ADOLESCENT Priority Need 1: Enhance strengths, skills and supports to promote positive development and ensure youth are healthy and thrive. (2020-2025 Action Plan) 

 

Surveillance:

Throughout 2021-2022, The Maternal, Child, and Adolescent Health Division of the California Department of Public Health (CDPH/MCAH) monitored the health of California adolescents as part of its routine health surveillance efforts. The select indicators and measures listed in the table below were continuously and systematically collected, analyzed, and interpreted to guide program planning, implementation, and evaluation of interventions. These indicators were analyzed at the state and sub-state levels to identify specific improvement opportunities. 

 

Select Adolescent Health Indicators and Measures	Data Source
Referral to preventive services	Adolescent Family Life Program (AFLP) data
Adolescent birth rate, ages 15-19	CA Birth Statistical Master file (BSMF)/ Comprehensive Master Birth File (CMBF)
Intimate partner violence	CA Maternal Infant Health Assessment (MIHA)
Hormonal or intrauterine device contraceptive use	Youth Risk Behavior Survey (YRBS)
Condom use	YRBS
Contraceptive use (Dual Use)	YRBS
Sexually Transmitted Infections (STI)	STD Control Branch program data
Preventive medical visits	National Survey of Children’s Health
Suicide ideation	CA Healthy Kids Survey
Suicide rate	CA Comprehensive Master Death File, CA Department of Finance
Living in foster care	CA Child Welfare Indicators Project
Population size	State Population Projections, CA Department of Finance
Insurance status	American Community Survey
High school dropout	CA Department of Education
Graduation rates	CA Department of Education
California Sexual Health Needs Index	Multiple sources
Depression (related feelings; suicide ideation)	CA Healthy Kids Survey; YRBS
Teen dating violence	CA Healthy Kids Survey; YRBS
School connectedness	CA Healthy Kids Survey
Have a caring adult that they can talk to about a serious problem	National Survey on Drug Use and Health

 

As part of California’s Title V State Action Plan, focus areas were identified in each population domain to help guide the work. Each year, the 61 Local Health Jurisdictions (LHJs) in California develop annual Scopes of Work (SOW) that contain activities that align with the state’s Title V Action Plan and these focus areas.

 

The following graph shows the number of LHJs and the related focus areas in the Adolescent Health Domain that had activities the LHJs planned to implement in their 2021-2022 SOWs.

 

 

• 33 LHJs (55%) worked on Adolescent Focus Area 1: Improve sexual and reproductive health and well-being for all adolescents in California, in 2021-2022
• 18 LHJs (30%) worked on Adolescent Focus Area 2: Improve awareness of and access to youth-friendly services for all adolescents in California, in 2021-2022
• 27 LHJs (45%) worked on Adolescent Focus Area 3: Improve social, emotional, and mental health and build resilience among all adolescents in California, in 2021-2022

 

The following graph shows the number of activities in each focus area in which the LHJs conducted efforts to address these areas in their 2021-2022 SOWs.

 

 

• 49 SOW activities supported Adolescent Focus Area 1: Improve sexual and reproductive health and well-being for all adolescents in California were implemented by 33 LHJs (55%) in 2021-2022
• 17 SOW activities supported Adolescent Focus Area 2: Improve awareness of and access to youth-friendly services for all adolescents in California were implemented by 18 LHJs (30%) in 2021-2022
• 41 SOW activities supported Adolescent Focus Area 3: Improve social, emotional, and mental health and build resilience among all adolescents in California were implemented by 27 LHJs (45%) in 2021-2022

 

Adolescent Focus Area 1: Improve sexual and reproductive health and well-being for all adolescents in California. 

 

Adolescent Objective 1:

By 2025, increase the proportion of sexually active adolescents who use condoms and/or hormonal or intrauterine contraception to prevent pregnancy and provide barrier protection against sexually transmitted diseases as measured by: 

 

• percentage of sexually active adolescents who used a condom at last sexual intercourse from 55% to 58% 
• percentage of sexually active adolescents who used the most effective or moderately effective methods of FDA-approved contraception from 23% to 25%.

 

Story Behind the Curve:

Sexual development is a critical and normal part of adolescent development. Support for young people's healthy sexual development is essential.[1] Providing adolescents with access to high quality sexual and reproductive health information and services, such as contraception provision, is critical to promoting healthy sexual wellbeing, and preventing unplanned pregnancy and STIs.[2]

 

Factors that impact the curve from the baseline include a variety of barriers adolescents may face when accessing sexual and reproductive health care services and information, including the following:

 

• Black, Indigenous, and other adolescents of color often experience inequitable health care coverage and social determinants of health shaped by systemic racism that negatively impact their sexual and reproductive health outcomes and care.
• Young people who identify as LGBTQ may be less willing to seek care if they feel their provider is unable to meet their needs or that their identity will not be respected.
• The health care system in the U.S. makes minimal accommodations for adolescents with disabilities.[3]

 

Both nationally and in California, few young people (ages 15 to 19) use the most effective types of contraception. The Centers for Disease Control and Prevention (CDC) has reported that use of Long-Acting Reversible Contraception (LARC) is low, and even fewer use dual contraceptive methods.[4] To address this and similar issues, connecting youth with high-quality sexual and reproductive health education and services is core to the adolescent health program efforts put forth by the CDPH/MCAH.

 

Adolescent Objective 1: Strategy 1: 

Lead surveillance and program monitoring and evaluation related to adolescent sexual and reproductive health. 

 

Activity:

CDPH/MCAH will lead in updating and utilizing the California Adolescent Sexual Health Needs Index (CASHNI) to target adolescent health programs in areas of the state with greatest need.

