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

Adolescence (age 12-17) is a critical period of transition between childhood and adulthood. It includes the biological changes of puberty and development to adulthood. The behavioral patterns established during these developmental years can protect children or put them at risk for many different physical and behavioral health conditions. Older adolescents and young adults, including those with chronic health conditions, may face challenges as they transition from the pediatric to the adult healthcare system. This includes changes in their health insurance coverage and legal status. It may also include decreased attention to their developmental and behavioral needs. The Rhode Island Department of Health (RIDOH) strives to ensure that all adolescents and young adults receive timely, high-quality, culturally sensitive healthcare. This health domain section has taken into consideration that the care and outcomes of womxn, children, and families are impacted by the systemic racism, discrimination, unaddressed language barriers, and a lack of culturally responsive providers. The following quantitative, qualitative, and anecdotal information tries to tease out health disparities and the overarching healthcare needs of communities.

 

The following priorities for adolescent health emerged from Rhode Island’s 2019 Needs Assessment:

 

1. Support mental & behavioral health

 

Priority: Support Mental & Behavioral Health

Healthcare and Immunization: According to the 2019-2020 NSCH, 79.5% of adolescents ages 12 to 17 received a past year preventive medical visit. In 2019, NIS reports that 91.9% of teens ages 13 through 17 have received at least one dose of the HPV vaccine, a slight increase from 89.3 in 2018. RI has the highest rates of HPV vaccination in the US. Other adolescent immunizations were also high in 2019 with 98.2% receiving at least one dose of the meningococcal conjugate vaccine and 96.4% receiving at least one dose of the Tdap vaccine. Seasonal influenza, meningococcal, and Tdap vaccination in RI exceeds U.S. rates among adolescents. Rates of chlamydia and gonorrhea have increased by 25% and 133% respectively from 2014 to 2018 among youth ages 15-24.
 

Behavioral/Mental Health: There was a slight decrease in bullying in school property among high school students from 17.3% in 2017 to 16.4% in 2019. LGB high school students continue to be more likely to be bullied on school property (37.2%) than heterosexual high school students (13.0%), as well as more likely to be electronically bullied (LGB HS students: 26.5%; heterosexual HS students: 10.9%). Suicide ideation is an important issue which the MCH Program monitors. YRBS 2019 data report a slight decrease among high school teens who seriously considered committing suicide from 13.6% in 2017 to 12.1% in 2019, but a statistically significant increase from 9.9% in 2013. Disparities exist between 18.3% of Non-Hispanic Black teens who seriously considered committing suicide compared to 12.1% of Non-Hispanic White teens in 2019. In 2019, the prevalence of having attempted suicide was higher among gay, lesbian, and bisexual students (36.5%) than heterosexual (9.7%) students. The percentage of binge drinking (11.2%) among high school teens in 2017 has dropped slightly in 2019 (10.7%).  In 2018-19, 18.7% of adolescents ages 12-17 received treatment or counseling by a mental health professional.

Youth Survey Results: In 2019, RIDOH Title V and Adolescent Reproductive Health staff outlined and administered a youth survey. Youth ranked the following as their top four priorities that should be addressed to improve the health and well-being of teens: 1) Mental Health (54%), 2) Safe & Healthy Schools (53%), 3) Suicide Prevention (37%), and 4) Healthy Relationships (with adults, friends, and partners) (36%).

 

Similarly, 32% of teens ranked Mental health (Anxiety, depression, etc.) as one of their top four things that concerned them on a day-to-day basis. Rhode Island and SISTA FIRE collaboratively distributed a survey that asked womxn of color the top three important things that need to be addressed to improve the health and well-being of adolescents (12-17 years old). The top priorities that rose to the top are as follows: 1) Sexual Health (58.9%), 2) Mental Health (45.4%), and 3) Social & Emotional Health (40.2%). Womxn of color ranked the top three important things needed to be addressed for the health and well-being of young adults (18-24 years old). The following three priorities were overwhelmingly chosen: 1) Mental Health (64.2%), 2) Social & Emotional (44.9%), and 3) Sexual Health (42.6%).

 

All three surveys overwhelmingly align to show that there is a need to support the mental and behavioral health and development of youth. This theme was further fleshed out during a youth focus group the Title V needs assessment team held with the Youth Advisory Council (YAC). The youth agreed that mental health was an immense issue among their peers that encompassed substance and drug use and mental illness. Youth participants did see substance use, vaping, and drug use occurring within social scenes and gatherings. However, all agreed that much of the persistent drug use, substance use, and vaping they saw was tied to youth masking or self-treating underlying social and emotional issues. In all, Youth focus group participants emphasized that mental illness should be destigmatized, and schools and providers should find more educational and supportive avenues to help bolster youth mental health.

 

To respond to these disparities and comprehensively support mental and behavioral health for adolescents, RIDOH will resume, continue and add strategies as follows:

 

Maintain Teen Outreach Program Activities (TOP): TOP is a positive youth development curriculum to support youth life skills development and promote community connectedness. TOP has served approximately 875 youth since 2013. The program served approximately 70 youth during 2020-2021 program and 95 youth during 2021-2022 program. All community-based TOP implementation partners adapted their program implementation to offer 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.

 

System of Care of children’s behavioral health: Throughout 2021 EOHHS continued to convene a group of representatives from multiple state agencies, including BHDDH, DCYF. OHIC, RIDE, and RIDOH. The group is tasked with planning and preparing to implement the Children’s Behavioral Health System of Care (A system of care is a wide spectrum of effective, community-based services and supports that is organized into a coordinated network). The initiative included the following workgroups:
      • Crisis continuum, development and access, screening and assessment,
          • Care authorization, care coordination and care monitoring,
          • Service array,
          • Ensuring equity: race equity, family members, people with IDD, and                                 LGBTQ+ Families,
          • Workforce transformation,
          • Data systems for outcomes measurement and evaluation, and
          • Community outreach and education.

