The CT Title V program recognizes the value of providing adolescents with appropriate, comprehensive, and timely health care. We also recognize the importance of effective transition to all aspects of adult life, including health care and related services. In addressing the needs of adolescents, the CT Title V program strategies emphasize supporting Adolescent Wellness (including comprehensive well child visits) and process improvement for the transition to adult life – inclusive of the identification of primary care providers for Youth with Special Health Care Needs. The School Based Health Centers were used as an infrastructure in promoting comprehensive adolescent well child visits, developmental assessment, risk assessment and behavioral health screening, anticipatory guidance, and Body Mass Index (BMI) screening and intervention.
DPH supported 92 school-based health service sites in 27 communities statewide through a state budget line item as well as MCHBG funds. Included are 80 School Based Health Centers (SBHC) and 12 Expanded School Health (ESH) sites. SBHCs serve students, Pre-Kindergarten through grade 12, and are in elementary, middle and high schools. SBHCs provide access to medical, mental health and dental (in some locations) services to students enrolled in the school regardless of their ability to pay. Services provided to students include but are not limited to: diagnosis and treatment of acute injuries and illnesses, managing and monitoring chronic disease, physical exams, administering immunizations, prescribing and dispensing medications, laboratory testing, health education, promotion and risk reduction activities, crisis intervention, individual, group and family counseling, outreach, oral health (in some locations), referral and follow-up for specialty care, and linkages to community based providers. Being able to treat students while at school reduces absenteeism, saves money by keeping children out of emergency rooms, and supports families by allowing parents to stay at work. Care is delivered in accordance with nationally recognized medical/mental health and cultural and linguistically appropriate standards.
Mental health services are a priority within the SBHCs and experienced adolescent health clinical staff who provide mental/behavioral health services. Mental/behavioral health services include, but are not limited to - assessment, diagnosis and treatment of psychological, social and emotional problems, crisis intervention, individual/group/family counseling, psycho-social education, advocacy and case management, outreach to students at risk and referral to community-based providers to address needs outside the scope of SBHC practice.
Source: 2020-2021 DPH SBHC 1st Period Report
Source: 2019-2020 DPH SBHC Year End Reports. * 2019-2020 Numbers are severely reduced due to COVID-19 and school closures mid-March
Source: 2019-2020 DPH SBHC Year End Reports. * 2019-2020 Numbers are severely reduced due to COVID-19 and school closures mid-March
Source: 2019-2020 DPH SBHC Year End Reports. * 2019-2020 Numbers are severely reduced due to COVID-19 and school closures mid-March
79% of client’s have public or private insurance and the SBHC can bill and may be reimbursed for these client's services.
Source: 2019-2020 DPH SBHC Year End Report
In March 2020, all of CT schools were closed due to COVID-19. This had an immense impact on the schools’ SBHCs, which also had to close their doors and all services were shut down temporarily. As the schools started to do remote learning the clinics also started to do telehealth visits. These are some of their obstacles, trends, and successes that they experienced.
For Mental health visits that could be done remotely, the transition did not go easily for most of the schools. Students didn’t have devices to use for classes or Mental Health visits, and many didn’t have access to a stable Wi-Fi connection. The shutdown left a lot of families with difficulty accessing school and other necessities, like food a result of being unable to get free lunch.
There were some difficulties related to telehealth. Contact information was not accurate, telephones out of service, parents not answering phones, and blocked numbers. Connecting with students took time as parents/students access to this system had to be learned and services then provided. Students and parents were overwhelmed with the learning curve for technology and were often to burnt out after a day of online learning to log in again to a counseling session. Parents had difficulty helping their children to participate in telehealth due to other parental responsibilities and clinicians were stunned by the lack of schedules the students kept since they were at home full time and had a hard time with engaging students for morning appointments. There was a much higher no-show rate with telehealth and decrease in referrals than in the school as families forgot or got distracted with other things without a firm structure to their weeks. Students expressed having difficulty with telehealth visits and privacy. Many opted out of services altogether and some opted for only phone calls where they could have more privacy.
Closing the schools had a lot of negative effects on the students. Many reported symptoms of depression, anxiety, and loneliness due to the uncertainty of the COVID-19 pandemic.
