Adolescent Health Data
Adolescent Mortality
Adolescent mortality has decreased in RI among adolescents ages 10-19 from 20.3 deaths per 100,000 adolescents in 2017 to 17.7 deaths per 100,000 adolescents in 2018. From 2016-2018, the adolescent motor vehicle mortality rate was 6.5 deaths per 100,000 adolescents 15-19. This is an increase from 5.9 deaths per 100,000 adolescents in 2015-2017, however, due to small numbers, these rates may be statistically unstable. The unintentional injury mortality for adolescents ages 15-19 was 4.5 deaths per 100,000 adolescents in 2017, but this rate should also be interpreted with caution. In 2016-2018, child death review data indicate that there were 5.5 deaths per 100,000 in adolescents ages 15-19 due to suicide. When expanding the population to include youth ages 10-24, the suicide rate was 7.8 deaths per 100,000 adolescents in 2018.
Healthcare and Immunization
According to the NSCH 2016/17, 86.7% of adolescents ages 12 to 17 received a past year preventive medical visit. In 2017, NIS reports that 88.5% of females and 88.7% of males, ages 13 through 17, have received at least one dose of the HPV vaccine. This represents a 76.6% increase in females and a 69.3% increase in males from 2013. RI has the highest rates of HPV vaccination in the US. Additionally, 74.2% of adolescents were vaccinated against seasonal influenza in 2017. Other adolescent immunizations were also high in 2017 with 94.1% receiving at least one dose of the meningococcal conjugate vaccine and 94.6% receiving at least one dose of the Tdap vaccine. Seasonal influenza, meningococcal, and Tdap vaccination in RI exceeds U.S. rates among adolescents.
Obesity/Physical Activity
Trends for obesity have increased among high school teens. YRBS shows that 15.2% of high school students were obese in 2017 compared to 9.1% in 2001. Hispanic high school students were more obese (21.2%) compared to Non-Hispanic Whites (13.3%) in 2017. Moreover, more Hispanic teens (66.6%) reported trying to lose weight than Non-Hispanic White teens (49.2%) and Non-Hispanic Black teens (39.3%). We have seen a drop of high school teens who did not participate in at least 60 minutes of daily physical activity from 46.7% in 2011 to 16.5% in 2017.
Behavioral/Mental Health
- Train & support Patient Centered Medical Homes (PCMH)-Kids and adult practices, including care coordinators, on transition resources (Got Transition, transition policies, transition readiness assessment, portable medical summary).
PCMH-Kids – RIDOH has partnered with the Care Transformation Collaborative (CTC) to support the 19 participating pediatric primary care practices in the implementation of the PCMH-Kids model through the provision of trainings and technical assistance. RIDOH will continue in the role of collaboration with the CTC to support PCMH-Kids practices in education around the National TA center on Transition (Got Transition) resources (transition policies, transition readiness assessment, portable medical summary).
RI Transition Council – The Adolescent Transition Program joined the Rhode Island Transition Council (established by state law) in 2008 and continued to participate as a key partner with other state agencies, local education agencies, parents, and students to work toward the Council’s goal to enable students (including those with special needs) to successfully transition to adult life in their community. The Transition Council framework focuses on five areas of transition policy development: student focused planning, student development, family involvement, program structure and interagency collaboration. These focus areas are also addressed in the State Plan developed by the RI Transition Council with support from the National Technical Assistance Center on Transition (NTACT) institute. RIDOH staff regularly attend Transition Council meeting and provide technical assistance, resources, and advise on health related topics.
Transition Materials – The Adolescent Transition Program has developed educational materials and resources to assist RI students (including those with special needs) and their support teams in transition planning. Materials include a Youth Transition Workbook and a series of transition checklists entitled Ready? Get Set! Go! The checklist series modified (with permission) by Rhode Island, provided an online fillable format as a tool to support the accomplishment of transition activities and have been incorporated into life skills programs, service care plans, and individual education programs.
- Build self-determination skills among youth.