 

Narrative:

In March 2022, CDPH/MCAH released the report California Adolescent Sexual Health Needs Index 2018. This report revealed wide geographic disparities in sexual and reproductive health outcomes among young people across the state. To help address this challenge, CDPH/MCAH developed this data-informed index to assist in determining the geographic eligibility for service sites providing adolescent sexual health education and case management in a fair and equitable manner. The report was disseminated as part of MCAH adolescent programs’ Request for Application (RFA) and posted on the MCAH adolescent health data website.

 

Activity:

CDPH/MCAH will lead in updating and disseminating the Adolescent Sexual Health County Profiles.

 

Narrative:

CDPH/MCAH released the Adolescent Sexual and Reproductive Health County Profiles for each of California's 58 counties to its partners and stakeholders in March 2022. These reports are designed to provide insight into the health and environment (i.e., community, home, and school) of young people in California. Data presented in the county profiles reflect common measures of adolescent sexual health, as well as broader life experiences related to social determinants of health and social disparities. Each county profile contains overall California data and county-specific data for each indicator.

 

Activity:

CDPH/MCAH will lead surveillance of California adolescent birth rates, with a focus on identifying inequities, and disseminated findings.

 

Narrative:

CDPH/MCAH creates indicator-specific dashboards for California, all designed to serve the data needs of our partners and stakeholders. State-, county- and/or regional-level indicator data are shown by various stratifications or subgroups and by year. Each dashboard also includes a link to download the data. The dashboards are organized by the five Title V health domains. CDPH/MCAH released trend data on adolescent birth rates statewide, by race/ethnicity, age group, and by county through MCAH data dashboards.

 

Activity:

CDPH/MCAH will disseminate data briefs focused on key topics and trends related to the adolescent birth rate and/or adolescent birth outcomes (e.g., pre-term and low birthweight) and/or suboptimal interpregnancy interval in California.

 

Narrative:

Partners and stakeholders identified Adolescent Repeat Births, and State Regional Contributions of Declining Adolescent Births as the two data briefs most valuable to their local programs.

 

Activity:

CDPH/MCAH will lead monitoring and evaluation of the MCAH adolescent health programs: Adolescent Sexual Health Education (ASH Ed) Programs, CA Personal Responsibility and Education Program (CA PREP) and Information and Education (I&E), and the Adolescent Family Life Program (AFLP).

 

Narrative:

CDPH/MCAH continued to monitor and evaluate the MCAH adolescent health programs, provide data dashboards to local-funded agencies, and disseminate the findings through data briefs, as well as programmatic and scientific abstracts and manuscripts.

 

The Adolescent Family Life Program (AFLP) launched the Youth Satisfaction Survey in May 2022 to gauge the experiences and preferences of youths participating in the program. The survey was conducted between May 16 and June 30 of 2022, and aimed to collect biennial, cross-sectional data. In order to ensure the smooth conduct of the survey, AFLP provided Youth Satisfaction Survey data collection training in May 2022. Additionally, in March 2022, AFLP obtained Spanish language translation certification for one of its research scientists to support the translation of all youth data collection instruments and the analysis of qualitative data. This move aimed to ensure the inclusion of Spanish-speaking youths in the survey and the availability of translated data for analysis.

 

The Adolescent Sexual Health Education (ASH Ed) Program has been preparing for a new program cycle by revising and streamlining data collection processes and developing a new data collection system, which is scheduled to launch in October 2022. To ensure the relevance of the program, the team worked closely with various agencies and updated the California-specific portions of the entry and exit surveys. This revision included the addition of two items to assess youths' exposure to intimate partner violence and the removal of items assessing sexual behavior and the assigned-sex-at-birth of youths' sexual partners. The ASH Ed program also regularly analyzes and submits aggregate data to meet CA PREP federal reporting requirements, which occur four times per year. However, the program experienced substantial staff changes that caused some delays in evaluation activities and quality improvement work with local agencies.

 

Activity:

CDPH/MCAH will provide both static and dynamic data dashboards to MCAH adolescent health programs to help maintain and/or improve data quality, monitor program implementation, monitor participant engagement with program, and inform technical assistance and continuous quality improvement efforts.

 

Narrative:

MCAH continued disseminating monthly AFLP data quality dashboards and provided ongoing technical assistance to support agencies using dashboards to improve data quality and program implementation. Dashboards are now provided to agencies on the 15th of every month or the next business day if the 15th falls on a weekend or holiday. CDPH/MCAH launched Penelope case management system Tableau reports in September 2021, enabling state and local staff to perform real-time monitoring of program implementation.

 

Activity:

CDPH/MCAH will disseminate MCAH adolescent health programs data and findings and statewide population-based surveillance data and research through issue and data briefs and/or programmatic and scientific abstracts and manuscripts.

 

CDPH/MCAH released an annual data summary for AFLP in September 2021. The summary provided a comprehensive overview of the characteristics of the youth served and program implementation during the previous state fiscal year. In preparation for a series of data briefs on program implementation and outcomes, CDPH/MCAH analyzed data from the AFLP Comprehensive Baseline Assessment and Youth Outcome Assessment throughout the reporting period. The validation of these analyses began in January 2021 and the data briefs are expected to be completed during the 2022-2023 reporting period. MCAH also routinely shares relevant surveillance data related to adolescent sexual and reproductive health with the state Adolescent Sexual Health Work Group (ASHWG) to stay updated and informed on the latest developments in the field.

