2018 Report: Adolescent Well Care
National Performance measure (#10):
Percent of adolescents with a preventive medical visit in the last year.
Interpretation of national performance measure data:
The National Performance Measure (NPM 10) percent of adolescents with a preventative medical visit in the last year has been steadily increasing since 2003 (according to the National Survey of Children’s Health). While 2017 data is not comparable to 2012 – the rates of adolescents with a well-visit is at a state high of 79.9 percent of those aged 12-17. State level data (Oregon Health Teens and Medicaid data) echo improvements in preventative care for adolescents. We believe that Medicaid Coordinated Care Organizations’ emphasis on the well-visit in combination with partnerships between Medicaid, Title V, and Oregon Pediatrics Society have increased knowledge of the well-visit among providers and have provided more promotion of these services. Moreover, the Affordable Care Act ensures access to the well-visit by mandating insurance coverage for this preventive care without cost sharing.
Strategy: Promote policies and practices to make youth health care more youth friendly.
Report
- Educated health professionals with data on measures of health and well-being from Oregon Health Teens Survey, and tied data to the importance of the adolescent well-visit and programs that support youth resiliency such as youth participatory action research. After the release of the 2017 Oregon Healthy Teens data, we updated the Snapshot of Adolescent Health, a multi-domain data presentation for providers, educators, and other health professionals to help them understand all aspects of adolescent health. The Snapshot highlights policy and socioeconomic context for trends in health outcomes and highlights the need for preventative services in addressing and screening for health issues which youth face. Domains include substance use, mental health, physical health/activity, access to clinical services, reproductive health, and social determinants of health. The Snapshot can be tailored to the audience’s needs, but always presents data on adolescent well-visits and promotes its use as an intervention in improving the presented outcomes. Presented the Snapshot to 20 audiences (about 250 attendees total) across the state of Oregon in the 2017-18 grant cycle.
- Through the Snapshot, we created data visuals that highlight disparities in adolescent health and access to clinical services. The Snapshot clearly shows health and access disparities for Native American and LBGTQ+ youth and as part of outreach. We used the data points to promote the need for culturally competent and youth friendly care for these populations.
- Presented data to health care providers and insurers on the importance of resilience building and positive youth development on youth health outcomes – relating those concepts back to the adolescent well-visit. In June of 2018, made a presentation to 265 health professionals associated with Oregon Medicaid’s Coordinated Care Organizations on the importance of positive youth development and resilience.
- Over the summer of 2018, sat on a workgroup with Oregon’s school administrators, principals and teachers for policy discussions related to school-based health services, with an emphasis on access to mental health services. Provided information to 60 school administrators on school-based health centers (SBHCs), qualified mental health providers at SBHCs, the adolescent well-visit, and how those strategies provide screenings and interventions for youth at school. Helped to formulate policy ideas that promote access to school-based services in schools.
- Over the summer of 2018, began a process of youth engagement to improve school health surveys. Held focus groups, key informant interviews and surveys with youth to better understand how they feel about their health and how the State should tailor the content and process of youth health surveys to better capture those feelings. Based on qualitative data from youth, we presented recommendations to survey steering committee for changes to the survey content and process. One key piece that came out was that youth want to be asked about resources and assets in their lives that help them make healthy decisions, and this included access to clinical services like the well-visit.
- Supported and educated providers on confidentiality laws relevant to minors, particularly HB 2758. Information material on HB 2758 (allows for patients enrolled in a private health insurance policy to request confidential communications) distributed to health care providers via email in response to inquiries about the law.
- Promoted adolescent well-visits using social media messages. The Oregon Health Authority uses Twitter and Facebook to promote messages around the Oregon State Health Improvement Plan (SHIP). We took this as an opportunity to:
1. frame adolescent health issues within the context of SHIP priorities areas and
2. promote the well-visit as a viable way to meet SHIP goals. The Adolescent and School Health Program submits two social media messages per month, with many of those messages promoting the well-visit.
Accomplishments
When updating and promoting the Snapshot of Adolescent Health, the data showed important trends with respect to mental health, resilience, and sexual health. It was used by audience members in legislative testimony, reporting, and other presentations. The Snapshot was presented to 20 audiences across the state of Oregon in the 2017-18 grant cycle. Audience members often refer other groups to see the presentation – creating new partnerships in promoting the well-visit and adolescent health.
Our engagement with youth driven organizations on youth health surveys has created partnerships that can be used to improve youth outreach and youth friendly policy and clinical practice. It has also improved our survey process and helped us consider ways to make health surveys more youth friendly.
Challenges and emerging issues
Integrating school-based health services into schools has been difficult in some communities due to a lack of providers and various funding streams/financial constraints for school-based health. This has created access issues for the well visit and mental health screenings.
ESM 10.1: Number of health professionals trained on adolescent well-visits.
Progress on ESMs
ESM 10.1: For the 2018 reporting year, the Oregon Title V program reached 575 professionals working on youth health with presentations on positive youth development, confidentiality and privacy, and population health data for youth
Strategy: Promote practice of going beyond sports physicals. (State and local Level).
