III.E.2.c Annual Report: Adolescent Health

Adolescence is a critical transitional period that includes the biological changes of puberty and development to adulthood. The behavioral patterns established during these developmental periods can protect them or put them at risk for a myriad of physical and mental health conditions. Older adolescents and young adults, including those with chronic health conditions, may face challenges as they transition from the child to the adult health care system, such as changes in their insurance coverage, legal status, decreased attention to their developmental and behavioral needs. Rhode Island identified increasing the capacity and efficiency of the adolescent system of care as one its state priority needs. Even though NPM 12 (adolescent healthcare transition to adulthood) was chosen, RI monitors and addresses many other adolescent health issues including teen pregnancy, teen obesity, and behavioral mental/health.

 

Rhode Island had the following priority for adolescent health from October 1, 2019 to September 30 2020:

1. Support the Capacity & Efficiency of Adolescent Systems of Care

Priority: Support the Capacity & Efficiency of Adolescent Systems of Care

The following strategies support RIDOH’s priority to support the capacity and efficiency of adolescent systems of care:

 

Supporting adolescent health care transitions

During childhood, parents and caregivers usually help children with their health and health care needs. As youth get older, managing those needs becomes their own responsibility and achieving this independence requires an organized transition process to gain independent health care skills, prepare for an adult model of care, and transfer to new clinicians.  RIDOH is supporting healthy health care transitions through the following strategies:

 

Health Care Transition Initiative: In 2019, RIDOH began a collaboration with the CTC to pilot a program for practitioners and care coordinators in Patient Centered Medical Homes (PCMH)-Kids and adult practices to provide education around the National TA Center on Transition (Got Transition) resources (transition policies, transition readiness assessment, portable medical summary).  This program was supposed to begin in 2020 but the effort was paused due to a contracting delay resulting from the COVID pandemic.  It resumed this year with a continuation of the contract with CTC and RIDOH has begun work with CTC to implement a 1-year pilot project with several pediatric/adult practice dyads.  PCMH-Kids practices were required to apply as a dyad (matched with an adult practice. The selected practices have held an initial kick-off meeting and started work. Once the pilot is completed the program will be initiated in other pediatric/adult practices to provide Adolescent Transition Training and support.

 

Got Transition: The Rhode Island Department of Health, has been utilizing the guidance and resources of the Got Transition/Center for Health Care Transition Improvement to advance, improve and promote the transition from pediatric to adult health care using the innovative strategies for health professionals, youth, and families available from the Got Transition site. The Program facilitated communications to all Rhode Island pediatric and family practices to introduce adolescent transition resources to remind providers of the 2002 consensus statement coauthored by the American Academies of Pediatrics (AAP), Family Physicians (AAFP), American College of Physicians (ACP) and American Society of Internal Medicine stating the importance of supporting/facilitating the transition of adolescents, including those with special needs into adulthood. The RIDOH will continue to collaborate with the CTC to develop a plan to promote the guidance/resources of the Got Transition/Center for Health Care Transition Improvement with PCMH pediatric and adult practices to implement transition statewide.

 

Fostering positive youth development

The RI Department of Health (RIDOH), promotes the successful transition of youth (including those with special needs) in understanding their health condition/disability, how to advocate for themselves, and knowledge regarding navigation of the health care system. The RIDOH utilizes evidence-based research to foster leadership development through forums for youth investment to provide support, services, and opportunities that help youth including those with special needs achieve positive outcomes. In accomplishment. The RIDOH developed several initiatives to reach large numbers of transition age youth (Dare to Dream Initiative and forums to recruit, train, and support young adults (Youth Advisory Committee) to serve as mentors to other youth (including those with special needs).
 

