Adolescent Health Annual Report
To improve adolescent health outcomes Title V MCH Program selected NPM 15, NPM 10, and NPM 8. Title V MCH sought to increase the percent of children, ages 0-17-year-old (y.o). who are adequately insured (NPM 15), grow the percent of adolescents, ages 12-17 y.o. with a preventive medical visit in the past year (NPM 10), and to increase the percent of adolescents who are physically active at least 60 minutes a day (NPM 8). Health outcomes are anticipated to improve when youth are adequately insured, receive yearly wellness visits, and physically active. Program activities and successes on these efforts are highlighted in the report.
The National Survey of Children’s Health (NSCH): 2016-2017 Report stated 71.7% of Nevadan’s ages 12-17- y.o. received a preventive health visit, compared to 78.7% nationwide. Efforts to increase preventive medical visits included partnering with outside agencies to increase the percent of children, ages 0-17 y.o. who are adequately insured (NPM 15). The NSCH 2017-2018 Report revealed 61.8% of Nevadan’s ages 12-17- y.o., had adequate and continuous insurance coverage compared to 64% nationwide. It is important to ensure adolescents receive recommended health screenings to address physical, emotional, cognitive, and social changes which can have a lasting impact on their lives. As of 2013, most insurance plans cover preventive health services for adolescents with no out-of-pocket cost, as mandated by the Patient Protection and Affordable Care Act (ACA). These no-cost preventive health visits include alcohol, drug, and nicotine use screening; behavioral health and depression assessments; reproductive health and sexually transmitted infection prevention counseling and screening; administration of age-recommended vaccines; and obesity management.
To increase access to care, the AHWP disseminated 30,760 brochures (English/Spanish) highlighting the value of yearly adolescent checkups and how to apply for health insurance. Primary distribution partners included Division of Welfare and Supportive Services, Division of Child and Family Services, Silver State Health Insurance Exchange (Nevada online Marketplace), Title V MCH funded partners, and community agencies working to enhance the uptake of yearly adolescent well-visits.
The AHWP Coordinator disseminated best practice youth-friendly resources with the goal of improving adolescent health and wellness outcomes. The materials included unique activities and tips to address health and wellness, health insurance, self-advocacy, and health literacy. Content was shared with the Title V MCH Children and Youth with Special Health Care Needs (CYSHCN) Coordinator, Title V funded agencies, community organizations, and health care providers. Additionally, the state Sexual Risk Avoidance Education Program (SRAE) and Personal Responsibility Education Program (PREP) distributed materials to enhance programming at youth-serving non-medical agencies. Best practice materials disseminated were created by Nemours Children’s Health System, Got Transition, University of Michigan Adolescent Health Initiative Program, and the Oregon Health Authority. Materials highlighted adolescent well-visits, youth-friendly services, adolescent risk screening, transition from pediatric to adult health care, and other pertinent topics to enhance the provision of adolescent care.
Collaboration with Youth Serving Agencies
The AHWP Coordinator engaged with other state staff through the National Network of State Adolescent Health Coordinators which unites state adolescent health coordinators responsible for Title V MCH and other adolescent health programs. Discussions focused on ensuring youth topics and lived experiences of young people became part of Title V Needs Assessments; improving adolescent-centered clinic environments, policies, and practices; co-occurring risk and protective factors; and emerging vaping concerns and suicide attempts impacting health outcomes. Attendance at the HRSA Region XIII Adolescent Health & Wellness Summit provided opportunities to network with other Title V MCH state adolescent health coordinators and identify best practices.
Several DPBH programs cross-over into each other’s field of expertise, including prevention and education surrounding sexual and intimate partner violence, teen pregnancy, sexual risk avoidance education, obesity, food security, tobacco, suicide, substance use, and mental health. The AHWP Coordinator shared topical information with Title V MCH funded partners and DPBH adolescent-focused programs pertinent to their field about upcoming webinars and trainings, round-table discussions, community events, new publications, and youth-focused materials.
The AHWP Coordinator disseminated adolescent-focused health information through the statewide MCH Coalition and state Primary Care Office e-newsletters. Additionally, partners contributed content on agency Facebook pages covering topics such as teen health week, adolescent physical activity, adolescent-centered care, information briefs for parents, and materials to promote National campaigns for suicide prevention, childhood obesity awareness, and physical fitness and sports.
The AHWP Coordinator played a key role in ensuring youth-serving agencies and adolescents were included in the Nevada needs assessments prepared for Title V and SRAE. Forty-three youth-serving organizations were invited to participate to reduce suicide/bullying, pregnancy, repeat teen births, substance and alcohol use, mental health issues; improve immunizations, sustainable skills for pregnant and parenting teens, food security, housing, LGBTQ+ support; youth advisory councils, schools, juvenile justice programs, as well as welfare and supportive services. Youth were recruited for focus groups to obtain lived experiences from young people.