Dare to Dream Initiative: In May of 2009, RIDOH in collaboration with the RI Transition Council sponsored a statewide initiative and the first student leadership conference entitled “Dare to Dream” (D2D). Modeled after the Dare to Dream initiative developed by the State of New Jersey, the goal of the conference was to provide a forum for high school students (including those with special needs/disabilities) to begin to explore transition from school to adult life and develop self‐determination and self‐advocacy skills. Held on a college campus within the State of RI, the student led leadership conference provides youth with a forum for skill building through peer led workshops addressing topic of relevance to adolescent transition and workforce development. This past year, RIDOH launched Dare to Dream 2.0 Youth Conference on May 23, 2019 at the University of Rhode Island which was attended by over 486 students and 190 teacher/support staff from 45 different schools. The conference was supported by two (2) partner state agencies including the RI Office of Rehabilitation Services and RI Department of Education to provide programming to address social emotional health, exploration of personal strengths, and tools for resiliency. The 2019 conference themed ‘My Abilities, My Superpower’, featured engaging guest speakers, as well as an array of interactive workshops centered on knowledge and skill building. The format was designed to empower students, help them to identify and build on their strengths through teambuilding, while incorporating fun activities such as music, dance, yoga, fitness, and photography.
Employment First - In 2014, the State of RI rolled out the Employment First Initiative to promote community-based, integrated employment as the first option for employment services for individuals with special needs and disabilities. The Employment First initiative encourages youth with special needs and disabilities in transition to pursue real work experiences while working with community-based supports. Rhode Island is part of the national movement toward a greater emphasis on community employment that echoes a general shift toward services designed to integrate individuals with special needs/disabilities into their communities to afford them the same opportunities as people without special needs/disabilities. The RIDOH has supported Employment First since initial roll-out through the development and implementation of youth initiatives such as the Youth Advisory Committee, Youth Internship Program, and Dare to Dream Conference to provide youth with information, resources, and experiences that promote successful transition to employment and independence.
Youth Advisory Council – Over the past six years, RIDOH has implemented the Youth Advisory Council (YAC) to provide youth and young adults, ages 14-24, interested in developing their leadership skills and learning about health topics with a forum for connection to other youth and an opportunity for the development of leadership skills. Since the inception, the YAC has advised and collaborated with various RIDOH programs affecting the health, wellness, and transition of youth (including those with special needs/disabilities). This past year, the YAC was comprised 18 members, and included for 4 new members. The YAC met 15 times from September through June and worked on the following 3 focus areas: professional development and training, soft skills building, and project/event planning and facilitation. YAC accomplishments for this year include: the development of a youth transportation training; participation in an overdose prevention focus group, and participation in a HEZ Learning Community round table session with the Drug Prevention Task Force. Members of the YAC were active in the annual Dare to Dream 2.0 Youth Conference, providing the opening remarks and serving as event volunteer assistants. During 2018, the Youth Advisory Council was recognized as an emerging practice from AMCHP’s Innovation Station.
RIDOH Youth Internship Program - The RIDOH Youth Internship program places transition age students including those with special needs/disabilities throughout the Department in various program areas. The program is designed to assist RI high school students in career exploration in areas of public health. Over the past year, RIDOH continued to expand the Youth Internship Program for youth with special needs to provide 9 students with opportunities to practice job skills in a real work setting. The participating RI school districts included: RI Nurses Institute Middle College Providence RI (3 students); Cranston Transition Program Cranston RI (1 student); Lincoln High School Lincoln RI Transition Program (2 students); West Bay Collaborative Transition Academy (2 students); and William Tolman High School Pawtucket RI (1 student). The RIDOH programs that participated in providing internship placements included: Center for Preventive Services (Family Planning, Immunization, Woman Infants & Children); Center from Health Promotion (Traumatic Brain Injury); Center for Health Data & Analysis; Center for Healthy Homes; Distribution Center; and Health Equity Institute. During the summer of 2018, two students were able to received compensation for their internship, with compensation provided through the City of Providence Office of Economic Opportunities. In 2019, the RIDOH was able to provide another student with a paid internship position to provide date entry support for the Traumatic Brain Injury Program. In 2018, the RIDOH Internship Program was awarded the AMCHP Innovation Station designation of “Promising Practice”.