Dare to Dream Initiative: In May of 2009, the RI Department of Health (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 topics of relevance to adolescent transition and workforce development. 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, the RI Office of Rehabilitation Services and the RI Department of Education, and provided 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 team building, while incorporating fun activities such as music, dance, yoga, fitness, and photography. The D2D Youth Conference scheduled for May 2020 required rescheduling due to the COVID-19 crisis and the movement of the Rhode Island School System to virtual learning. RIDOH and OSN, with the continued support of its state partners, re-designed the conference in a virtual format (Virtual D2D 2.0) for the 2020-2021 academic school year, with tremendous success. The conference was attended by 546 RI Middle and High School Students and focused on social/emotional health through the facilitation of student strengths-finder assessments and virtual workshop programming delivered in partnership with University of Rhode Island Center for Student Leadership Development and a National Training Agency entitled Leading to Change, Inc. Workshops provided by the two entities were able to accommodate students attending in-person and virtual school throughout the academic school year. The development of a unique D2D website provided teachers with the ability to participate in either real time or when available. Additional workshop resources and activities were posted following each workshop to provide topic enhancements.

Planning is currently underway for the facilitation of D2D during the 2021/2022 school year through a collaboration with contracted agencies including the University of Rhode Island Center for Student Leadership Development, Leading to Change, Inc., and state agencies that have supported D2D since inception. Due to continued uncertainty surrounding the COVID -19 environment, the RIDOH, OSN will design a hybrid program to facilitate virtual workshops to RI’s Middle and High School students during the academic school year and an on-site conference on a college campus during Spring 2022.

Youth Advisory Council: In 2013, the RI Department of Health (RIDOH) implemented a Youth Advisory Council (YAC) to provide youth/young adults, ages 14-24, with a forum to connect with other youth and an avenue to practice leadership skills within a safe environment for addressing social/emotional health. 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). The YAC has met consistently over that time and served more than 161 young people, many who stay involved over multiple years. This involvement over time yields youth led leadership within the YAC and in outside councils. Our co-chair is a member of the RI Special Education Advisory Committee, Advocates in Action, and has presented nationally for the UCLA Autism Center. Another one of our members, who first joined as a high school student in 2016, was hired as a youth resource specialist and is the new chairperson of the YAC.

During the last Title V reporting period, the YAC served fifteen (15) members who met monthly from September 2020 through May 2021 in the virtual environment to address topics including: strengths assessing, stress reduction, health equity, emergency preparedness, and voting rights. The YAC also has a significant role in the RI Department of Health Programs to provide youth voice on health/wellness messaging and the development of strategic plans. The YAC meeting structure also provides a means for members to connect with their peers. As a group, the YAC wrote a beautiful poem, It’s OK not to be OK, describing the difficulties of the past year. The ease of taking part in remote meetings appealed to youth and we had a banner recruiting year with 6 new members.

Through a contract with several professional entities, the YAC also provided needed supports relevant to the COVID-19 pandemic including a Coping with COVID series that was open to the public. This workshop series showcased strategies on how to incorporate coping skills into daily life and how to utilize tools to help deal with stress/life changes. The YAC also facilitated a capacity building training series on running remote meetings for youth and young adults. These Zoom Boot Camps taught community serving organizations how to reach youth and keep them engaged through remote connections.

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 Internship Program is designed to assist RI high school students in career exploration and to allow them to become familiar with the expectations and norms of a natural work setting. In the past years, the RIDOH Youth Internship Program provided students from various Transition Programs and Academies throughout the state with opportunities to practice job skills in a natural work setting. The participating Rhode Island schools included: Central Falls High School Transition Program (2 students) ; Lincoln High School Transition Program (1 student) ; Providence Autism School to Tomorrow Academy (1 student) ; West Bay Collaborative Transition Academy (1 student) ; Shea High School (1 student); and William Tolman High School (1 student). The RIDOH programs that participated in providing internship placements for the students 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; Health Equity Institute; and the Distribution Center. Students who successfully completed internships at the RI Department of Health provided these glowing reflections:

"My favorite part of the internship was working in an office. I like going to the different rooms and talking to different people." (Lincoln High School Transition student)

 "I learned how to travel on the public bus to get here. I learned how to be responsible for getting to work on time and also get my lunch at school before we left to get the bus. I enjoyed the quietness of working in an office because it is more comfortable." (Central Falls Student)

 "The meeting I was able to sit in on concerned the LGBTQ community; they were talking about putting unisex bathrooms into state buildings. I was excited to be in these meetings and have them listen to my suggestions." (Central Falls student)

“By Speaking and answering questions at the conference, it has helped me with my confidence and made it easier for me to speak for myself.”, (Central Falls student)

During the last reporting period, the RIDOH Internship Program was awarded the designation of "Promising Practice" by AMCHP and publication of this award was utilized to promote the program as a model for other state agencies and non-profit organizations.