Students experienced anxiety and stress around managing online learning and navigating the online learning world as well as personal/family issues during covid. Students often worried about their relatives getting sick and students expressed their concerns about the violence in their own community and nationally. Students struggled with not being able to see friends, ending the school year early, and missing end of year activities which caused isolation, loneliness and for some suicidal ideation. Students lacked energy and motivation to engage in schoolwork, were frustrated, distracted, and developed behavioral issues related to distance learning. It was especially difficult for a lot of the students in the bilingual program to adapt to distance learning. The lack of fluency of English, deficits in technology knowledge, and limited access to good internet connection made the process of distance learning frustrating for many students and parents.
Medical visits were even more difficult to maintain since there is only so much that could be done remotely through telehealth. There was a decrease in the number of vaccinations given, which also lead to having vaccines that were going to expire and what to do with them. Some schools that are linked with a Community Health Center could refer the student to one of their other sites, but getting there could be difficult, because of lack of transportation. There were few physicals done and PCPs were also working on limited schedules making it even harder for the students to get services. Some SBHCs held flu vaccination clinics and other primary care services outside for students and their families. SBHC staff also assisted with COVID activities in the community.
SBHCs did have some successes when it came to COVID-19. After initial set up, many telehealth visits were successful with no breaks in coverage for the students. The ability to reach parents through the phone or computer increased parent contact and involvement in treatment planning. Parents engaged more frequently by text with the providers. Some students thrived in quarantine since in person school was the source of their anxiety. Many schools resumed free lunch and students could go and pick up meals daily. Several SBHCs opened before the 2020-2021 school year to provide physicals to students who need them.
Source: DPH SBHC 2019-2020 3rd Period Reports through 2020-2021 2nd Period Reports.
Source: DPH SBHC 2019-2020 3rd Period Reports through 2020-2021 2nd Period Reports.
A statewide virtual school-based health conference sponsored by the Connecticut Association of School Based Health Centers (CASBHC) was held in the fall of 2020. The event “Healing From The Inside Out”, was attended virtually by more than 180 participants including: school personnel, nurses, physicians, mental health clinicians, state agency personnel, and other stakeholders with an interest in adolescent health. The keynote speaker, Kevin Hines, “Cracked Not Broken” author spoke about his true story of surviving and thriving after a suicide attempt off the Golden Gate Bridge. Other breakout workshop topics included: mindfulness, PREP, eating disorders, human trafficking, PANDAS, violent encounters, motivational interviewing and suicide risk assessment and intervention.
Suicide prevention had been a focus among adolescents, and more recently to a broader group of youth and young adults ages 10 to 24 years old. Injury and Violence Prevention and Surveillance staff regularly participated in CT Suicide Advisory Board (CT-SAB) meetings (virtual meetings as of March 2020) and shared information with Title V staff. The statewide 1 Word 1 Voice 1 Life campaign, developed by the CT-SAB, is intended to educate Connecticut residents on how to recognize the warning signs of suicide, how to find the words to have a direct conversation with someone in crisis, and where to find professional help and resources, including the preventsuicidect.org web site and the Suicide Prevention Crisis Line at 2-1-1 (text 741-741). Title V distributes 1 Word suicide prevention awareness campaign materials throughout all programs. DPH worked with the United Way of CT to distribute the 1 Word campaign via animated video PSAs and print messaging in various venues such as youth and social services agencies and college campuses around the state as well as outdoor advertising at Yard Goats minor league baseball games at Dunkin’ Donuts Park.
DPH continued to partner with Child Health and Development Institute and CT Children’s Medical Center to promote Educating Practices training on suicide prevention for pediatric providers.
DPH staff were involved with the CT-SAB during 2019-2020 in updating the CT statewide Suicide Prevention Plan 2020-2025 and worked on a CDC grant application for Comprehensive Suicide Prevention in Connecticut, which was ultimately awarded in August 2020. Two of the targeted vulnerable populations for the grant project will be 10 to 17 year old’s and 18 to 24 year old’s, who both have higher suicide attempt rates compared to the rest of the population.
The Suicide Crisis phone and text line was posted on additional high suicide risk locations (bridges and on railways). In July 2019, a letter was sent to 10 communities’ Town Manager, Elected Official, Director of Health, and Local Prevention Council from the Lethal Means subcommittee of the CT-SAB and CT Department of Transportation (DOT) asking for support to install signs on a bridge in their city. To date, two communities successfully posted signage on local bridges. Several other communities are pursuing signage and working with the DOT to apply for an encroachment permit. Also, radio ad space for suicide prevention was purchased on three CT radio stations WDRC- AM, WDRC-FM, and WMRQ-FM HD2 from 12/09/2019 - 06/30/2020 and continued through the remainder of 2020.