Teen Outreach Program (TOP) - TOP has served approximately 700 youth since 2013. It is estimated that the program will serve 225 youth in 2018-2019, and 240 youth in 2019-2020. In terms of program success, overcoming the barriers of school district administration and accessing youth in the classrooms during the school day were quite significant for us. This year, Progreso Latino obtained permission and support from the new administration to implement the Teen Outreach Program in Central Falls Middle School. Facilitator trainings and professional development opportunities through Response to Intervention (RTI) are addressed with the network on a regular basis. Additionally, two TOP Clubs (Sojourner House and Youth in Action) teamed up for “Intimate Partner Violence Training” and became “IPV” Peer Educators in their respective schools. Their story was featured in the US Department of Human Services, Family Youth Services Bureau quarterly newsletter (https://www.acf.hhs.gov/fysb/success-story/innovative-partnership).
Princes 2 Kings (P2K) – P2K is a youth mentorship program that combines academics and tutoring in Science, Technology, English, Art, and Math (STEAM), athletics, cultural enrichment activities, and workforce development for program participants year-round. Supported by a grant from the Federal Office of Minority Health, P2K is a collaborative effort between the RIDOH, the Boys and Girls Club of Providence, Roger Williams University, and Brown University School of Public Health. The primary objective of P2K is to address low high school graduation rates ( a key social determinant of health), among Hispanic, Black, and Southeast Asian males 12 to 18 years of age. Low graduation rates are associated with a number of poor economic and health outcomes (e.g., poverty, poor mental health, teen pregnancy, and chronic disease).
The P2K Program currently has 64 participants (boys) and it is presently preparing for the 2019 summer enrichment program. Initial evaluations efforts have found that P2K has high levels of acceptability from program participants and their families as well as strong support from community members and organizations. Further findings suggest that P2K is meeting the academic, emotional, and social needs of program participants. Further evaluation efforts will determine how the program supports achievement of improved grades and behavior. This year, the first cohort of 7 seniors will be graduating high school; the program is proud to report that each young man will be moving on to higher learning institutions.
Girls Empowerment Mentoring Support (RI-GEMS) – RIDOH seeks to reduce the impact and prevalence of violence and trauma among at-risk young women of color through opportunities to learn skills and gain experiences that contribute to positive social environments and healthy life choices. RI-GEMS is an innovative approach to empower young women of color to achieve academically and become leaders in their community. This year RI-GEMS will provide year-round mentoring, academic support, and leadership development program to a cohort of 62 young women of color who attend two middle schools in Providence, RI. The academic-year component of the program will emphasize academic performance and developing social and non-violent skills. The six-week summer component of the program will focus on summer learning loss prevention, community building, and social and emotional learning. This work builds on the successful RIDOH funded P2K program.
- Develop a Web-based resources (ri.medicalhomeprotal.org) to provide a consumer-friendly way to navigate the CYSHCN system of care that includes robust transition resources.
The Medical Home Portal(MHP) - www.medicalhomeportal.org is an online resource established by RIDOH to provide comprehensive diagnostic, education, specialty care, social service, and resource information and support to improve the system of care and health outcomes for CYSHCN. Sections of the MHP address specific areas including: Diagnosis and Conditions; Physicians and Professionals; Parents and Families; and a Services Directory. The MHP was developed through a partnership with the University of Utah in 2016, and has been an on-going contractual collaboration since, to build the RI Resource component of the portal directory. RIDOH worked with other state agencies and community stakeholders to import state specific provider and service information. As of June 2019, the number of listings in the RI Service directory was 720. The Family to Family Help Information Center (F2FHIC) and the Autism Project assist RIDOH in keeping the resources up to date. RIDOH convenes the MHP Advisory Committee, comprised of families, partner state agencies, community stakeholders, health professionals, and advocates to provide guidance and oversight. In addition to the local advisory committee, RIDOH also participates as a member of the Medical Home Portal ‘s state partners’ advisory board to ensure content integrity, improved avenues for resource navigation, and a mechanism for user feedback, utilization tracking and usability testing. A quality assurance project was initiated in January of 2019 to review and update pediatric specialists. Data is also collected monthly from a google analytics report for number of users, type of device used for MHP access, top twenty (20) viewed pages, and state location. This year’s numbers increased dramatically due to the new national landing site and mechanism to select RI as your home state. The Medical Home Portal has been visited 4,894 times during the past year.
