Adolescent Health, Annual Report FY 22 

 

The annual report is organized by the two priorities identified through the needs assessment process to address adolescent suicide and substance use. 

 

The Adolescent Health Coordinator is responsible for coordinating MCH priorities and also oversees the ODH youth homelessness initiative.   

 

Priority: Increase developmental approaches and improve systems to reduce adolescent and young adult suicide rate 

 

Measures 

The State Performance Measure (SPM) was selected to track intentional self-harm, an important indicator for the National Outcome Measure (NOM) as suicide attempt is a risk factor for completed suicide, and intentional self-harm without wanting to kill oneself might also result in unintentional suicide. Evidence-based Strategy Measures (ESM) development for this SPM will be explored during FY 22. 

•       NOM 16.3- Adolescent suicide rate ages 15-19 per 100,000 

•      According to Federally Available Data (FAD), data from the National Vital Statistics System show that the suicide rate among adolescents aged 15-19 was 10.0 per 100,000 during 2019-2021. This is a decrease from the peak in 2017-2019 (12.6 per 100,000), but still higher than 2013-2015 (8.0 per 100,000). 

•       SPM- Rate of nonfatal intentional self-harm ED visits and hospitalizations ages 15-19, per 100,000 (VIPS) 

•      According to data from Ohio Hospital Association, the self-harm related ED visits and hospitalizations among youth 15-19 years in Ohio was 457.3 per 100,000 in 2021, an increase from 2020 (424.1 per 100,000) after a steady decline from 2016. 

•       ESM: None developed at this time. 

 

Objective 1: By 2025, reduce risk and increase protective factors for adolescents. 

Strategies: 

1. Implement evidence-based adolescent resiliency projects through MP grant. 

2. Continue MCH participation in existing prevention workgroups and coalitions, such as Ohio Anti-Harassment, Intimidation, and Bullying (HIB) Initiative. 

3. Provide resources, technical assistance and professional development to health professionals working in the school and early childhood level to support resiliency and decrease HIB. 

4. Support programming in local communities for professionals and community members on preventing violence and identifying and responding to victims of violence through SADVPP. 

 

As part of the needs assessment process for the five-year Title V adolescent health action plan, Ohio prioritized adolescent mental health and suicide for the first time.  While mental health and suicide are essential topics for adolescent health, Title V staff have historically supported ODH and state agency partners’ work in these areas.  These priorities were determined before the COVID-19 pandemic, which drastically highlighted the need to address mental health concerns among adolescents and young adults.  Reducing risk factors and increasing protective factors are supported through ODH programs including the Maternal and Child Health Program (MP); through participation in existing workgroups such as Ohio’s Anti-Harassment, Intimidation and Bullying (HIB) initiative, Ohio Interagency Council for Youth, Whole Child Advisory Group, and participation in the ASPIRE learning collaborative; trainings by School Nursing and Early Childhood Programs; and the work of the Sexual Assault and Domestic Violence Prevention Program (SADVPP).  

 

Adolescence is an important time for promoting health and preventing disease; one that is sometimes overlooked. Most of the nation’s 42 million adolescents, who are between the ages of 10 and 19, are generally healthy. All adolescents can benefit from guidance on how to improve their health and development during these years and for some, serious challenges remain.  

 

Adolescent health encompasses changing transitions within multiple domains, including the physical, social, emotional, cognitive, and intellectual. The fast-paced development of these different domains can lead to phenomenal growth during this period. This growth can also occur at different rates, which can put adolescents at a higher risk for risk-taking behaviors and emerging mental health issues. It is important to understand adolescent development, environmental influences, and the risk and protective factors that can affect adolescent health so that organizations and individuals who work with youth can support the health and healthy development of all adolescents.  

 

A recent government survey of almost 8,000 high-school students, conducted in the first six months of 2021, found a great deal of variation in mental health among different groups. More than one in four girls reported that they had seriously contemplated attempting suicide during the pandemic, which was twice the rate of boys. Nearly half of LGBTQ teens said they had contemplated suicide during the pandemic, compared with 14 percent of their heterosexual peers. But the big picture is the same across all categories: Almost every measure of mental health is getting worse.  