LINK: http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/RIDOH%20Intership%20Program.pdf

http://www.amchp.org/AboutAMCHP/Newsletters/Pulse/JulyAugust2019/Pages/State-Internship-Program-for-CYSHCN-Pays-Dividends.aspx"

During this period, with a waiting list of students including those with internships scheduled to begin in March 2020, the program was unfortunately interrupted due to the COVID-19 pandemic emergency and remains in the same status to date.

RIDOH Collaborations with Other Partners on Adolescent Transition

RI Transition Council: The Rhode Island Department of Health (RIDOH) has collaborated with the Transition Council to accomplish the goals in student focused planning practices, interagency collaboration practices through the promotion of health care transition and positive youth development initiatives. 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: (1) student focused planning, (2) student development, (3) family involvement, (4) program structure and (5) 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 meetings and provide technical assistance, resources, and advise on health-related topics.

During the last reporting period, the RI Department of Health, RIDOH, Office of Special Needs (OSN) participated as a key member of the Council to provide Strategic Plan activities in support of transition planning for students including those with special needs. The RIDOH, OSN will continue in this role during the 2021/2022 academic school year to work toward student transition planning goals in collaboration with other state agencies, local education agencies, parents, and youth.

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 has been incorporated into life skills programs, service care plans, and individual education programs.

During the last reporting period, Transition Planning educational materials and resources (including Youth Transition Workbook, Transition Checklists) developed by the RIDOH, OSN Adolescent Health Program were available to assist RI students/support teams in an online format on the RIDOH website. These materials will continue to be available to support professionals, families, and youth in transition planning through RIDOH on-line access during the 2021/2022 academic school year.

Employment First: In 2014, Rhode Island 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 providing services designed to integrate individuals with special needs/disabilities into their communities, which affords them the same opportunities as people without special needs/disabilities. The RIDOH has supported Employment First since initial roll-out and throughout this grant reporting period through the development and implementation of youth initiatives. The RIDOH Youth Advisory Committee, Youth Internship Program, and Dare to Dream Youth Conference are included in these initiatives that provide youth with special needs and disabilities with information, resources, and experiences that promote successful transition to employment and independence.

During the last reporting period, the RIDOH, OSN Youth Internship Program, which provided on-site work experiences for eligible students, was interrupted due to the COVID-19 Pandemic and remains in that status currently. The Dare to Dream Youth Initiative/Conference continued to provide RI Middle and High Schools students with a virtual program environment attended by 546 students from school systems throughout the state. The RIDOH, OSN Youth Advisory continued to meet virtually during the 2020/2021 period for facilitation of enrichment opportunities including trainings, workshops, and engagement with other community youth groups.

Program planning and design is currently in process for D2D 2021/2022 in partnership with long standing contracted entities and state partners. In collaboration with other entities, the RIDOH, OSN will provide a hybrid program model for RI Middle and High Schools with virtual programming during the academic school year and an on-site conference at the University of Rhode Island during Spring 2022.

Teen Outreach Program (TOP): TOP has served approximately 775 youth since 2013. The program served 149 youth in the 2019 – 2020 program and approximately 70 youth during 2020-2021 program. All community-based TOP implementation partners adapted their program implementation to offer virtual or hybrid programs to reach students during COVID-19 pandemic. Virtual meetings allowed a space for students to discuss their concerns about COVID-19, connect with others, and continue community service-learning projects. TOP facilitators also enhanced their engagement efforts to stay connected with their youth, including routine texting, emailing, and one-on-one support meetings. RIDOH hosted monthly TOP network meetings to provide technical assistance on virtual implementation and for facilitators to share challenges, lessons learned, and successes.