Healthy Transitions Grant – RIDOH assisted the Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH), with the implementation of the Healthy Transitions (HT) Grant, a grant program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). The goal being to improve life trajectories for youth and young adults with, or at risk for, serious mental health conditions. Through this work, a Youth MOVE chapter (a behavioral health youth leadership group) was established within the Parent Support Network of RI. The RIDOH Youth Advisory Council collaborated with BHDDH to represent the voice of youth with complex medical and/or behavioral health conditions. In 2018, the RIDOH advised BHDDH on the development a transition resource for youth involved with the child welfare system entitled “Take Charge of Your Behavioral Health: A Guide for Young Adults in Rhode Island’s Behavioral Health System”.
Growing a safer and more connected community: Central Fall’s Youth Shoveling Program
As part of its Growing Communities Initiative, the Pawtucket-Central Falls Health Equity Zone started a Youth Shoveling Program in Central Falls. Through this program, youth in the community receive a stipend for shoveling and clearing the walkways and driveways of elderly residents during the winter. This program helps keep seniors in the community safe during the winter, and helps prevent social isolation by fostering relationships between youth and seniors in the community. Seed funding for a two-year pilot program helped this initiative get off the ground. During this time, the program became so popular that seniors knocked on doors and reached out to anyone they believed could help to make sure the program was continued. Their action was so impactful that the Mayor of Central Falls included the program as a line item in the City budget, continuing the program for a third year.
Engaging Youth in Community Planning
The Youth Advisory Council (YAC) collaborated with the Pawtucket/Central Falls HEZ evaluation team from Pawtucket/Central Falls HEZ in finding participants for a young adult focus group “Community Conversations: Help solve the substance use in Central Falls and Pawtucket”. The HEZ was having difficulty recruiting participants. RIPIN staff person Geraldine McPhee connected the project Lead, Jennifer Constanza to the RIDOH YAC. The YAC encouraged members of the community to participate as a leadership opportunity. The Council also gave feedback on locations and times to ensure that the event was convenient. After the event, the YAC received a thank you from the HEZ team which included the following: “The event really well last night! Thank you for all your help organizing and recruiting the kids to come. I also think many of them were genuinely interested in the project and in coming to the big meeting where we prioritize needs and start developing the prevention plan as a community “. The event was such a success, that the YAC has been invited to additional focus groups and HEZ events.
Building social capital for a healthier Central Falls
To address senior isolation and improve access to better nutrition in the community, the Pawtucket-Central Falls Health Equity Zone launched a pilot event to gauge the success of an intergenerational cooking program. This program paired local high school students with seniors to take part in cooking demonstrations at Forand Manor, a public housing facility for seniors. The program also incorporated a cultural education component thanks to a partnership with Rhode Island Black Storytellers, and a physical activity component where, thanks to a partnership with Health Equity Zone Collaborative member Progreso Latino, participants had the opportunity to take part in Zumba lessons and learn from a local dance troupe. One resident of the senior housing facility, a woman of Cape Verdean descent, felt much more socially isolated than other seniors in the program, because she felt most comfortable speaking in her native Cape Verdean Creole, a Portuguese-based Creole. Through the Health Equity Zone Collaborative, the program partnered with the Cape Verdean Club at the local high school, bringing students into the program who could communicate more effectively with her. Thanks to this partnership, she was able to communicate and build relationships with these students that continue to this day, and flourish.
Statewide Adolescent Health Strategic Plan – Rhode Island’s Adolescent Health Strategic Plan utilizes Healthy People 2020 and Maternal and Child Health’s Title V performance measures as a guide in identifying these health priorities. This plan discusses each health priority by presenting an overview of the issue and providing a snapshot on how it is affecting different segments of the adolescent population. The Adolescent and School Health program at RIDOH identified overarching goals and guiding principles that support the plan. The eight key areas each have specific goals and objectives needing action to improve the health status of adolescents in RI through 2022. The goals and objectives were developed based upon existing data, current research, identified gaps, and by integrating initiatives supported by collaborating partners. Best practice strategies for achieving the goals and objectives will be discussed in the strategic plan to address the unique health needs of adolescents. Currently the version is in its final draft, and circulated for editing and final comments.