 

The MP Adolescent Health Evidence-based Resiliency project is a continuation of a 3-year project that focuses on a program that identifies/supports the implementation of evidence-based projects related to physical activity, prevention activities including vaping, tobacco, illicit drugs, mental health, and healthy eating. It also encourages staff capacity training for community-based organizations. Twelve counties continue to participate in the adolescent health projects.

 

During FY22, the program served 3750 adolescents, with 3486 completing their respective program. Overall, 78% of participants reported being satisfied with the program. The program results showed that 69% of participants increased skills and confidence, 76% of participants increased knowledge, and 70% of participants with positive behavior change.   

 

MCH staff participated in a wide variety of workgroups and coalitions that support adolescent health initiatives. The Anti-Harassment, Intimidation, and Bullying Initiative, led by the Ohio Department of Education (ODE), was initially developed as part of legislation in Ohio that requires Ohio schools to have a bullying policy. The group has expanded its focus beyond bullying and harassment to prevention work, including focusing on mental health and suicide, violence prevention, substance use prevention, human trafficking prevention, and related topics. ODH staff that represent includes the Adolescent Health Coordinator, School Nurse Consultant, and YRBS/YTS Coordinator.  Additionally, ODH Violence and Injury Prevention (VIPS) staff, including SADVPP staff and the Youth Suicide Consultant also participate.  Other agencies represented include the Ohio Department of Mental Health and Addiction Services (OhioMHAS), the Ohio Department of Public Safety, the Ohio Domestic Violence Network, the Ohio Center for Autism and Low-Incidence (OCALI), and other state and local organizations, including universities.  Activities for the group included exploring data from Ohio’s YRBS and Ohio Healthy Youth Environment Survey (OHYES) surveys and updating training modules for Ohio school administrators and staff.    

 

Another workgroup that supports this strategy is the Ohio Department of Education’s (ODE) Whole Child Advisory Group (WCAG). The WCAG is a diverse group of stakeholders focused on supporting the whole child. The group’s role is to guide, promote, and support the adoption and implementation of Ohio's Whole Child Framework throughout the state. Members also will help the ODE establish best practices and develop and identify resources that school districts can use to implement the framework. School Nursing program staff were also recruited to participate in the group’s School and Student Health Problem of Practice to identify ways to promote physical health of students.  

 

The Ohio Interagency Council for Youth (OICY) focuses primarily on youth behavioral health. OICY was established to serve as the advisory body to the state and support the creation and maintenance of a comprehensive continuum of care for timely access to appropriate services among youth and young adults with behavioral health needs.  The purpose of the group is to advise state agencies and promote evidence-based and promising practices related to behavioral health programming. The goals of the group are to increase access to behavioral health services for children and youth 0-25 and to reduce behavioral health disparities among children and youth 0-25.  Workgroups focus on policy development affecting youth in behavioral health; workforce development; justice, equity, diversity, and inclusion; funding for youth behavioral health services; and data and evaluation. Youth and families with lived experience are present at each meeting and are also represented on OICY’s steering committee. OYIC was created by the OhioMHAS through funding from the Substance Abuse Mental Health Services Administration (SAMHSA).  OhioMHAS continues to provide backbone funding for the group. Current initiatives align goals from multiple grants across cabinet-level agencies, including ODE, OhioMHAS, Ohio Medicaid, Ohio Department of Job and Family Services (ODJFS), ODH (Title V and Health Care Shortage funding goals), Ohio Department of Youth Services (DYS), and Ohio Department of Developmental Disabilities (DODD). During FY 22, the MCH Adolescent Health Coordinator was elected as a co-chair for OICY, serving alongside the first youth co-chair for the group.   

 

The ODH School Nursing program provides school nurses, schools, and school communities with resources to support the health and academic achievement of students. The program provides technical assistance, creates resources, manages the School Nurse Bulletin Board communication system, collects data regarding school health needs and services, and provides extensive professional development for licensed nurses working in the school setting. Title V and state funds support the School Nursing program staff, venues, and speakers for conferences if needed. The American Rescue Plan Workforce Development funding created 5 Regional School Nurse Consultant positions and one State School Nurse Consultant position. The regional consultants provide additional support and knowledge of local resources to nurses working in the school setting, including 1000 technical assistance requests.

