The Bureau of Family Health (BFH) provides services to the adolescent health population domain through a combination of Title V funding and other federal funding, as described below. Within the BFH, most adolescent health programs are situated in the Division of Child and Adult Health Services (DCAHS). By administering the majority of adolescent federal grants in the same division, expertise about emerging needs and best practices for the population is easily shared among Title V and other federally funded programs. Based on overall population needs and the existing capacity and accomplishments of other programs, the BFH has developed strategies for the Title V action plan that do not duplicate other funding sources and fill gaps that are not addressed by the existing system of care.

 

In 2018, the sex and race/ethnicity of Pennsylvania’s adolescent population (n=1,565,533) were distributed as shown in the table below.

 

2018 Pennsylvania Adolescents (ages 10-19)
Sex
51%	Male
49%	Female
Race/Ethnicity
77%	White
14%	Black
4%	Asian/Pacific Islander
4%	Multi-race
11%	Hispanic

 

According to 2017 Youth Risk Behavior Surveillance System (YRBSS) data, 37.6 percent of ninth through 12th grade students in Pennsylvania (PA) responded affirmatively that they, “ever had sexual intercourse.” In 2017, 27.1 percent of ninth to 12th grade students reported that they had sexual intercourse with at least one person during the three months before taking the survey. Additionally, 11.8 percent of ninth to 12th grade students who were currently sexually active reported that they “did not use any method to prevent pregnancy” during their last sexual intercourse encounter. These combined data demonstrate the need for programming on the prevention of pregnancies and sexually transmitted infections, including HIV/AIDS in PA.

 

In PA, there is a downward trend of teen pregnancy rates and teen birth rates. Despite this trend, there remains a disparity in teen pregnancy rates in PA, particularly by race and ethnicity, as shown in the table below.

 

2018 Pennsylvania Teen Pregnancy Rates, per 1,000 youth (ages 15-17)
Race/Ethnicity
5.2	White
24.6	Black
2.2	Asian/ Pacific Islander
17.3	Multi-Race
20.5	Hispanic

 

The BFH implements several initiatives aimed at addressing the disparate impact of teen pregnancy on racial and ethnic minority youth and provides parenting supports for youth with the greatest need. The Personal Responsibility Education Program (PREP), funded by the Administration for Children and Families, educates youth on abstinence, contraception, and adulthood preparation subjects. Evidence-based curricula are implemented in settings including drug and alcohol facilities, residential treatment facilities, and community-based health or human service agencies. During calendar year 2019, 2,699 youth completed an evidence-based program at a PREP facility (an increase of 82 percent from the previous year). The Department has nine subgrantees that provide PREP programming.

 

The BFH also utilizes Support for Expecting and Parenting Teens, Women, Fathers and their Families funding from the Office of Adolescent Health. Funding is used for the Support. Empower. Learn. Parenting Health Initiative (SELPHI) program which helps expectant and parenting adolescents and their families navigate key social and health services in Philadelphia. Philadelphia has the highest teen birth rate of any county in PA and ties for the third-highest teen birth rate among the 11 largest counties in the United States. In state fiscal year 2019, SELPHI served 123 clients, including 55 pregnant women.

 

Adverse Childhood Experiences (ACEs) can have lasting effects on one’s health and behaviors. ACEs typically fall into three categories: abuse, neglect, and household challenges (e.g. witnessing domestic violence in the home or having a parent or guardian who is incarcerated). The 2017-2018 National Survey of Children’s Health reveals that 21% of PA children 17 years of age and younger have experienced one ACE, and 16.5% have experienced two or more ACEs.

 

While ACEs and risk factors are associated with negative health outcomes, protective factors are those characteristics in relationships, communities, and society that lower the likelihood of negative outcomes, or even counter the effects of risk factors. The BFH aims to increase protective factors among adolescents through evidence-based and evidence-informed mentoring programs. The Teen Outreach Program (TOP), funded by the Title V Sexual Risk Avoidance Education Grant, promotes abstinence from sexual activity among youth through an evidence-based approach that aims to affect positive youth behavior change and improve outcomes for youth. The program implements strategies to build protective factors for participants and promote the optimal transition of youth living in high-risk communities from middle childhood to adolescence. A competitive Request for Applications was released in 2019 and sites were selected in Philadelphia, Allegheny, Fayette, Lawrence, and Mercer Counties. A total of 32 TOP Clubs were formed in schools with 756 youth attending TOP Clubs. The 2019-2020 school year is the first year for TOP implementation in PA.

