Annual Report Adolescent Health

 

Connections between Title V & EPSDT[SI(1]

Vermont’s Title V is closely linked with EPSDT-funded initiatives and efforts to promote the administration of Medicaid and improve health for children and adolescents including connections with Vermont’s school health services and their school systems.

• This partnership allows the advancement of performance measures addressing access to health insurance, medical, and dental homes, and well care visits as recommend by Bright Futures.
• Certain key program elements of EPSDT in Vermont are administered within FCH and coordinate closely under interagency agreements with DCF and VT’s Medicaid agency. Services for children (families making up to 312% FPL + 5% disregard) include: ensuring all children have health insurance, education on preventive health care/age-appropriate health screening; assistance with scheduling medical/dental/health-related appointments; assistance in locating providers to establish medical and dental homes; information/ referral on health and community services, and targeted follow-up.
• FCH manages grants to the Vermont chapter of the American Academy of Pediatrics (AAPVT) and the Vermont Academy of Family Physicians (VAFP) to improve population-based health outcomes and access to preventive services for Medicaid-eligible children, youth, and their families.
• FCH’s annual grant to the Vermont Child Health Improvement Program (VCHIP) is designed to improve health outcomes for Medicaid-eligible children, youth, and their families through population-based child and youth health services research and quality improvement.
• FCH works with school personnel to promote the administration of Medicaid for school-aged children and youth through the State’s school-based health access program and Medicaid Administrative Claiming. FCH encourages the use of funds reimbursed to schools through this program for the creation of an Annual Reinvestment Plan.
• Annual Reinvestment Plan priorities included:  school health services and school nurses; school counselors; implementation of the CDC’s Whole School, Whole Community, Whole Child (WSCC) model; student assistance professionals for substance abuse prevention, screening, and referral; dental hygienists to connect at risk kids with dental services in a dental home and other efforts related to the 802 Smiles Network’s different tiers ; establishing, maintaining, and implementing  WSCC teams who may work on programs and policies that support health and academic achievement across their local education agency (LEA); purchase and effective utilization of electronic health records for school health services; supporting student-led YRBS analysis program (Getting to ‘Y’ offered by our partners at Up for Learning); healthy school environment (including school climate and physical environment); tobacco use prevention; and more.

 

State School Nurse Consultant and School Health Services

The State School Nurse Consultant (SSNC) is located within the Division of FCH. This role helps to further Title V efforts and promotes the administration of Medicaid while reducing barriers to access and use of services. The SSNC aligns the Standards of Practice: School Health Services Manual with current school nursing best practice and concepts of the National Association of School Nurses’ Framework for 21st Century School Nursing Practice to provide technical assistance on school health services, and related policies and procedures. The SSNC maintains and updates the new school nurse online orientation, which is required by the Agency of Education for school nurse licensing, in collaboration with the School Nurse Advisory Committee. The SSNC is also engaged with the work of the National Association of State School Nurse Consultants, and the Vermont State School Nurses' Association. 

The Health Department received federal “Public Health Crisis Response” funding which we used to offer training to support school nurse leadership workforce development. During the reporting period the Health Department worked with the Northeastern University School Health Academy to plan for leadership educational opportunities to offer during the school year. This included:

• Planning for the creation of six foundational school nurse leadership webinars.
• Monthly leadership virtual educational series for a small cohort of school nurse leaders, and three professional learning collaboratives for school nurses offered in November, February, and May.
• The Health Department also provided grants of $79,000 each to 11 Local Education Agencies (LEAs) to support investment and implementation over the school year of the school nurse leadership vision made by the school health teams and school nurses.

 

The SSNC chairs the School Nurse Advisory Committee, whose tasks include continuous improvement and revision of  the Standards of Practice: School Health Services Manual, the online new school nurse orientation, implementation of the Essential School Health Services model, and school nurse workforce development. Content in the Manual is validated and verified through expert, legal, and FCH leadership review. The work of the School Nurse Advisory Committee guides school nurse practice within Vermont to ensure all school-aged children and youth receive the recommended, age-appropriate care, as described by Bright Futures, and that chronic health conditions are managed effectively for the best possible outcomes. The School Nurse Advisory Committee is comprised of school nurses from different locations around the state, the president of the Vermont State School Nurses Association, an appointed professional from the Agency of Education, an APRN that specializes in children & families, and the SSNC. The committee regularly connects with various subject matter experts and leaders in the state to discuss content areas related to their specialty. The School Nurse Advisory Committee continues to look for parent and student input to assist in the development and revision of resources and tools for school nurses throughout the state. We plan to reach out in the future to partners such as Vermont Family Network (VFN) who work with and advocate for families and individuals with special health needs, to assist us with direct family engagement in the development and revision of tools for school nurses.