CDPH/MCAH disseminated the following scientific abstracts and manuscripts:

 

• Drafted a manuscript describing the development of the Expectant and Parenting Youth Resilience Scale with co-authors from the University of San Francisco.
• Oral presentation at APHA, October 2021: Chabot, M., Kwan, K., Campa, M., Pressfield, L., Leff, S., Mitchell, C. Family resilience and supportive neighborhood: Relationships with ACES and California children, ages 0-17.
• Oral presentation at National Conference on Health & Domestic Violence, April, 2021: Chabot M., Mitchell C. Association between adolescent relationship violence and suicide attempt among California youth.
• Manuscript published November 2021: Decker, M., Atyam, T., Gilmore-Zárate, Bautista, C., Saphir, M. & Bayer, A. Adolescents’ perceived barriers accessing sexual and reproductive health services in California. BMC Health Services Research.
• Manuscript submitted for publication April 2022: Decker, M., Gilmore-Zárate, Atyam, T., & Saphir, M. Improving adolescent perceptions of barriers and facilitators to sexual and reproductive health services through sexual health education.
• Manuscript published June 2022: Decker, M., Price, M., Unti, L., Firpo-Triplett, R., Atyam, T., Spitzer, J & Coyle, K. Monitoring unplanned sexual health curricula adaptations. Using results to improve fidelity and support implementation. Evaluation and Program Planning, 94, 102-126.

 

Success(es):

CDPH/MCAH updated the California Adolescent Sexual Health Needs Index (CASHNI) to target adolescent health programs in areas of the state facing the greatest need. This index allows CDPH/MCAH and others to provide a data-based distribution of available resources for adolescent health programs to areas across the state facing the greatest inequities in sexual and reproductive health services and outcomes. The updated CASHNI was used in the recent ASH Ed Request for Applications for the CA PREP and I&E programs released in January 2022.

 

Challenge(s):

Lack of staffing, due to a combination of COVID-19 redirections and other staff vacancies, has resulted in activities for this strategy being paused, slowed, or shifted. Priorities have changed at the local level due to the COVID-19 pandemic, and activities need to be re-examined and potentially revised.

 

Adolescent Objective 1: Strategy 2: 

Lead to strengthen knowledge and skills to increase use of protective sexual health practices within CDPH/MCAH-funded programs. 

 

Activity:

CDPH/MCAH will lead, develop, and disseminate a resource brief for public health professionals and parents/caregivers related to youth-friendly sexual and reproductive health information and resources.

 

Narrative:

This activity was delayed due to staffing vacancies for this reporting period. There are plans to develop and disseminate helpful resources for parents and caring adults in celebration of Let’s Talk month, which occurs every October and encourages adults to discuss sexual and reproductive health with the young people in their lives.

 

Activity:

CDPH/MCAH will lead in dissemination of revised Positive Youth Development (PYD) Model content that will be implemented by 16 local AFLP agencies and tracks local feedback for the next round of revisions and/or supplemental materials.

 

Narrative:

CDPH/MCAH’s updated PYD model tools were implemented by 16 AFLP local agencies during this reporting period. CDPH/MCAH continues to track local agency feedback for future revisions.

 

Activity:

CDPH/MCAH will lead in sharing trainings on protective sexual health practices to local agencies.

 

Narrative:

CDPH/MCAH hosted a live virtual training for 29 ASH Ed and 16 local AFLP agencies on the topic of supporting adolescent healthy relationships. The material presented was intended to build knowledge and skills around identifying and supporting important conversations around healthy and unhealthy aspects of relationships and young people’s experiences.

 

CDPH/MCAH hosted a live virtual training for 29 local ASH Ed agencies on the topic of healthy masculinity. The goals of the training were to help local staff identify the six major negative impacts of adhering to rigid norms around masculinity and to understand how messages we receive about gender roles impact them and their work with youth.

 

Activity:

CDPH/MCAH will lead in providing family planning and safer sex content (as a core program priority) into PYD Model basic trainings.

 

Narrative:

CDPH/MCAH coordinated one AFLP PYD basic training for 16 local AFLP agencies that covered topics relating to family planning and safer sex strategies.

 

Activity:

CDPH/MCAH will lead in promoting best practices for parent/caring adult engagement.

 

Narrative:

CDPH/MCAH’s Adolescent Sexual Health Education (ASH Ed) Program led in promoting best practices for parent/caring adults in the following ways:

• 29 local ASH Ed agencies engaged parents and caring adults through various activities in the community to support youth in receiving comprehensive sexual health education as well as build parents/caring adults’ confidence in engaging in medically accurate and open conversations. Parents/caring adults were given a virtual preview of the evidence-based/evidence-informed sexual health curricula prior to implementation.

• In the 2022-2025 Request for Application (RFA), CDPH/MCAH added an additional option to expand and enhance parent/caring adult program activities with general funds (I&E) to build parents’/caring adults’ knowledge through specific training, outreach, education, and engagement activities. CDPH/MCAH approved three program models (“Parents Matter,” “Families Talking Together,” and “Talking Parents, Healthy Teens”) as evidence-based options for implementation.

 

Activity:

CDPH/MCAH will partner with the CDPH Violence Prevention Initiative, a cross department priority, to reduce adolescent relationship violence.

 

Narrative:

CDPH/MCAH maintains participation in the Violence Prevention Initiative (VPI) Steering Committee and collaborates with/supports VPI partners on a variety of activities. During this reporting period, CDPH/MCAH continued learning sessions between the MCAH Adolescent Health team and the Injury and Violence Prevention Branch to learn and share about the adolescent healthy relationships education, rape prevention, and suicide prevention programs within CDPH.

 

Success(es):

The ASH Ed program was restructured to allow CA PREP agencies to apply for I&E funding to expand and enhance their parent/caring adult program activities. Research indicates that parents/caring adults who are informed and able to talk about sexual and reproductive health issues with the young people in their lives can play a foundational role in ensuring that youth have sufficient information, skills, and support to access care. The I&E funding strengthens the impact of parents/caring adults on adolescent sexual and reproductive health outcomes by providing additional dedicated funds for local agencies to build parents’/caring adults’ knowledge through specific training, outreach, education, and engagement activities.