 

The professional development offered by the School Nursing program includes a library of more than 40 online independent study courses housed in OhioTRAIN. Program typically hosts 3 live Regional School Nurse Conferences, 1 summer conference, and 1 three-day New School Nurse Orientation each year. With the onset of COVID-19, the program has pivoted to offer these as live, virtual events. Continuing Nursing Education contact hours are offered for many of the courses. The program also develops and disseminates resources, such as handouts and resources for school nurses to use to teach school staff how to administer medications to students. These resources are heavily used by school nurses, with more than 750 nurses attending the live conferences and more than 1,000 participating in the online independent study courses annually. In 2023, the program will offer a combination of live, in person conferences and virtual conferences. Revisions are being made to all online independent study courses to keep their content current and provide updated continuing education credits to the nurses. 

 

With funds from Title V, the School Nursing Program was able to contract with an external evaluator (Philliber Research Group) to conduct an evaluation of the program with the overarching goal to use a mixed methods approach, drawing from both existing and new data, to measure the impact the School Nursing Program has had on school nurses throughout Ohio as they provide care to students, families, staff, and the school community. The final report was submitted in January 2022. 

 

The next iteration of the ODH Survey of Health Services in Ohio Schools was planned for spring 2020 but was postponed because of pandemic restrictions. The survey was conducted in 2022, but the response rate was too low to report results. The program plans to conduct another survey in 2024.  

 

The State School Nurse Consultants in the School Nursing program participate and share their expertise in numerous state level and national committees such as the Ohio Violence and Injury Prevention Program, the Ohio Association of School Nurses, the Ohio Adolescent Health Partnership, and the National Association of State School Nurse Consultants. The School Nursing Program staff participates in the Ohio Department of Education Anti-Harassment, Intimidation, and Bullying group as well as the state level Trauma Informed Schools Committee, and Interagency Whole Child Problem of Practice workgroup. The resources developed by these workgroups are shared with school nurses across the state.  

 

According to CDC, Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence (Wilkins, Tsao, Hertz, Davis & Klevens, 2014), suicide, teen dating violence, sexual violence, and bullying share the same risk and protective factors. ODH is pooling resources to prevent multiple forms of violence at once by working on strategies that address shared risk and protective factors.   

 

The ODH SADVPP funds eleven rape prevention education programs in local communities, some of which reach multiple counties, such that a total of seventeen of Ohio’s 88 counties receive some programming.  Funded primarily through the Center for Disease Control and Prevention’s Rape Education Program, with some additional support through the Public Health and Health Services Block Grant, these programs are focused on the primary prevention of sexual violence with a focus on community and societal change.   

 

Programs worked together to select risk and protective factors of focus for Ohio.  These are reducing the risk factors of lack of non-violent problem solving skills, cultural norms supporting aggression, harmful norms around masculinity and femininity, societal norms that support sexual violence, and weak health, educational, economic, and social policies and laws, and supporting the protective factors of association with pro-social peers, connection/commitment to school, connecting with a caring adult, community support and connectedness, and coordination of resources and services among community agencies. 

  

Strategies for implementation were selected from or aligned with the CDC technical assistance package to prevent sexual violence, STOP SV.  These strategies included to prevent social norms that protect against violence, teach skills to prevent sexual violence, provide opportunities to empower and support girls and women, and to create protective environments. A recent area of focus for this work has been to complete these strategies within a community mobilization framework, ensuring participation at every stage of implementation from the community to be reached by the strategy. 

An increased focus for local programs has been on social marketing and social media efforts. New to the SADVPP team in 2022 was Eric Greene; Eric has a strong background in social marketing and has started leading a group of funded sexual violence prevention programs in a social marketing learning cohort.  Additional cohorts are planned so that all funded programs will benefit from this experience by the end of 2023.  Eric and Dr. Sandra Ortega, RPE Evaluator, are building a toolkit on social marketing specific to sexual violence prevention using examples generated by the local programs and a thorough literature review.  The toolkit will include evaluation components integrated into each of the steps of the process. 