 

School Liaisons

The Health Department School Liaisons (Public Health Nurses in each of the 12 Offices of the VDH Offices of Local Health), are instrumental to supporting FCH efforts at the local level in communities throughout Vermont.

• They work with the SSNC, school nurses, and other school staff to assist families in obtaining health insurance and to encourage them to access medical and dental homes for regular preventive care. Also, to address potential special health needs through engagement of our school and community partners (not direct service to the public) using a population-based approach.
• School Liaisons engage local schools and school personnel (e.g., school nurses and school counselors) to monitor their student and family population for those that are uninsured and connect them with Vermont Health Connect (VT’s health insurance exchange) or assistor organizations.
• School Liaisons often have strong relationships with local primary care providers and can assist with addressing issues that may impact coordination or communication between school nurses and local practices. School Liaisons formed, reestablished, enhanced, or reinvigorated these relationships during the last year, as schools and providers offered support and leadership locally to further our ongoing efforts at the Health Department and with the Schools and Childcare Branch of our COVID-19 pandemic response work.

 

Partnering With Schools: Ongoing COVID-19 Pandemic Response[WN(2]

FCH continued to partner with schools (and the provider community) around the ongoing COVID-19 Pandemic response:

• The Health Department (specifically including members of the FCH division and Health Surveillance), Agency of Education, members of the pediatric infectious disease community, and other State and community partners collaborated to create evidenced based guidance for the 21-22 and 22-23 school years to ensure students could access their education and other needed services that are best provided in-person.
• The Office of Local Health School Liaisons promoted vital connections between medical homes and schools to plan for in-person classes in the fall, while supporting a new or reinvigorated interest in the role of the school physician providing consultation or education for operationalizing local school reopening.
• As the impact of COVID-19 cases and information about the virus evolved, FCH served as a key partner to help update school (and out of school time care) guidance. Specifically, FCH was central in the development, rolling out, and updating of the “Test to Stay” program to promote safe in-person learning when a student or staff member had been exposed to COVID-19.
• When the Test to Stay program ended due to changing COVID-19 guidelines, FCH advocated for and supported the distribution of test kits to schools to support clinical decision making for school nurses working with mildly symptomatic students.
• The Schools and Childcare branch helped to clarify guidance, answer tough questions, and connect with Health Department and Agency of Education partners to get clarification or aid in decision making as needed.
• The Schools and Childcare branch answered calls and emails from the public and other State partners and helped provide clinical guidance and consultation.

 

Through targeted, evidence-based work, the Health Department effectively minimized the impact of COVID-19 cases on in-person education (and extracurricular experiences) and helped to ensure schools remained open and safe.

 

Sports Clearance

Schools may choose to use the Bright Futures sports clearance well child form which was recently updated but not yet rolled out to schools due to other ongoing competing priorities as well as the ongoing impact of COVID-19 on the last two+ school years. The updated version better highlights the importance of annual well care and provides families with action steps they can take to access well care. Additionally, the Health Department (and Agency of Human Services as a whole) began to increase the emphasis on the use of “plain language” to improve how we message important health related information to the public in the last few years. We would like to review the most current iteration of this document during the next grant period and update it using this plain language lens (as well as a health equity lens) in partnership with VCHIP and the VT AAP chapter. We plan to work on roll out in the next school year (2023-24).

 

Youth Health Improvement Initiative & VT RAYS

Vermont Child Health Improvement Program’s (VCHIP) Youth Health Improvement Initiative (YHII) continued to partner with the Vermont Department of Health’s (VDH) Family & Child Health division to improve Adolescent & Young Adult (AYA) health care throughout the state, focused on improving quality of AYA health services and building opportunities for meaningful youth engagement. During the reporting period, VCHIP continued to serve as a liaison between youth and the medical community, public health entities, and other state and/or national stakeholders.

 

VT RAYS (Raise Awareness for Youth Services) is a specialty youth group focused on AYA public health issues, with a particular interest for improving access and utilization of preventive health services. In collaboration with the YHII team, Vermont Afterschool and FCH, VT RAYS engaged youth in initiatives that addressed health equity, the impact of COVID 19 on youth, developing youth focused COVID education materials. VT RAYS facilitated presentations to the pediatric medical community that addressed the behavioral needs of youth and developed suggestions for providing youth friendly and culturally responsive care. 