The coordinator shared youth-friendly resources and information with the Nevada Primary Care Association (NVPCA) staff working on the Healthy Tomorrows Partnership for Children Program (HTPCP) grant. The HTPCP project collaborated with Title V MCH to improve rates of adolescent well-visits in federally qualified health centers (FQHCs). MCAH served on the technical assistance team visit with the NVPCA staff to discuss project progress and future plans. Outcomes included new MCH partnerships with the Nevada American Academy of Pediatrics (AAP) Chapter, and Community Access to Child Health (CATCH) Program, as well as participation on the advisory council to improve adolescent health care services through input and feedback on program focus, development, and operations.
MCAH staff contributed content to a NVPCA Project ECHO webinar; Improving Sexual and Reproductive Health for Nevada Teens, sharing information about evidence-based programs and education materials for adolescents, their families, and health care providers. AHWP staff informed attendees about availability of the Does Your Teen Need Health Coverage brochure to increase access to care through health insurance and improve uptake in adolescent well-visits, as well as promote the AAP Bright Futures Parent and Patient Handout for Adolescent Ages. Program staff from the state teen pregnancy prevention programs SRAE and PREP shared content about curriculums and funded projects.
Youth Engagement
The AHWP Coordinator attended webinars and conferences to learn best practices of authentic youth engagement to prepare Nevada for future planning and implementation. Adolescent-focused motivational interviewing (MI) solicits more effective youth communication to identify and reduce risky behaviors. The Possibilities for Change MI questions focus on sexual risks whereas, the Hilton Foundation Adolescent SBIRT materials concentrate on substance use. The youth engagement conferences focused on health equity, cultural humility, and intersectionality while building systems for engaging youth in organizations and community projects. Significant content included evidence-based recommendations for increasing authentic youth engagement, resources to support system development and services to engage and support youth and young adults, skills to assist young people working within organizations and in the community, and methods to ensure health equity is inherent in program planning, implementation, and systems-building. Handouts and PowerPoint presentations on meeting topics were shared with Nevada youth-serving agencies, including youth advisory councils such as Healthy Young NV, and Youth M.O.V.E.
Pregnant and Parenting Teens
The MCAH Section partners with agencies serving pregnant and parenting teens through work conducted by the AHWP, Nevada Home Visiting, Maternal and Infant Health Program (MIP), and PREP. The AHWP Coordinator sent out webinar announcements and best-practice materials to organizations serving new young families. A collaboration to share informational resources was established between the AHWP program and staff conducting workshops for low income pregnant and parenting teens. The Supporting Teens Achieving Real-Life Success (STARS) workshops, offered by the Nevada Public Health Foundation (NPHF), supports pregnant and parenting teens with tools to reach their highest level of self-sufficiency. STARS is offered four times a year, with three workshops serving Clark County and one in Northern Nevada reaching women in Carson City, Washoe, Douglas, Lyon and Storey counties. The AHWP program provided workshop attendees with materials promoting the value of yearly wellness visits and no-cost yoga classes to supplement resources provided by the MIP such as Text4Baby water bottles and lunch bags, oral health kits and handouts on safe sleep, marijuana, WIC, and developmental screenings. Additionally, Title V MCH provided Reality Works dolls to reinforce the importance of abstaining from alcohol use while pregnant. Other focus areas of the workshops included reducing a repeat teen pregnancy, birth control, continuing education, and job readiness. The Nevada Home Visiting program serves young adult families to improve health outcomes, promote breastfeeding, increase developmental screening, reduce teen pregnancy and substance use. One of their programs helps parents engage with children in daily learning activities to promote literacy and school readiness.
Substance Use
The AHWP Coordinator attended the NVPCA substance use round table meeting and shared the Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) Project’s curriculum including the toolkit, PowerPoint, and other resources. Among the information learned included Washoe Tribal Health Clinic efforts to reduce opioid use among Native American pregnant teens and women, and Las Vegas Mission High School’s recovery program driven by peer mentors to empower students in meeting education and career success. MCAH partnered with Nevada’s Substance Abuse Prevention and Treatment Agency (SAPTA) to create a document of agencies serving youth for substance use and co-occurring disorders. Programs using peer educators were noted since this principle is considered a best practice. New resources were added to strengthen the content already placed within the Medical Home Portal.