 

For the year currently under report, a campaign was developed and implemented using a survey of youth leaders previously conducted by the statewide social marketing practices workgroup.  The survey identified the need to strengthen ties with the work of local county Alcohol, Drug Addiction, and Mental Health Boards.  Youth leaders identified mental health issues (i.e., depression and anxiety) and the lack of an adult to turn to as their top concerns.  Based on this information, the group prepared a social media campaign and resource materials that were released for mental health awareness month in the spring of 2022.  Six local agencies were funded to conduct sexual violence prevention work and used the materials across media platforms including Twitter, Facebook, and Instagram, and shared their results.  Other organizations, including the Ohio Alliance to End Sexual Violence, also used the materials.  Of the six reporting agencies, the total reach across all three platforms was 12,607.  The experience of this campaign and lessons learned will inform future work on what can be done across shared topics related to social media, using more of the components of a full social marketing endeavor in the future. 

 

The School Policy workgroup completed a rubric of best practice for related school policy, which was shared with all funded programs.  The team that created the rubric presented to audiences including the other funded sexual violence prevention programs and other violence and injury prevention partners through both the Anti-Harassment, Intimidation, and Bullying work initiative in January 2022 and the Public Health and Health Services Block Grant Advisory meeting in November 2021. 

ODH staff, including staff in positions partially funded through the MCH Block Grant, continued to support local efforts in partnership with the state sexual assault coalition, the Ohio Alliance to End Sexual Violence (OAESV), which also receives the Rape Prevention Education funding.  Support includes the provision of technical assistance to the programs as well as offering networking opportunities, trainings, regional meetings, and an annual conference. (Wilkins, et al (2014).  https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf  

While not funded by Title V, the Sexual Risk Avoidance (SRA) Program provides resources to support the objective and partners with other Title V funded programs to reduce risk and increase protective factors for youth.  

  

ODH utilizes a multi-pronged approach to reduce the birth rate among 13-19-year-olds. Resources are provided to support teenagers and their families in making healthy and informed choices about their reproductive health.   

  

The SRA Program reflects the commitment of ODH to facilitate programming that is designed to meet the distinct and unique needs of local communities. Teenage pregnancy is a complex social issue that has far-reaching consequences in the lives of teen parents, their children, and the state. The goal of SRA is to reduce births among teens.     

   

The SRA Program currently funds organizations that oversee and facilitate Sexual Risk Avoidance Education programming across four geographical regions. The Ridge Project is Ohio’s subrecipient in Region 1, which covers northwest Ohio cities and communities. Relationships Under Construction is Ohio’s second subrecipient and they reach Regions 2, 3, and 4, which cover the remainder of the state.    

   

Currently, each region is awarded upward of $500,000 through the SRA grant. Subgrantees partner with local school districts to provide SRA curriculum through health classes and afterschool programs. Some sub grantees offer summer camps and Spring Break camps with an emphasis on Risk Avoidance programming.    

   

The subrecipients operate by contracting with local agencies to build upon the strategy of local control, community collaboration, and evidence-supported program design. Subgrantees also utilize student led initiatives such as Ohio Youth Council, advisory groups, and teen led podcasts to encourage youth leadership in initiatives. They also offer parent classes and resources, both in person and virtually.   

   

Each agency focuses on specific priority counties with high rates of teen pregnancy or birth rates. In addition, the program targets youth ages 11-14 to promote good decision-making and positive healthy behaviors through prevention and positive youth development messages. In FY 2022 Ohio's SRA program served 61,123 students.  The program targets middle school students, and 76% of those served in FY22 were middle school students.  Although this is a decline from our general numbers of around 100,000 students per year, our programs are on the upturn and climbing from year to year after the pandemic. 

   

Moving forward, the program will aim for a return to pre-pandemic levels of engagement, reaching upward of 100,000 students in Ohio schools. The focus will continue to be 11–14-year-olds and priority counties where higher birth rates are present. 