 

Additionally, VCHIP’s YHII team continued to provide clinical guidance and technical expertise to Medicaid-eligible adolescent initiatives and skilled professionals working with AYA including injury prevention, suicide prevention, substance misuse prevention and treatment, and improving access to and utilization of high quality AYA health services.

 

VCHIP supports medical homes, stakeholders, and other partners who care for and provide services to adolescent and youth adults through the maintenance of the Adolescent and Young Adult Resources web page. New content is added as relevant topics, resources, or tools are developed or revised.

 

UP for Learning, Getting to 'Y', & Personal Power & Community Connections

In addition to improving adolescent well care visits, Vermont aims to promote healthy behaviors among youth through an empowerment model. FCH joined with other organizations in partnering with UP for Learning who lead teams of school personnel and youth in the Getting to Y’ program. Getting to 'Y' is an opportunity for students to take a lead in bringing meaning to their own Youth Risk Behavior Survey data and taking steps to strengthen their school and community based on their findings by addressing risks and promoting strengths.

• Following a participatory action research model, teams attend a training day to learn tools and strategies to organize their own retreat to analyze data, producing a “Student Executive Summary.” This summary includes priority strengths and areas of concern they identified at their retreat, and a preliminary plan of action, based on an exploration of root causes. Examples of the student’s previous work can be found in the Getting to ‘Y’ newsletters located here (or the 2021-22 newsletter here).
• UP for Learning adapted what was normally a day-long in-person training into virtual training ensuring students were still able to access and participate in this important program during the 22/23 school year.
• Getting to ‘Y’ was added to AMCHP’s Innovation Station Evidence Based Best Practice Database last year, and the Health Department will now consider Getting to ‘Y’ an evidence-based practice. UP for Learning youth and adults joined AMCHP as co-presenters at the Adolescent Health Initiative’s 2021 Conference on Adolescent Health.

 

FCH is also continuing to support Personal Power & Community Connections (P2C2), in partnership with our Division of Substance Use Programs. The more students know about how they learn and believe in their potential as learners, the more successful they will be. Personal Power & Community Connections guides and empowers youth and adults to create nurturing learning environments. In partnership, participants will explore the skills necessary for personal growth and wellbeing and how to effectively contribute to a healthy and just society by infusing social and emotional strategies. A school culture based on these principles will increase student engagement and self-efficacy, build intrinsic motivation through metacognitive strategies, and foster a growth mindset for both educators and students. The P2C2 concepts of mindful listening, resilience, belonging, generosity, mastery, independence, values, and empathy are integrated into all of UP’s youth empowerment programs to fully align with the Whole School/Whole Community/Whole Child national initiative, which takes a holistic approach to the well-being of children and their community.

 

The UP team continues to rapidly prototype resources to meet the needs arising in the field, particularly around social-emotional learning, and mental health for both remote and in-person programming. UP for Learning adapted and responded to individual teams' needs and designed training and support to meet these needs.

 

Partnership with PATCH

FCH partnered with VCHIP’s, Youth Health Improvement Initiative to explore the use of the Wisconsin-based, PATCH (Providers and Teens Communicating for Health) program to promote the use of, PATCH for Teens Toolkit. This program provides youth, school health educators, health-related professionals, youth workers, and other adults the materials and resources needed to teach young people about their rights and responsibilities in health care settings. Due to competing priorities the last two+ years and key VDH personnel’s deployment to support Schools and Childcare Branch HOC pandemic response duties, we have not recruited high school sites to participate in using the curriculum yet. We plan to revisit recruitment in the next school year (2023-24). The COVID-19 response and recovery efforts and the transition away from emergency response work were the main priority during the previous school year.

 

FCH Adolescent Health Team

Prior to COVID, the Adolescent Health Team engaged in more intentional outreach to other divisions in the Health Department and to other departments across the Agency of Human Services. These included the Department of Mental Health, the Division of Substance Use Programs, and the Division of Health Promotion and Disease Prevention, namely the tobacco prevention team. These partnerships are critical to enhancing the coordination of our adolescent health efforts across our department and agency, especially related to mental health, suicide prevention, youth voice and engagement, and substance use prevention.