Clinic Adolescent Health and Wellness Outcomes
Thirteen public health clinics were awarded Title V MCH funding to promote adolescent health and wellness. These entities encompassed Carson City Health and Human Services (CCHHS), a local health authority in Northern Nevada and 12 nursing clinics within DPBH Community Health Services (CHS) providing services in Nevada’s rural and frontier areas. During clinic visits, adolescents were screened for risk behaviors including nutrition and weight management, depression, intimate partner violence, alcohol, drugs, and tobacco/nicotine (including vaping) using Bright Futures Brief Risk Assessment tools. Age appropriate education and counseling were conducted along with referrals as needed. Education provided to avoid sexually transmitted infections and communicable diseases and treatment protocols follow Centers for Disease Control (CDC) guidelines. Clinicians were mandatory reporters and educated in the recognition of patients at risk for human trafficking, neglect, and abuse, as well as trained in the delivery of culturally competent care, including the provision of services to those in non-traditional relationships. Adolescents were screened for sexual coercion and encouraged to include family engagement in discussions regarding sexual decisions. Services were customized to the individual based on age and social determinants of health.
Through 4,284 clinic visits, adolescents were educated on wellness and the value of yearly visits. Reporting criteria to Title V MCH varied by funded agency. CCHHS revealed among the 184 well-visits, education and referrals were made to 49 users of alcohol, 50 substance users, 7 adolescents affected by intimate partner violence, and 19 experiencing depression. Additionally, CCHHS conducted reminder telephone calls for adolescent delayed in age-appropriate vaccinations. CHS provided 475 well care visits, 422 nutrition and weight management counseling sessions, and referrals were made to 4 experiencing depression. Title V MCH activities resulted in 306 identified sexually transmitted infections, delivery of 606 contraceptives, and administration of 636 immunizations (only a portion of reported numbers were Title V funded). During clinical visits, staff distributed diverse adolescent health-related brochures. Materials covered the benefits of being adequately insured, value of annual well-visits, reproductive health, sexually transmitted infections, depression, intimate partner violence prevention, tobacco cessation, and nutrition.
Clinics conducted outreach events and marketing campaigns to promote adolescent health and wellness. CCHHS provided education and resources to 237 high school students during health classes. Materials covered reproductive health, sexually transmitted infections, importance of a medical home, and value of annual well-visits. CCHHS promoted adolescent wellness exams at three outreach events and through a Facebook campaign reaching 2,681 individuals. CHS nursing personnel promoted wellness through outreach events and partnerships with schools, coalitions at health fairs, point of dispensing sites, and vaccine clinics.
Adolescent Immunizations
Title V MCH funding supported a 0.5 FTE position for Nevada’s Immunization Program. The linkage strengthens the infrastructure of the Title V MCH Program by improving adolescent health outcomes utilizing Bright Futures immunization schedule promotion within the medical home portal. Efforts focused on improving human papillomavirus vaccination completion (HPV) rates by providers participating in peer-to-peer education to deliver strong recommendations, and reminder/recall campaigns. Letters and materials for improvement were sent to 24 providers with low initiation rates and 43 clinicians with low series completion rates for adolescents aged 13-17 y.o.
Teen suicide is an emerging issue in Nevada. Data from the Electronic Death Registry System shows suicide rates for Nevada residents ages 0 through 17 have steadily increased from 2008 to 2018, rising from 0.9 per 100,000 to 3.9 per 100,000. A decrease was observed from 2018 to 2.08 per 100,000 in 2019. The chart below illustrates these trends.
*2019 data is preliminary and subject to change
Furthermore, the National Vital Statistics System (NVSS) shows adolescent suicide rate for ages 15 through 19 per 100,000 in Nevada was 15.2 from 2016-2018. This represents an increase of 12.6% from 2015-2017. This is higher than the U.S. rate of 11.1 from 2016-2018.
When stratifying suicide rates for ages 0 through 17 by county, differences are apparent between urban and rural residence. From 2015 to 2019, the urban counties, Clark (2.31 per 100,000) and Washoe (3.04 per 100,000), had lower suicide rates than the rest of the state (4.9 per 100,000), which is primarily composed of rural counties. Differences in suicide rates by urban/rural residence are also apparent when examining NVSS data for adolescent suicide rate for ages 15-19. The 2014-2018 rate was 22.1 in non-metro areas compared to 13.7 and 12.3 in small/medium and large metro areas respectively.
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2019 Nevada Youth Risk Behavior Survey |
|
|
|
|
Middle School Students |
High School Students |
|
Percentage of students who seriously considered attempting suicide/killing themselves during the 12 months before the survey |
21.8% |
18% |
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Percentage of students who made a plan about how they would attempt suicide/kill themselves during the 12 months before the survey |
12.9% |
15.3% |
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Percentage of students who tried attempting suicide/killing themselves during the 12 months before the survey |
8.1% |
8.9% |
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Percentage of students who have done something to purposely hurt themselves without wanting to die, such as cutting or burning themselves on purpose during the 12 months before the survey |
19.1% |
N/A |
|
Percentage of students whose suicide attempt resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse during the 12 months before the survey |
N/A |
2.8% |
While teen suicide specifically is not listed as a priority in the Nevada 2019 Needs Assessment, behavioral health is, which encompasses mental health concerns such as suicide.