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. P2K is comprised of 64 participants. The primary objective of the program 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).

P2K is divided into two components: Academic Year Program and Summer Enrichment Program. The Academic Year Program coincides with the Providence Public School District’s calendar. The summer program consists of a Civil Discourse program where P2K youth engage with local activists, lawyers, and environmental specialists to discuss the impact of environmental justice issues on the local community. The Academic Year Program is held at the Boys & Girls Clubs of Providence South Side Clubhouse where activities take place three days per week (Tuesday, Wednesday, and Thursday) with optional Saturday field trips. During the week, activities run from 4:00 PM to 8:00 PM with an optional teen hour from 8:00 PM – 9:00 PM. Due to COVID-19, programming has shifted to virtual engagement and food delivery to program participants.

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. In May 2020, the Governor of the State of Rhode Island issued a stay-at-home Executive Order which halted all in-person programming for P2K. P2K’s program coordinator maintained contact with participants virtually and ensured all had access to academic, family, and social supports. During the summer of 2020, Boys and Girls Club Providence hosted virtual summer programming and supported eligible participants with employment opportunities. P2K hosted limited activities during Fall of 2020 with the program concluding on 12/31/2020. A review of P2K program evaluation findings is available in the final evaluation report prepared by Dr. Akilah Dulin of Brown University.

Girls Empowerment Mentoring Support (RI-GEMS): RIDOH seeks to reduce the impact and prevalence of violence and trauma among at-risk young womxn 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 womxn of color to achieve academically and become leaders in their community. The program provides year-round mentoring, academic support, and leadership development programming to a cohort of 62 young womxn of color who attend two middle schools in Providence, RI. The academic-year component of the program emphasizes academic performance and developing social and non-violent skills. The six-week summer component of the program focuses on summer learning loss prevention, community building, and social and emotional learning. This work builds on the successful RIDOH funded P2K program.

In May 2020, the Governor of the State of Rhode Island issued a stay-at-home Executive Order which halted all in-person programming for GEMS. The GEMS program coordinator-maintained contact with participants virtually and ensured all had access to academic, family, and social supports. During the summer of 2020, Boys and Girls Club Providence hosted virtual summer programming for GEMS in partnership with Roger Williams University. Eligible program participants were provided with summer employment opportunities.

Develop web-based resources (ri.medicalhomeportal.org (MHP)) to provide a consumer-friendly way to navigate the CYSHCN System of Care that includes robust transition resources: www.medicalhomeportal.org is an online resource established by the RI Department of Health (RIDOH) to provide a one-stop-shop for comprehensive diagnostic, education, specialty care, social service, and resource information to improve the system of care and health outcomes for CYSHCN. The MHP addresses specific informational areas for: Diagnosis and Conditions; Physicians and Professionals; and Parents and Families. The MHP was developed in 2016 through a partnership between the RIDOH and the University of Utah and has been an ongoing contractual collaboration since to build the RI Resource component of the portal directory that includes state specific provider and service information. As of June 2021, the number of listings in the RI Service directory was 795.

The RIDOH convenes an Advisory Committee composed of families, partner state agencies, community stakeholders, health professionals, and advocates to provide guidance and oversight of the MHP. In addition to the Advisory Committee, the RIDOH also participates as a member of the Medical Home Portal’s State Partners’ Advisory Board to ensure content integrity, an improved avenue for resource navigation, and a mechanism for user feedback/utilization tracking.

Resulting from the 2020 pandemic crisis, a COVID-19 Section was incorporated into the MHP to share vetted information on health insurance, safety guidelines, community supports, and tools to help families and professionals caring for CYSHCN. In response to the limits of in person outreach fairs, other outreach efforts were explored. A short video pitching the MHP as a tool for families was recorded and promoted by RIPIN and Family Voices and also available in Spanish. A video promoting using the MHP for professionals is in process and features testimonials from 3 community partners.