 

Lesbian, Gay, Bisexual, Transgender and Questioning/Queer (LGBTQ) youth face unique challenges, including higher rates of bullying and harassment than their non-LGBTQ peers. The 2017 Gay, Lesbian, and Straight Education Network (GLSEN) National School Climate Survey reports a majority of PA’s LGBTQ youth regularly heard anti-LGBTQ remarks at school and had been victimized at school. Many LGBTQ youth did not have access to in-school resources and supports. Only 13 percent of students attended a school with a comprehensive anti-bullying/harassment policy that included specific protections based on sexual orientation and gender identity/expression. Due to the lack of support for these youth, 54 percent of LGBTQ students who were bullied never reported it to school staff. Among those students who did report bullying to staff, only 35 percent said reporting resulted in effective intervention by staff. While these statistics are specific to youth attending school, youth in out-of-home placement experience bullying and harassment at even higher rates. A study found 78 percent of LGBTQ youth were removed or ran away from their out-of-home placements because of hostility based on their sexual orientation or gender identity. Other research has found that approximately 56 percent of LGBT youth in out-of-home care have spent some time without stable housing because they felt safer on the streets than in group or foster homes.

 

According to the 2017 YRBSS, 38.5 percent of LGB high school students in PA seriously considered suicide (survey participants were only asked about their sexual orientation). Compared with the percentages for heterosexual peers, these numbers are exceptionally high. The survey results showed that 12.1 percent of straight teens had seriously considered suicide. Rates are even higher among LGBTQ youth who come from highly rejecting families: families whose behaviors rejected their child’s LGBTQ identity, such as preventing a gay youth from attending family events or physically hurting a child because of their LGBTQ identity.

 

In addition to the aforementioned programming, the BFH began implementation of the Acquired Brain Injury (ABI) and Opioid Training Program, funded by the Title V Maternal and Child Health (MCH) Block Grant in 2019. The ABI and Opioid Training Program was developed to create and deliver a training curriculum that focuses on the correlation of ABI and opioid use/misuse. The BFH contracted with the Brain Injury Association of Pennsylvania (BIAPA) to create and deliver training to professionals who serve adolescents and are within the brain injury and drug and alcohol field on a statewide level. The ABI and Opioid Training Program will ensure that appropriate health and health related services, screenings and information are available to the adolescent population. In 2019, BIAPA created a brain injury fact sheet and identified possible training locations. Development of the curriculum will continue in 2020 and this new strategy is described further in the application narrative

Priority: Protective factors are established for adolescents and young adults prior to and during critical life stages

 

NPM 9: Percent of adolescents, ages 12 – 17, who are bullied or who bully others

 

Objective 1: For the duration of the grant cycle, BFH will annually increase the number of adolescent health vendors receiving training to improve rates of intervention when bullying/harassment is witnessed and increase the number of supportive staff available to LGBTQ youth

 

ESM: Percent of adolescent health vendors receiving LGBTQ cultural competency training

 

PREP grantees are required to attend LGBTQ cultural competency training. In addition, PREP grantees must attend additional LGBTQ-focused trainings: both a “101” that serves as an introduction to LGBTQ issues that may arise during PREP implementation, and an Advanced Topics training, on topics ranging from bullying, to transgender youth, to health disparities. In addition to the PREP implementation sites’ training requirements, the BFH offers optional LGBTQ cultural competency training to all adolescent health vendors/grantees. In 2019, 56 percent of currently active adolescent health grantees received LGBTQ cultural competency training, a decrease of fifteen percent from the previous year. Scheduling conflicts at the end of the year resulted in Title V mentoring and bullying prevention programs tabling training initiatives until the early part of the next calendar year, which was then impacted by the COVID-19 pandemic. Trainings that had to be canceled or postponed will be rescheduled and the BFH will aim to exceed the evidence-based strategy measure (ESM) 9.1 annual goal (the percent of adolescent health grantees receiving LGBTQ cultural competency training), and have new grantees trained within the first year of the grant agreements.