The AHWP Coordinator attended the Adolescent Task Force convened by the Safe Kids Coalition in Washoe County. The task force provided direction for activities to develop Latino culturally and linguistically competent teen suicide prevention messages. Grant funds awarded by the Nevada Department of Health and Human Services by the Statewide Executive Committee to Review Child Fatalities allowed the Children’s Cabinet to conduct research to solicit responses from Latinos about depression and suicide risks. Latino clients, with an established base of trust with the agency, revealed cultural insensitivities to the most common assessments used. Further work from evidence-based assessments will address how to reduce cultural barriers for obtaining information.
Title V MCH state general fund MCH match funding helped support the Nevada Office of Suicide Prevention (OSP) in teen suicide prevention and systems-building projects. OSP supported Youth Mental Health First Aid (YMHFA) and school-based suicide prevention programs which enables adults to better recognize and assist adolescents in need of intervention. Statewide, mental health literacy was enhanced by training 561 community helpers to identify youth mental health risks using the YMHFA model.
OSP supported the Project AWARE comprehensive plan of activities, services, and strategies to decrease youth violence and support the healthy development of school-aged youth. Project AWARE helped develop a safe and respectful learning environment, promoted behavioral and mental health through school-based prevention and early identification efforts, and built awareness, connection and infrastructure across local and state entities to increase capacity providing access to mental health support.
OSP worked with the Nevada Department of Education (NDE) Office of Safe and Respectful Learning Environments on a multi-tiered system of support to threat assessment teams and practicing of protocols across Nevada school districts. During the 80th (2019) Session of the Nevada Legislature, several school-based suicide prevention bills were passed. OSP provided technical assistance and resources to help school districts implement the new requirements. The collaboration with NDE included cross-training staff in bullying prevention and suicide prevention during the Statewide Suicide Prevention Conference. OSP and NDE worked together on Model School District Policy on Suicide Prevention for schools to address the risks and protective factors impacting bullying and mental health concerns to decease suicide risks. Title V MCH match funds supported the Crisis Support Services of Nevada (CCSN) phone and text lines and the salary of the OSP Manager. CCSN assisted 5,560 youth with resources for depression, suicide, sexual assault, and intimate partner violence.
Success Story
Signs of Suicide (SOS) education program for students received the following feedback:
A grandmother anonymously called OSP whose 15-year-old granddaughter said a friend with mental health concerns was talking about suicide. The granddaughter did not want to get involved because she feared being bullied by others in her school. SOS teaches students how to identify the symptoms of depression and suicidality in themselves or their friends and encourages help-seeking by the ACT technique (Acknowledge the need for help, show you Care, Tell a trusted adult). The student reached out to her grandmother as the trusted adult to help her friend. The grandmother was given local resources to Safe Voice an anonymous system to report student safety or well-being threats, the Crisis Support Services Text line, and the National Suicide Prevention Lifeline. She followed through to help her granddaughter’s friend.
Sex and Human Trafficking
MCAH staff expanded partnerships with groups working to eliminate sex and human trafficking, an issue of concern to populations served by Title V MCH Programs, especially adolescents. Staff attended Protecting Our Adolescents Round Table Discussion facilitated by NVPCA. The workshop identified access barriers, shared available resources, potential interventions, and helped create partnerships for future efforts. Additionally, Title V MCH staffed a vendor table to network with community partners at an event raising funds for survivors of sex and human trafficking resulting in connections with the Attorney General’s Human Trafficking Program, Nevada Operation Underground Railroad, and Parents and Educators of Clark County. Title V MCH staff attended a meeting to learn the outcome of efforts by the Nevada Coalition to Prevent Sexual Exploitation of Children (CSEC). DCFS led the efforts directed by the Governor’s Executive Order 2016-14 to develop a strategic plan. The purpose of the meeting was for DCFS to share the CSEC Model Coordinated Response Protocol and Toolkit and Prevention Resource Guide. Title V staff shared the resources with the statewide MCH Coalition, Primary Care Office, and Nevada 211 allowing for agencies and providers to know of the resources.
Rape Prevention and Education Program
The Nevada Rape Prevention and Education (RPE) Program implements prevention strategies to avert sexual violence from occurring by using the public health approach to prevent first-time perpetration and victimization, reduce modifiable risk factors, and enhance protective factors associated with sexual violence. RPE primarily targets adolescents; however, the program also reaches young adults to reduce multiple forms of sexual and intimate partner violence. The RPE Program Coordinator is co-funded through Title V MCH Block Grant funds to create a full-time position dedicated to supporting sexual assault and violence prevention. Federally approved strategies reflected the expansion of previous RPE Program work preventing sexual violence through approaches impacting agency professionals, advocates, coaches and athletes, as well as school-aged students.