Adolescent Sexual Health Strategic Plan and Workgroup – In 2016, RIDOH collaborated with the Rhode Island Department of Education (RIDE) to develop a Profile on Adolescent Sexual Health. RIDOH continues to meet monthly to discuss activities and interventions related to adolescent sexual health. Since its publication, the Adolescent Sexual Health Profile has been presented to key stakeholders in many different settings. Using this profile as a basis for adolescent sexual health in Rhode Island, the workgroup is in the process of prioritizing next steps and determining the best ways to improve sexual health for adolescents in Rhode Island. The priorities for this plan include increasing access to health services and improving sexual health education. This is done through a variety of methods, including conferences such as the Conference on Youth Sexual Health Education, as well as working with the Rhode Island Healthy Schools Coalition to convene a series of focus groups with teens on adolescent sexual health education and services. Building upon the success of a pilot program in the Spring of 2018 semester aimed at reducing rising sexually transmitted disease rates among 15-24 year olds in Rhode Island, RIDOH offered student assemblies featuring an overview of sexual health topics for public/charter high schools in Providence, Central Falls, and Woonsocket. RIDOH’s Center for HIV, Viral Hepatitis, STD and TB Epidemiology (CHHSTE) has contracted with Planned Parenthood of Southern New England to offer the series of 20 English and Spanish language assemblies. The disease intervention program received high marks in evaluations from teachers, administrators and students.
Social Media Marketing and RIghtTime App – In the fall of 2018, the Center for HIV, Viral Hepatitis, STD and TB Epidemiology (CHHSTE) collaborated with RIDOH’s Family Planning Program to develop an app for smartphones and other mobile devices named RIghtTime. The mission of this app is to help teenagers and people of all ages and genders to navigate an increasingly complicated landscape of information surrounding sexual health. It offers information on birth control, family planning, and HIV/STD prevention, testing and treatment. It also offers a partner notification tool. This app was promoted in conjunction with other messages related to condom distribution and testing campaigns, on commercial TV, YouTube, Instagram, Facebook, SnapChat, and gay dating apps. In 2018, CHHSTE launched a robust multimedia campaign, “ProtectYourselfRI,” which encouraged adolescents to get tested for HIV/STDs and promoted RIDOH’s condom distribution program. In addition, prevention materials are regularly distributed to school nurse teachers.
Adolescent Clinical STD Services –CHHSTE has partnered with Providence Community Health Centers (PCHC) to enhance chlamydia screening among young women seen at their clinics. PCHC is a large health care provider to many individuals who are uninsured or underinsured and provides services to over 40,000 individuals annually in various settings including traditional, walk-in, school-based, homeless shelter, and dental clinics. The purpose of this collaboration is to improve the health of women and their children by screening, diagnosing, and treating sexually transmitted infections, primarily chlamydia. The project also includes screening data related to gonorrhea, HIV, Hepatitis C, and TB. RIDOH and PCHC staff have met regularly since the start of the partnership to discuss provider trainings, patient education, and electronic medical record system improvement. Through the collaboration, RIDOH has found that provider education and EMR reminders are useful tools to improve STD/HIV/Hep C screenings in the populations of interest and continues to partner with PCHC.
Additionally, due to the rising rates of chlamydia across the state, RIDOH has met with Rhode Island’s largest health insurance companies to discuss a collaboration to improve screening and treatment. Because chlamydia screening is a national HEDIS measure, the health insurers (especially United Healthcare) have been interested in exploring this opportunity. Future plans may include: analyzing HEDIS data stratified by geography and/or provider location; distributing CDC chlamydia Toolkits; developing a chlamydia awareness campaign; developing messaging for insurance company newsletters, and providing training and technical assistance to clinical providers.
Finally, the program continues to work to shape policy around explanation of benefits (EOBs) with the goal of ensuring all individuals have access to sexual health resources and adequate privacy in their healthcare and documentation of healthcare services.
Vaccinate Before You Graduate (VBYG) – RI has conducted school located vaccination (SLV) clinics every year since 2001 through our Vaccinate before You Graduate (VBYG) program. VBYG is a “catch-up” school-based vaccination program initially targeting high school seniors but has expanded in recent years to include all students in middle school and high school. The goal of the program is to ensure that students have access to all routinely recommended vaccines and are fully immunized before graduating from high school and entering college and/or the workforce. All vaccines recommended for adolescents by CDC’s Advisory Committee on Immunization Practices (ACIP) including influenza are available through the VBYG program. The program has been acknowledged for its innovative approach to improving adolescent access to vaccines and has helped in our work towards reaching state and national immunization goals. In 2018, RI was recognized for achieving the highest adolescent immunization coverage rates compared nationally at the National Immunization Conference. During school year 2016-17, a total of 107 schools participated in VBYG program. A total of 2,433 students received one or more vaccines through the program and 5,060 vaccine doses were administered.