The workgroups met over a period of six months and each workgroup developed a plan related to its section/subject matter; a compilation of this work created the detailed draft plan. Due to funding constraints, the planning team needed to prioritize areas for implementation. It was determined, with community input, that the mobile crisis unit would be implemented with the initial funding; funding was secured from RIDE to create partnerships with schools to implement a mobile crisis unit. The goal of the unit is to address crises when they happen and reduce visits to emergency departments. The 2023 budget included funding to implement additional components of the system of care which are currently under evaluation. One known component that will be funded to stabilize the workforce is a provider rate increase for those programs implemented by the child welfare agency. The group is currently evaluating what else can be implemented.
 

Bolster the Violence and Injury Prevention Program (VIPP): VIPP collaborates with RI Student Assistance Services to implement a 12-session emotional regulation pilot program in middle schools throughout Rhode Island. This intervention targeted students who were referred by school professionals and parents. In addition, the VIPP works with the Brain Injury Association of RI to implement concussion prevention and management initiatives. Schools have access to free ImPACT Neuropsychological Baseline testing to high school youth who participated in school sports. 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. Lastly, The VIPP in collaboration with various stakeholders brought the REAP Concussion Management Manual to Rhode Island to provide schools with a tool to comply with Rhode Island legislation.

• 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 Violence Prevention which 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, resources 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 and continues to explore national and regional learning opportunities. The second initiative created is the RI Student Collaborative on Sexual Violence Prevention, 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 Student Collaborative has increased their social media presence which has increased recruitment and awareness of the group.

 

Youth Sport Concussion Prevention Program (YSCPP): The VIPP has continued to seek for funding opportunities for the Youth Sport Concussion Prevention Program. Title V provided Venture Capital funding in the past to offer neuropsychological baseline testing (NBT) to middle and high school youth ages 11-18 who participate in school sports and youth athletic leagues.  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 has collaborated with state and community stakeholder since 2019 to implement a universal return to learn protocol called REAP which focuses on concussion management for schools. The Return to Learn protocol was completed in 2021. The Program has outreach to schools to assist in the school implementation and will continue to offer TA to schools.

 

• In 2019, VIPP contracted with 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. Once manuals were distributed in 2021 the Brain Injury Association of Rhode Island Education manager and RIDOH VIPP developed webinars to assist schools in understanding how to implement the manual.

 

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.

 

• In the 2020- 2021 school year the RISAS program was able to implement the Emotion Regulation initiative in North Kingston, Barrington, Chariho, Burriville, and West Warwick. The Program adapted to COVID-19 restrictions which included utilizing Zoom and finding group space to accommodate for COVID-19 protocols. The Program was successfully in adapting and pivoting to continuous interruptions. The schools were able to complete the evaluation component.

 

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 Health team 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. Plan development was impacted by the COVID 19 pandemic. RIDOH Adolescent Health is updating current data sources, as well as re-engaging community partners to share additional feedback. The plan framework is being circulated for comment with the expectation of the final draft to be released in Fall 2022. RIDOH Adolescent Health plans to launch a statewide Adolescent Health Coalition to support implementation of strategic plan activities.

 

Further progress on Rhode Island Youth Suicide Prevention Project: Through its CDC Rape Prevention Education grant, the Violence & Injury Prevention Program works with its partners to implement interventions targeting risk and protective factors for teen dating and youth sexual violence at the community-level. Interventions implemented during the 2021-2022 project year included the evidence-based Girls Circle Program implemented by the YWCA of RI with middle school girls from Providence and Central Falls, a virtual Certified Peer Education training provided by SafeBAE to high school students across the state, youth leadership and civic engagement training for Providence high school students by Young Voices in Providence, K-12 Title IX training and certification from The Association for Title IX Administrators, and the development of evidence-informed guidelines for sexual health and consent education in K-12 settings, created by Day One of RI. 

 

During the 2020-2021 project year, the RPE Program also worked with Day One of RI to convene the first public meetings of the Rhode Island Sexual Violence Prevention Coalition, which was developed under this funding and is the first state-wide coalition focused solely on preventing sexual violence. During this project year, the RPE Program began working with its funded partners to develop a storytelling evaluation resource for others in youth sexual violence and teen dating violence prevention, highlighting successes, lessons learned, and the impact that these interventions have had on community members who’ve participated. Youth suicide prevention program strategies included:

• Created and promoted our Over the Counter is not On the Counter campaign which raises awareness with caregivers of small children about locking up painkillers and common drugs. This is in partnership with BHDDH and the RI Regional Coalitions and includes a QR code which, when scanned, leads to a place where the public can request a free medication lock bag. We also distributed medication lock bags and timer caps at community events, supplied in part by our program. This is part of the broader Count It! Lock it! Drop It! Campaign of the RI Regional Coalitions, supported by our program.
• Revitalized the Suicide Proof Your Home campaign.
• Launched a new, comprehensive, suicide prevention website for the state: preventsuicideri.org.
• Continued to train 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  
• Created an SPI Handbook as a key tool for counselors/school crisis team members using our crisis evaluation assessment protocol.
• Responded to the new Nathan Bruno and Jason Flatt Act passed on July 2 requiring suicide prevention training in all public-school districts for all school staff, teachers, coaches, contracted lunch staff, bus drivers, and volunteers.  This will require training for students each year in grades 6-12.  Since there is no funding attached to this new law, RIDOH worked with BHDDH and RIDE on the implementation of training.  RIDOH purchased 50 Signs of Suicide kits to be available for schools to implement training in the middle and high schools.  RIDOH provided subject matter expertise on policy creation as well.
• Partnered with NEA RI on another Mental Health Summit and other opportunities to train teachers and staff under their umbrella.
• Continued to partner with the RI Office of Veterans’ Affairs on the SAMSHA/VA Governors Challenge to Prevent Suicide Among Service Members, Veterans and Families initiative (unfunded).  Another 2-day meeting took place in August with the federal TA provider on activities across the RI National Guard, Vet Center, VA, and veteran serving community-based organization.
• Co-created, supported, and promoted Mental Health Day of Action in May along with the RI Office of Veterans’ Affairs.
• Brought The Us in Campus, a social media project co-created by our team with RI college students, to four RI campuses via Facebook, Instagram, and TikTok since launching it in fall 2021. The Us in Campus has reached over 2500 viewers on Facebook and over 2700 on Instagram (TikTok data not yet available).
• Successfully completed year 3 of our Garrett Lee Smith Grant from SAMHSA.
   