The Nevada Coalition to End Domestic and Sexual Violence (NCEDSV) hosted Courageous Conversations, an annual conference to support domestic and sexual violence statewide prevention efforts. The annual conference hosted 112 individuals from 11 counties introducing new strategies for improving organizational infrastructure through emerging trends, and best practices for creating systemic changes in the community and society.
MCAH Program staff from AHW, SRAE, PREP, CYSHCN, and RPE programs attended the conference to increase strategies for linking adolescent health to risks and protective factors related to sexual assault and intimate partner violence. Workshops focused on prevention efforts and services reflecting the rich diversity of the anti-sexual violence movement by dismantling the systems of oppression and inequity perpetuating and allowing gender-based violence to thrive. AHW staff expanded its knowledge about authentic youth engagement, trauma-informed principles, health equity, cultural humility, and intersectionality when building systems for engaging youth in organizations and community projects. SRAE/PREP staff learned how to reduce sexual and domestic violence by enhancing healthy relationships, reducing sexual coercion-related pregnancies, and using trauma-informed holistic approaches in safe and supportive environments. CYSHCN staff better understood the incidence of relationship violence in special needs populations and how to reduce occurrences.
NCEDSV held four regional trainings to support domestic and sexual violence statewide prevention efforts. Seventy-one individuals attended the trainings, taught by the Ohio Domestic Violence Network, discussing methods for reducing economic disparities which allow sexual and domestic violence to thrive. A webinar hosted by the NVPCA, Screening and Intervention Strategies for Adolescent Patients, shared how health care providers can make appropriate referrals to domestic and sexual violence organizations. The webinar included participants from rural areas where in-person trainings are not always feasible.
RPE provided education and awareness on issues related to dating violence through Your SPACE presentations. A total of 9,673 middle and high school-aged youth received healthy relationship presentations promoting respectful relationships and increased awareness of sexual abuse connected to dating violence. The training encouraged bystander behavior to circumvent potentially violent situations whenever possible.
Funded activities included the Party SMART Campaign. Party SMART used social media to endorse planning and awareness of ways to avoid sexual assaults by following simple tips to ensure a good time without compromising safety.
RPE funded community partners to increase athlete awareness of relationship abuse and toxic masculinity through Mentors in Violence Prevention (MVP) training. The teaching consisted of role-plays intended to allow students to construct and practice viable options for active bystander intervention in response to incidents of harassment, abuse, or domestic and sexual violence. MVP trainers conducted workforce development with school personnel for improving leadership skills to promote the role of adult professionals in creating and sustaining a school climate which discourages abusive behavior. Participants included 3,821 individuals from 66 agencies including University of Nevada, Reno, fraternities and sororities, community-based organizations working with high- risk youth (Job Corps, incarcerated youth, homeless youth, youth living in residential treatment centers) and Washoe County School District students attending Title I Schools.
In collaboration with the University of Nevada Las Vegas Jean Nidetch Women’s Center, a CARE Peer Program 45-hour empowerment-based training curriculum was conducted with 292 students. The interactive modules focused on increasing awareness of community and societal factors leading to sexual violence and harassment, as well as increasing social norms which protect against violence. Following leadership preparation, new peer advocates delivered trainings on campus to the student body and self-identified campus groups. An Interpersonal Violence Collaborative Interest Group, consisting of administrative and educational faculty, convened quarterly for the purpose of building campus infrastructure to establish best practices and evidence-based strategies for policy reform in response to interpersonal violence and harassment on the campus.
Using MCAH funding and technical assistance from subject matter experts facilitated by the CYSHCN MCH Coordinator, NCEDSV created an advisory committee to identify needs of parents and caregivers who wish to support and protect youth and young adults living with developmental disabilities prevent relationship abuse. The committee reviewed existing sexual assault prevention materials and made recommendations on preferred strategies to support parents and caregivers. A webpage was added to the NCEDSV website to provide appropriate resources for this high-risk population. A “Supporting Adolescents with Disabilities Who Are Experiencing Relationship Abuse and Sexual Violence: Setting the Stage for Prevention” workshop was presented at the Nevada State Child Abuse Prevention and Safety Conference, as well as two similar workshops offered during the NCEDSV Annual Conference.
According to the 2010 National Intimate Partner and Sexual Violence Survey Summary Report, among adult victims of rape, physical violence, and/or stalking by an intimate partner, 22.4% of women and 15.0% of men first experienced some form of partner violence between 11 and 17 (y.o.). More than three-quarters of female victims were first raped before 25 years of age and 42.2% experiencing their first rape before the age of 18. One quarter of male victims of completed rape were first raped when they were 10 (y.o.) or younger.
