WSCC) model focuses on the child to align the common goals of both sectors to put into action a whole child approach to education.

 

School Health’s Whole School, Whole Community, Whole Child Crosswalk- 5 Tenets (WSCC):

 

• Ensure programmatic infrastructure to support the implementation and operation of the K-12 school health program across the state.
• Support quality school health programs and school nursing practice, by providing consultation and technical assistance to Kentucky school nurses and other school staff to ensure that student wellness and health needs are supported for optimal educational access.
• Collaboration with a variety of multidisciplinary specialists across the Department for Public Health, Kentucky Department of Education and community partners, and as the consultant team in support of all stakeholders in the health and education of children and youth.
• Collaborate with school systems on public health activities.
• Provide consultation and TA to KY School staff to ensure that student wellness and health needs are addressed for optimal education achievement.

• Enhance school health emergency preparedness capabilities by supporting preparedness planning and response.

     

The WSCC model includes the following ten components:

 

1. Health education
2. Physical education/physical activity
3. Nutrition environment and services
4. Health services
5. Counseling/psychological and social services
6. Social and emotional climate
7. Physical environment
8. Employee wellness
9. Family engagement
10. Community involvement

 

The goal of using this model as the foundation of program development is to address the whole child through integration of preventive best practices to ensure a successful health and academic journey. KDE and KDPH continue collaborate to provide guidance to school districts, and community partners to incorporate opportunities for students to create a healthier environment in which to live, play, and learn.

 

Additionally, the School Health Program staff will continue to work closely with KDE’s coordinator for Comprehensive School Counseling and the Department for Behavioral Health Disorders and Intellectual Disabilities (BHDID). Both entities participate on the KBE School Health Subcommittee also known as the WSCC committee. For KY school districts, addressing student mental health is a great concern as they familiarize themselves with the importance of addressing adverse childhood experiences (ACEs) and the long-term effect of exposure to trauma. MCH continues to make great strides when working with schools to reinforce the importance of trauma informed care in classrooms and trainings. The increased focus on adolescent mental health has been on mental health issues or concerns of most adolescents from social isolation during the pandemic. The School Health Program’s expansion into mental health focuses on the changing needs of adolescents to include addressing specific mental health needs, developing training and interventions, increasing mental health awareness, decreasing mental health stigma, and consulting with key partners and professionals for further enhancement and collaboration.

 

Youth Thrive

 

In FY21, the Adolescent Health program was reorganized from the Division of Women’s Health (DWH) to MCH. In FY22, this program collaborated with the Department for Behavioral Health, Developmental, and Intellectual Disabilities (DBHDID); and many other state and community agencies to promote Youth Thrive. Family Thrive, consisting of two components, Strengthening Families and Youth Thrive, is a framework that can be used in any setting or program to achieve positive outcomes by mitigating risk and enhancing healthy development and well-being of children and youth. In areas of KY in which Youth Thrive was strongly established some content and work continued despite multiple barriers for live meetings with youth. This work was severely limited by COVID restrictions for the past two years, and the LHD or community agency staff’s ability to reach adolescents. Additionally, the adolescent health program had ongoing staffing vacancies and attrition of state supporting staff.

 

The vision of KY Youth Thrive is to increase the likelihood that all youth are supported in ways that advance healthy development and well-being, as well as reduce the impact of negative life experiences. This is done by promoting five protective factors through all adolescent programs.

 

• Youth Resilience: Youth bounce back when life gives them challenges.
• Social Connection: Youth have genuine healthy and supportive connections with others.
• Knowledge of Adolescent Development: Youth understand the science of their development.
• Concrete Support in Times of Need: Youth find resources and support in their community that helps them.
• Cognitive and Social-Emotional Competence: Youth know how to communicate their thoughts and feelings effectively.

 

Suicide

 

In KY, suicide is the second leading cause of injury-related death among those 10-24 years of age. According to the CDC and KY Vital Statistics, in 2021, the number of suicides increased slightly to 25 from 23 being reported in 2020. However, in previous years, KY had experienced a steady decline in suicides with no particular pattern to geographical distribution of child suicide deaths. Most suicide deaths are in teenagers who are 14 years old or older. However, in recent years, KY has experienced some child suicides as young as age 9. Additionally, according to the 2021 KY YBRSS, 19.1% of adolescents have seriously considered attempting suicide, 15% have made a plan about how they would attempt suicide, and 9.5% actually attempted suicide.

 

 

The KY Incentives for Prevention (KIP) Survey resumed in 2021. The KIP survey is normally conducted bi-annually but had been delayed for two years due to COVID-19 and has changed from the original intent of determining use of alcohol, tobacco, and other drugs to surveying students about handguns, bullying, dating violence, suicide, and mental health. The following data is the most current from the 2021 KIP survey tabular results. (Note: the following tables are excerpts from entire KIP survey questionnaire. Q22, Q23, etc. refer to the survey question number, which may have subsequent parts).