 

Objective 2: Increase the number of adolescents participating in a bullying awareness and prevention program

 

In 2019, the BFH was accepted to participate in the Child Safety Network Child Safety Learning Collaborative (CSLC) and plan to focus on bullying prevention efforts. This collaborative will allow the BFH to join a national network of peers to share lessons learned, implement evidence-driven strategies and programs, participate in ongoing trainings, and receive technical assistance from nationally renowned content experts.

 

ESM: Number of trainers trained in the Olweus Bullying Prevention Program

 

The Olweus Bullying Prevention Program (Olweus) is the most commonly used bullying prevention program in PA. In addition, PA has the largest cadre of Olweus trainers in the nation. Clemson University’s Institute on Family and Neighborhood Life is the hub for Olweus training and consultation for North America; therefore, BFH staff met with Clemson University and the PA Department of Education staff in early 2017 to determine how the BFH can best support implementation of Olweus and its trainers and address the objective: increase the number of adolescents participating in a bullying awareness and prevention program.

 

Based on these discussions, the BFH and Clemson University have partnered to develop a program to train and certify community youth organizations to implement Olweus. Clemson University began their work developing the program July 1, 2018. The BFH issued a Request for Applications (RFA) in January 2019 and selected eight community youth organizations to become trained and implement the program beginning January 1, 2020. Grant agreements with community youth organizations were expected to begin in 2019, but delays in grant agreement execution occurred. These delays prevented trainings from occurring until 2020.

 

Priority: Protective factors are established for adolescents and young adults prior to and during critical life stages

 

Objective 1: For the duration of the grant cycle, BFH will annually increase the number of LGBTQ sensitive organizations which provide services to youth

 

ESM: Number of organizations certified as a safe space provider

 

The BFH continues to support Persad Center (Persad) and Mazzoni Center (Mazzoni) with Title V funds to provide services to LGBTQ youth. Persad implements the Safe Spaces Project, which provides suicide prevention training to youth, and engages in coalition building activities with known ally organizations and new partners to help the organizations become Safe Space certified. To address ESM 9.6 (the number of organizations certified as a safe space provider) in calendar year 2019, Persad provided one organization (50 individuals) with training to become Safe Space certified, resulting in 34 organizations that are now safe space certified as of 2019. There were 511 youth who took advantage of the Safe Spaces provided by Persad in 2019, 129 fewer youth than were reached last year. Persad experienced a high rate of staff turnover in 2019 and, for this reason, struggled to provide the same level of services that were provided in previous years.

 

Mazzoni provides training on health disparities related to sexual orientation, gender identity and appropriate standards of care for LGBTQ individuals and LGBTQ cultural competency training to medical, behavioral health and social service providers. During calendar year 2019, Mazzoni trained 2,043 participants in cultural competency and health disparities. The number of trained participants has increased from the previous year. Mazzoni was able to provide training to many community-based organizations, including county agencies and hospital programs. Mazzoni continues to utilize electronic training evaluation forms and complete training needs assessments before providing trainings to tailor them to the audiences Mazzoni is serving.

 

Objective 2: For the duration of the grant cycle, BFH will annually increase the number of LGBTQ youth who have access to suicide prevention interventions

 

ESM: Number of LGBTQ youth receiving evidence-informed suicide prevention programming

 