 

In addition to the strategies listed above, training and resources related to ACEs, risk and resiliency, and other mental health topics addressing children under the age of 10 are included in the child section of the report.  School nurse trainings and other school-based trainings and programs cover both the child and adolescent population, as school staff can work with preschool-aged children up to twelfth grade.  There is ongoing collaboration between child and adolescent workgroups to coordinate strategies included in each action plan, including co-leading of the two workgroups by three MCH staff (Adolescent Health Coordinator, Early Childhood Health staff, and Parent Consultant).  The groups meet separately, bi-monthly, as there are many MCH staff who sit on both workgroups.  The workgroups meet as a large group to share updates and discuss coordination twice a year.  

 

Objective 2: By 2022, develop a plan for MCH to support implementation of Ohio Suicide Prevention Plan among targeted youth population.  

1. Increase MCH representation on State Suicide Plan implementation team. 

2. Identify gaps in state programming that would fit within MCH work. 

3. Explore programs that MCH can support. 

4. Coordinate work within MCH to align with state plan and external partner programs. 

 

Youth suicide prevention is a state-level priority.  The Violence and Injury Prevention Section (VIPS) in ODH is currently on the writing team for Ohio’s next state suicide plan, which will go from 2023-2025, to help coordinate services and resources to make the most significant impact on preventing suicides, to include youth as a high-risk population.    

  

The ODH-funded Child Injury Action Group (CIAG) created a youth suicide subcommittee. This subcommittee created a strategic plan that aligns with the Suicide Prevention Plan for Ohio. This youth strategic plan is in the final approval stage and will go through 2026. This plan was developed with partners including OMHAS, Ohio Chapter of Mental Health America of Ohio, local health departments, Ohio Suicide Prevention Foundation, local mental health boards, mental health agencies, National Alliance on Mental Illness (NAMI) and other CIAG members.  This group continues to meet bi-monthly to share ideas and other topics related to youth suicide.  

  

ODH and the OMHAS partnered with the American Academy of Pediatrics, Ohio Chapter, to expand their counseling on access to lethal means, called Store It Safe (SIS), in a quality improvement project with pediatric and family medicine practices where data shows high burden of youth suicides.  This project supports practices in improving depression and suicidality screening in pediatric and family practices medical settings for youth aged 12-21.  The project provides education and resources that providers can share directly with patients and families at their appointments.  This project will run through February 2023 and currently has 7 pediatric and 7 family practices engaged. In September 2022, 336 youth were screened by pediatric practices and 25 referrals were made because of the SIS QI program. Family practices screened 126 youth and 20 referrals were made due to the SIS program. Data collection will also continue into February 2023. VIPS is anticipating expanding this program in 2023. 

 

To further support mental health and suicide work, Ohio was invited to participate in the Adolescent and Young Adult Behavioral Health CoIIN facilitated by AMCHP and NIPN.  The Ohio team is led by the BCFH Adolescent Health Coordinator and includes team members from MCH and ODH VIPS; ODE; OhioMHAS; Ohio Association of Community Health Centers (OAHC); the Ohio Chapter of American Academy of Pediatrics (AAP) and Nationwide Children’s Hospital (NCH).  ODH VIPS already had a contract in place with Ohio AAP to complete a Quality Improvement project around depression screenings in primary care, so the Ohio CoIIN team decided to utilize School-Based Health Centers (SBHC) for the QI arm of the project.  The CoIIN kicked off in July 2021, with Ohio’s team meeting monthly throughout the 18-month project.  The Ohio team focused on mapping out existing mental health initiatives and determining gaps.  Quickly, the team decided to focus on how Ohio could strengthen work related to pediatricians or primary care providers, given the number of strategies focused on school and community support.  Coordination among the CoIIN partners and discussing ways to support and enhance existing work was a key strategy of the team and the team decided to continue to meet quarterly after the AMCHP support ended at the end of 2022.   

 

Priority: Increase protective factors and improve systems to reduce risk factors associated with the prevalence of adolescent substance use 

 

Measures 

The SOMs were established to align with measures from the State Health Improvement Plan and will measure the impact of Ohio’s efforts to address adolescent substance use priority. The selected NPM aligns with the priority as adolescent preventive medical visits provide key opportunities for screening, education, and referral on numerous topics including mental health and substance use. The ESM measures continued efforts to increase rates of adolescents served by Medicaid with well visits. 