State Teen Pregnancy Prevention Programs
Two teen pregnancy prevention programs are housed within MCAH; the Sexual Risk Avoidance Education Program (SRAE) and the Personal Responsibility Education Program (PREP). The SRAE Program educated youth on benefits associated with delaying sexual activity to avoid related risky behaviors, and to prevent sexually transmitted infections (STIs), including HIV/AIDS. The SRAE and PREP Programs both shared positive youth development (PYD) principles, whereas, the PREP curricula focused on enhancing adulthood preparation by providing abstinence and comprehensive sex education to prevent pregnancy and sexually transmitted infections, including HIV/AIDS. While Title V MCH funds do not support SRAE efforts, Title V MCH staff worked closely with SRAE and PREP on cross-cutting efforts to enhance positive youth development, outreach to high-risk youth, teen pregnancy prevention, and preventing relationship violence by supporting healthy relationship education. Program staff shared pertinent resources provided by other state adolescent health coordinators focused on similar goals and embraced opportunities to network with Title V MCH staff at national conferences.
Sexual Risk Avoidance Education Program
Over 750 youth ages 10-19 y.o. participated in SRAE in northern and rural Nevada. Priority enrollment was given to adolescents who are at-risk, homeless, or in foster care. Participants were recruited through CCHHS, Family Resource Center of Northeastern Nevada-Elko, (FRCNEN), Quest Counseling, and NyE Communities Coalition and local partnerships.
In 2017, National Vital Statistics System data shows the teen birth rate in Nevada was 21.9 births per 1,000 females ages 15-19 y.o., whereas in 2018, the teenage pregnancy rate was 20.5 pregnancies per 1,000 teen girls ages 15-19 y.o. SRAE built partnerships to reduce teen pregnancies and births through evidence-based curricula providing an inclusive, non-stigmatizing environment addressing the social, psychological, and health gains realized by abstaining from sexual activity.
The curricula, Promoting Health Among Teens! -Abstinence Only (PHAT! -AO and Teen Outreach Program (TOP), used theoretical frameworks focused on PYD principles. Topics covered included healthy decision-making, engagement in healthy relationships, and peer group development for positive social values and norms. The curricula reduces teen pregnancy by teaching sexual responsibility through accountable sexual behavior decision making, encouraging respect among themselves and others, increasing effective life management skills, and stresses the importance of developing a positive self-image. The activities were designed to help participants feel comfortable practicing abstinence, address concerns about this practice, and provide strategies for overcoming obstacles through community service-learning projects.
Two data factsheets in English and Spanish, highlighting national, state, and county-specific statistics on teen pregnancy were disseminated through the TPP Program and sub-awardees for promotional events and conferences. Sub-awardees promoted the Nevada 211 website and distributed Nevada Tobacco Quitline, Medical Home Portal and Title V MCH provided Does Your Teen Need Health Coverage? brochures.
As part of the Nevada SRAE local evaluation plan, a statewide needs assessment was implemented to identify barriers and gaps to improving the health of youth across the state. The needs assessment, conducted by Health Management Associates, Inc., included cross mapping to identify Health Professional Shortage Areas (HPSA) in primary care organizations working with teens, Nevada’s unique needs related to HPSAs across the state, and challenges many counties are currently experiencing. Seven interviews were completed with 15 participants from Carson City, Clark, Nye, Elko, Washoe, and Eureka counties. Five focus groups, consisting of 34 participants were held in Pahrump, Las Vegas, Henderson, and Reno. The interviews included topics of discussion on mental health, substance use, violence, and sexual health. A community survey was implemented in White Pine, Eureka, Elko, and Humboldt counties with 40 participants composed of health service providers in Elko. Individuals who participated in the local evaluation were teens and young adults, including but not limited to, pregnant and parenting teens, parents, teachers, and health care providers.
Success Story
Partner implementing SRAE Program
“This success story is about one of the girls who took the class while at the juvenile detention center. During class the girl expressed that she knew she could be someone, but apparently had never had anyone support her in that belief. She made the choice to take the educator’s words to heart and to believe in herself and her ability to make proud and responsible choices going forward. She knew that putting her old life behind would be difficult. She knew that she would risk potential fallout from her old friends, and that she may repeat certain mistakes. A few months after the class, the educator saw the girl again. She was no longer in the juvenile detention center. The girl ran up to the educator and gave her a giant hug. The girl thanked the educator for helping her see who she could be. She told the educator she had left all her bad influences behind and made all new friends, joined clubs at school, hadn’t been placed back in detention since their first meeting and she was getting ready to attend her very first youth group. This youth had transformed into a successful young woman as a result of the positive influence of the program.”