The BFH provided Title V funding to Persad to implement the Yellow Ribbon Suicide Prevention Program five times, which reached 67 youth in the calendar year 2019. This is 246 fewer youth than were reached in 2018. Persad staff report that this training has been in less demand due to the “Safe 2 Say Something” programming that is being implemented in schools across the state. “Safe 2 Say Something” is a violence prevention program run by the Pennsylvania Office of Attorney General that provides a confidential way to report potential safety concerns, including recognizing suicide warning signs. Persad implements the Yellow Ribbon Suicide Prevention Program within their Signs of Suicide program, an evidence-informed intervention that is modified to be LGBTQ inclusive. The Signs of Suicide program includes screening and education and aims to prevent suicide attempts, increase knowledge about suicide and depression, develop desirable attitudes towards suicide and depression, and increase help-seeking behavior among youth. Persad utilizes this program in schools and community centers throughout Allegheny and Washington counties. The program is also used to raise awareness of suicide prevention in the community. Signs of Suicide has been shown to significantly lower rates of suicide attempts and increase youths’ knowledge of depression and suicide. The program demonstrates significant reductions in self-reported suicide attempts.

 

Priority: Protective factors are established for adolescents and young adults prior to and during critical life stages

 

SPM: Percent of youth ages 8-18 participating in evidence-based or evidence-informed programs who increased or maintained protective factors or decreased risk factors

 

Current mentoring grantees are unable to accurately collect and report the percent change in protective factors or risk factors influencing positive youth development and health outcomes. Each mentoring grantee is implementing an evidence-based or evidence-informed model unique to their agency, and uniform data collection is not feasible. As such, this SPM will be discontinued and a new measure corresponding to this work was developed. The new SPM is described in greater detail in the application narrative.

 

Objective 1: Annually increase the number of youth participating in evidence-based or evidence-informed mentoring, counseling and adult supervision programs

 

ESM: Number of youth participating in evidence-based or evidence informed mentoring, counseling or adult supervision programs

 

Objective 2: For the duration of the grant cycle, the BFH will annually increase the number of evidence-based or evidence-informed mentoring, counseling, and adult supervision programs available to youth ages 8-18

 

ESM: Number of evidence-based programs implemented in high risk areas of Pennsylvania

 

The benefits of youth forming supportive, healthy relationships between mentors and mentees are both immediate and long-term. Increased high school graduation rates and a better attitude about school; overall healthier relationships and lifestyle choices; higher college enrollment rates and higher educational aspirations; higher self-esteem and self-confidence; improved behavior, both at home and at school; stronger relationships in part due to improved interpersonal skills; and decreased likelihood of initiating drug and alcohol use are all outcomes that can be obtained through effective mentoring programs for youth.

 

The BFH awarded three grants to implement youth mentoring programming. Three organizations, Big Brothers Big Sisters Independence Region, City Year Philadelphia, and Students Run Philly Style began program implementation in January 2018 and were selected based on their ability to increase protective factors in the target population and their capacity to reach youth. In state fiscal year 2019, a total of 13,347 unique youth mentees received evidence-based mentoring from 567 mentors. This did not meet the goal of 15,270 youth outlined in the mentoring grantees’ work statements due to slight changes in reporting. The mentoring grantees’ work statements do not specify unique youth. In prior reporting periods, youth may have been counted multiple times if they received multiple forms of mentoring. Reporting changes were made to collect data on unique youth served.

 

A comprehensive LGBT health needs assessment conducted by Bradbury-Sullivan LGBT Community Center revealed that the LGBT community in the Lehigh Valley has the highest obesity rate in PA when compared to other LGBT respondents across Pennsylvania. Additionally, two-thirds of youth served by Bradbury-Sullivan are LGBT youth of color who are at increased risk for obesity and Type II Diabetes. To address this disparity, the BFH partnered with Bradbury-Sullivan to implement the Healthy Eating and Active Living (HEAL) Program with the goals of increasing knowledge about healthy eating and active living and improving the overall health and wellness for participants. The HEAL Program began on April 1, 2018 and provides youth participants with healthy eating and recreational activities on a weekly basis that are guided by adults. Adults also supervise and lead a weekly healthy living discussion group designed to facilitate and promote healthy habits. The HEAL program served 557 unique youth in calendar year 2019.

