Priority: Prosocial Connection

Performance Measures and Annual Objectives

NPM 16: Percent of adolescents, ages 12 through 17, who have one or more adults outside the home who they can rely on for advice or guidance is 75.4% for reporting year 2025. The annual objective for reporting year 2026 is 76.2%.

ESM 16: The number of policy, practice, systems, or environmental changes implemented to support youth mental health in schools is 0 for reporting year 2025. The annual objective for reporting year 2026 is 5. 

The data for this national performance measure (NPM) is collected through the Healthy Kids Colorado Survey that is administered every other year. The NPM is a measure of youth-adult connectedness, which is a protective factor for positive youth development and is foundational to adolescent health and well-being. The data for the ESM is tracked by the Connectedness Specialist in the Office of Suicide Prevention and the School Age Systems Specialist in the Children and Youth with Special Healthcare Needs Section and will be calculated annually. The ESM was selected because policy, practice, systems and/or environmental changes can foster connectedness among youth and trusted adults, a protective factor for youth mental health. 

Resource Allocation to Advance this Priority

MCH Block Grant dollars will continue to fund approximately 2.0 FTE to implement the social connectedness state action plan. In addition, MCH staff time will be leveraged with additional state funding including: $400,000 of state General Funds to support school climate, staff mental health training and federal SAMHSA funds from the Colorado Department of Education to support the development of comprehensive suicide prevention policies. The strategies planned for the upcoming year for this priority are summarized below. 

Strategy Implementation

Social connectedness was identified as a priority for the upcoming five-year block grant cycle through a robust needs assessment process. The priority name shift from prosocial connection to social connectedness is a slight, but intentional, shift to include broader connectedness activities. Through input from community focus groups, Colorado data, and partner input, three strategies have been selected for implementation for the coming year. The three strategies include: 1) create affirming environments for youth; 2) address intergenerational healing and connection and; 3) increase connection to behavioral health care for all youth. 

The first strategy to create affirming environments for youth will build off and continue work from previous years. MCH staff will continue to partner with the Colorado Department of Human Services on the implementation of the positive youth development training system. Technical assistance and contract monitoring will be provided to school and district grantees implementing efforts outlined in Senate Bill 18-272. This includes four district grantees prioritizing building positive school environments, developing suicide prevention and crisis policies and providing mental health training for staff and students. It is also anticipated that an additional 10 grantees will receive one-year awards to support mental health training for staff and students. A request for applications will be released in Fall 2025 to identify new grantees in alignment with SB 18-272 for a new five year cycle. 

A new strategy that was identified through youth input during the needs assessment process, is to address intergenerational healing and connection. Colorado youth described a strong need for a multi-generational approach to mental health, as it is difficult to positively impact a young person’s mental health when their parent or caregiver’s mental health is poor. Youth identified wanting to see parents and caregivers prioritize their own mental health as a means to help care for their child’s mental health. This pressure of living with and managing the mental health of parents is making youth feel pressure to heal generational trauma, which has resulted in youth focus group participants not wanting to speak to their parents or caregivers about their own mental health.

The third strategy for the coming year is to increase connection to behavioral health care for all youth. This will involve a multifaceted approach focused on three main activities: 1) increasing community-based support for behavioral health; 2) capacity building for primary care providers working with youth; and 3) improving referral pathways. Increasing community-based support will involve assisting young people in providing peer-to-peer support and building their own resiliency. Activities focused on capacity building for primary care providers involve developing and strengthening partnerships with programs like the Colorado Pediatric Psychiatry Consultation and Access Program (CoPPCAP) and IMatter, which increase primary care physician understanding of mental health treatment and provide streamlined referral pathways. To support more referrals to behavioral health providers for young people, MCH staff will align efforts across state agencies to improve coordination of mental health referral pathways. For example, the Behavioral Health Administration is contracting with Behavioral Health Administrative Service Organizations (BHASOs) to design a new system for behavioral health safety net services in the state, facilitating more timely referral for young people. MCH staff will ensure these BHASOs are well connected to other care coordination and referral pathways such as the school system, to ensure referrals are streamlined and targeted to young people’s needs.

During the upcoming reporting period, prosocial connections priority staff will continue to support local public health agencies. It is anticipated that several agencies will continue to implement a local action plan for the prosocial connection priority. Additionally, state prosocial connections staff will provide consultation on the development of local action plans and budgets, assist with problem solving, and provide connection to community resources and aligned initiatives.

Priority: Social Emotional Wellbeing

Performance Measures and Annual Objectives  

NPM 14a: Percent of women who smoke during pregnancy was 3.0%. The annual objective for reporting year 2024 was 4.3%. The annual objective was met. The annual objective for reporting year 2025 is 4.0%. 