•       SOM- Percent of high school students who have used alcohol within the past 30 days (YRBS)  

•      According to the 2021 Ohio YRBS/YTS, 22.8% of Ohio high school students drank alcohol during the 30 days before the survey, which is not a statistically significant change from 2019.  

•       SOM- Percent of high school students who have used marijuana within the past 30 days (YRBS) 

•      According to the 2021 Ohio YRBS/YTS, 13.3% of Ohio high school students used marijuana during the 30 days before the survey, which is not a statistically significant change from 2019.   

•       SOM- Percent of high school students who have used cigarettes, smokeless tobacco (i.e., chewing tobacco, snuff, or dip), cigars, pipe tobacco, hookah, bidis, e-cigarettes, or other vaping products during the past 30 days (YRBS/OYTS) 

•      According to the 2021 Ohio YRBS/YTS, 20.4% of Ohio high school students used cigarettes, smokeless tobacco (I.e., chewing tobacco, snuff, or dip), cigars, pipe tobacco, hookah, bidis, e-cigarettes, or other vaping products during the 30 days before the survey, which was a significant decrease from 31.7% of students in 2019.  

•       NPM 10: Percent of adolescents (12-17) with a preventive medical visit in the past year 

•      According to the Federally Available Data (FAD), data from the 2020-2021 National Survey of Children’s Health show that 76.4% of adolescents aged 12-17 had a preventive visit in the past year. This is a slight decrease from 79.6% in 2019-2020. 

•       ESM:  Percent of Ohio schools that have a school-based health center that offer health services to students 

•      In 2022, 23.5% of middle and high schools in Ohio reported that they have a school-based health center that offers health services to students (2022 Ohio School Health Profiles Survey). This has remained steady in past years (2020, 18.3%). 

•       ESM: Percent of adolescents (12-17) served by Medicaid with adolescent well visits 

•      In State Fiscal Year (SFY) 2022, 44.6% of Ohio’s eligible Medicaid youth, ages 12-17, received a well-care visit, which has remained relatively stable in past years (SFY21; 46.5%). 

 

Objective 1: By 2025, increase percent of adolescents with a preventive medical visit in past year by 3%  

Strategies: 

1. Continue collaborative efforts to convert sports physicals to comprehensive well-visits. 

2. Partner with payors to incentivize the well-visit. 

3. Partner with Medicaid and Education to support School-Based Health Care initiatives. 

4. Increase access to school-based health centers. 

 

Objective 2: By 2022, develop plan for promoting comprehensive adolescent well visit that includes:  

Strategies: 

1. Provider education/training for comprehensive well-visit emphasizing the connection between physical health and mental health, substance use including tobacco, trauma, and appropriate screenings and referrals to services (Bright Futures). 

2. Partnership between programs that can mutually promote comprehensive well-visit (e.g., state immunization). 

3. Reviewing state/systems-level policies to assure equitable access to and uptake of high-quality well visit. 

  

Well-visits and immunizations continue to see the impacts of COVID-19.  ODH MCH continues to leverage partnerships to address the decreases in well-visits.  One major strategy is to increase access to healthcare through School-Based Health Centers.  

 

ODH received funding through CDC’s Workforce Development Grant in July 2021 to support the creation or expansion of School-Based Health Centers (SBHC).  The large project braids multiple funding streams and involves internal ODH partners from the Offices of Rural Health and of Health Opportunity and the Ohio Department of Education.  

 

The School-Based Health Center (SBHC) initiative, funded by OD), is a health center that provides healthcare services to children, adolescents, and community members located on or near a school campus. SBHCs can offer various services, including primary care, behavioral health care, oral health, vision, health education, and care coordination. ODH funded 14 SBHC contracts and two training academies, Nationwide Children’s Hospital and Alliance, to provide training and technical assistance to all funded agencies. The SBHCs provide services to 18 counties and 32 school districts, including seven rural districts. Each SBHC is required to submit quarterly reports to report who is being served, what services are being provided, staffing quality metrics, and partnerships. Since June of 2022, more than 3000 youth have been served to receive a variety of services including but not limited to Well Child Checks, Immunizations, Behavioral Health Care, Vision Care, etc. ODH’s support and funding will continue until June 2023. 