 

Challenge(s):

Lack of staffing, due to a combination of COVID-19 redirections and other staff vacancies, has resulted in activities being paused, slowed, or shifted. Priorities have changed at the local level due to the COVID-19 pandemic, and activities need to be re-examined and potentially revised.

 

Adolescent Objective 1: Strategy 3: 

Partner across state and local health and education systems to implement effective comprehensive sexual health education in California. 

 

Activity:

CDPH/MCAH will lead and fund implementation of ASH Ed Programs, CA PREP and I&E, with diverse youth populations using evidence-based and evidence-informed curriculum.

 

Narrative:

CDPH/MCAH led and funded implementation of 21 local CA PREP and eight I&E programs. CA PREP is federally funded by the Family and Youth Services Bureau and I&E is state funded through the General Fund. ASH Ed contributed to the strategy in the following ways:

 

• CA PREP provided comprehensive sexual health education via effective, evidence-based program models to 10,615 California youth, nearly all of whom were between the ages or 10 and 19.
• CA PREP agencies provided comprehensive sexual health education in a range of settings, including schools, juvenile justice facilities, homeless shelters, and foster care group homes. CA PREP activities also included community engagement, adult preparation, and promotion of clinical linkages to youth-friendly reproductive health services.
• In the Request for Application (RFA) for State Fiscal Years 2022-2025, the ASH Ed Program was restructured to leverage the unique parameters of both CA PREP and the I&E funding, allowing for innovation and enhanced programming based on best practices and input from formerly funded ASH Ed agencies. The structure was developed to address local-level needs and challenges and to create opportunities to effectively meet the ASH Ed goals.​

 

Activity:

CDPH/MCAH will lead in updating the selected evidence-based and evidence-informed CA PREP/I&E curricula.

 

Narrative:

CDPH/MCAH revised the approved Evidence-Based Program Model (EBPM)/Evidence-Informed Program Model (EIPM) list for CA PREP and I&E curricula in response to feedback received from local implementing agencies (LIA). The program model review process was informed by LIA feedback and by the results of the California Healthy Youth Act (CHYA) growth and development and sexual health curricula reviews completed and published by the California Healthy Kids Resource Center (CHKRS) and ASHWG in November 2021. The CDPH/MCAH added “Teen Talk” (all versions) and “Rights, Respect, and Responsibility (3Rs)” and removed “Cuídate” and “Be Proud! Be Responsible!” from the approved curricula list.

 

Activity:

CDPH/MCAH will lead in coordinating ASHWG and participates in the Steering Committee to strengthen the network of state health, education partners, and non-governmental organizations working to improve adolescent sexual and reproductive health.

 

Narrative:

CDPH/MCAH led in coordinating quarterly ASHWG meetings and continued to participate in the Steering Committee. CDPH/MCAH contributed to the development of a blog post for ASHWG’s public-facing website describing the Steering Committee’s participation in a Racial Equity Challenge. CDPH/MCAH also supported the revision of the ASHWG membership application to include questions about racial equity. Most recently, CDPH/MCAH participated in discussions to update the structure and bylaws of the group to better align with its anti-racist and inclusive framework. CDPH/MCAH continued to fund the coordination of ASHWG meetings, including the quarterly membership meetings, the monthly Steering Committee meetings, and bi-monthly subcommittee meetings.

 

Activity:

CDPH/MCAH will partner with ASHWG to develop and disseminate resources and best practices to local MCAH programs.

 

Narrative:

CDPH/MCAH contributed to developing and disseminating state and national level data comparison and analysis from the 2019 Youth Risk Behavior Survey (YRBS). The resource was posted on the ASHWG website and disseminated to 61 local health jurisdictions and 45 local AFLP and ASH Ed agencies.

 

Activity:

CDPH/MCAH will support the Healthy Sexual Development workgroup led by the California Department of Social Services (CDSS) to ensure comprehensive sexual health education is provided to foster youth.

 

Narrative:

CDPH/MCAH continued to participate in the CDSS Healthy Sexual Development workgroup, formed with the passage of Senate Bill 89, which requires social workers, caregivers, and other adults in the lives of youth in foster care to be trained in reproductive and sexual health issues. CDPH/MCAH disseminated information and resources to local AFLP agencies about a new state law (AB 153) that expands financial benefits to expectant and parenting youth in foster care.

 

Success(es):

Updating the selected evidence-based and evidence-informed comprehensive sexual health education curricula was a major accomplishment for MCAH during this reporting period and allows MCAH to continue to fund high quality comprehensive sexual health education to young people in a variety of settings across the state.

 

Challenge(s):

• Misinformation about sexual health education targeted at parents and caregivers makes this strategy challenging, particularly in rural areas of our state. ASH Ed agencies should continue to engage with parents/caregivers and school administrators about laws in California related to sexual health education and student and parent/caregivers’ rights. Agencies should also discuss the positive health outcomes of sexual health education for young people in terms of their health and well-being.

 

Adolescent Focus Area 2: Improve awareness of and access to youth-friendly services for all adolescents in California. 

 

Adolescent Objective 2: 

By 2025, increase the percentage of adolescents aged 12-17 with a preventive medical visit in the past year from 76.2% to 83.8%. 

 

Story Behind the Curve:

During preventive health care visits, adolescents get important screenings, health counseling, and interventions.[5] The Bright Futures guidelines recommend that adolescents have an annual checkup from age 11 through 21. Preventive visits are especially important for this age group because behaviors that can affect long term health often start in adolescence.[6]

 

Receiving health care services, including annual preventive well visits, helps adolescents with the following:

 

• Staying healthy and avoiding health risks.
• Talking about and getting help for mental health concerns.
• Getting immunizations to prevent cancer and infections and managing chronic conditions.[7]

 

Data demonstrate that a significant proportion of adolescents and young adults are not receiving the recommended preventive health services to address their behavioral and physical health needs. Services they do receive may not be youth-centered or align with their developmental stages.