ESM 14.1: Percent of pregnant women insured by Medicaid who smoke during the last three months of pregnancy was 6.4%. The annual objective for reporting year 2024 was 7.7%.

The annual objective was met. The annual objective for reporting year 2025 is 6.0%. 

SPM 4: Percent of women of reproductive age (18-44 years) who report good mental health was 66.5%. The annual objective for reporting year 2024 was 75.0%. The annual objective was not met. Colorado’s data is in line with national measures showing that mental health concerns and frequent mental distress is increasing among women of reproductive age (America’s Health Rankings, 2023), in part attributed to larger societal factors, including increasing social isolation, increasing income insecurity, and the lingering impacts of the COVID pandemic (Thomas, 2023 and Reinert & Nguyen, 2021). The annual objective for reporting year 2025 is 77.0%. 

The data source for the NPM is the National Vital Statistics System that is administered annually. This NPM was selected for this priority because tobacco use before, during and after pregnancy is higher amongst individuals who experience social emotional stress and/or mental health concerns. The data source for the ESM is the Pregnancy Risk Assessment Monitoring System that is administered annually. The ESM was selected to monitor progress on the tobacco cessation activities that are focused on pregnant women who are enrolled in Medicaid that are described in strategy one. The data source for the SPM is the Behavioral Risk Factor Surveillance System that is administered annually. The SPM was selected to monitor the impact of behavioral health screening, referral and connection activities for women of reproductive age described in strategy one.  

Resource Allocation to Advance this Priority

For this reporting period, MCH Block Grant dollars were allocated for contracts with local public health agencies to implement local work under the Social Emotional Wellbeing Priority. To expand impact, multiple funding sources were braided and blended to support MCH work and support 1.0 FTE of the Family Adversity and Mortality Prevention team and 1.0 FTE on the Children and Youth with Special Health Care Needs (CYSHCN) team. MCH leveraged funding from state General Funds to reduce maternal mortality as well as support CYSHCN work, the ERASE Maternal Mortality grant through the CDC, and HRSA funding through the State Maternal Health Innovation and Data Capacity grant. In addition, MCH Block Grant dollars continued to fund a portion of a Tobacco program staff position (0.25 FTE) to serve as a liaison between the Tobacco and MCH programs. Amendment 35 tobacco state tax revenue and a CDC grant continued to provide annual funding for additional Tobacco program staff and comprehensive Tobacco program efforts, including MCH-related tobacco activities. Leveraging combined funds enabled the Tobacco program to extend the reach of strategic efforts that reduce the burden of perinatal tobacco use and exposure, increase positive birth outcomes and improve the health of families throughout the lifespan. Funded strategies and key outcomes are summarized below. 

Strategy Implementation 

Strategy 2: Support universal prevention, early intervention, and treatment of behavioral health among MCH populations 

The Tobacco program, alongside Rocky Mountain Center for Health and UpRISE (an employee assistance mental health program), continued to provide Tobacco program grantees technical assistance and support to address youth vape/e-cigarette use, promote alternatives to punitive measures, and provide cessation/quit resources to grantee and non-grantee schools/school districts administrators and school community partners. In this period, 150 schools representing 61 school districts and 1,493 middle and high school students completed the Second Change program during the 23-24 school year. Seventy percent of schools committed to using Second Chance as an alternative to suspension and agreed not to use out-of-school suspension for students' first violation of the Tobacco Free Schools policy.

The Tobacco program, alongside Rocky Mountain Center for Health and UpRISE (an employee assistance mental health program), continued to provide Tobacco program grantees technical assistance and support to address youth vape/e-cigarette use, promote alternatives to punitive measures, and provide cessation/quit resources to grantee and non-grantee schools/school districts administrators and school community partners. In this period, 150 schools representing 61 school districts and 1,493 middle and high school students completed the Second Change program during the 23-24 school year. Seventy percent of schools committed to using Second Chance as an alternative to suspension and agreed not to use out-of-school suspension for students' first violation of the Tobacco Free Schools policy.

The Rocky Mountain Center for Health has begun working with a developer on updating the current Second Chance program platform and content with a youth connectedness section. 

The Tobacco program continued to collaborate with the Colorado Department of Education, the Behavioral Health Administration, and Rocky Mountain Center for Health on developing and providing technical assistance to support the testing and implementation of the non-punitive TrekPointe Youth program. TrekPointe is an alternative to suspension and substance use education program offering Colorado students a chance to map their path by reflecting on their experiences, building healthy coping skills, positive connectedness, and fostering personal growth. The program is currently in a pilot phase for facilitators and participants. Developers recruited and compensated several youth ages 13-19 to review seven modules and provide feedback. 