Report
- In October of 2017, state staff held a panel discussion for Oregon’s school-based health center coordinators on different ways sites are transforming sports physicals into adolescent well-visit. Three sites which have modified workflows, practice, and policy to increase the number of student athletes getting adolescent well-visits were highlighted. These examples acted as models for other school-based health centers working on the same issue. Overall, 68 health professionals received the information.
- Oregon School Activities Association (OSAA), Public Health Division, Transformation Center, Health System partners continued to distribute joint adolescent well-visit and PPE comparison document to School-Based Health Centers, athletic departments, CCOs, and local partners. In Summer of 2018, distributed 100 copies of the document to health professionals at the National School Based Health Alliance conference.
- State Title V staff supported Harney, Jefferson, and Lake Health Departments as they work to promote the adolescent well-visit over the sports physical. Provided well-visit/sports physical document to these sites and help Lake and Harney County prepare and shift the focus of health fair events that were traditionally geared towards sports physicals.
- Lake County shifted the focus of health fair events that were traditionally geared towards sports physicals. 150 youth participated in the fair and they rotated youth through stations that included other preventive services like immunizations.
- Jefferson County worked with local healthcare providers to "phase out" sports physicals and incorporate well-visits as part of routine care. 100% of sports physicals done in the Jefferson County SBHC now include a full well-visit. However, some other community providers continue to only do sports physicals.
- Harney County partnered with schools, the local hospital system and clinics to try to encourage families to get well-visit for their youth, including at the school. They also promoted the well-visit through media and newspaper through 15 media releases.
Accomplishments
The biggest accomplishment of the year was the panel discussion for SBHC coordinators, because it gave sites best practice and practical methods for implementing policy and work flows to improve adolescent well-visits through the sports physical.
Challenges and emerging issues
Coordinated Care Organizations can still count a sports physical as an adolescent well visit for incentive metrics. The sports physical is still entrenched in some local adolescent practices. While CCOs have been a great partner in trying to get their providers to do well-visits instead of sports physicals, providers can still meet their metrics by doing sports physicals. Removing sports physicals from the adolescent well-visit metric will take a state policy change involving many partners. Several communities still prefer the sports physical to the well visit – one reason being that Athletic Departments use the screening as a revenue source. There is some parent resistance to the well-visit and the more comprehensive screenings that are included.
ESM 10.2: The number of health professionals trained and informed to promote the practice of going beyond the sports physical.
Progress on ESMs
ESM 10.2: For the 2018 reporting year, the Oregon Title V program reached 168 health professionals with training and information about the differences and comparative strengths between the adolescent well-visit and the sports physical, and how to use the Oregon Sports Pre-Participation Examination (PPE) either to complete or refer for an adolescent well-visit.
Strategy: Increase outreach to key populations in the community.
Report
- Coos County created a sizeable amount of promotional materials and distributed them through county fairs and community partners. Radio and Facebook messages were also posted regarding the importance of adolescent well-visits.
- Morrow County connected with community partners – CCO, FQHC, Schools, and others – to promote adolescent well-visit and offered several events to increase referrals for the adolescent well-visit. They were able to generate 250 referrals through these events.
Accomplishments
Morrow County had a list of well-established regional partners which contributed to 3-month campaign with at least three major events. This helped increase the number of referrals (250 referrals of the grant period) for well-visits.
Challenges and emerging issues
Local level documentation of data has been a challenge. It has been difficult to assess what outcomes events drives and referrals are having.
Strategy: Leverage SBHC to conduct broader outreach within school and community.
Report
- Jefferson County leveraged youth to inform students and families of the importance of the adolescent well-visit. As a result, Madras High School School-Based Health Center (in Jefferson County) had doubled monthly visits (15 per month) in the second year of operation. Community awareness of the clinic and the services provided also increased. Additionally, there was an overall increase in the awareness of the importance of the mental/behavioral health components of the well-visit.
Accomplishments
Jefferson leveraged youth word of mouth to increase utilization, which could further their youth engagement in other issues (youth friendliness of clinic space, etc).
Challenges and emerging issues
There were issues with referrals between SBHCs and other community providers when well-visit screenings revealed the need for other care.
Strategy: Raise awareness of the importance of adolescent well-care.
Report
Morrow County staff created targeted messages which were delivered to students and families through monthly school-based robo calls, social media, organization websites, community promotoras/outreach workers and print media. Youth were also identified by utilizing a patient roster or student athlete list to contact and schedule those in need of a well care exam.
Accomplishments
Morrow County reports that sports physicals “have essentially been replaced with adolescent well care exams.” Partners have “committed to a community benefit payment policy that once insurance has been billed, there is no out of pocket cost to the individual. Quality measures are reviewed on a monthly basis and quality improvement plans are initiated if quality goals are not met. The intent going forward is to spread the broader message about the value of accessing age appropriated well care visits for everyone, which will present its own unique set of challenges.”
Challenges and emerging issues
N/A
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