 

The FCH Adolescent Health Unit team did not meet due to staff COVID-19 deployments. We started to reconvene as a team in November 2022. The team includes:

• FCH adolescent health program manager, who also oversees the VT PREP program.
• FCH Injury and Violence Prevention program manager, who manages a broad body of work including RPE and youth suicide prevention initiatives.
• State School Nurse Consultant.
• Title X program manager, who also serves as our Title V Coordinator.
• Public Health Nurse and Lead for the FCH perinatal, and school and child health team.
• And the Director of Adolescent and Reproductive Health.

 

Our team spent the past few months getting to know and onboarding new staff, increasing our understanding of the changes to the structure of some of our work due to COVID, reconnecting with some of our key partners, coordinating with others in our division, such as our health equity team lead and our FCH division evaluator, working with our YRBS coordinator, and identifying shared priorities and opportunities for improved coordination across our division.

In the coming months we will also reconvene with our other health department colleagues who work on adolescent health: staff from our chronic disease prevention unit, emergency preparedness and injury prevention, and the division of substance use programs. There are also opportunities for collaboration with other state partners, including the Department of Mental Health, the Department for Children and Families, and the Agency of Education. Our Adolescent Health Team is working to identify priorities, assess the impact of COVID on our programs and partners, and identify next steps for our shared efforts related to adolescent health and wellbeing.

 

Members of the Adolescents Health Team also serve on and lead a variety of committees, workgroups, etc. FCH has representation on a vaping prevention workgroup that was established 3 years ago. While much of this was paused due to COVID-19, there were several opportunities for collaboration related to proposal review processes for regional tobacco control coalitions and supporting linkages to community partners such as Outright VT and VT Afterschool to expand work related to tobacco prevention efforts. FCH staff lead a Sexual Health Education Stakeholders group, serve on youth suicide prevention groups, Chair Child Fatality Review, and a Reproductive Health group. There is FCH representation on a training planning team and a legislatively mandated group to assess gaps in services related to eating disorders in the state. In 2023-2024 FCH will have representation on a newly formed Interagency Prevention Working Group, an initial topic of focus is school absenteeism.

 

Injury Prevention

Vermont FCH actively worked within the realm of injury and violence prevention to reduce Vermont’s teen and young adult suicide rate.

• Analyses by the FCH/CDC Assignee Epidemiologist enabled Vermont to further understand the influences behind its high suicide rate.

• FCH provides leadership to the statewide Suicide Prevention Coalition and works specifically with the Center for Health and Learning, the Department of Mental Health, Agency of Education, VCHIP, and Vermont’s Designated Agencies on youth suicide prevention efforts.
• FCH participates in the Suicide Prevention Data Workgroup and assisted in the preparation of several suicide prevention grant applications. The Vermont Department of Health increased its capacity to address youth suicide through the receipt of two grants: the Centers for Disease Control and Prevention Suicide Prevention Grant and the SAMSHA Garret Lee Smith Youth Suicide Prevention Grant. Title V assisted the Department in being a competitive applicant for these grants due to the longstanding youth suicide prevention work funded by Title V.
• Vermont funded a Zero Suicide Academy for youth serving providers to screen for suicidality and refer youth to treatment, implemented a robust Youth Mental Health First Aid and Teen Mental Health First Aid training plan, and prioritized BIPOC and LGBTQ+ youth by funding social support groups for youth to increase connectedness.
•  FCH also chairs the Child Fatality Review Team who review all youth suicide deaths in Vermont and make recommendations for systems changes that could prevent suicide deaths among Vermont’s youth. The Child Fatality Review Team will make recommendations to key stakeholders in the education sector encouraging the requirement of policies, practices, and programming are accessible and inclusive of LGBTQ youth.  Additionally, the Team will recommend safe storage messaging including the importance of adult supervision when youth are in the presence of a firearm.

 

Umatter YYA

Over the past several years, FCH has partnered with the Center for Health and Learning (CHL) to support funding for Umatter for Youth and Young adults. Umatter YYA “is a youth leadership and engagement initiative. The goal is to promote mental health wellness: healthy coping mechanisms among youth and young adults, and the ability to recognize when a peer needs help and how to provide it. The aim is to foster healthy community cultures for youth and young adults that promote mental health and resiliency, and address issues such as bullying and substance abuse prevention within a continuum for prevention through recovery. Umatter YYA is carried out with the support of adult facilitators who work with youth and want support opportunities that teach skills that foster resilience and create norms for self-care and help-seeking in schools and community settings. Umatter YYA trains young people on personal skills such as strength and risk assessment, coping and stress management, recognizing warning signs of mental health distress, awareness of the importance of depression screens and well-care visits, and knowing how to get help. These young people become peer leaders and work with other youth to bolster these skills.