Conference on Youth Sexual Health Education - In partnership with the RI HIV & STI Prevention Coalition, RIDOH hosted the seventh annual RI Conference on Youth Sexual Health Education (CYSHE) on May 10, 2019. CYSHE reached over 100 youth serving providers to improve professional capacity to address the sexual health needs of youth in a positive, safe and supportive environment with improved knowledge, comfort, skills, and resources. The key note speaker was Lorena Olvera Moreno, PhD, MEd, MPsT, is an educator and Fulbright awardee with more than 10 years of experience within the fields of sexuality education, reproductive justice, and reproductive health. Her talk “Honoring Marginalized Communities through Intersectional Sexuality Education” recognized the complexities of oppressed young people’s sexual and reproductive lives, and described the framework of intersectional sexuality education as it applies to youth.
The Violence and Injury Prevention Program (VIPP) - collaborated with RI Student Assistance Services to implement a 12-session emotional regulation pilot program in two middle schools. This intervention targeted students who were referred by school professionals. In addition, the MCH Program supported work with the Brain Injury Association of RI to provide ImPACT Neuropsychological Baseline Testing to high school youth who participated in school sports and youth athletic leagues. This program also provides concussion recognition and brain safety informational presentations to athletic trainers, coaches, parents, school professionals and middle and high school age youth who participated in school sports and youth athletic leagues.
The VIPP in collaboration with Day One, the states only rape crisis center, has created two initiatives for college professionals and students. The RI Cross Campus Collaborative on Sexual Assault Prevention consists of Title IX and Sexual Assault Prevention professionals from the 11 colleges and universities in Rhode Island. The collaborative meets monthly to share best practices, conduct process and outcome evaluation trainings, and has participated in an American Public Health Association (APHA) training on on-campus sexual assault prevention planning. The second initiative created is the RI Student Collaborative on Sexual Violence, which includes undergraduate and graduate students from the 11 colleges in Rhode Island. The student collaborative hosted sexual assault prevention fundraisers and implemented a student led sexual assault prevention rally.
The VIPP collaborates with the RI Department of Transportation, Office of Highway Safety on their 10-year highway safety plan including work on distracted driving, teen driver safety, impaired driving, as well as the rollout of the www.rippleeffectri.com impaired driving website and media campaign. The campaign kickoff event was hosted by RIDOH and online video and radio PSA’s include the Director of RIDOH as well as the RIDOH Office of the State Medical Examiner. The VIPP also participated in an Impaired Driving Summit, Older Adult Driving Summit, Distracted Driving Summit with public safety partners as well a federal agencies such as Federal Highway Motor Carrier, National Highway Traffic Safety Administration, and Federal Rail partners.
Youth Sport Concussion Prevention Program (YSCPP) – Title V provided Venture Capital funding to offer neuropsychological baseline testing (NBT) to middle and high school age youth ages 11-18 who participate in school sports and youth athletic leagues. This project proposes the use of the ImPACT neuropsychological baseline test to capture a baseline for youth athletes. ImPACT is a web-based 20-minute test that measures attention span memory, problem solving, and reaction time that can reveal a wide range of deficits in neuropsychological functioning. This test is easy to administer by computer, is relatively inexpensive to administer, and provides a database that can be used to monitor youth who are affected. In addition, the program provides concussion safety informational presentations to athletic trainers, coaches, parents, school professionals and middle and high school age youth ages 11-18 who participate in school sports and youth athletic leagues. During October 1st, 2018 through May 31st, 2019. The Youth Sport Concussion Prevention Program was implemented in 18 schools in a variety of ways. Six out of the eighteen schools only participated school in concussion education presentation activities. 1626 students aged 11-18 completed baseline ImPACT testing. The Program was able to educate 596 parents who received concussion awareness information throughout the year. The Program also collaborated with the RIDOH’s School Nurse Consultant on steps to support schools in developing a return to learn protocol. Next steps for the Program are to work with the REAP Program, a national return to learn organization, to train the Youth Sport Concussion Prevention Coordinator in the REAP “Train the Trainer” program.
