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ADOLESCENT HEALTH DOMAIN 

SUMMARY/OVERVIEW

FY20 ANNUAL REPORT

NOTE:  The FY20 Annual Report represents the final year of priorities, strategies, and activities aligned with the 2016-2020 needs assessment and state action plan for the Adolescent Health Domain

DOMAIN CONTRIBUTORS:

Adolescent Health Program – Division of Child and Family Health Reproductive Unit

Injury & Violence Prevention Program – Division of Prevention and Health Promotion 

School Health - Division of Child and Family Health 

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DOMAIN OVERVIEW

The focus and activity around the Virginia Title V adolescent population demonstrate strength and intention, recognizing the pivotal role that adolescence plays in the life course perspective approach.  Adolescence has strong connections to the two life stages on either side.  Clearly, protective and risk behaviors that develop during this influential period of life contributes to measurable consequences in adulthood.  Virginia’s Title V recognized the importance of allowing the youth population to have a voice in guiding the work in a number of topics related to this Domain, offering unique input into programmatic planning and implementation.

Key work in this Domain includes:

COMPREHENSIVE SEXUAL EDUCATION PROGRAM:  VDH’s Adolescent Health Program funds three grantees who implement Get Real: Comprehensive Sexual Education that Works, a LGBTQ+ inclusive, trauma-informed comprehensive sexuality education curriculum for middle and high school students. The grantees are located in Central Virginia, Hampton Roads and southwest Virginia. The Get Real program is funded exclusively through Title V. 

YOUTH ADVISORS:  VDH’s Adolescent Health Program recently hired two Youth Advisors, young people who provide input and leadership on VDH initiatives that impact young people. These two part-time VDH employees provide input on existing VDH initiatives that impact young people and are in the process of developing a larger youth advisory structure.

POSITIVE YOUTH DEVELOPMENT: VDH’s Adolescent Health Program funds positive youth development programs throughout the Commonwealth. The Reproductive Health Unit uses Title V State SRAE funds to support two evidence-based positive youth development programs: Teen Outreach Program (TOP) and Project AIM. Five sites throughout the state – four in southwest Virginia and one on the coast – receive these funds and use them to serve youth. 

RESOURCE MOTHERS:  Resource Mothers is an adolescent health program for pregnant and parenting teens. Resource Mothers uses two evidence based programs: Growing Great Kids and AIM4TM (AIM for Teen Moms). Funded through federal TANF funds allocated by the Virginia General Assembly, Resource Mothers is offered at six local implementation sites, including four local health districts, one hospital system, and one community-based organization. Title V funds support curriculum-specific training sessions for Resource Mothers staff. 

YOUTH SUICIDE PREVENTION:  VDH Injury and Violence Prevention Program (IVPP) focuses on efforts to address youth suicide through training youth-serving professionals and organizations to comprehensively screen for suicide risk and refer affected youth to immediate care. IVPP coordinates gatekeeper trainings in partnership with James Madison University. IVPP also facilitates the Prevention Interagency Advisory Group (SPIAG) and is currently drafting the Commonwealth of Virginia Suicide Across the Lifespan Prevention Plan.

SCHOOL HEALTH:  The VDH School Health Nurse Consultant partners and collaborates closely with the Virginia Department of Education (DOE) School Nurse Consultant to serve elementary to high school aged children enrolled in public, private and parochial schools in the Commonwealth.  The program aims to provide technical assistance and professional development training opportunities to school systems, particularly to school-based medical professionals and families, and also to develop and update certain guidelines relevant to mandated services noted in the Code of Virginia. 