 

Due to COVID, CHL made several creative adaptations, including transitioning many of their materials into an online learning format, and offering programming “a la carte”, that led to more options for programming and increased reach. CHL is revisiting their YYA program and has chosen not to accept grant funding until they can complete an assessment of the program and ensure alignment with other statewide youth engagement efforts.

 

CDC/Rape Prevention and Education (RPE) Grant

During the planning phase for Vermont’s 2020-2024 CDC/RPE grant program, sub-recipient organizations recruited cohorts of youth to partner with organizations in their sexual violence prevention efforts. Key leaders in the implementation of youth-adult partnerships including Up for Learning and Outright Vermont provided TA to RPE subrecipients. The Building Consent Culture Youth Adult Partnership Program, Vermont’s sexual violence youth engagement program, trained over 15 youth this past year on sexual violence prevention and leadership skills.

 

Personal Responsibility Education Program

The Division of FCH’s Personal Responsibility Education Program (PREP) works with high-risk youth ages 10-19 (20 and under if pregnant or parenting) on healthy relationships and life skills in an “upstream” approach to pregnancy, STI and HIV prevention.

• FCH presently has 6 PREP subrecipients implementing the program across community-based youth serving sites, including Parent Child Centers, Boys and Girls Clubs, the Association of Africans Living in Vermont, and others.
• This work is overseen by the FCH Adolescent Health Program Manager, who co-chairs the Youth Services Advisory Council (YSAC) and co-chairs the Sexual Health Education Stakeholders Group.
• The FCH Adolescent Health Program Manager worked with Vermont Afterschool (VTA) to serve as an umbrella organization to oversee the PREP implementing sites.
• We are reorganizing our PREP program and bringing on new PREP sites while focusing equity by offering PREP throughout all regions of Vermont.
• This work will serve up to 250 youth annually.

 

FCH continues to partner with Dr. Gibson, a pediatrician and adolescent medicine specialist to provide training and technical assistance to Vermont’s PREP program to further enhance the training opportunities for program facilitators who implement evidence-based curriculum.

• Dr. Gibson provided a wide variety of training to PREP staff over the past years and this work expanded to include pediatricians, family practice physicians, afterschool staff, and school-based health educators. Trainings cover topics such as Adolescents and LARCs, Adolescents and STIs, and Adolescents and Emergency Contraception.
• Dr. Gibson also supported some new work related to eating disorders. Dr. Gibson is the medical director of an adolescent eating disorders clinic at UVMMC and played a key role in helping to plan and lead a one-day training course on multidisciplinary approaches to eating disorders.  The FCH Director of Adolescent and Reproductive Health also served on this planning committee. Dr. Gibson and the Adolescent and Reproductive Health director served on a legislatively mandated workgroup to assess the gaps in care related to eating disorders and contributed to recommendations for the legislature.
• Dr. Gibson is a member of the Sexual Education Stakeholders Group, working with members to further disseminate the best practices Essential Topics of Health Education guide.

 

Sexual Health Education

The Division of Family and Child Health continues to collaborate with the Agency of Education, and several community partners through the Sexual Health Education Stakeholders Group on workforce development activities related to improving sexual health education in schools and community-based settings. As well as to support the implementation of the Condom Availability Law and share resources, guidance, and sample templates for procedures created to support schools with the implementation of the law. Efforts included offering a webinar through the Vermont School Nurses Association on the new law and collaborating with community partners to offer educational sessions to Vermont health educators through the VT Higher Education Collaborative on Essential Topics in Sexual Health Education. We also continue to collaborate with Elevatus to support attendance in their 3-day Sexuality Educator training for people who work with people with Intellectual and Development Disabilities. Over 50 people were trained in the Elevatus curriculum through support from the FCH Division. In addition, with the use of RPE funds, we purchased the rights to a sexuality training for parents of teens with intellectual and developmental disabilities for over 40 agencies including domestic and sexual violence advocacy organizations, schools, and parent support organizations.