Personal Responsibility Education Program (PREP)
Over 600 youth ages 13-19 y.o. participated in PREP in northern, southern and rural Nevada targeting youth who are experiencing homelessness, in foster care, juvenile justice involved, and minority groups, including LGBTQ. Five agencies, Planned Parenthood Mar Monte and Rocky Mountain, The Center, FRCNEN, and CCHHS, were awarded funds to reduce Nevada teen pregnancy and teen births, as well as reduce sexually transmitted infections including syphilis and HIV/AIDS, and implement activities to prevent sex trafficking of youth. Comprehensive sex education was taught using several evidence-based curriculums: ¡Cuidate!, Sexual Health and Adolescent Risk Prevention (SHARP), Teen Success, Making Proud Choices (MPC), and Reducing the Risk with the lesbian, gay, bisexual, transgender, and queer (LGBTQ) supplemental adaptation. This focus on LGBTQ youth is driven by data showing this population experiences disproportionate burdens of priority health risk behaviors and negative health outcomes. The 2019 Nevada High School YRBS Sexual and Gender Minority report found that LGBTQ students had increased risk burdens across six different risk categories compared to non-LGBTQ students, as shown in the tables below.
Footnote: Students were asked to report on risk behaviors and health outcomes for each risk category. The number of behaviors per category varies. The tables below show how many risk behaviors or health outcomes within each risk category were significantly different for LGBTQ youth.
Footnote: Students were asked to report on risk behaviors and health outcomes for each risk category. The number of behaviors per category varies. The tables below show how many risk behaviors or health outcomes within each risk category were significantly different for LGBTQ youth.
The curricula reduce teen pregnancy and repeat teen birth by teaching confidence and skills to reduce STDs, HIV, and pregnancy by abstaining from sex or increasing condom use if choosing to have sex, as well as reducing alcohol-related sexual risk behavior. Furthermore, the curricula contain culturally based interventions to reduce HIV sexual risk among Latino youth and empowers teen mothers through social-emotional learning skills for healthy relationships and self-care for a successful future. The maps below illustrate Nevada’s teen pregnancy rate and repeat teen birth rate by mother’s residence zip code.
The 80th Legislative Session of the Nevada Legislature passed Senate Bill (SB) 94 allocating 6 million dollars over the biennium in state general funds to support reproductive health and contraceptive access statewide. While funding is focused on supporting reproductive health and access, SB 94 also allows for the use of funds for immunizations and prenatal care support. Local health authorities, community, public health clinic, and county partners were awarded funds to implement the goals of SB 94. The Reproductive Health Coordinator funded by SB 94 is situated within the MCAH Section and has worked closely with MCAH data and teen pregnancy prevention staff.
Success Story
Partner Implementing PREP
“What I love about teaching sexual health is creating an environment that empowers young people to talk about their own experiences. Sometimes their experiences are horrible and other times they are very healthy. Each group offers unique learning opportunities through discussion of the subject material. I must admit I usually learn something each group. Youth vary in their knowledge and attitudes around sexual and reproductive health. I had a couple in one of my groups recently that were vocal about not needing to use condoms and that they were fine and in love, nothing could touch them. My program Making Proud Choices is 8 hours long, so I was with this group for several weeks. I did not shame the couple but did ask curious questions like “Have you both been tested for STIs?” or “What method of birth control do you practice?”. On the last day of the group, I asked everyone if they had any takeaways from the class. The young woman from the couple said, “We [her and her partner] had a long talk and we decided that we really need to change how we’re protecting ourselves.”, as she looked to her partner who nodded in agreement. The group gasped collectively and clapped for the new decisions this couple had decided to make. I found out later that the reason I had been contacted to teach was because one of the members of the group had become pregnant months earlier and the facilitator wanted to prevent another group member from becoming pregnant or infected with an STI.”
Adolescent Physical Activity Report
Social Media
DP Video was awarded Title V MCH funding to arrange promotional efforts of physical activity video posts on Facebook, Instagram, and Twitter targeting youth and parents/caregivers to help promote change in adolescent daily physical activity habits. Campaign messaging was pilot tested by Nevada youth of various socioeconomic and cultural backgrounds, including those experiencing special health needs.
DP Video created two seasonal social media campaigns to increase the number of middle school and high school students engaging in at least 60 minutes of daily physical activity. The one-month campaigns displayed adolescents and families with youth engaging in physical activity. All English and Spanish messages reached intended targeted ages, racial and ethnic groups, and met Culturally and Linguistically Appropriate Services (CLAS) standards. The campaign accommodated individuals with visual impairments to ensure compliance with Americans with Disabilities Act (ADA) regulations. Youth assisted messaging and images resulted in 185,483 twitter display impressions, Facebook video advertisements resulted in 145,045 views, 205,342 impressions, and 117,179 engaged visitors.