STATE ACTION PLAN UPDATES

The Reproductive Health Unit funds teen pregnancy prevention programs that are implemented in schools.  In many schools, these programs are used to meet the state’s optional Family Life Education standards.  The Adolescent Health Coordinator keeps the Virginia Department of Education (VDOE) apprised on where programs are being implemented and what curricula grantees are using.  VDOE, who is responsible for revising the standards on a regular basis, enlists the help of VDH to provide the public health perspective during this revision process

The Adolescent Health Coordinator has worked with James Madison University’s Appalachian Replication Project (ARP), which is part of JMU’s SexEdVA Initiative.  This is funded by the Teen Pregnancy Prevention Program in the Office of Population Affairs.  The aim of ARP is to increase access to evidence-based teen pregnancy prevention programs in Southwest Virginia.  The Adolescent Health Coordinator has connected JMU’s ARP program with a number of local health departments and schools in th region that have expressed an interest in expanding access to comprehensive sex ed in their communities.  In turn, JMU’s ARP program has been able to provide funding and programs in communities in need of comprehensive sex education, which advances the goals of VDH’s Adolescent Health Program.

By leveraging Maternal and Child Health funds with Substance Abuse and Mental Health Services Administration (SAMHSA) Youth Suicide Prevention Program funds, IVPP Youth Suicide Prevention Program partnered with James Madison University and the American Association of Suicidology to meet its annual objective. 

During the project period, the Campus Suicide Prevention Center of Virginia trained 237 gatekeepers. A detailed breakdown is included in the table below. In addition to the table, the Center purchased 300 CAMS licenses for distribution. As of September 2020, 264 licenses had been purchased by providers with 150 having started the modules. As CAMS is an online, self-paced training, specific location completion date cannot be provided. 

PLEASE REFER TO ORAL HEALTH REPORTS IN WOMEN/MATERNAL HEALTH AND CHILD HEALTH FOR CROSS-DOMAIN ACTIVITIES THAT IMPACT ADOLESCENT HEALTH DOMAIN.

ADDITIONAL DOMAIN-RELATED ACTIVITIES

VDH SCHOOL HEALTH PROGRAM: 

The Mission of the Virginia Department of Health is to protect the health and promote the well-being of all people in Virginia.  Immunization rates have fallen dramatically since the pandemic and VDH school health program will continue to focus on increasing immunization rates for our school age population.  The current data suggest only 88.1% of public school students are adequately immunized.  

On March 13, 2020 schools closed in Virginia due to COVID-19 and it was clear from the beginning of the pandemic, our unserved school population would be greatly impacted by school buildings being closed. School nurses across the Commonwealth, with support from the Virginia Department of Health (VDH) and the Virginia Department of Education (VDOE), identified students and developed plans to implement programs to address the social determinants of health (food insecurity, virtual learning disadvantages, mental health, abuse, and homelessness).  Many school nurses assumed responsibilities outside of their usual job duties and found innovative solutions to difficult situations by expanding existing partnerships with local health departments.  School nurses provided access to care by staffing local health departments as contact tracers, COVID testers and many joined the Medical Reserve Corps (MRC). Professional development opportunities were made available to all Virginia school nurses and contact hours were awarded to those who completed the MRC vaccinator training and approved contact tracing courses.  The Virginia Department of Health (VDH) partnered with the Virginia Department of Education (VDOE) and the Virginia Association of School Nurses (VASN) to provide educational opportunities, training, best practices and guidance necessary for school nurses/school health staff to meet the medical and social emotional needs of their students and school staff.

Due to the pandemic, well child visits to healthcare providers and local health departments decreased.  Vaccination rates decreased across all ages during the COVID-19 pandemic.  Initially, the CDC recommended prioritizing vaccines for children under 24 months of age.  As a result, vaccines typically given to children older than 24 months and adults saw the steepest decline.  Vaccines entered in the Virginia Immunization Information System (VIIS) in May 2020 were 23% lower compared to previous years.  In June, Virginia saw community pediatricians increased their outreach efforts to parents. The Virginia Department of Health (VDH) developed guidance for school based drive thru immunization clinics.  School nurses were encouraged to partner with local health departments and community organizations.  A collaboration between the Medical Reserve Corps (MRC) and VDH school health streamlined the training requirements for school nurses.  School nurses around the Commonwealth joined the MRC to become volunteer vaccinators. As volunteer vaccinators, school nurses were able to provide school required immunizations to their students.  Once the COVID vaccine became available, school nurses joined the volunteer vaccinator program and vaccinated their community. The partnership between the MRC and school nurses expanded to include assisting schools with COVID mitigation measures and health screenings.  The MRC’s Infection Prevention Ambassador Program was tasked with stopping the spread of COVID in the school setting and previously trained MRC volunteers assisted school nurses with hearing and vision screenings and referrals. 