HEZ suicide prevention efforts: RIDOH continued to engage monthly with the Bristol HEZ’s suicide prevention subcommittee, Newport County’s Zero Suicide grant team, Washington County’s Zero Suicide team, and the Zero Suicide committee within Care New England which includes WIH, Butler, Kent, Memorial Clinic, Providence Center, and Anchor Recovery.
 

National suicide prevention efforts: A representative from RIDOH participated on the national steering committee of the Children's Safety Now Alliance through the Children’s Safety Network and their advisory team. 
 

Suicide prevention hotline number to an easier to use number: RIDOH representatives continued to participate in planning efforts to change the suicide prevention hotline number from 1-800-273-8255 to 988.

 

PediPRN Program: Like MomsPRN, PediPRN serves providers treating children and adolescents in partnership with Bradley Hospital. 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.  PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise to achieve its mission. This service, funded by a 5-year HRSA grant, is free and provides all Rhode Island pediatric primary care providers assistance with their patients' mild to moderate mental health care needs. PediPRN focuses on creating a culture of empowerment for pediatric primary care providers. The clinical team works closely with providers offering CME opportunities, educational e-blasts, an updated website with assessment and educational resources on pediatric behavioral health topics, and ongoing support during telephonic consultations.
 

PediPRN continued to implement training, mentoring, and education for Pediatric Primary Care Providers (PPCPs) in the PediPRN Intensive Program. The second (2020) cohort launched in Sept 2020 (delayed from the planned start of March 2020) and ended in May 2021. Specific topics included Attention Deficit Disorder Assessment and Treatment in Pediatric Primary Care; Depression and Non-Suicidal Self Injury; Teen Substance Use: Screening and Treatment; Evidence-Based Practices in Autism; Eating Disorders in Primary Care; and Obsessive-Compulsive and Anxiety Disorders in Pediatric Primary Care. Out of 10 enrolled participants, ten graduated. CME evaluation forms reflected positive feedback from the participants. PIP graduates continued to meet for regular consultation sessions (as requested by the 1st cohort graduates) virtually (via Zoom) until funding was no longer available to support this program component. We have applied for additional funding from local funding sources to continue this component from PIP.

 

PediPRN Program Utilization, Enrollment, and Outreach: In 2020, PediPRN fielded 437 teleconsultation calls from 358 providers at 68 practices, directly helping 242 unique pediatric patients. In addition, during the reporting period, 27 providers have graduated from the PediPRN Intensive program (PIP). Preliminary evaluation of both PIP graduates and highly engaged providers show that these providers have:

• Higher rates of mental health-focused visits
• Fewer psychiatric hospitalizations per year
• Report increased knowledge and comfort with assessing safety, evaluating and managing non-suicidal self-injury, and awareness of available mental health care

This data reflects a decrease in utilization during the height of the COVID pandemic when practices were adjusting to telehealth visits and workflow changes. Since offices resumed in-person visits and practices have adapted to workflow changes, utilization has increased and stabilized at volumes similar to previous years.

 

However, enrollment continues to be slow as we have already captured many practitioners in the State. We have made efforts to access working lists of pediatric practitioners in the State to establish estimates of eligibility and enrollment and target enrollment efforts to those eligible but not enrolled. Final numbers should be available soon.

 

Outreach visits were stopped due to COVID restrictions and added burden (time and work) for PCPs related to the pandemic. We are now resuming outreach visits, starting with practices that have not utilized the program recently, via teleconference or in-person (based on practice preference). The goals of these visits are to review current PediPRN services, assess mental health needs and services of the specific practices, and solicit feedback regarding future programming endeavors.

 

PediPRN Electronic Education: Electronic education via e-blasts and newsletters provides up-to-date information regarding mental health resources, mental health screening and treatment training, and PediPRN services.

 

PediPRN ‘Office Hours: Practice-based office hours have been a successful strategy to provide training, consultation, and support to specific practices. Office hours have also been an excellent opportunity to learn more about the mental health needs of particular practices across the State and establish program champions to support programming and sustainability efforts. The modality for practice-based office hours is Zoom and the frequency is monthly for one hour for each practice. During this time, PPCPs ask for support with specific cases and general mental health questions, share mental health-related challenges within their practices, and provide feedback regarding service needs in these discussions. We have also shared PediPRN sustainability efforts and inquired about PPCP's comfort with supporting these efforts via advocacy. Practitioners have utilized general/open “drop-in” office hours less frequently, so we have decided to pause on continuing these open office hours and are considering alternative strategies.