 

To increase protective factors among LGBTQ youth transiting to adulthood, the BFH partnered with Persad Center to implement the Youth Age Opportunity Program (YAOP), funded by Title V. YAOP serves LGBTQ youth ages 17 to 24 years old who experience skill and opportunity barriers to launch successfully into adulthood. Youth are offered screenings and assessments during Persad Center’s drop-in hours. In 2019, 198 youth were provided services. Services ranged from job preparation, financial literacy classes, emergency housing, practicing interview skills, social outings with a mentor, and leadership development.

 

In 2018, BFH developed a program in partnership with the Pennsylvania Coalition Against Domestic Violence (PCADV) to address healthy relationships and intimate partner violence. Funded with Title V funds, the program titled Healthy Adolescents Promoted by Partnerships for Youth (HAPPY) is operational in Delaware and Lawrence Counties. Services began in the summer of 2018. HAPPY engages community-based adolescent health providers and reproductive health providers to accomplish three goals: 1.) Decrease the incidence of adolescent relationship abuse in PA through improved case identification and clinic based direct assessment/interventions; 2.) Increase adolescent health and safety by promoting healthy relationships; and 3.) Improve core and other community partners’ capacity to prevent adolescent relationship abuse. Community teams, located in the individual counties, continue to meet with youth to assess for incidents of adolescent relationship abuse using evidence-based practices and educational materials. The primary point of contact for youth is through school personnel, who is usually the school nurse. Appropriate referrals are made to medical professionals and domestic violence agencies when necessary. The community teams also provide outreach services in the schools and communities to inform youth and adults about available services.

 

A total of 1,195 youth were reached in calendar year 2019 either through medical clinical visits, educational and outreach activities, or warm referrals for family planning or domestic violence services.

 

There is also a State Leadership Team (SLT) within the HAPPY program which is comprised of individuals from across the Commonwealth and serves as an advisory committee to the community teams. The SLT meets quarterly and works towards assisting the community teams with program implementation and providing any additional technical assistance requested by the community teams. There is also an evaluation team from the Children’s Hospital of Pittsburgh which has been evaluating the HAPPY Program. The evaluation team has been collecting program specific data including number of youth served by provider type, number of adolescent relationship abuse prevention cards distributed, and number of warm referrals being made. The data is then analyzed to take a more qualitative approach to programming and to look at areas which may need additional support. One of the areas of need found within the past year of the project include the warm referral process. It was determined extensive technical assistance was needed for the community teams in determining when a warm referral is necessary and how exactly to conduct a warm referral.

 

In 2019, the BFH contracted with the Ed Snyder Youth Hockey Foundation to implement the Male Involvement Initiative program and address intimate partner violence. The program utilizes the Coaching Boys into Men (CBIM) curriculum to promote violence prevention, greater gender equity and respectful and non-violent relationships with dating partners. The Foundation has provided CBIM to adolescent and young males during their life skills hockey program and 97 individuals were served during 2019.

When combining numbers reached for all programs within the ESM: number of youth participating in evidence-based or evidence-informed mentoring, counseling and adult supervision programs, a total of 16,150 youth were served in reporting year 2019. The 2019 goal is 475 youth served. This goal was estimated prior to the three youth mentoring grants being in place and will be adjusted for future years. The 2019 goal for ESM 9.5: number of evidence-based mentoring, counseling or adult supervision programs implemented in high risk areas of PA, was nine. In 2019, that goal was exceeded as youth were attending programming in 11 counties, all selected for their high-risk, high-need youth populations.

 

Priority: Adolescents and women of child-bearing age have access to and participate in preconception and interconception health care and support

 

NPM 10: Percent of adolescents, ages 12-17, with a preventative medical visit in the past year

 

Objective 1: In the first year of the grant cycle, BFH will annually increase the number of counties with an HRC available to youth ages 12-17 either in a school or community-based setting

 

ESM: Number of counties with an HRC available to youth ages 12-17

 

Objective 2: Beginning in the second year of the grant cycle, the BFH will annually increase the number of youth ages 12-17 utilizing HRC services

 

ESM: Number of youth receiving services at an HRC

 

ESM: In schools with an HRC, the percent of youth within that school utilizing the HRC services

 