DPH supports the suicide-crisis information and referral line through United Way’s 211 Infoline and partnered with Department of Mental Health and Addiction Services (DMHAS) and Department of Children and Families (DCF) to provide sustainability to crisis line services, of critical importance related to the national Zero Suicide model. Additionally, DPH in consultation with the CT-SAB worked with Wheeler Clinic to plan trainings that address the risk factors related to suicide ideations and the reduction of stigma in mental health help seeking. Similar to last year’s activities, Wheeler Clinic planned to offer one training course of “Assessing and Managing Suicide Risk: Core Competencies for Behavioral Health Professionals (AMSR),” a one-day 6.5 hr. training for behavioral health professionals, and two suicide prevention webinar trainings, “Recognizing and Responding to Suicide Risk: Essential Skills for Primary Care Practitioners (RRSR-PC)” for primary care providers of adults, young adults (18-24), and youth (RRSR-PC-Y). RRSR-PC-Y webinar participants will learn how to work with parents of at-risk youth. These trainings were postponed, partly due to COVID-19, and are planned to start up again July/August 2021.
Source: CT Violent Death Reporting System
The DPH Office of Injury and Violence Prevention (OIVP), Opioid and Drug Overdose Prevention Program is helping CT combat the ongoing opioid epidemic. In April 2019, Governor Ned Lamont and the Commissioners of DMHAS and DPH launched two additional statewide resources, the LIVE LOUD (Live Life with Opioid Use Disorder) multi-media campaign (liveloud.org) and a CT Naloxone + Overdose Response App (NORAsaves.com). In the Fall and Winter of 2019/2020, DPH worked with DMHAS to combine the LIVE LOUD campaign with Fentanyl risk awareness and harm reduction. In CT, opioids are involved in 95% of the drug overdose deaths, and among all opioid-involved deaths, about 90% of those are caused by Fentanyl overdose. These fentanyl percentages are higher in CT that most parts of the U.S., so much education and awareness is needed to those with opioid use disorder. The statewide public awareness campaign, called Change the Script, which launched in February 2018 to help communities, health care providers, pharmacists and individuals address the opioid crisis, is also ongoing and points people to drugfreect.org. CT values interagency collaboration and seeks to ensure sustained statewide, multi-agency education and awareness campaigns that align with the CT Opioid REsponse (CORE) Initiative, a strategic plan which lays out a series of actions designed to rapidly reduce opioid-related overdose deaths in CT. Change the Script was chosen as the theme of the campaign to speak to the need to change public perception and thinking about drug dependence and acknowledge addiction as a chronic brain disease. The campaign also seeks to address the stigma associated with opioid misuse, which often prevents a person or their loved ones from seeking help. A variety of marketing strategies were developed to address several different demographic audiences, including adolescents. Change the Script messages were and continue to be disseminated across the state through a variety of mass media mediums. The Connecticut Interscholastic Athletic Conference (CIAC) is delivering Change the Script messaging to target student athletes and their families. The CIAC represents the largest youth agency in the state of CT and serves all CT public and parochial high schools and K-8 schools through its umbrella organization, the CT Association of Schools. The CIAC is the sole provider of access to CT’s student athletes for championship games, which attract huge numbers of adolescents and their families. In the past year, CIAC ran multiple events that included the campaign messages as well as providing outreach to coaches, athletic directors, school administration and staff. CIAC is utilizing all Change the Script communications materials provided by DPH including but not limited to banners, PA announcements, print and electronic programs, press conferences, the CIAC Monthly News-blast, and annual website exposure on the CIAC website. Since COVID-19 hit the state in March 2020, many of the awareness and marketing activities with CIAC converted to online and digital advertising.
Source: Office of the Chief Medical Examiner, Connecticut
One area of interest is Neonatal Abstinence Syndrome (NAS) surveillance and related education and targeted interventions. Title V and OIVP staff sit on the CT Perinatal Quality Collaborative, led by the CT Hospital Association, which focused on NAS education and cross system collaboration as well as participating in the Substance Exposed Infants-Fetal Alcohol Spectrum Disorder working group. Additional work around prenatal substance exposure and NAS will continue in the coming grant year.