 

While KY youth report bullying and cyberbullying has slightly declined, rates remain higher than national rates. Suicidal ideation and reported suicide attempts have been increasing for the last decade in all grades. There has been significant increase among 6th grade respondents reporting they have seriously considered attempting suicide in recent years.

 

 

Prior to the pandemic, MCH and DBHDID began collaborative efforts using the Sources of Strength program curriculum as an integrative piece of outreach and prevention supported at the local level. Training programs across the state have been conducted with local school districts to promote peer-led youth resiliency programs. Sources of Strength continued virtually during the pandemic and technical assistance and training was available from their home office. This program has also extended their reach to elementary students. Traditionally the program has offered services only at the middle school and high school levels.

 

The KY Violence and Injury Prevention Program (KVIPP) has been a trusted resource for education and awareness of self-harm and injury of KY’s adolescent population. The current State Injury and Violence Prevention Plan is being updated with a strategy specific to suicide and self-harm prevention.

 

The work in the Child Safety Learning Collaborative (CSLC), since 2020, has focused on suicide and self-harm prevention. This work also included seven other states. This work in addition to the Child Fatality Review (CFR) program has established a closer working partnership with BHDID’s state suicide prevention coordinator. This coordinator assists our CSLC with expertise in suicide prevention and trends and is also currently participating in a Suicide Prevention State Infrastructure Community of Practice (CoP). Participating states in the CoP are working toward the following goals: gain a deeper understanding of SPRC’s state suicide prevention recommendations, identify KY’s infrastructure strengths and needs, and engage the state’s team in activities to advance specific elements of the state’s infrastructure.

 

As part of the CSLC, data was evaluated for self-harm and suicide. MCH, KY Injury Prevention and Research Center (KIPRC), BHDID, and the university forensic pediatricians meet with other CHFS programs to review data sets for both children and young adults to determine potential trends and patterns that could lead to stronger prevention measures. The data is varied geographically across the state with trends. The suicide coordinator in BHDID, also has been instrumentally in helping MCH to design surveys to understand the type of practice available statewide for adolescent mental health and the comfort level of providers in screening for suicide and development of interventions beyond resource and referral. 

 

The CSLC reviewed multiple resources of screening and plans for evaluation of health and behavioral health systems. From this review, the KY CSLC opted to utilize the Zero Suicide framework. This model allows a health or behavioral health system to assess their organization structure, protocols, and policies related to suicide screening and care and transform and fill any gaps found. Building upon a culture of support for providers and systems, the Zero Suicide framework created a toolkit embracing core values that suicide can be eliminated by improving service access and quality, sets aggressive goals to eliminate suicide attempts, organized service delivery, and adopts evident based clinical practices throughout the health care system of care. Continuing work is ongoing in a pilot project with Hopkins County. From this pilot, MCH anticipates 4 trainings to be developed with two live courses, Question, Persuade, Refer (QPR), and 2 webinar-based trainings.

 

Suicide and Self-Harm Injuries varied widely between male and females, among all age groups.

 

Suicide and Self-Harm Injury by Age and Sex, 2021

Source: KIPRC 2021 KY Injury Indicators Report

 

Suicide and Self-Harm injury-related emergency room visits varied by age group and sex, with half of the visits occurring among 10-14 and 15-19-year-old (female) age groups.

 

Suicide and Self-Harm Injury by Age and Sex, 2021

Source: KIPRC 2021 KY Injury Indicators Report

 

Particularly of interest is the comparison by gender for self-harm and suicide deaths, with females being more likely to have self-harm injury-related emergency department visits (and hospitalizations), and males being more likely to die from suicide.

 

Drug poisonings remain the greatest cause of self-harm and injury-related emergency department visits among female adolescents FY22.

 

Drug Poisoning by Age and Sex, 2021

Source: KIPRC 2021 KY Injury Indicators Report

 

The Bullying and Suicide Prevention package provides opportunity for collaboration with school districts and communities to share resources and support for mental health wellness. With this package, programs such as WEDCO Health District’s Beautiful Minds Project, in collaboration with University of KY Adolescent Health, Sources of Strength were provided to two central KY school districts. Beautiful Minds supports on-site mental health screenings and, when possible, counseling on-site. In addition, Lake Cumberland Health District has initiated several projects around the Child Safety package aimed at preventing suicide.

 

The long-term impact of COVID-19 on adolescent mental health, self-harm, and suicide is still yet to be seen. With both the KIP and YRBSS now resumed, this should give a better indication of the effect, that past two years has had on the adolescent population in KY. 

 

Teen Driving

 

MCH addresses teen driver deaths through collaborative efforts with KIPRC. LHDs had the opportunity to implement strategies through a Teen Driving CFR Package.

 

According to the KY Office of Highway Safety, there were 57 teenage fatalities out of the total of the 806 fatalities in 2021, there were 744 total fatalities in 2022. While 2022 teenage fatality data is still being released, reports in recent years indicate that KY leads the US in teenage driver fatalities. Unfortunately, crashes involving young drivers aren’t just a problem in Kentucky. Nationally, automobile accidents involving teen drivers and teenage automobile fatalities have on the rise.