 

Factors that influence the curve include whether the youth is enrolled in school, is housed, is in the foster care or juvenile justice systems, identifies as LGBTQ+, has access to health insurance, feels comfortable with health care providers, and has access to a network of supportive adults in their communities.

 

The COVID-19 pandemic has significantly impacted a young person’s ability to have a preventive health visit. A recent study showed that overall, 26% of US households reported that one or more children or adolescents had missed or delayed preventive visit because of COVID-19.[8] Access to and coverage for telemedicine has the potential to increase preventive visits given the pandemic.

 

Adolescent Objective 2: Strategy 1: 

Lead to develop and implement best practices in CDPH/MCAH funded programs to support youth with accessing youth-friendly preventive care, sexual and reproductive health care, and mental health care. 

 

Activity:

CDPH/MCAH will continue to partner with local partners to implement evidence-based screening tools or evidence-informed assessments to link adolescents to needed services.

 

Narrative:

CDPH/MCAH partnered with several stakeholders to implement the following evidence-based screening tools or assessments to link adolescents to needed services:

• Despite decreases in overall enrollment and monthly caseload (likely due to COVID-19) and challenges adapting to virtual services, local AFLP agencies continued to administer both baseline and follow-up assessments to youth. These assessments were utilized to learn about youth needs and strengths and were conducted using motivational interviewing techniques. Among 999 youth receiving services, 91% received at least a baseline or follow-up assessment. (Source: AFLP 2021-2022 Annual Data Summary)
• CDPH/MCAH worked with local AFLP agencies to increase the percentage of youth who were screened and referred for basic needs and who received a comprehensive assessment of needs through quality improvement efforts, including monthly data quality dashboards released in 2021-2022. Some local AFLP agencies conducted supplemental mental health, substance use, and other screenings to support the well-being of youth and their families.

 

Activity:

CDPH/MCAH will partner to develop resources and templates for local pathway maps to link youth to needed services.

 

Narrative:

CDPH/MCAH partnered with members of the Adolescent and Young Adult Behavioral Health Collaborative Improvement and Innovation Network (CoIIN) to develop and disseminate a collection of youth-focused mental health resources for medical providers participating in the primary care arm of the CoIIN. The providers were focused on increasing rates of depression screening and referrals to mental health resources within their practices. The resources were tailored for youth audiences and included specific ones for Black, Indigenous, and People of Color (BIPOC) youth and youth identifying as LGBTQ+. The collection featured a wide range of formats such as blogs, videos, websites, toolkits, mindfulness exercises, Instagram posts, and crisis text and phone lines.

 

Activity:

CDPH/MCAH will lead to ensure CDPH/MCAH program participants are referred to youth-friendly preventive care, mental health care, and sexual and reproductive health care, including the California Family Planning, Access, Care, and Treatment program (Family PACT).

 

Narrative:

CDPH/MCAH continued to utilize AFLP’s Comprehensive Baseline Assessment (CBA) and Youth Outcome Assessment (YOA), which are evidence-informed data collection tools that AFLP case managers complete with young adult participants to assess needs and connect them to resources. The CBA is completed within the first two months of program enrollment and the YOA is completed every six months from the date of program enrollment. Both assessments include questions regarding family planning and contraceptive use, which based on youth responses may result in referrals to Family PACT services. Local AFLP agencies continued to maintain a coordinated system of care focusing on adolescent health and supporting expectant and parenting youth and their families.

 

Local AFLP agencies maintain a collaborative service network of local providers to assist AFLP participants access comprehensive, youth-friendly, culturally appropriate, supportive, and necessary services. The collaborative service network established by agencies included both a Local Stakeholder Coalition (LSC) and a referral network. LSCs included representatives from various organizations including Family PACT and Medi-Cal providers (preventive obstetrics/comprehensive perinatal services program). All AFLP agencies identified Family PACT as partners in their implementation plan. 95.7% of AFLP youth received primary preventive health care and 87.5% of pregnant youth in AFLP received prenatal care. (Source: AFLP 2021-2022 Annual Data Summary)

 

CA PREP and I&E agencies, as required in their CDPH/MCAH SOW, established formal partnerships with their local Family PACT providers to increase adolescent access to reproductive health services.

 

CDPH/MCAH requires all CA PREP and I&E agency staff to be trained and knowledgeable about Family PACT and reproductive health services in their communities to make timely referrals for youth. CA PREP and I&E health educators provided information to youth on the location, cost, and confidentiality of local sexual and reproductive health services, including Family PACT.

 

Activity:

CDPH/MCAH will partner in the dissemination of recommendations for adolescent preventive care to local MCAH programs.

 

Narrative:

CDPH/MCAH recommended the following trainings, webinars, and resources to local AFLP agencies related to adolescent preventive care:

• Youth mental health first aid training – Training for professional staff that provided information on how to identify, understand, and respond to signs of mental illness and substance use disorders in youth.
• Birth control and emergency contraceptives – Webinar for youth participants that provided information on different birth control methods, their advantages and disadvantages, and how to access them through a clinic in their area.
• Every Woman California website – This website includes a variety of resources such as key health messages, ways to think about health holistically, and information about how to access preventive health services, specifically for young people.

 

Success(es):

A major success for this strategy was the improvement of the rate of youth who received a primary preventive health care/prenatal care visit for this reporting period. 95.7% of AFLP youth received primary preventive health care.