 

Health Education Framework: RIDOH served on the Advisory Group for the RI Department of Education’s revision of the Health Education Framework (HEF) for RI schools. The HEF was updated to integrate inclusive practices and align with the National Health Education Standards with the goal of ensuring RI students are health literate and have the essential skills to lead healthier lives. The HEF establishes that health education should be comprehensive, skills-based, age/developmentally appropriate, and aligned with best practice instruction. Health education should also be recognized as a core content area in the overall K-12 curriculum. The HEF outlines practices and expectations that health education be medically accurate, inclusive of diverse language, integrate social and emotional learning, and be delivered with trauma informed practices.

 

RIDOH programs provide training and technical assistance to local education agencies (LEAs) for implementation of comprehensive, medically accurate, inclusive health education in alignment with the HEF. RIDOH has contracted with the RI Healthy Schools Coalition to engage LEAs to utilize CDC’s Health Education Curriculum Analysis Tool and provide professional development for health educators to improve their knowledge and comfort in implementing comprehensive health education.

 

Promote Teen Dating Violence and Youth Sexual Violence Prevention Activities: Through its CDC Rape Prevention Education grant, the Violence & Injury Prevention Program works with its partners to implement interventions targeting risk and protective factors for teen dating and youth sexual violence at the community-level. Interventions implemented during the 2021-2022 project year included the evidence-based Girls Circle Program implemented by the YWCA of RI with middle school girls from Providence and Central Falls, a virtual Certified Peer Education training provided by SafeBAE to high school students across the state, youth leadership and civic engagement training for Providence high school students by Young Voices in Providence, K-12 Title IX training and certification from The Association for Title IX Administrators, and the development of evidence-informed guidelines for sexual health and consent education in K-12 settings, created by Day One of RI.

 

During the 2020-2021 project year, the RPE Program also worked with Day One of RI to convene the first public meetings of the Rhode Island Sexual Violence Prevention Coalition, which was developed under this funding and is the first state-wide coalition focused solely on preventing sexual violence. During this project year, the RPE Program began working with its funded partners to develop a storytelling evaluation resource for others in youth sexual violence and teen dating violence prevention, highlighting successes, lessons learned, and the impact that these interventions have had on community members who’ve participated. 

 

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 178 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. He is also a member of the AMCHP committee Youth Voice Amplified.

 

During the last Title V reporting period, the YAC served sixteen (16) members who met monthly from September 2021 through May 2022 and in the virtual environment to address topics including: strengths assessing, stress reduction in times of change, health equity, oral health and healthy relationships. 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. Additional leadership opportunities are shared, and members have contributed to the new flyer and alternate ways to join YAC. The YAC meeting structure also provides a means for members to connect with their peers. As a group, the YAC worked with the Wilbury Theatre educators to develop an opening skit for the annual Dare to Dream Conference. This year saw a number of our members age out and move on to full time employment, military or college. The numbers remained steady with several new members joining the group.

 

Through a contract with several professional entities, the YAC also provided needed supports relevant to the social emotional toll of the COVID-19 pandemic. The Coping with the Unexpected workshop continued the COVID series from the previous year and 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 provided feedback that they wanted to learn more about setting boundaries to achieve healthy relationships. A training was developed for transition age young people of all abilities addressing this important topic and will be presented to the public in the future. 

 

Expand the Youth Ambassador Program: RIDOH Adolescent Health promotes authentic youth engagement for RIDOH programs and partners. The Youth Health Ambassador (YHA) program supports RIDOH engagements of youth as partners, advisors, experts, and leaders. YHA is a year-long program that works with a cohort of 15 high school age youth. The Youth Health Ambassadors learn about public health and RIDOH to support their readiness to advise RIDOH on policies, programs, and communications for youth, as well as to lead their own public health projects. YHA encourages their growth and development with guest speakers and skills-building workshops.

 

Promote the Conference on Youth Sexual Health Education: The Rhode Island HIV & STI Prevention Coalition facilitated collaboration between Rhode Island professionals, community members, and agencies to promote sexual health and prevent HIV & STIs. Currently, the Coalition consists of 14 different agencies and together, they worked to promote the Conference on Youth Sexual Health Education (CYSHE). This year’s CYSHE event was on May 21, 2021, from 9:00-2:00 PM, virtually. The theme for this year was Sex, Drugs, and TikTok. The conference featured presentations addressing youth sexual health, opioid addiction, and social media as a tool for education.

 

Convene the MCH/HEZ Learning Classroom: The HEZ MCH Learning Classroom is an interactive educational space created to educate Health Equity Zones on Maternal Child Health issues across all six domains. The Maternal Child Health Program has put together a list of speakers from both the community and RIDOH to attend our bi-monthly meetings and educate the group on the initiatives they implement. Each HEZ must send a representative to consistently attend the learning classroom meetings. The learning classroom will move into its 2nd year of programming in October 2022.

 

Adolescent Health and Health Equity Zones:

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

• Expand HEZ Mental and Behavioral Health Supports
• Expand HEZ Out-of-School Programming Scholarships

Please see below for a further exploration of the activities mentioned above:

 

Expand HEZ Mental and Behavioral Health Supports: Since its inception, Health Equity zones have been committed to engaging and empowering youth to take on issues affecting their peers. As a result of this, the issue of youth mental and behavioral health has risen to the forefront. Thus, a multiplicity of HEZs began to center programming meant to address this issue within their respective communities.

 

• Statewide Initiatives: Youth Engagement Community of Practice is being launched in the Health Equity Zone Initiative. The Health Equity Zone Initiative recognizes that adolescent health is a critical component in the overall health of communities. Furthermore, adolescents themselves are best positioned to determine what their health priorities are and what strategies will be most effective in driving those priorities forward. As such, the Health Equity Zones seek to incorporate youth engagement into their collaboratives so that youth can lead initiatives to more effectively address the social determinants of health that impact them. To support the HEZs in doing this, the HEZ Initiative is launching a Youth Engagement Community of Practice.