 

As part of KY’s child fatality and injury prevention program(s), many health departments completed child passenger safety plans including car seat checks, the Checkpoints™ program, and the graduated licensure program. LHDs have been innovative in creating distracted driver videos, working with local high schools to provide education, and working with local police and first responders.

 

The KY Violence and Injury Prevention Program (KVIPP), supported by CDC Cooperative Agreement Number U17 CE924846, collaborates with the KY Office of Highway Safety (KOHS), Traffic Safety Education Foundation, KIPRC, KY Safety Prevention Alignment Network (KSPAN), and KDPH to address teen motor vehicle safety education. The Checkpoints™ program is an evidence-based, parent-oriented teen driving intervention, originally developed by Dr. Bruce Simons-Morton of the National Institute of Child Health and Human Development, an agency of the US Department of Health and Human Services, is being implemented statewide in KY. The program continues to be updated and revised, including new video clips provided by the Traffic Safety Education Foundation to emphasize key points in the training. KY Checkpoints™ educational materials are designed to reflect KY’s Graduate Driver Licensing program requirements and to include current KY injury data.

 

The Checkpoints™ program provides parents and teens with information about:

 

• Risks teens face when first licensed (e.g., facts and myths about teen driving safety).
• KY’s Graduated Driver Licensing requirements.
• Ways to improve the safety of the teen driver.
• Ways to effectively communicate with teens about safe driving (video content).
• How to set Interactive Parent-Teen Driving Agreements that are customizable to the respective parent and teen, establishing clear guidelines, expectations, and consequences for their teens’ early driving and adaption as the teen progresses.

 

Checkpoints™ continued in FY22, with an implementation goal of 20 counties with 35 high schools. The COVID-19 pandemic impacted implementation as priorities for schools shifted to virus protection and safety. In 2020, changes and updates were made to Checkpoints to allow for virtual training of Checkpoints. The use of Redcap (online assessment tool) was a definite advantage for use in the updated Checkpoints protocol for online training delivery. Redcap enabled participants to use their smart phones, tablets, and computers to complete the pre and post-tests as well as the course evaluation sheets.

 

In addition, KVIPP is providing training and curriculum across the state to law enforcement officers on traffic safety checkpoints (traffic stops). The relevant components of the training to adolescent health are educating officers on the identification of impaired driving, human trafficking, improper restraint use (passenger safety), and any other obvious violations.

 

When reviewing areas of teen driver collisions, it was anticipated the higher population density would be a factor. KVIPP also prepared a heat map of KY roadways to determine if any specific roadways or type of roadway had higher rates. Population density and travel (particularly in Central KY, between urban Lexington and Louisville) showed higher rates of teen collisions.

 

Adolescent Health/Teen Pregnancy Prevention

 

The Adolescent Health (AH) program has closely collaborated with MCH leadership for ongoing program transition from DWH to MCH. This includes evaluation of current program needs related to work force capacity, community engagement, deliverables for both the Personal Responsibility Education Program (PREP) and Sexual Risk Avoidance Education (SRAE) program  The AH program has hired and is training an Adolescent Health Policy Specialist and an Adolescent Health Program Administrator which is enabling the development of policies and procedures addressing grant deliverables, program monitoring, and budget analysis for local health department funding and/or local adolescent health community-based organization funding. With additional staff the AH program is better able to connect to the Youth Thrive initiative, mental health collaborations, family planning programs, or and other coordinated school health efforts. The movement of this program to MCH allows the AH program and the MCH division to integrate the expertise and knowledge of both for a more comprehensive understanding of the beliefs and values of families and adolescents in this shared work. 

 

KDPH has been awarded the SRAE and PREP grants to educate young people on both abstinence and contraception to prevent pregnancy and sexually transmitted infections. These programs primarily target youth ages 10-19 who are homeless, in foster care, live in rural areas or in geographic areas with high teen birth rates, or come from racial or ethnic minority groups, or are involved in the Juvenile Justice system. These projects replicate effective, evidence-based program models that have been proven to teach the optimal health behavior of delaying sexual activity, increasing condom or contraceptive use for sexually active youth, reducing pregnancy and STIs among youth, and providing tools and resources to prevent engagement in other risky behaviors through holistic, trauma-informed, and positive youth development approaches. These programs are grounded in the need to help youth achieve optimal health by providing them with information and resources to help them make healthy decisions for themselves.

 

Family planning is another health service accessed by adolescents at LHDs. Services to adolescents for contraception, pregnancy, or childbirth can be accessed without parental consent per KRS 214.185. These visits may include diagnosis and treatment of sexually transmitted diseases or other conditions. The Family Planning Advisory group has met throughout 2022 and into 2023 with leaders from the AH program, Coordinated School Health, adolescent health clinicians from the University of Kentucky and local health departments, and local community adolescent health agencies or advocacy groups. This advisory group has set a goal to reduce the rate of teen pregnancies in KY and is researching methods for completion of an adolescent needs assessment to identify barriers in accessing family planning services.