 

Youth Voice and Youth Engagement

This work is overseen by the FCH Adolescent Health Program Manager, who also serves on several youth and young adult related statewide initiatives broadly related to youth development, including the Youth Thrive Statewide Coordination Team, and co-chairs the Youth Services Advisory Council (YSAC). The Youth Thrive framework grew out of the Center for the Study of Social Policy’s development of the Strengthening Families model. Youth Thrive utilizes the most current science on adolescent brain development, trauma, and resilience.

 

The Youth Services Advisory Council (YSAC) promotes shared responsibility across state and community stakeholders for achieving positive outcomes for youth and young adults in Vermont. The YSAC includes representation from the Health Department’s Divisions of Family and Child Health and Substance Use Programs, as well as the Department of Mental Health, Department for Children and Families, Department of Vermont Health Access, Department of Labor, Agency of Education, Vermont Afterschool, and adolescent treatment providers, among others. The Council identified several core outcome measures which include improving health care access and having a medical home; successfully completing high school, preparing adults to work with youth, youth having employment or vocational training, stable housing, and at least one supportive relationship; youth being free from incarceration, and engaged in planning for their future.

 

Partnership with Vermont Afterschool

Much of the youth voice and youth engagement work is carried out in collaboration with VT Afterschool Inc. The FCH collaboration with  Vermont Afterschool Inc. continues and has expanded. Vermont Afterschool Inc. mission is to: support organizations in providing quality afterschool, summer, and expanded learning experiences so that Vermont’s children and youth have the opportunities, skills, and resources they need to become healthy, productive members of society. Vermont Afterschool’s work is additionally supported by the CDC Opioid Data to Action funding.

• This funding continues to support the work of the Youth and Community Health Coordinator and the Youth Voice Coordinator.
• The Youth Voice Project supports multiple, regional Youth Councils across the state that.

collect proposals from youth statewide for small projects and initiatives that help improve the lives of youth in Vermont by increasing opportunities for youth to belong, gain proficiency in a skill, give back, and make decisions.

• The Vermont Legislature created law to enact a Vermont State Youth Council. The Youth Council will provide advice to the Governor and the General Assembly on policy changes necessary to improve the lives of Vermont youth. FCH is working collaboratively with Vermont Afterschool and members of the Youth Services Advisory Committee-YSAC, to guide this work.
• Vermont Afterschool staff provide training and technical assistance on resilience and transformative social emotional learning to Family and Child Health staff.
• Vermont Afterschool Inc. leads the Youth Thrive work, with one of their staff members serving as the primary trainer. They are connected to the national Youth Thrive staff. Recently, they launched Youth Thrive training for youth, which young adults facilitate. VT Afterschool is supporting these trainers as well.
• FCH staff provide guidance on best practice approaches to out of school programming, performance measurement, stakeholder engagement, positive youth development, and communications/messaging.

 

Partnerships[WN(3]

 

The Primary Care and Public Health Integration meeting, which convened monthly and included pediatric, family practice, women’s health/adult, and Ob providers was an important partner in identifying innovative strategies to increase access to, utilization of, and quality of adolescent well-care, as well as other youth empowerment strategies. This group was sunsetting towards the end of this reporting period.  We will still have access to leadership from participating organizations (especially VCHIP and the VT Chapter of AAP) to meet as needed to address ad hoc issues, hot topics, or gather needed support, information and feedback moving forward. Additionally, some of the activities of this group have transitioned into the Monthly Scoop calls referenced in the Public Private Partnerships section.  

 

As described throughout this report, a key partner across all population domains is the Vermont Child Health Improvement Program (VCHIP). VCHIP is a population-based child and adolescent health services research and quality improvement program of the UVM.

 

In addition, partnerships as outlined above include the Youth Thrive Statewide Coordination Team, the Youth Services Advisory Council, and Vermont After School Inc. Vermont Raise Awareness for Youth Services (VT RAYS) is our youth health advisory council as mentioned above.

 

Other partners in our adolescent work include Planned Parenthood of Northern New England, the Vermont Network Against Domestic and Sexual Violence, Outright VT, Vermont Medicaid, the Agency of Education, the Department of Mental Health, Vermont State School Nurses’ Association, the Center for Health and Learning, local schools and school boards, and a broad range of youth serving organizations.

[SI(1]Maybe repeat the first sentence or two in this session and the SN section in the child section and reference that there is more detail in the Adolescent section?

[WN(2]Completed with Molly's guidance.  Ilisa may want to take a look at this section.

[WN(3]Ilisa may want to review this section