The past grant reporting period showed a dramatic increase in users among families and professionals and has been visited over 23,481 times. Data collection is captured through google analytics for monthly reporting on the number of users, type of device used, and top twenty (20) viewed pages and state locations.

Adolescent Health & Health Equity Zones

During the reporting period, the Health Equity Zones worked with their communities around a several initiatives related to adolescent health including:

 

• Expanding Opportunities for Youth Leadership and Development
• Engaging Youth in Community Planning
• Engaging Adolescents in Community Assessments
• Engaging Adolescents in Health/Wellness
   

Expanding Opportunities for Youth Leadership and Development

At the start of the 2019-2020 reporting year, HEZs were surveyed to assess their interest and needs around youth/young adult development and leadership (Y/YALD). The results indicated a need to train adults in authentic youth engagement while furthering opportunities for youth leadership and development across the HEZ Initiative. A HEZ-wide Youth Advisory was formed, and all agreed that what was needed was funding for a Youth Engagement Consultant (YEC) to elevate youth voice in all priority areas within the HEZ network by providing assessments and recommendations. The HEZ YEC was also responsible for collaborating with the HEZ youth engagement advisory to assess HEZ strategies concerning youth engagement. It was also agreed that the HEZ YEC would assist in developing a resource library of best practices and tools to initiate/improve youth engagement, maintain consistent communication with the Rhode Island Department of Health (RIDOH) HEZ leadership and other relevant staff, implement quality improvement measures to improve HEZ efficiency and outcomes in relation to youth voice, and will assist in youth engagement policies and programs as appropriate. The work of this group was put on hold in early March due to COVID-19.

With support from Woonsocket HEZ, the WATCH Coalition (Woonsocket Alliance to Champion Hope) implemented an overnight youth leadership retreat in February 2020. The goals of the retreat included providing leadership skill training for Woonsocket youth so that they could return to the community and apply the skills they learned. There, they engaged in hands-on workshops that taught leadership skills such as communication, advocacy, and conflict resolution, as well as community organizing skills such as visioning, issue cutting, equity analysis, and action planning.

Topic covered at the youth retreat included:

•  Economic disparities, classism, and resource distribution
•  Racism
•  Criminal justice reform
• Restorative and transformative justice
•  Human rights (Universal Declaration of Human Rights)

RIDOH HEZ team will continue to meet with RIDOH youth and adolescent programs, specifically the youth/young adult development and leadership (Y/YALD) and the RIDOH Youth Engagement Consultant (YEC) to address needs and develop strong leadership skills among youth to promote participation in their communities, applying the leadership skills they have learned and supporting community engagement.

Engaging Youth in Community Planning

During 2019-2020 the RIDOH Youth Advisory Council (YAC) continued to collaborate with the Pawtucket/Central Falls HEZ (PCF HEZ) evaluation team to recruit participants for a young adult focus group “Community Conversations: Help solve the substance use in Central Falls and Pawtucket.” Youth leaders from the community participating in this project identified opioid education and awareness as a need and became part of the PCF HEZ Opioid Action Plan. This plan included substance use education for youth, and positive social opportunities and employment opportunities for youth and young adults. The PCF HEZ offered substance use education programs that reached 216 students at local schools. In a post-presentation survey, 91% of students reported that the presentation helped them understand how opioids affect the body, and 92% of students reported feeling very or somewhat confident that they would be able to help someone in the case of an overdose. The PCF HEZ also developed plans to strengthen their collaborative by establishing a youth engagement taskforce (work group) to identify specific needs for youth and youth serving organizations in the PCF HEZ.

This team conducted a mini-grant project that resulted in a youth artist COVID prevention art being rolled out on a bus stop and the back of RIPTA buses. The team was excited to have her work featured in such a public way.

Within the Boys and Girls Club (BGC) leadership program, youth are part of a Health Advisory Council. Students worked alongside a Brown resident to plan programming and activities. Youth identified physical fitness, healthy eating, skin care, and hygiene as areas to address. A third session with BGC staff covered physical strength, stamina, and proper use of exercise equipment. During the summer, the program ran a job exploration program with 8 different speakers and served 56 members. Youth leaders also participated in an online forum about safety and leadership.