In the beginning of the 2020 summer, families were encouraged to make well child visit appointments with their pediatrician, healthcare provider or local health department to avoid the "back to school rush".  Many children had not received medical care since the pandemic and were not up to date on school required immunizations. This trend was particularly alarming because unmet health needs create barriers to learning and academic success. The VDH, with input from the VDOE and community stakeholders, redesigned the 2014 School Entrance Health Form (MCH 213G) to include the updated ACIP immunization requirements and for the first time, the form was made available in Spanish.  In partnership with the Virginia Department of Education, the newly revised School Entrance Health Form was provided to local school divisions.  In addition, a Superintendent’s memo addressing the importance of maintaining health requirements for school enrollment was sent to all school administrators in Virginia. This was particularly important because routine childhood immunizations and well care visits had dropped significantly during the pandemic. 

The 2020 Virginia General Assembly passed HB1090.  This legislation amended the minimum vaccination requirements for attendance at a public or private elementary, middle or secondary school to include Rotavirus, Hepatitis A, HPV for both male and females, and MenACWY for 7th and 12th grade students.  VDH continued to encourage school nurses to bridge the gap and increase access to adolescent vaccines by hosting school based immunization clinics with the focus being the 7th grade adolescent vaccinations of HPV, Tdap, and MenACWY. Local school divisions were encouraged to partner with their local health departments to provide immunization clinics to their school community.  VDH school health developed a helpful hints for school based immunization clinics resource document/brochure explaining immunization clinic needs, training requirements, staffing requirements, consents, and communication materials for families.  The drive thru immunization clinics have been well received by families and many school divisions have established year around school based vaccination clinics throughout the 2020-2021 school year.  

The VDH school health program and the VDH Immunization Division will continue to provide support, guidance, training and resources to school nurses, local school divisions and local health departments to increase adolescent vaccination rates in Virginia.  Many school divisions have established school based vaccination clinics throughout the entire 2020-2021 school year and have offered families the ability to receive the COVID vaccine along with routine childhood vaccines during regular school hours in the school setting. Together, VDH and the American Academy of Pediatrics (AAP) presented immunization updates (HB1090) and guidance for drive thru immunization clinics to school nurses during the Children’s Hospital of Richmond (CHOR) Fall Conference (11/3/20) for School Nurses. VDH school health will continue to strengthen their partnership with the American Academy of Pediatrics (AAP) and Immunize VA Coalition. 

VDH School Health Nurse Consultant, VDOE School Health Specialist, Manassas Park City Schools, University of Virginia School of Nursing, George Mason University School of Nursing, and Mason and Partners Clinic applied for a P4 Challenge Grant from HRSA to increase immunization rates in Manassas Park City Public Schools.  Our healthcare reform efforts were recognize and Manassas Park City Schools received a grant for $10,000. Round 2 of the challenge is underway, our plan consist of decreasing conditional enrollment and increasing vaccination rates in Manassas Park City Public Schools.  Implementation of the plan with documentation and data collection using interdisciplinary teams will be the next phase of the P4 challenge. 

Professional development opportunities are available to school nurses during the Summer Institute for School Nursing 2021.  The 2021 conference is a collaboration between VDOE, VDH and the Virginia Association of School Nurses (VASN).   This all virtual conference will focusing on community/public health, care coordination and leadership and is titled “Coming out of the Pandemic: Envisioning a new normal”.  Currently over 507 school nurse have registered for the 3 day conference.  School nurse are able to earn Continuing Nursing Education Credits through VASN.  VDH, VDOE and the Children’s Hospital of Richmond (CHOR) collaborated, earlier in the year, to provide 2 mini conferences for school nurse.  Several of the topics for the two half day conferences (11/2020 and 2/2021) focused on health promotion and outreach including immunizations, vaccine hesitancy, drive thru immunization clinics and the upcoming changes to school required immunizations effective July 1, 2021.  