 

Adolescent Objective 2: Strategy 2: 

Partner with the CDPH Adolescent Preventive Health Initiative (APHI) to increase the quality of preventive care for adolescents in California. 

 

Activity:

CDPH/MCAH will partner with the California Adolescent Preventive Health Initiative (APHI) to develop, disseminate, and sustain a communications platform with a comprehensive set of youth-friendly resources for adolescent service providers.

 

 

Narrative:

While this activity was incomplete due to staff transitions and organizational changes, CDPH/MCAH disseminated information and resources to 61 Local Health Jurisdictions (LHJ) related to improving preventive care for adolescents, including details about the California School-Based Health Alliance at Care Beyond the Clinic Walls statewide conference and Starter Guides for Clinicians from the Adolescent Health Initiative at the University of Michigan, which are toolkits that offer concrete, actionable steps to strengthen adolescent preventive care on topics like addressing mental health in primary care.

 

Challenge(s):

Lack of staffing, due to a combination of COVID-19 redirections and other staff vacancies, has resulted in the activity for this strategy being shifted. Priorities have changed for the Division leading the work for this strategy. CDPH/MCAH will stay involved as a partner if this project continues.

  

Adolescent Focus Area 3: Improve social, emotional, and mental well-being and build resilience among all adolescents in California.

 

Adolescent Objective 3: 

By 2025, increase the percentage of adolescents aged 12-17 who have an adult in their lives with whom they can talk about serious problems from 77.2% to 79.7%. 

 

Story Behind the Curve:

Youth connectedness is an important protective factor for health and well-being. Youth who feel connected at school and home are less likely to experience negative health outcomes related to mental health, violence, substance use, and sexual health risk.[9]

 

Connectedness refers to a sense of being cared for, supported, and belonging, and can be centered on a feeling connected to school, family (i.e., parents or caregivers), or other important people or organizations in their lives. Research demonstrates the powerful contribution of positive peer and adult relationships to healthy adolescent development and well-being.[10] Adolescents are more likely to engage in healthy behaviors if they have a supportive and trustworthy adult in their life, leading to increased well-being in adolescence and contributing to improved social, emotional, and academic outcomes that have a lasting impact on health across the life course.[11]

 

Factors that influence the curve include whether the youth is enrolled in school, is housed, is in the foster care or juvenile justice systems, and has access to a network of supportive adults in their communities. The impacts of the COVID-19 pandemic aggravated the mental health challenges of young people. Efforts to mitigate the spread of the virus led to social isolation and other disruptions in education, services, and social activities, even as mental health challenges were already increasing among youth before the pandemic. It is critical to build resilience among youth, especially when they are faced with adverse experiences, and connect them to trusted and caring adults. Connecting youth with caring adult support is core to the CDPH/MCAH adolescent health program efforts.[12]

 

Adolescent Objective 3: Strategy 1: 

Lead to strengthen resilience among expectant and parenting adolescents to improve health, social, and educational outcomes. 

 

Activity:

CDPH/MCAH will lead and fund implementation of Adolescent Family Life Program.

 

Narrative:

CDPH/MCAH continued to provide funding, training, technical assistance, monitoring, and oversight to 16 LHJs and community-based organizations (CBO) to implement AFLP. These agencies implemented the evidence-informed, strengths-based Positive Youth Development (PYD) model. 999 youth received AFLP services, which included the following:

 

• 707 (70.8%) were in the program for at least six months.
• 445 (44.5%) had enrolled into AFLP during the reporting period.

 

(Source: AFLP 2021-2022 Annual Data Summary)

 

Activity:

CDPH/MCAH will partner with local agencies to address impacts of the COVID-19 pandemic to their programs and youth populations they serve.

 

Narrative:

 

For AFLP local agencies:

• CDPH/MCAH developed a survey to learn about each agency’s experience with virtual implementation and the transition back to in-person visits, explore support needs for the transition back to in-person visits as well as approaches and supports for hybrid implementation.
• CDPH/MCAH issued modified guidance for implementing AFLP during the COVID-19 pandemic since a majority of policy and procedure documents mentioned or operated under the assumption that case management services occurred in person.
• CDPH/MCAH continued to act quickly and responsively to protect the public health and safety in response to the COVID-19 pandemic and provided information to local health jurisdictions and community-based organizations about the use of MCAH Title V funds during the COVID-19 pandemic.

 

For ASH Ed agencies:

• CDPH/MCAH issued modified guidance for implementing CA PREP and I&E during the COVID-19 pandemic since various policy and procedure documents mentioned or operated under the assumption that implementation occurred in person. During the COVID-19 pandemic, local agencies provided implementation and community events virtually to promote the well-being and safety of program participants, staff, and communities.
• CDPH/MCAH supported local agencies to assess and determine whether to begin implementation virtually or in-person based on local needs, circumstances, and agency/county/state/national public health guidance.

 

Activity:

CDPH/MCAH will lead trainings for local staff to implement the AFLP PYD Model.

 

Narrative:

CDPH/MCAH collaborated with outside trainers, ETR and UCSF, to conduct a four-day virtual AFLP PYD basic training in January 2022. The training was designed for new staff (directors, supervisors, coordinators, and case managers) and covered the core components of the AFLP PYD model, how to implement the intervention with fidelity, and how to use strategies and tools to integrate life planning and positive youth development into case management approaches.

 

CDPH/MCAH collaborated with ETR and UCSF trainers to conduct a two-day virtual AFLP PYD spring training on two separate sessions in May and June 2022. The overall training objectives were for participants to:

 

• Gain a deeper understanding of youth engagement models.
• Identify one action item to increase youth engagement at the program/agency level.
• Demonstrate increased comfort with and ability to integrate motivational interviewing in texting conversations with youth.
• Connect with peers from other AFLP agencies.