Pediatric psychiatry Resource Network (PediPRN) - Rhode Island’s children and adolescents face significant challenges in accessing timely and affordable mental health care. In response to this need, the RIDOH is working in conjunction with the Emma Pendleton Bradley Hospital to expand its existing child psychiatry access program, the Pediatric Psychiatry Resource Network (PediPRN). The project’s mission is to improve access to behavioral health care for Rhode Island children and adolescents by integrating psychiatry into the state’s pediatric primary care practices. To achieve its mission, PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise. This service is free and provides all Rhode Island pediatric primary care providers assistance with the mild to moderate mental health care needs of their patients. Activities include prompt telephonic consultations, including recommendations for medical prescribing; face to face psychiatric evaluations, as needed, with return to the treating primary care practitioner for medication management; phone availability for ongoing collaboration; referral to other mental health services and programs, and short-term therapy to bridge children awaiting the appropriate behavioral health services. In addition, PediPRN offers educational activities focusing on creating a culture of empowerment for pediatric primary care providers. Through CME opportunities, educational e-blasts and the PediPRN Intensive Program (PIP), the project offers training and educational support.
Emotional Regulation Intervention Project –The Rhode Island Department of Health Violence and Injury Prevention Program in conjunction with the Rhode Island Student Assistance Program (SAP) aim to provide a wide range of prevention and early intervention services to high risk adolescents. The intervention will be implemented by master's-level counselors who will provide a Prevention Education Series (PES); individual and group counseling for students enrolled in; and referral to community-based social service and mental health agencies. The intervention was piloted during the ’17-’18 school year in which SAP counselors were trained in Project TRAC, a developmentally tailored emotion regulation training program designed for middle school students. The focus of the program is to help students 1) become aware of the connection between emotions and behaviors (especially risk behaviors), 2) improve recognition of when one is having a strong emotion, and 3) learn strategies for managing emotions in moments when they are making decisions.
The 2018 Title V MCH Venture Capital Funding allowed the Violence and Injury Prevention Program (VIPP) to scale up the implementation of the Emotional Regulation Intervention Project from two to five schools. During the 18-19 school year the SAP hosted a two-day emotional regulation intervention training for five counselors returning and new who showed interest in the Emotional Regulation Intervention Project. The Emotional Regulation Intervention Project implemented five 12 session workshops in five different school districts in Rhode Island. The number of students who participated varied between three and eight students per group. The Emotional Regulation Intervention Project served 31 students but the pre and post surveys were only completed by students who received parental approval before the start of the workshop. The evaluator will analyze the pre-post survey data and develop a report by September 2019. In efforts to sustain the intervention the VIPP will work with the Emotional regulation consultant to adapt the 12-session workshop into strategies that can be implemented by teachers in the classroom. In addition, the VIPP was able to obtain additional funding through the Rape Prevention Education grant to implement seven workshops in the 19-20 school year.
The Rhode Island Youth Suicide Prevention Project (RIYSPP) - works with a broad range of partners to implement a combination of strategies aligned with the 2012 National Strategy for Suicide Prevention that are focused on lowering youth (10-24) suicide death and attempt rates. The three primary interventions associated with this project are: 1. Training youth and adults across the State in evidence-based gatekeeper training programs, 2. Training counselors/school crisis team members from schools across the state in a novel streamlined crisis evaluation assessment tool/protocol and connecting them to clinicians (via the Kids’ Link line at Bradley Hospital) who can help them triage and connect students in crisis with a local mental health provider, and 3. Implementing RI’s first systemic linkage of non-health organizations with mental health using various strategies in order to coordinate and share resources for the assessment, referral, treatment, and provision of follow-up care with wrap around services for at-risk youth, including sharing de-identified data. Also, the project maintains a statewide Youth Suicide Prevention Coalition with representation from all priority populations and funded/non-funded partners and works to promote suicide prevention principles to all Rhode Island residents. VIPP has implemented the SPI Youth Suicide Prevention work to some degree in every town in Washington County. The VIPP has also implemented the Emotional Regulation program in on SCHEZ middle school (Westerly). The VIPP has also participated in the HRSA funded Collaborative Office Rounds grant the HEZ has received and is targeted to local pediatricians. The Program also held a training with local pediatricians and the Bradley Hospital Pedi PRN. PediPRN is a State Innovation Model grant funded initiative providing tele-psychiatry access to pediatricians for medication management and other consultative services. The VIPP also participates with the Bristol Health Equity Zone through their suicide prevention subcommittee.