 

The Youth Engagement Community of Practice will be a quarterly convening of representatives from each HEZ, as well as other community and state-level partners who are involved in youth engagement work. During the quarterly sessions, participants will learn best practices for recruiting, retaining, and nurturing the leadership of youth in their communities. The sessions will be co-facilitated by youth and adults, who will work collaboratively to determine key benchmarks for progress and create content to help participants meet those goals.

 

Since 2014, the Health Equity Institute has invested in hiring and supporting Youth Resource Specialists. Their input into the transition process and generation of self-determination resources has been invaluable. Youth Resource Specialists on the YAC Advisory participate as a team in the RIDOH annual youth conference opening/volunteer activities, represent RI at national youth forums, and promote inclusion in RI’s youth serving organizations. In 2019, youth resource specialists led a monthly Youth Advisory Council where an average of 35 students with disabilities served as advisors to RIDOH programs and policies; presented at the national AMCHP Conference‌; and presented at the Turn Up Rhode Island Conference featuring career exploration for 300 students of color. Unfortunately, youth conferences expected to take place in the Spring of 2020 were cancelled due to COVID-19.

 

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 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.

 

The plan for the 2022/2023 reporting period included continuing a remote meeting option along with in- person meetings (when resumed) to accommodate the many youths with transportation challenges. The planned agenda for this period included professional development/leadership training, social/emotional/resilience workshops, community youth engagement opportunities, and RIDOH Program support activities. 

 

• Cranston HEZ: Cranston residents had identified mental and behavioral health as a priority area. In response to this, OneCranston HEZ created a Trauma Committee that would provide resources and opportunities to improve mental and behavioral health outcomes among Cranston families. One of the opportunities launched by OneCranston HEZ’s Trauma Committee was monthly Stress Down Days. These events provided residents of all ages with the tools to proactively manage their emotional and mental wellbeing. They were able to engage 400 people in their series of Stress Down Days.

 

OneCranston HEZ’s Trauma Committee and Youth Opportunity Zone Committee collaborated to offer an educational series called Let’s Talk About It. This series teaches teenagers about sexual health and healthy relationships in order to increase access to health care, improve behavioral health, improve sexual health, and reduce the transmission of STIs (sexually transmitted infections) among Cranston’s teens. A total of 9 youth participated in the series.

 

The Trauma Committee and Youth Opportunity Zone Committee also partnered to develop a family support and resource center called The Huddle Center. The Huddle Center helps youth, parents, and families access mental, behavioral, and physical health resources, social services, and education resources. It also serves as a space for children, youth, and families to participate in interactive activities that help to nurture social-emotional development. The Youth Opportunity Zone hosted two events at The Huddle Center that provided children and young adult books to local youth in order to increase mental health awareness through literacy.

 

• West Warwick HEZ: West Warwick Public Schools Implemented a 3-tier trauma-informed high school initiative and trained teachers and staff throughout the school department. Trauma informed care was an important focus of the HEZ and Trauma remains a pillar of focus, crosscutting our other content areas. West Warwick is a trauma informed community with trauma informed schools.

 

• Newport HEZ: In addition to continuing to support ongoing maternal and child health work throughout their community, the Newport HEZ began focusing on key target populations most in need of health equity work. For example, they began working with community partners and healthcare providers to improve healthcare access and improve healthcare experiences for LGBTQ+ teens. Several of Newport HEZ’s workgroups incorporated youth voice and needs into their action plans. The LGBTQ+ Health Working Group partnered with Child & Family, a social service provider in Newport County. This workgroup aimed to support healthcare facilities in earning the designation as LGBTQ+ safe spaces, thus increasing the safety and wellbeing of LGBTQ+ youth. Newport HEZ’s Arts and Culture Working Group also partnered with the Newport Youth Chorus and Newport Public Schools to engage young people in coordinating public art and other cultural activities in Newport.

 

• East Providence HEZ: The East Providence HEZ conducted a comprehensive community assessment in 2020, which included a youth focused survey. The youth survey was distributed to youth at the East Providence Boys and Girls Club and EBCAP’s Youth Center. The response rate from the community needs assessment totaled 494, representing both youth and adult community members. Based on the findings from the EP HEZ Community Needs Assessment, the HEZ created five preliminary action areas, one of which being supporting health & wellness across the lifespan.

 

EP HEZ took this priority into the classroom with their cross-grant programming. The Rhode 2 Equity grant worked with EP HEZ Family Navigator to place hydroponic systems within 10 classrooms. These hydroponic systems allow students to grow fresh produce in the classroom, which they are then able to take home and share with their families. The Family Navigator has been embedded into the local middle school for 1 day per week where she in accessible resource for parents. Support for the family navigator will continue in the application year.

 

EP HEZ is particularly interested in increasing engagement with EP HEZ teens and creating meaningful opportunities for leadership and feedback. Two teen “meet and greet” sessions were hosted during the summer which were led by two EP HEZ teen interns. The sessions identified the following priorities: recreation opportunities, community events, and a focus on mental health, substance use and bullying. These identified priorities will be used to support related activities and programs in the coming year.

 

• Central Providence (CP) HEZ: The CP HEZ introduced young girls to the computer science pipeline through learning circles, mentoring, and after school and summer programming. This resulted in 360 hours of IT mentoring and training offered in-person via Zoom for young girls via YWCA 6 weeks of summer programming and 12 weeks of afterschool programming took place to provide training on IT basics, HTML, and basic coding. 20 young girls were recruited for tech-related virtual field trips and programming.