Trauma-Informed Care Yoga for Youth
Student self-reports from the 2019 Nevada YRBS disclosed 21.9% of middle school and 20.5% of high school students engaged in physical activity at least 60 minutes daily, indicating the need for more movement programs. Furthermore, Nevada lacks specialized physical activity programs for high-risk and special needs youth, although state physical activity education standards are predicated on inclusivity. A 2017 Nevada YRBS Adverse Childhood Experiences (ACEs) report revealed 51.1% of middle school and 62.2% of high school students were affected by a lifetime prevalence of ACEs which can contribute to negative health outcomes. This indicates the need for prevention and intervention strategies targeting early adverse experiences to reduce mental health consequences into adulthood.
Consequently, MCAH staff attended conferences and webinars to understand how trauma effects the developing adolescent brain in healthy decision making. The AHW, SRAE, and PREP programs shared resources obtained with youth serving agencies and youth advisory councils to enhance their understanding of trauma-informed principles and better engage with youth impacted by ACEs.
Title V MCH Program funded Urban Lotus Project (ULP) to provide physical activity to high-risk adolescents and those with special health care needs. ULP offers Trauma-Informed Yoga for Youth to benefit adolescents effected by a high lifetime prevalence of ACEs to increase physical activity, provide resilience, support mindfulness to combat obesity and chronic disease, enhance wellness, and help mitigate other harmful public health outcomes.
This practice allows physical activity to be available at no-cost in a safe environment to high-risk young people. It provides access to physical activity for 60 minutes, often only available at a significant financial cost to youth of all socioeconomic statuses and in restrictive contexts for other physical activity alternatives. Urban Lotus Project provides inclusive environments, regardless of social and cultural factors. Cultural humility is built into the practice since teachers nurture the strengths, interests, and talents of each student, as well as honor each person’s beliefs, customs, and values.
During the reporting period, adolescents were served at 18 facilities with 624 yoga classes taught to 640 individuals. Most students attended multiple yoga classes resulting in 3,077 pupil exposures. Extensive evaluations resulted in moving this cutting-edge practice along the continuum to a promising practice inside the Association of Maternal and Child Health Programs (AMCHP) Innovation Station database. http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Urban%20Lotus%20Project%20Trauma-Informed%20Yoga%20for%20Youth.pdf
Success Story
Student Reponses to Yoga Exposure
"I learned I was capable of calming my body without anything or anyone else." - age, 14
"Yoga has changed who I am. I feel more happy and I'm starting to love myself." - age, 15
"It has made me think I'm not just a violent person." - age, 14
"I feel a little closer to finding out who I am inside." - age, 13
“I was feeling sad, depressed and homesick before I came to yoga. After, although I can feel them still, I have a sense of peace about me now.” - age, 12
“Being mindful is like being awake. Like knowing what’s up all around and inside you.” – age, 14
Admissions Manager at Location
“Urban Lotus provides a great opportunity for these youth to find peace within themselves in a world that affords them so few opportunities to do so.”
Mom of Urban Lotus Project Student
“My son was recently incarcerated at the Jan Evans juvenile facility for several months. While he was there, he attended yoga classes taught by Hannah from Urban Lotus Project. I happened to visit him one day just after he had finished one of her classes. He told me that he felt so peaceful and relaxed afterwards. I have always thought [yoga] would be good for him because he has ADHD and a lot of trouble controlling his impulses. I am so happy that he was able to experience what yoga has to offer him. The work that Urban Lotus Project is doing is so valuable to these at-risk kids. It offers them an opportunity to learn techniques to calm themselves and be reflective. I know it has shown my son that he has the capacity to calm himself and slow down his thoughts.”
Accomplishments of Adolescent Health and Wellness Program
The AHWP focused its activities to help improve the health status of adolescents, which have long-term implications for adult health, productivity, and longevity. Title V MCH successfully promoted public health approaches to protect, promote, and improve adolescent physical, behavioral, emotional, and mental health statewide. Best practices were shared with funded agencies and community members on how best to serve adolescents regarding yearly well-visits, healthy weight management/exercise, immunizations, sexual behavior, nicotine/tobacco/vaping, alcohol/substance use, and mental health. Extensive evaluations resulted in moving the Urban Lotus Project Trauma-Informed Yoga for Youth cutting-edge practice along the continuum to a promising practice inside the AMCHP Innovation Station database. The AHWP expanded its knowledge base about authentic youth engagement, trauma-informed principles, health equity, cultural humility, and intersectionality when building systems for engaging youth into organizations and community projects.
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