 

In addition, the Ohio Department of Education and the Ohio Department of Medicaid convened a workgroup to discuss how state agencies could impact the well-visit rate. ODM plans to work through their provider plans to come up with strategies to support school-based health centers and other strategies to decrease barriers to accessing healthcare.  

 

To further support initiatives related to increasing well-visits and supporting comprehensive well-visits, MCH developed a contract with Ohio AAP during FY21.  The contract deliverables address multiple priorities across the bureau.  The contract was developed during the summer of 2021 and awarded in October 2021.  The first year of the contract offered monthly webinars on a variety of topics, including adolescent immunizations and well-child visits, behavioral health, ACEs, and other related topics.  Resources for physicians and handouts for families on various topics were also created and available on AAP’s website, along with all of the recorded webinars.  Focus groups with families and physicians were conducted to inform the creation of materials to ensure they speak to a diverse audience.  The second year of the contract includes a quality improvement project focused on improving various screening tools in pediatric practices, such as depression screenings.  ODH plans to continue the partnership with Ohio AAP to further support MCH priorities. 

 

Cross-program partnerships and coordination will benefit strategies focused on both adolescent well-visits and school-based health centers.  Internally, capacity issues have continued to occur due to the COVID-19 pandemic.  The ODH Immunizations Program has been primarily focused on the COVID-19 response, but MCH plans to coordinate work as the pandemic needs decrease and staff can return to normal duties.   

 

The Parenting at Mealtime and Playtime (PMP) program provides primary care office staff with strategies to enhance counseling during well-child visits for children.  The goal of PMP is to promote a shift towards earlier intervention in children at risk and a shift from unhealthy to healthy habits through physician discussions with families. PMP is an education-based model providing resources and educational opportunities for professionals working with children and families from birth to age 10. In the next fiscal year, the age range will increase to age 18 and cover topics around female health triad and nutrition and eating disorders.  OAAP will partner with community experts to facilitate trainings and disseminate resources. 

 

Supporting access to clinical services in schools, the Oral Health Program funded 12 subrecipients for the School-Based Dental Sealant Program.  The 12 programs provide dental sealants to students in 33 counties in Ohio.  Qualifying schools have at least 40% of the students eligible for the Free and/or Reduced-Price Meal Program.  Students in these schools are at higher risk for tooth decay because of poorer access to preventive dental care due to lower family income, lack of dental insurance, or barriers to finding a dentist who accepts Medicaid. The sealant programs primarily target students in 2nd, 3rd, 6th, and 7th grades.  

 

The School-Based Dental Sealant Program experienced similar challenges as other school-based programs, due to COVID-19.  During FY21, 3,207 students received dental sealants, a significant decrease from the 18,793 students in ODH funded programs who received sealants in 2019.   During FY22, 9,628 students received sealants.  Participation is increasing, but there is still a way to go to get back to pre-COVID-19 numbers. 

 

The Reproductive Health and Wellness Program (RHWP) provides monitoring and support to its Title X family planning clinics. The 42 subrecipients provide direct healthcare services in a total of 85 counties. All clinics are adolescent friendly. In state fiscal year (SFY) 2022, RHWP clinics reported 62,666 visits, and of those 5,142 (8.2%) were adolescent visits (i.e., 12 – 17 years old). Most clinics offer telehealth visits, which allowed adolescents the ability to have a visit without transportation. In SFY 2022, 268 adolescents used telehealth for their visits. Beginning in April 2021, nearly half (48%) of the clinics offered incentives to help offset the costs of going to an appointment (e.g., transportation passes, and gift cards). 