In response to National Performance Measure (NPM) 10 (percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year), the BFH supports teen pregnancy prevention services through AccessMatters, who uses Title V funds to provide a variety of services to high school students through the Health Resource Center (HRC) program. The HRC program provides sexual and reproductive health education, confidential, individual level counseling, screening for chlamydia, gonorrhea, and pregnancy testing, referrals and direct linkages to core family planning services, and distribution of safer sex materials (male and female condoms and dental dams). HRCs are located in high schools or clinics near a school and are open during hours that are convenient to youth. AccessMatters operates HRCs in thirteen Philadelphia area schools and three Philadelphia area community sites. There are an additional twenty-seven sites in ten additional counties across the Commonwealth. The twenty-seven additional HRCs, considered expansion sites from the original HRCs, operate in areas with high rates of teen pregnancies, STIs and youth leaving school before graduation.

 

Currently, there are HRCs operating in eleven counties. The counties are Philadelphia, Delaware, Berks, Lackawanna, Lycoming, Dauphin, Allegheny, Fayette, Beaver, Lehigh, and Venango Counties. The goal for ESM 10.1: the number of counties with an HRC available to youth ages 12-17 for 2019, is eleven counties.

 

In calendar year 2019, the HRCs provided services to 11,134 youth. The goal for ESM 10.2: the number of youth receiving services at an HRC during this time period, was 4,500 youth.

 

The goal for ESM 10.3: In schools with an HRC, the percent of youth within that school utilizing the HRC services, was 21 percent. In calendar year 2019, the percent of youth, of all school-based HRCs, who utilized HRC services was 12 percent.

 

To increase visibility and youth-friendliness of the HRCs, the expansion sites were given additional funding to form Youth Advisory Boards. The Boards promote the services of the HRCs, design health awareness campaigns, inform HRC services, and ensure HRC services are teen-friendly. AccessMatters continues to provide training and technical assistance to sites for developing and maintaining Youth Advisory Boards.

 

Objective 3: For the duration of the grant cycle, the BFH will annually increase the number of LGBTQ youth with a medical visit in the past year

 

ESM: Number of youth receiving services at a drop-in site funded by the BFH

 

Mazzoni Center provides, with Title V funds, a drop-in health center for youth to obtain a variety of health care and social services. Mazzoni Center provided 3,164 youth with medical services at their drop-in health center in calendar year 2019. This was 684 fewer youth than last year. Mazzoni Center nearly reached their goal of 4,200 youth served at a drop-in site. Moreover, 4,802 youth received case management visits (1,499 more youth than calendar year 2018), and 3,618 unduplicated youth received one service.

 

Objective 4: Starting with reporting year 2015, BFH will increase the number of youth receiving health education and counseling services during a reproductive health visit

 

ESM: Number of youth receiving health education and counseling services from a reproductive health provider

 

In April 2019, the BFH increased the age limit for adolescents eligible for Title V services from 17 years of age or younger to 21 years of age or younger to provide more adolescent clients with reproductive health counseling services. In calendar year 2019, BFH provided 22,870 adolescents with services, far exceeding the goal of 15,375 youth served and increasing reach by 114% over the previous year. The BFH periodically reassesses the scope of services that are billable to Title V. In 2018, the family planning councils reported that more youth are obtaining services under their parents’ insurance plans or are otherwise able to pay for services. For youth who are unable to pay, there is a wider range of services needed than were previously allowable. As such, the list of allowable billing codes grew.

 

Maternal and Family Health Services, a family planning provider, continued their promotion of the SafeTeens Answers! text line. Staffed by Planned Parenthood of the Rocky Mountains, youth can text their sexual health and healthy relationship questions to the text line and receive a complete, age-appropriate, and medically accurate response within a few hours. Referrals to the appropriate hotlines are also provided if a texter identifies a need for prenatal care, LGBTQ support, suicide intervention, or information on rape, abuse, or neglect. During calendar year 2019, 1,602 texts were received, and 176 teens were referred to in-person services. The most common question topics were pregnancy related, including how to know if one is pregnant and identification of the most effective birth control method.