 

Activity:

CDPH/MCAH will lead the development of a plan for AFLP PYD Model updates, further evaluation, and program expansion.

 

Narrative:

CDPH/MCAH has a partnership with Mathematica who worked with local AFLP agencies that participated in the 2015-2018 federal evaluation. Mathematica held listening sessions with more than 50 case managers in December 2021 and June 2022 to review federal evaluation findings and to gather their reactions to the federal findings. Participants shared their impressions and feedback to the AFLP PYD model. Case managers liked using the model, highlighted the importance of the relationship between themselves and the youths, and provided their recommendations for increasing youth engagement and program retention.

 

Activity:

CDPH/MCAH will lead implementation and analysis of data from evidence-based/evidence-informed assessment tools such as the AFLP Resiliency Scale.

 

Narrative:

CDPH/MCAH prepared to relaunch the AFLP Youth Resilience Survey, which was paused in April 2020 due to the shift to virtual implementation resulting from the COVID-19 pandemic and remained paused. Preparation for the relaunch included refinement and finalization of the Expectant and Parenting Youth Resilience Scale, translation of finalized scale items into Spanish, preparation of data collection guidance and training materials, and technical work to implement the mechanism for uploading survey data into the Penelope case management system for use by case managers. Data collection resumed July 2022.

 

Activity:

CDPH/MCAH will lead in updating and disseminating the physical activity and nutrition guidelines for adolescent parents.

 

Narrative:

CDPH/MCAH led a workgroup to update sections of MCAH’s Adolescent Nutrition and Physical Activity Guidelines, and updated language to be more gender inclusive and responsive to changing norms and behaviors. The workgroup met through the fall of 2021 to provide feedback on existing sections of the guidelines and a new section on food insecurity. At the conclusion of the workgroup, this project was paused until a more significant update of the guidelines could occur. CDPH/MCAH removed the outdated guidelines from the website.

 

Success(es):

The close relationships that CDPH/MCAH maintains with locally funded adolescent health agencies is a big success in implementing this strategy through the COVID-19 pandemic where local agencies were stretched thin to provide services and support to expectant and parenting youth.

 

Challenge(s):

Lack of staffing, due to a combination of COVID-19 redirections and other staff vacancies, has resulted in various activities of this strategy being paused, slowed, or shifted. Priorities have changed at the local level due to the COVID-19 pandemic, and activities need to be re-examined and potentially revised.

 

Adolescent Objective 3: Strategy 2: 

Partner to identify opportunities to build protective factors for adolescents at the individual, community, and systems levels.

 

Activity:

CDPH/MCAH will partner with ASHWG to finalize the PYD Organizational Assessment and Toolkit and disseminate to other partners.

 

Narrative:

This project has been delayed due to shifting priorities during COVID-19, including applying the newly adopted anti-racist framework in its vision, mission, membership application materials, and strategic plan. CDPH/MCAH is exploring currently available PYD Toolkits from other state agencies and will compare with the current toolkit and consider sharing others as resources with ASHWG and other partners.

 

Activity:

CDPH/MCAH will partner to establish a CDPH youth advisory board.

 

Narrative:

CDPH/MCAH partnered with colleagues from the Office of Health Equity and STD Control Branch to develop a proposal for a new youth advisory board for CDPH leadership consideration, which is still under review. CDPH/MCAH is exploring options to build a youth advisory board for their Adolescent Programs and Special Health Needs Section.

 

CDPH/MCAH ensured youth voices were reflected in state and local programs. Local AFLP agencies were given the opportunity to hire a youth advisor (YA) and include the position in their budget to support quality improvement efforts. CDPH/MCAH started meeting with the hired YAs and their supervisors on a quarterly basis to provide an ongoing space for YAs to share their efforts, debrief successes and challenges, brainstorm ideas, and provide feedback on state MCAH projects impacting youth populations.

 

Activity:

CDPH/MCAH will lead to ensure youth voices are reflected in local programs.

 

Narrative:

In the 2022-2025 RFA, the I&E funding was restructured, and Enhanced Youth Engagement became a new program option. It is intended to strengthen program activities by providing dedicated funds for LIAs to hire who will engage in a variety of innovative educational activities. YA are also encouraged to participate in Local Stakeholder Coalitions, program quality improvement efforts, and decision-making.

 

CDPH/MCAH hosted a two-day virtual spring training in May-June 2022 which was required for all AFLP coordinators, supervisors, and case managers. The training featured a module specific to enhancing youth voice and engagement in local AFLP agencies.

 

Activity:

CDPH/MCAH will report on youth in AFLP who reported having an adult in their lives with whom they can talk about serious problems.

 

Narrative:

Throughout the reporting period, CDPH/MCAH analyzed data from the Adolescent Family Life Program Comprehensive Baseline Assessment and Youth Outcome Assessment in preparation for a series of data briefs on program implementation and outcomes, including change over time on the percentage of youth in AFLP who reported having an adult in their lives with whom they can talk about serious problems. Validation of the analyses began in January 2021 and the briefs are scheduled to be completed in the 2022-2023 reporting period.

 

Success(es):

• The YA in San Diego created a closed Facebook page for program participants in AFLP as a space where the participants could connect directly with each other and create community. The YA created marketing materials about the Facebook group and presented them to the Case Managers who in turn shared it with their clients. The YA contributed to the agency’s efforts to strengthen participant retention and engagement in the virtual space.

 

Adolescent Objective 3: Strategy 3: 

Partner to strengthen knowledge and skills among providers, individuals, and families to identify signs of distress and mental health related needs among adolescents. 

 

 

Activity:

CDPH/MCAH will lead in assessing public health needs around adolescent mental health.