Statewide Plan for Improving Behavioral Health - The Governor signed an executive order (Executive Order 18-03) which charges state agencies with “develop[ing] an action plan to guide improvements to RI’s adult and pediatric behavioral healthcare systems” and reporting back to the Governor by November 30, 2018. To do this work, the Governor’s Office has asked to convene a small group of liaisons from RI State agencies to develop this action plan, in collaboration with their agencies, agency directors, and the Governor’s Office.
PCHM-Kids SBIRT Learning Collaborative- The MCH Medical Director was involved with this initiative that was designed to train groups of pediatric primary care providers and trainees in SBIRT and integrate substance use and abuse screening and brief intervention into practices through a pediatric learning collaborative. Combining efforts and resources with RI PCMH-kids, the RI State Innovation Model primary care initiative, eleven pediatric practices representing a heterogeneous mix of patients throughout the state joined the learning collaborative. The practices worked regularly with experts in adolescent substance use who coached pediatricians and helped them develop referral networks. Practice workflow was also addressed. Specific educational sessions both didactic and simulation were held to cover specific topics including; confidentiality issues when caring for adolescents with substance abuse, opioid use in adolescents, and intervention techniques when managing concerning adolescent substance use A substance abuse referral resource guide for pediatric practice is being developed by medical students as part of a collaborative initiative with the intent to distribute the resource to all pediatric providers in the region. All of the 11 practices involved in the initiative enhanced their knowledge about the role and impact of recreational substance use in the lives of their adolescent patients and about adolescent decision making related to substance use. All of the participating pediatric providers found the initiative beneficial and successfully integrated substance use screening into their practices. They reported and demonstrated increased knowledge of motivational techniques to discuss substance use with adolescents and were more comfortable assessing and managing adolescents with substance use and abuse. They all exceeded their initial screening goals and established ongoing quality metrics that will be sustained in practices. They expressed needs for ongoing assistance with sustainment as they navigate increasing screening in practices and also start to address how to provide early intervention to patients with risks for substance use disorder and in particular opioid abuse and chronic cannabis use. They identified gaps in services and designed specifically for youth and expressed need for local resources for referral. The practices will continue to make progress and grow during the 2019 sustainment period when they will receive additional coaching to help them further integrate SBIRT into their practices.
Healthy Transitions Grant – RIDOH assisted the Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH), with the implementation of the Healthy Transitions (HT) Grant, a grant program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). The goal being to improve life trajectories for youth and young adults with, or at risk for, serious mental health conditions. Through this work, a Youth MOVE chapter (a behavioral health youth leadership group) was established within the Parent Support Network of RI. The RIDOH Youth Advisory Council collaborated with BHDDH to represent the voice of youth with complex medical and/or behavioral health conditions. In 2018, the RIDOH advised BHDDH on the development a transition resource for youth involved with the child welfare system entitled “Take Charge of Your Behavioral Health: A Guide for Young Adults in Rhode Island’s Behavioral Health System”.
Governor’s Commission on Behavioral Health - The RIDOH Adolescent Transition Program provided on-going technical assistance to the BHDDH and the Healthy Transitions Statewide Advisory Council (SAC) in the implementation of the “Now is the Time” Healthy Transitions: Improving Life Trajectories for Youth and Young Adults with, or at Risk for, Serious Mental Health Conditions, a Substance Abuse and Mental Health Services Administration (SAMHSA) grant to develop and sustain a system of services for youth and young adults ages 16-25 who have serious mental health conditions and co-occurring disorders. The RIDOH Transition Program provided best practice and guidance regarding the process and scope of transition and transfer of youth and young adults to augment the knowledge of BHDDH staff and sub-contracted organizations.
RIDOH Healthy Summer Toolkit for Youth Program Leaders - Multiple RIDOH programs plan to contribute health information and links to health resources as part of a new bi-weekly sent between May-August. So far, three issues have gone out: insect and animal bite disease prevention, youth mental health resources, and emergency preparedness for youth. Future issues will include smoking/vaping/substance use prevention, healthy relationships, sun/extreme heat safety, and youth worker safety.
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