 

CP HEZ and Central Providence Opportunities (CPO) aimed to decrease chronic absenteeism and identified the need for before-school time programing providing parents with more flexible drop-off times allowing parents to get to work while kids get to school. 37 students are currently enrolled in this program. In addition, CP HEZ supported the development of Educator-Led Communities of Care by the Service Employees International Unions (SEIU). The Service Employees International Union (SEIU) Education Fund brings together family childcare providers to share skills, build collective power, and assert agency over policy to improve the home-based childcare industry in the long-term. The CPHEZ/CPO will hire and train peer leaders to facilitate the cohorts made up of 15-30 family childcare providers.

 

• Pawtucket and Central Falls HEZ: The Pawtucket Central Falls HEZ developed an Opioid Action Plan, which included plans for substance use education for youth, and the creation of positive social opportunities and employment opportunities for youth and young adults. The 2020-2021 plan was informed by the 2019 Opioid needs assessment. Target population included young adults, families with a loved one who has a substance use disorder, and pregnant women and mothers with substance use disorder (or in recovery). Needs assessment participants also included staff of organizations in the community who work with young adults or people with a substance use disorder. 

 

Secondary data from RIDOH and law enforcement was also used to identify needs. The PCF HEZ’s substance use education programs reached over 216 students at local schools in 2020. In a post-presentation survey of those students, 91% reported that the presentation helped them understand how opioids affect the body, and 92% reported feeling very or somewhat confident that they would be able to help someone in the case of an overdose. The PCF HEZ’s substance use education programs reached over 216 students at local schools in 2020. This year the HEZ helped facilitate a class at Blackstone Academy for high school students addressing substance use. The PCF HEZ’s substance use education programs plan to continue their efforts. PCF HEZ continues to leverage the expertise of state and community stakeholders and remain flexible in their approach as they empower youth in guiding the work.

 

Given that the PCF HEZ identified youth engagement as a priority focus, many priorities will be addressed through the lens of youth’s perspective. Currently, PCF HEZ is in the beginning stage of the implementation of their 3-year strategic plan; a response to the recent assessment that included diverse representation of HEZ youth, residents and members. PCF HEZ will continue to tap into the expertise of the youth as they identify and address disparities. To that end intentional opportunities for youth leadership and advancement has been prioritized.

 

PCF HEZ also houses the Childhood Lead Action Project (CLAP), an initiative that continues to provide lead poisoning prevention and education to the Pawtucket and Central Falls communities. CLAP facilitated a lead poisoning prevention workshop at a high school for students studying environmental justice. The HEZ’s partnership with CLAP has contributed to achieving a decrease in childhood lead poisoning in Pawtucket, and the HEZ continued to support work to decrease childhood lead poisoning throughout the community. Over 50 individuals were engaged in receiving education regarding lead hazards.

 

• Bristol HEZ: Unlike the previous year, Bristol Health Equity Zone (BHEZ) Engagement Navigator was unable to offer one-on-one counseling to students at Mt. Hope High School. However, continuous feedback from residents and community organizations, including Bristol Warren Regional School District, strengthened BHEZ’s focus on behavioral health needs of youth and families, and informed decisions to partner with the school district to deploy two community health workers (CHWs) in the school and community-at-large as part of an integrated team. Looking to the coming application year, in June of 2022, two CHWs are slated to begin training and organizing/collecting resources for the community.

 

The long-term goal of this effort is to decrease the number of students and families accessing emergency rooms for mental health support services and to support COVID-19 recovery and resiliency. In that vein, BHEZ continues to partner with prevention coalitions to support the collective mental health of the community and identify new partners to collaborate on combating social isolation. In addition to decreasing isolation, BHEZ hopes to increase resident engagement. One of the ways they intend to achieve this goal is through an organized Mental Health First Aid (MHFA) training through the regional coalition for the Bristol Warren Regional School District. MHFA trainings are slated to begin in August of 2022 and continue through the application year.

 

A group of residents and community stakeholders, including representatives from the school department, the Bristol Police Department, Bayside YMCA, Roger Williams University, the National Alliance on Mental Illness, and more, continue to meet monthly toward a community-wide suicide prevention plan. This group initiated the Mount Hope Bridge Camera project. This led to Bristol Police Department writing new policy for the use of flock cameras near to bridge to decrease response time for calls to the bridge. Accomplishments also include getting signage on Mount Hope Bridge, conducting mental health forums, and suicide prevention trainings in coordination with American Foundation of Suicide Prevention. They continue to work with faculty and students who developed a policy brief around barriers on RI bridges. This group also received a legislative grant which will enable them to have the signs translated and displayed in Portuguese; a big demographic group in the Bristol community.

 

BHEZ continued its support of The Change Direction campaign at Mt. Hope High School by utilizing a student advocate to support the initiative. The campaign was previously supported by the student advocate and a group of students. This group has since morphed into a student union group that worked on additional activities around equity and inclusion. Their work is ongoing.

 

BHEZ also participated on the Bristol Warren Regional School District's Wellness Committee to provide input on wellness activities within the school. In efforts to provide access to health and wellness for all community members and residents BHEZ will partner with the school district and local library to provide on-site family navigator services at libraries, schools, community locations and parks. A Family Navigator who is charged with this work is slated to be hired summer of 2022 for work completed in the coming application year.