The YMCA adopted their All-Star curriculum for the Pawtucket YMCA and the online reality. This is a well-developed curriculum and the program was excited to bring it to this YMCA. This prevention program targeted young teens in looking at their future and making positive choices. Recruitment took place online, but by July 2020, they were able to have middle school students in an in-person pod examine tough questions about the next 20 years and their own vision of their future.

In the coming year, Woonsocket HEZ intends to continue working with the youth who participated in the youth leadership retreat, as well as other youth in the community, to engage in equity work in the city. The PCF HEZ plans to continue youth engagement activities and collaborative efforts with the YMCA and BGC leadership program.

Engaging Adolescents in Community Assessments

Several of the Health Equity Zones reported conducting community assessments during the Fall of 2019, which included several community events to gather student and family needs assessment data.
 

Cranston HEZ: During the Fall of 2019, OneCranston HEZ attended several community back-to-school events to collect feedback from students and their families. The official data collection process for OneCranston HEZ’s Community Assessment began with a community Speak-Out at Arlington Elementary School in November 2019. After the Speak-Out, an adult survey and a teen survey were circulated for three months. The surveys were created with feedback from students, residents, partners, and the Rhode Island Department of Health. The surveys were distributed through all of the schools in OneCranston HEZ’s catchment area, were sent home to parents, and were advertised at community gathering places, such as the Cranston YMCA, CCAP Health Center, and the Senior Center. These outreach methods allowed OneCranston HEZ to incorporate the input of children and teenagers into the Action Plan that would be implemented in the coming year (2019-2020).

 

East Providence HEZ: The East Providence Health Equity Zone also engaged youth and young adults in their initial community assessment process. In response to their findings, the EP HEZ planned to establish a Youth Health and Wellness workgroup to further explore and to develop plans to address areas of concern identified by the youth, including bullying and substance misuse.

 

West Elmwood HEZ: During the reporting period the WE HEZ assessment was designed around four priority areas: affordable safe stable housing, food access and systems, environmental conditions, and education. The assessment approach included a secondary data review, interactive community speakouts, online surveys, and virtual focus groups. Throughout this process youth and young adults were engaged, with over 40 young parents engaged in the online surveys.

 

Engaging Adolescents in Health/Wellness

The Central Providence and Woonsocket HEZs implemented programming with partner organizations to engage community adolescents in health and wellness activities.
 

Central Providence HEZ: During the reporting period, the CP HEZ provided community grant funding to provide youth in the community the opportunity to participate in leadership activities through free, high quality after-school and out-of-school programming. Over 70 youth participated in the programming, which included a playwriting program for middle school students, multiple after-school and out-of-school programs for 3rd-5th graders, a “Teen Voices” paid internship for ten (10) students, bi-weekly online play festivals, an online “Young Womxn’s Group,” and online tutoring as needed. All activities were designed to help young people “create and connect,” as well as to support learning and engagement.

 

Woonsocket HEZ: Woonsocket HEZ continued to provide sexual health education to ninth grade students at Woonsocket High School. The HEZ also partnered with local healthcare providers to maintain a healthcare center in the school that was available to students. In addition, HEZ partners continued to provide community education. HEZ partner RiverzEdge Arts launched a campaign to promote utilization of Title X services among teens in Woonsocket.

Other Programs/Initiatives Related Adolescent Health

Statewide Adolescent Health Strategic Plan

Rhode Island’s Adolescent Health Strategic Plan is in development. Healthy People 2020 and Maternal and Child Health’s Title V performance measures were used as a guide in identifying health priorities. This plan considered 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. Additionally, the RIDOH’s Adolescent and School Health conducted extensive formative research to inform strategic plan development, including a youth health and well-being survey, youth listening sessions, and community input sessions of youth-serving professionals. Six adolescent health priority areas were identified. The Plan's goals and objectives are being 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. The plan framework is being circulated for comment with the expectation of the final draft to be released in Fall 2021. RIDOH Adolescent Health plans to launch a statewide Adolescent Health Coalition to support implementation of strategic plan activities.