 

Narrative:

MCAH analyzed population-based data on suicide using the California Comprehensive Master Death File and California Department of Finance population data among adolescents and young people. MCAH also analyzed Youth Risk Behavior Survey data to assess mental health, including suicide attempts, among California’s public high school students. MCAH continued to analyze the National Survey of Children’s Health data to assess relationships among adverse childhood experiences, family resilience, and neighborhood support. The suicide rate data between 2019 and 2020 was submitted to the 2022 American Public Health Association meeting for consideration as oral presentation under the Mental Health Session. CDPH/MCAH plans to develop a data brief using data on positive experiences and adversities among adolescents aged 12-17 (National Survey of Children’s Health) to share with partners and stakeholders.

 

Activity:

CDPH/MCAH will lead in promoting trainings and resources, including Mental Health First Aid.

 

Narrative:

• CDPH/MCAH disseminated information and resources related to mental health from the newly launched CalHOPE initiative to local adolescent health and MCAH agencies. CalHOPE delivers crisis support and resources for communities impacted by COVID-19 and other traumas. Services include a Warm Line to connect with others who have persevered with mental health struggles, relevant resources specifically for youth and young adults, Black Californians, LGBTQ+ communities, and veterans. It also features videos of celebrities aimed at destigmatizing mental health. CalHOPE has links to a peer support program for tribal and urban Indian populations as well as stress management skills.
• CDPH/MCAH disseminated resources about mental health and well-being to local MCAH agencies, including a tip sheet called Media Use and Youth Mental Health created by young people.
• CDPH/MCAH recommended Youth Mental Health First Aid training to local AFLP and ASH Ed agencies.

 

Activity:

CDPH/MCAH will lead the Adolescent and Young Adult Behavioral Health CoIIN.

 

Narrative:

• CDPH/MCAH established a mental well-being youth ambassador program to amplify youth voices in the 18-month Adolescent and Young Adult Behavioral Health Collaborative Innovation and Improvement Network (AYA BH CoIIN). Two young people participated. One is a parenting youth interested in strengthening mental health supports for adolescent parents. The other is a pre-med student at a California State University who is passionate about expanding the mental health workforce to include more individuals of color. The CoIIN aims to strengthen depression screening rates and follow-up through primary care quality improvement and public health strategies.
• CDPH/MCAH mentored two Mental Well-Being Ambassadors who participated in monthly public health meetings and developed a survey instrument to collect information about priority areas of focus from youth across the state.
• CDPH/MCAH coordinated monthly meetings with the public health arm of the CoIIN, which included governmental and non-governmental partners, to understand the changing policy landscape of mental health services in our state using a life course and positive youth development perspective.
• CDPH/MCAH connected with physicians who participated in the clinical side of the CoIIN and provided mental health resources that the public health arm team developed or was aware of.

 

Success(es):

The two Mental Well-Being Ambassadors who participated in the AYA BH CoIIN regularly met with CDPH/MCAH to connect and brainstorm ideas about the direction and growth of the CoIIN. They decided to create a survey instrument to gather input from a wide variety of youth since they felt a wider spectrum of youth voice was missing. They co-created the instrument using free software and shared it back to the CoIIN for suggestions for improvement.

 

Challenge(s):

Lack of staffing, due to a combination of COVID-19 redirections and other staff vacancies, has resulted in the activities in this strategy being slowed. CDPH/MCAH is discussing the future of the AYA BH CoIIN and reflecting on lessons learned as the convener of this network of partners.

[1] Adolescents Deserve Better: What the Biden-Harris Administration and Congress Can Do to Bolster Young People’s Sexual and Reproductive Health. https://www.guttmacher.org/gpr/2021/02/adolescents-deserve-better-what-biden-harris-administration-and-congress-can-do-bolster .

[2] Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019. https://www.sciencedirect.com/science/article/pii/S2590151621000113 .

[3] Adolescents Deserve Better: What the Biden-Harris Administration and Congress Can Do to Bolster Young People’s Sexual and Reproductive Health. https://www.guttmacher.org/gpr/2021/02/adolescents-deserve-better-what-biden-harris-administration-and-congress-can-do-bolster .

[4] Preventing Teen Pregnancy. A Key Role for Health Care Providers. https://www.cdc.gov/vitalsigns/larc/index.html .

[5] Bright Futures. https://brightfutures.aap.org/Bright Futures Documents/BF4_AdolescenceVisits.pdf .

[6] Increase the proportion of adolescents who had a preventive health care visit in the past year — AH‑01. https://health.gov/healthypeople/objectives-and-data/browse-objectives/adolescents/increase-proportion-adolescents-who-had-preventive-health-care-visit-past-year-ah-01 .

[7] Child and Adolescent Health. https://mchb.hrsa.gov/maternal-child-health-topics/adolescent-and-young-adult-health .

[8] Missed and Delayed Preventive Health Care Visits Among US Children Due to the COVID-19 Pandemic. https://journals.sagepub.com/doi/10.1177/00333549211061322 .

[9] School Connectedness Helps Students Thrive. https://www.cdc.gov/healthyyouth/protective/youth-connectedness-important-protective-factor-for-health-well-being.htm .

[10] 7 Positive Childhood Experiences that Help Kids Grow into Successful Adults. https://www.youthranch.org/blog/7-positive-childhood-experiences-that-help-kids-grow-into-successful-adults

[11] Increase the proportion of adolescents who have an adult they can talk to about serious problems — AH‑03. https://health.gov/healthypeople/objectives-and-data/browse-objectives/adolescents/increase-proportion-adolescents-who-have-adult-they-can-talk-about-serious-problems-ah-03 .

[12] The Role of Coping Skills for Developing Resilience Among Children and Adolescents. https://link.springer.com/chapter/10.1007/978-3-030-64537-3_14 .