 

• Woonsocket HEZ: Woonsocket HEZ’s efforts around adolescent health continued to center on sexual health education and reproductive healthcare access. The HEZ’s goal is to decrease Woonsocket’s teenage birthrate (which is currently the second highest in the state of Rhode Island at 39.5 per 1000 births to teens) by 50% by the year 2025. To achieve this goal, Woonsocket HEZ seeks to ensure that all high school students have access to high quality sexual health education and that all youth have access to free and confidential healthcare. Woonsocket HEZ’s Teen Health Workgroup, in partnership with Thundermist Health Center and the Woonsocket Education Department, employed one Family Planning & Sexual Health Educator who worked fulltime at Woonsocket High School. Because of the ongoing COVID-19 pandemic, resulting in school closures, virtual learning, and a city-wide increase in chronic absenteeism, only 20% of enrolled students were able to complete the sexual health curriculum. However, the students who did not complete the program were re-enrolled in the class for the following semesters, and thus far 69% of them have completed the curriculum. The Family Planning and Sexual Health Educator taught 122 hours of comprehensive and inclusive sexual health content in the fall of 2021.

 

To improve healthcare access, Woonsocket HEZ leveraged its partnership with Thundermist and the Education Department to reopen the Teen Health Hut located inside of Woonsocket High School, which had previously been closed for much of the COVID-19 pandemic. The Teen Health Hut at Woonsocket High School is staffed by pediatricians, nurse practitioners, and other medical professionals who offer pediatric healthcare services including physical exams, immunizations, dental care, testing and treatment for STIs, family planning counseling, and more. All services are available to Woonsocket High School students free of charge, regardless of insurance coverage. To increase awareness of the healthcare services that are available to teens, Woonsocket HEZ partnered with a local youth-led arts and media organization called RiverzEdge Arts. The youth at RiverzEdge Arts launched a video, print media, and social media campaign to raise awareness about LARC (Long Acting Reversible Contraceptives), Title X reproductive healthcare services, and primary healthcare services. As part of the campaign, they created large scale graphics including one multi-language graphic, one video public service announcement, and social media promotion through content with over 1094 total views.

 

In addition to the promotion of adolescent health, Woonsocket HEZ and its partners invested in opportunities to enhance youth engagement in the HEZ collaborative. Woonsocket HEZ partnered with a local organization called The WATCH Coalition to develop a youth leadership initiative. They connected with Youth in Action, a Providence based youth leadership organization, to provide trainings on authentic youth engagement work. Over 50% of adult members of the Woonsocket HEZ collaborative participated in the Youth in Action trainings to learn how to engage and uplift youth voice. The WATCH Coalition onboarded 9 Youth Ambassadors who were also trained by Youth in Action to learn more about the connections between identity, leadership, and social justice. The WATCH Coalition also led 14 hours of community organizing trainings for the Youth Ambassadors. The Youth Ambassadors participated in every workgroup and subcommittee of Woonsocket HEZ to provide youth perspectives on a variety of local health issues.

 

The Youth Ambassadors co-coordinated a community vigil to honor local victims of violence, co-coordinated and facilitated four political education workshops to teach Woonsocket residents about the different levels of government, initiated and facilitated a series of focus groups about mental health with Woonsocket Middle School students, and created a mental health resource guide for Woonsocket youth. Woonsocket HEZ’s Youth Ambassadors also contributed valuable feedback to Rhode Island Department of Health’s COVID-19 Response Team, Rhode Island Department of Health’s Adolescent Health Program, and Rhode Island Foundation’s Make It Happen Initiative. Additionally, the Woonsocket Youth Ambassadors assembled and donated 50 bags of basic needs items and school supplies to local shelter residents, and 60 bags of COVID-19 PPE (personal protective equipment) and resources to Woonsocket community members.

 

Woonsocket HEZ will continue to strengthen its youth engagement and leadership development in the application year. They plan to onboard additional Youth Ambassadors who will go through community organizing and leadership development training. The training will be co-facilitated by existing Youth Ambassadors, thus increasing opportunities for youth leadership. Each Youth Ambassador will join and co-lead a subcommittee within the Woonsocket HEZ collaborative. The goal for the coming year is for workgroup meetings featuring mixed age participants (adults and youth) to be led by the Youth Ambassadors. Woonsocket HEZ will also be onboarding additional staff who will partner with Thundermist Health Center and the Woonsocket Education Department to offer comprehensive sex education in Woonsocket schools. Previously, this was offered only at Woonsocket High School. However, during the application year, starting in the 2022-2023 school year, this initiative               will expand to the Woonsocket Middle Schools.

 

• Washington County HEZ: Maternal and child health was a primary focus of South County Health Bodies Healthy Minds (HBHM), which served as the backbone for the Washington County Health Equity Zone. HBHM implemented 5-2-1-0 to prevent childhood obesity and promote healthy habits, by encouraging families to be more physically active and eat healthier, while engaging community partners to create healthier environments for children. The 5-2-1-0 program promotes eating 5 fruits and vegetables, engaging in no more than 2 hours of recreational screen time, getting 1 hour of exercise, and drinking 0 sugary drinks per day. The Washington County HEZ reached over 19,000 children and adolescents with their 5-2-1-0 programming. Forty-six 5-2-1-0-related strategies were implemented in schools, childcare centers, and other organizations. Five summer camps incorporated 5-2-1-0 materials and/or activities into their curriculum. An estimated 16,986 youth and adults have been indirectly impacted by 5-2-1-0 this reporting year through the efforts made at the organizational and county-levels.