 

Social Media Marketing and RIghtTime App

In 2019-2020, the Center for HIV, Viral Hepatitis, STD and TB Epidemiology (CHHSTE) continued its collaboration with RIDOH’s Family Planning Program to promote the RIghtTime app. The mission of this app is to help adolescents and people of all ages and genders to navigate an increasingly complicated landscape of information surrounding sexual health. In 2020, many of our outreach activities were put on pause due to the COVID-19 pandemic. We were able to participate in a few virtual events including a virtual high school sports awards ceremony. RIDOH had planned a large RIghtTime launch at Rhode Island College to promote the app, which was unable to happen due to the COVID pandemic. We were able to redirect these funds to advertise a new condoms by mail initiative. Individuals who are looking to access condoms are able to receive a package of about 15 condoms shipped to their house as frequently as once per month. The condoms by mail program was promoted through traditional social media methods as well as on dating and hookup apps. It has had great success in meeting individuals throughout the state (representing all 39 cities and towns). We have also continued building partnerships with healthcare providers, community organizations, and educator organizations such as the Rhode Island Healthy Schools Coalition, the Rhode Island School Nurse Teacher Association, and the Rhode Island Association for Health, Physical Education, Recreation, and Dance and presented workshops and training opportunities promoting RIghtTime as a sexual health resource for youth, educators, and parents.
 

RIDOH Partnership with RI Healthy Schools Coalition

During 2019-2020, RIDOH continued to work with the RI Healthy Schools Coalition (RIHSC) to engage school districts in assessing and implementing positive change related to Adolescent Sexual Health (ASH). Efforts continued to focus on raising greater awareness of Adolescent Sexual Health as a part of comprehensive health education, developing policy, and providing school committee members, administrators, educators and nurses with tools and resources to improve education and access to services in their schools. Despite competing priorities in schools in 2020 with COVID, the RI Healthy Schools Coalition was able to conduct multiple virtual professional development opportunities for schools across Rhode Island, and strengthen its relationship with school health committees throughout the state.

 

Vaccinate Before You Graduate (VBYG)
Rhode Island Department of Health’s Office of Immunization has conducted school-located vaccination (SLV) clinics every year since 2001 through our Vaccinate before You Graduate (VBYG) program. Vaccination is one of the best ways to protect children and adolescents from 16 potentially harmful diseases, many of which can be deadly. The Rhode Island Department of Health (RIDOH) Childhood Immunization Program’s mission is to protect all Rhode Island children from these vaccine-preventable diseases. Vaccinate Before You Graduate (VBYG) helps achieve this mission by making 11 important vaccines available to Rhode Island middle and high school students at no out-of-pocket cost. Many of these vaccines are required for school entry. The goal of the program is to ensure that students have access to all routinely recommended vaccines and that high school students are fully immunized before graduating 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 at the National Immunization Conference for achieving the highest adolescent immunization coverage rates as compared to other states. In the 2019-2020 school year 95 schools participated in the VBYG program and 1,825 students received one or more vaccines, with a total of 3,776 vaccine doses administered. With the early closure of schools due to the COVID-19 response, fewer clinics were held and therefore fewer students were vaccinated than previous years. (2020-21 data will be available in late 2021). However; this upcoming school year we anticipate business as usual with the schools.

 

Conference on Youth Sexual Health Education

This event was not held in 2020, but a virtual conference was held in May 2021.

 

The Violence and Injury Prevention Program (VIPP)

VIPP collaborates 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 participate in school sports and youth athletic leagues.

 

The VIPP, in collaboration with Day One, the state’s only rape crisis center, has created two initiatives for college professionals and students. The first initiative is 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 and conduct process and outcome evaluation trainings. Also, the collaborative 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.