The Tobacco program collaborated with tobacco control partners and local public health agencies, leading to a successful tobacco flavor ban in December 2024. The Denver City Council voted 11-1 to ban the sale of flavored tobacco products, including e-cigarettes, menthol cigarettes, vapes, chews, oral nicotine pouches, and other flavored tobacco and nicotine items. The ordinance applies to licensed retail tobacco stores, with an exception for hookah tobacco products. In support of this ban, the Tobacco team provided data on the negative impacts of flavored tobacco and nicotine products on pregnancy and birth outcomes. 

Another strategy to support the social emotional wellness of pregnant women and positive maternal health outcomes includes access to doula support, and in July 2024, Colorado’s Medicaid program launched a doula benefit. MCH staff partnered with Medicaid to support the implementation of this new benefit by co-hosting a summit in November 2024, Building Bridges in Perinatal Care for Coloradans. The summit was attended by doulas, doulas training organizations, hospital administrators, midwives, and other stakeholders. The goals of the summit included exploring ways for state and community partners to collaborate more effectively, enhance understanding of each other’s work, and discover available resources that can strengthen the perinatal care continuum. State agencies continue to work together to support the implementation and utilization of this benefit. CDPHE is directly supporting doula training with HRSA State Maternal Health Innovation funding. 

The CYSHCN Director continued to participate in the Co-chair Coordinating Team for the Colorado Partnership for Thriving Families. This statewide collaborative aims to decouple poverty and neglect to reduce families' involvement with Child Welfare. Four workgroups meet monthly in addition to the quarterly full partnership meetings with multiple MCH staff engaged. The CYSHCN Director currently co-facilitates the Partnership’s Policy Workgroup. which is in the process of developing a policy agenda and is leveraging the Colorado Department of Early Childhood’s Thriving Families Framework and Early Childhood Framework, Colorado Department of Human Services Child Abuse and Neglect Prevention recommendations, CDPHE’s Child Fatality Prevention System recommendations, the Early Chilhood Comprehensive System’s policy tracker, the Get Ahead Colorado website, and the MCH Needs Assessment to guide the development. 

The Child Abuse Prevention Treatment Act (CAPTA) and Beyond State Interagency Workgroup is an ongoing collaboration comprised of four state agencies representing public health and environment, education, early childhood, and human services in partnership with representatives from county child welfare agencies, early intervention service providers, pediatricians, local public health agencies and family leaders. Colorado’s child welfare system requires a referral for a developmental screening for every child under the age of five found to have experienced child abuse and/or neglect. In Colorado, this equates to approximately 3,700 children annually. Currently, there is not a clear system or organization responsible or equipped to ensure that the referral from child welfare results in an appropriate screening and, if needed, referrals to relevant services and support. 

The purpose of this partnership was to explore barriers, potential solutions, and to develop deliverables for improving developmental screening, referrals, and system-wide improvements to ensure that children from birth through age five who are involved in child welfare have their needs identified and are connected to relevant family-driven services and supports. Over the past few years, the workgroup developed three briefs outlining gaps and requirements, community solutions, and recommendations for improvement. The workgroup focused on short term goals designed to help move forward a series of long term recommendations: 1) establish a goal that 100% of children under age five who have experienced abuse and/or neglect are referred for screening and connected to additional evaluation, services, and supports as needed; 2) secure consistent, sustainable, and long term funding for the implementation and continuous improvement of community-designed solutions; 3) revise baseline requirements to include both the state’s core requirements and a menu of opportunities for communities to exceed those expectations; and 4) support implementation through the creation of a toolkit for Colorado communities to use when designing their local developmental screening and referral processes.  

The Advisory Group met with the leads from key state agencies, namely, the Colorado Departments of Human Services, Education, Early Childhood, and Public Health and Environment, twice during the fall of 2024 to clarify next steps to improve how referrals are made by child welfare for developmental screening of children under age five. Several critical steps were identified to further guide the work including the following refined goal: 100% of children from birth through five who have an open child welfare case and/or have substantiated abuse/neglect findings are referred to an agency that is prepared and able to conduct developmental screening. This expanded goal increased the scope of work for both screening and referral beyond the requirements of the existing Child Abuse Prevention Treatment Act. The Advisory Group also agreed upon a framework and a detailed action plan, which includes securing funding and potential policy changes that may be necessary to achieve the above goals. The workgroup refined membership to ensure state, community and family voice representation for the relaunch of the 2025 workgroup to complete next steps.

For more about the Social Emotional Wellbeing priority, see the Women/Maternal Health domain.