The knowledge, skills and expertise of school nurses has been recognized by the VDH.  Fifteen school nurses were awarded a scholarship from the VDH to become nationally certified. VDH partnered with VDOE and VASN to offer a scholarship opportunity, including study materials and review course, during the Summer Institute for School Nursing 2021.  The participants, who successfully complete the review course and receive a passing score for the National Board Certified School Nurse exam, will receive full reimbursement for the cost ($360) of the exam. 

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 CONSUMER FAMILY ENGAGEMENT/PARTNERSHIP

INJURY PREVENTION: IVP Program provides an opportunity for family and consumer input into LISSDEP. Staff continue to work with the Division of Population Health to construct an exit survey to evaluate programmatic education and technical support efforts. In the upcoming FY, the VDH Injury and Violence Prevention Program will continue family and consumer input expansion through its Project Patience and Youth Suicide Prevention initiatives. 

FROM INJURY PREVENTION:  The Coronavirus Disease 2019 (COVID-19) pandemic has impacted individuals, families, and communities on a worldwide and statewide scale since the beginning of the amplified response. In Virginia, as of the end of May 2020, almost three months since the first COVID-19 case was reported in Virginia, there were 41,401 positive cases, 4,442 hospitalizations, and 1,338 deaths statewide (vdh.virginia.gov) To mitigate the spread of COVID-19 throughout the Commonwealth and the United States, state and federal policymakers announced ‘stay at home’ orders and social distancing guidelines, which led to school closures and more families working and spending greater amounts of time together at home. The pandemic not only can force individuals and families to alter their way of living and working, but outbreaks can also increase stress and anxiety, due to fear and worry of one’s health or health of loved ones, difficulty sleeping or concentrating, worsening of chronic or mental health conditions, loss of a job or other economic support, responding to COVID-19 as a healthcare worker, essential worker, or first responder, social isolation and loneliness, or loss of loved ones (https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html).  Recent studies have indicated that, during the COVID-19 pandemic and other major natural disasters, there is increased risk of family and interpersonal violence, including child abuse and neglect and intimate partner violence, greater risk of childhood injury, suicide, drug overdose, and other substance abuse and mental health issues (IVPP analysis FY19 report quote).

It is critical to link families with young children with resources as it relates to childhood injury and violence prevention. Hospitals, prevention, and public health programs are reduced in their capacity to hold community level meetings with families to provide these resources and education.  As such, the VDH IVP Program is working to enhance its community level interventions with virtual options for hospitals, transportation safety, and prevention programs to utilize when training community members in injury prevention. These methods come in the form of VDH IVP Program virtual instruction, technical assistance, hard copy toolkits, video and website landing pages, and evaluation options. In addition, VDH IVP continues to remain connected to national IVP stakeholders to understand emerging topics in injury and violence prevention during the pandemic response and beyond. 

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 CHALLENGES/BARRIERS 

(1). The residual effects of the COVID-19 pandemic continue to impact youth programming, particularly for sub-grantees that partner with schools.  Although many schools will return to in-person instruction in the Fall of 2021, many schools and students are drastically behind in core subjects like math and reading, which makes them more reluctant to partner with outside agencies for youth programming.  Title V sub-grantees will continue to find alternative ways to serve young people in the event that some schools are unable to partner with them in Fall 2021. 

(2). The COVID-19 pandemic brought unprecedented challenges to the Resource Mothers program and the families served.  In-home services completely stopped out of safety concerns, and staff were challenged to explore alternate modalities for meeting with you, including phone calls, video calls, and porch visits.  In-person trainings were not offered during the pandemic and the GGK and AIM4TM distributors took time to shift all trainings to online formats.  As a result, VDH only offered one virtual training to nineteen community health workers on the AIM4TM program model during the FY20 reporting period.