 

Ten K-12 schools implemented policy, systems, or environmental changes including offering a new grab-n-go breakfast option, eliminating chocolate milk for breakfast, and starting advisory committees for students to work with food service providers to give input on school nutrition. Three Washington County schools have established student committees. In addition, policy, systems, and environmental (PSEs) have impacted an estimated 1,439 children. 83% of Washington County K-12th grade Schools and 74% of Washington County childcare centers continue to be engaged in promoting 5-2-1-0 and/or making changes to support youth in adopting healthy behaviors. 12,273 youth attend the childcare centers and schools where 5-2-1-0 activities were implemented & changes made. 94 organizations partnered to increase awareness about healthy behaviors and/or created environments that provide opportunities for youth & families to engage in these behaviors.  Examples of policy/environmental changes: eliminating chocolate milk, implementing grab-n-go breakfast, and installing water refilling stations

 

Food access and family health has been the primary focus of the “Healthy Bodies” portion of Washington County’s Healthy Bodies Healthy Minds (HBHM). 5-2-1-0 has been pre-established and implemented within almost all school districts across Washington County (with the exception of Exeter). These materials, teachings, and workbooks remain within the schools, classrooms, and have been verified to be a continuous resource for educators in their classrooms. While existing efforts remained continuous, the new Healthy Bodies Outreach Coordinator established existing and new relationships within the schools via their Wellness Committees, nutrition and physical activity sub-committees, and 3rd party food service providers to ensure that messaging remains consistent and opportunities to collaborate and improve existing policies continue. Currently, the Chariho district is working to offer the Farm to School program in more locations, long term, all schools within the district, short term, capturing grades youngest to oldest. New implementation efforts will begin for the 22/23 school year. Chariho will also offer alternative (non-sugary) beverage options, based on post-covid restrictions and supply chain availability. These PSEs will impact ~1,129 students.

 

From an organizational standpoint, HBHM has made substantial progress in impacting their community, engaging 71 organizational partners, including 18 schools (K-12), 23 preschools, 8 health service organizations, and 22 afterschool programs, and provided 145 hours of technical assistance to organizations in their efforts to support healthy eating and physical activity. This included: Connected community partners with Rhode Island Department of Health (RIDOH) to assist with needed COVID-related resources; supported Community Health Workers (CHWs) and the community members they serve to address food insecurity needs; provided school staff—nurses and health and physical education teachers—physical activity resources to engage children and families remotely; assisted 10 child care organizations fulfill a total of 17 NAPSACC^ goals; and disseminated 1,522 5-2-1-0 materials, including frisbees, water bottles, jump ropes, toolkits, and pedometers to increase awareness of, and support for engaging in healthy behaviors. HBHM organized and conducted an online school garden conference with local school garden experts, now posted on HBHM’s YouTube channel; and partnered with Peace Dale Library to provide garden kits (accompanied by gently used books related to healthy habits) to children in the Champaign Heights neighborhood as well as South County YMCA and South Kingstown Parks & Recreation programs.

 

Healthy Bodies of HBHM has impacted their community by following up with existing partners and engaging 14 new community partners including: 2 grocery/retailers, 5 libraries, 1 Social Services Director, 3 URI professionals (related to food access and recovery), 1 food rescue technology professional, and 1 patient experience and food access professional within South County Hospital. The principal focus of these relationships is to fully develop and implement a plan to increase culturally appropriate food access awareness (where and when), accessibility (how and feasibility), and education (budgeting, preservation, and culinary). Existing partners will serve as communicators and potential site-locations for vending and new partners will aid in plan development and implementation to meet community need. A newly establish pilot exists in Exeter which will serve as a test “pop-up” Farmer’s Market/Pantry.

 

The Washington County HEZ published Healthy Habits/recipe book and distributed hard copies and electronic versions throughout the county, and created the Feeding Toddlers Info Sheet for local pediatricians/PCPs to use with families in their practices. In addition, water bottle filling stations were installed in Narragansett schools, the HEZ provided support for the state passage of sweetened beverage tax, supported the Bradford-on-the-lane food pantry, and the Davisville hangouts, which provided an online middle school community to support youth connections during the COVID-19 lockdown.

 

HBHM recognized the need to continue wide-scale mental health literacy training with Mental Health First Aid (MHFA) and the QPR (Question, Persuade, Refer) with the national goal of attaining 1 in 10 trained in MHFA. Subsequent to goal and implementation, it was evaluated that 122 people were MHFA trained. 20 of the 122 individuals trained are youth. HBHM recognized how death by suicide; particularly among youth was devastating their community. An innovative strategy employed was outreach and support through QPR suicide prevention codes which launched in October 2020. Washington County HEZ was the first in Rhode Island to launch this initiative. As of June 2022, there has been over 950 signs placed county wide and over 15,317 unique devices scanned. 315 people were trained in QPR suicide prevention. Signs were strategically placed county-wide provide access to free mental health & suicide prevention supports.

 

Due to funding, no new materials were created or distributed throughout Washington County on behalf of Healthy Bodies. Currently, there is a “free” family fun catalog in the development phase – this database will share all activities in Washington County that are free for families and will highlight interesting and fun places to visit. This will be made available via hard copy for partners to share in their lobbies. The handout will also contain a QR code directing to a more detailed listing. Partners have agreed to share this listing on their websites and social sites once complete.

 

The Chariho Youth Task Force continued their work in Davisville via Davisville Hangouts. This year, they engaged with 45 Davisville middle school students, meeting bi-weekly virtually and/or in-person. They also hosted a successful paint night for children and their families – having over 40 attendees! They created and disseminated 500 stress first aid kids for students and teachers, as well as 500 calendars promoting health and wellness via student art.

 

Expand HEZ Out-of-School Programming Scholarships:

• Cranston HEZ: The isolation caused by the COVID-19 pandemic played a significant role in hindering the social-emotional development of young people around the world. To combat this, OneCranston HEZ sought to increase the opportunities for Cranston youth to engage in out-of-school time programming that would nurture their social-emotional development. To do this, they offered scholarships to a variety of summer camps and programs. In total, 15 Cranston children were awarded scholarships to fund their participation in five different youth programs that covered areas including STEM (science, technology, engineering, and mathematics), the environment, physical fitness, and the arts.

 

Other Programs/Initiatives Related to Adolescent Health

 

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.

 

 

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 condom 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 were 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.