 

Youth Sport Concussion Prevention Program (YSCPP)

Title V provided Venture Capital funding to offer neuropsychological baseline testing (NBT) to middle and high school 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. It 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 youth ages 11-18 who participate in school sports and youth athletic leagues. Between October 1st, 2019 through June 31st, 2020, the Youth Sport Concussion Prevention Program was implemented in 18 schools in a variety of ways. Six out of the eighteen schools only participated in concussion education presentation activities. 508 students aged 11-18 completed baseline ImPACT testing. The Program is working on implementing a universal return to learn protocol called REAP which focuses on concussion management for schools. By implementing REAP the Youth Sport Concussion Prevention Program will be able to help not only student athletes but any student who suffers a concussion.

 

In 2019 VIPP contracted the Brain Injury Association of Rhode Island to develop a RI specific REAP manual. The manual was supported by the Rhode Island Department of Education, Rhode Island Interscholastic League, Rhode Island School Nurse Association and the Athletic Trainers Association. The Brain Injury Association of RI, with the support of the National Association of State Head Injury Administrators, offered a webinar by Karen McAvoy, REAP developer, to kick off the roll out of the REAP manual. The manual was distributed to every school, superintendent, athletic director/ trainer and school nurse.

 

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), aims 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) involving individual and group counseling for students enrolled. It will refer to community-based social services and mental health agencies. The intervention was piloted during the ’17-’18 school year. During the pilot, 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 across five Rhode Island school districts, both returning and new, who showed interest in the Emotional Regulation Intervention Project. The number of students who participated varied between three to eight students per group. The Emotional Regulation Intervention Project served a total of over 50 students, but the pre- and post-surveys were only completed by students who received parental approval before the start of the workshop. The evaluator analyzed the pre/post survey data and developed a report in September 2019. In an effort to sustain the intervention project, 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 RISAS program was able to implement the Emotional Regulation Program in Westerly, North Kingston, Johnston, Pawtucket, Barrington, Chariho, and Burrillville in the ‘19-’20 school year. The Program was interrupted by COVID-19, however, and not all seven schools were able to complete the 12 sessions. Once schools went to a virtual platform RISAS counselors were not able to assemble the students to complete the sessions. No schools were able to complete the evaluation component, which includes a pre survey, post survey and a 1-month survey.

 

Mental Health Consultation within early care and education

Through a partnership with DHS, child focused mental health consultation is available statewide. RIDOH is currently working with DHS to sustain its program focused

mental health consultation to childcare as well. In 2020, several mental health professionals from Bradley Early Childhood Research Center, who are also early childhood mental health consultants, developed and delivered training on how to become a child care mental health consultant with the goal of expanding the capacity of the system overall.

 

The Rhode Island Youth Suicide Prevention Project (RIYSPP)

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 referring 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 is currently working to rollout the SPI Youth Suicide Prevention work to every public-school district in the state. The VIPP has also implemented the Emotional Regulation program in one Health Equity Zone middle school (Westerly). Additionally, the VIPP has participated in the HRSA funded Collaborative Office Rounds grant, whereby the HEZ has received the funding and training is targeted to local pediatricians. Furthermore, the VIPP participates with the Bristol Health Equity Zone through their suicide prevention subcommittee.

 

RIDOH Healthy Summer Toolkit for Youth Program Leaders

Between late spring and fall of 2019, multiple RIDOH programs contributed health information and links to health resources as part of a new bi-weekly newsletter. Multiple issues disseminated health information and resources about insect and animal bite disease prevention, youth mental health resources, emergency preparedness for youth, smoking/vaping/substance use prevention, and sun/extreme heat safety, among others. Late summer/early fall editions also served as back-to-school resource editions. This back-to-school newsletter project was not repeated in Summer 2020 given that summer camps and schools were either meeting virtually or were in flux due to the COVID-19 pandemic. Preliminary discussions have begun about disseminating at least one newsletter during Summer 2021 to school nurses, teachers and administrators to share miscellaneous non-COVID-19 and COVID-19 programmatic public health messaging and resources for teens and young adults.