The CT Youth Risk Behavior Survey (YRBS), which is administered as the “Connecticut School Health Survey” (CSHS) is a school-based surveillance system designed by the Centers for Disease Control and Prevention and collects data on substance use and abuse including alcohol, mental health, well-visits, physical activity and nutrition, obesity and overweight, sleep, violence and injury, sexual behaviors, as well as positive or protective factors. The CSHS was administered during the spring of 2019 to high school students in grades 9 through 12. Results were prepared for dissemination in early 2020, including annual estimates, a trend report, a health and academics report, sexual minority risk report. Reports were posted online and shared with stakeholders and partners. Results from the CSHS can be found at www.ct.gov/dph/CSHS.
Adolescent health data from the CSHS continues to support the work of adolescent health programs within DPH, as well as programs in other organizations that promote adolescent well-being, including the CT Department of Education, Department of Mental Health and Addiction Services, and Department of Children and Families and non-governmental agencies such as the Connecticut Alliance to End Sexual Violence, Connecticut Coalition to End Homelessness, the Suicide Advisory Board, and the CT Children’s Injury Prevention Center.
In the spring of 2020, the CDC released a funding opportunity to YRBS funded states to help increase knowledge about Adverse Childhood Experiences (ACEs) using the YRBS data. Connecticut DPH applied for this supplemental funding and was awarded to supplement the next administration of the survey in 2021 with a panel of ACEs-related questions. Subsequently, in May 2020, the CDC announced a competitive funding opportunity through the Preventing Adverse Childhood Experiences (PACE) Data to Action grant. An application was developed by a multi-agency team including CT DPH, the CT Office of Early Childhood, Department of Children and Families, University of Connecticut, Department of Mental Health and Addiction Services and was awarded for project period starting August 2020.
About 44,000 Connecticut high school students use at least one tobacco product, including e-cigarettes, which are the most common type of tobacco products used by high school students in CT. Every year in CT, 800 youth under 18 years of age become new daily smokers, and nearly 5,000 Connecticut adults die prematurely from their own smoking. Vaping has been marketed to youth as a safer alternative to cigarettes and other tobacco products. As a result, while cigarette smoking among CT high school students decreased from 25.6% in 2000 to 3.7% in 2019, the use of vaping products, such as e-cigarettes, more than tripled from 7.2% in 2015 to 27% in 2019, according to CT Youth Risk Behavior Survey data.
Source: 2019 Youth Risk Behavior Survey Results and Trends. *On at least 1 day during the 30 days before the survey; “tobacco” includes cigarettes, cigars, e-cigarettes, hookahs (waterpipes), chewing tobacco, snuff, snus, dip and pipes. †F>M; 11th>9th, 12th>9th, 12th>10th; W>B, H>B, W>O (Based on t-test analysis, p < 0.05). Note: This graph contains weighted results.
Source: 2019 Youth Risk Behavior Survey Results and Trends. *On at least 1 day during the 30 days before the survey; includes e-cigarettes and other vaping products. †F>M; 11th>9th, 12th >9th, 12th>10th; W>B, H>B, W>O (Based on t-test analysis, p < 0.05). Note: This graph contains weighted results.
Source: 2019 Youth Risk Behavior Survey Results and Trends. *Indoors or outdoors, on at least 1 day during the 7 days before the survey. †F>M; 9th>10th; W>B, H>B, O>B, W>H, W>O (Based on t-test analysis, p < 0.05). Note: This graph contains weighted results.
The CT Behavioral Risk Factor Surveillance System (BRFSS) concluded data collection for calendar year 2019 and prepared results for release in 2020. Both the 2019 and 2020 CT BRFSS collected child health information (age 0 to 17 years) from an adult proxy on the following topics: child’s dental visit, dental decay, and dental sealants; breastfeeding; physical inactivity (screen time including television viewing, use of electronic devices); nutrition; and self-reported height and weight to calculate BMI, obesity, and overweight. Results from the CT 2019 BRFSS were released in late 2020 and posted to the DPH CT BRFSS web page which can be found at www.ct.gov/dph/BRFSS.
Source: 2019 Youth Risk Behavior Survey Results and Trends.
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