 

All adolescents receive screenings and referrals, if necessary. In SFY 2022, the number of referrals reported in Ahlers Software for adolescents were 62 for diagnostic services, 46 for gynecology, 48 for prenatal care, 4 for adoption, 283 for victimization/domestic violence, 90 for mental health, 88 for immunizations, 554 for nutrition, 53 for dental, 21 for HIV testing, and 9 for substance use. Involvement of family is encouraged and methods to resist sexual coercion are presented. When appropriate, counseling and education are provided. For example, in SFY 2022, the number of counseling services provided to adolescents was 4,094 for contraception, 3,190 for reproductive life plans, 2,479 for sexual risk avoidance, 1,874 for abstinence, 4,451 for sexually transmitted infections, and 2,939 for healthy relationships. In the calendar year 2021, through counseling, education, and contraceptives, it is estimated that 448 births, 470 abortions, 136 miscarriages, and 1,054 unintended pregnancies were averted in clients 19 years and younger.  

  

The RHWP Title X clinics that participate in the special populations or faith-based organizations' deliverables received additional funding to provide enhanced services. One of the categories for the special population deliverable was adolescents, and 630 adolescents were provided clinical services through this funding. The clinics with faith-based organization funding were required to offer educational programming to adolescents geared toward life planning, goal setting, and healthy life choices.  

  

The RHWP usually provides one webinar on adolescent health annually. The webinars are intended for healthcare providers. Recent topics include adolescent education and counseling; connecting with teens; communication strategies and considerations; and outreach and special populations. The RHWP developed a state mandatory reporting webinar. The event was recorded live in March 2022 and made available on demand on Ohio Train. The course is available for continuing nursing education. Nearly 125 healthcare workers participated in this training. After listening to the mandatory reporting presentation, 93% of participants indicated they were more aware of how and when to make a report, 71% reported an improvement in recognizing risk factors for victimization, and 81% reported an increase in knowledge of Ohio laws and reporting guidelines. Furthermore, all Title X clinic staff, including doctors and nurses, must take annual required training on adolescents and mandated reporting. This is monitored annually with technical assistance visits/calls and comprehensive reviews.  

  

The RHWP encourages the sub recipients to prioritize the youth voice. For example, all Title X clinics are required to have an advisory committee, and it is expected that adolescents are included as members of these committees. Additionally, clinics are to have patient satisfaction surveys at least twice per year. Both actions provide an opportunity to receive feedback from adolescents. Some changes clinics have incorporated from these activities include offering specific teen clinic hours, having electronic forms and check-in, and providing chargers or Wi-Fi in waiting rooms.  

  

The RHWP continually seeks ways to promote Title X clinics to adolescents and young adults. The RHWP staff participated in a project promotion workgroup to increase awareness of the clinics among adolescents. Additionally, the annual program director meeting offered three sessions on advertising and marketing with social media. 

 

Objective 3: By 2025, increase coordination and capacity of state and local partnership to support adolescent mental health and reduce adolescent substance use, including tobacco use.  

Strategies: 

1. Identify existing collaboratives and build MCH representation and support. 

2. Collaborate with partners to conduct an environmental scan of current community prevention work, including risk and protective factors, at state and local levels, including youth led prevention programs. 

3. Explore with partners development of system for tracking and supporting mental health provider partnerships in schools. 

4. Analyze existing data to identify priority populations and disparities. 

5. Continue trauma-informed care efforts with public health partners (SADVPP). 

6.   Explore cross-program opportunities with TUPCP for youth tobacco use prevention and cessation (e.g., cross-program referrals, cross-program promotional/marketing opportunities). 

7. New strategy: Increase youth voice and engagement in ODH youth-serving programs. 

 

Title V has supported the Ohio Adolescent Health Partnership (OAHP) through leadership and facilitation. Over 100 agencies with expertise in adolescent health and wellness are members. The group provides professional development and networking, focusing on the needs of the whole adolescent. The aim is to reduce silos and build the capacity of agencies to serve adolescents more effectively and positively.  Since 2020, the partnership shifted to virtual meetings and attendance declined during the COVID-19 pandemic.  ODH used funds to contract with an OAHP Coordinator during FY21.   An individual with many years of experience with OAHP was awarded the contract, which was fully executed in FY22.  During FY22, ODH contracted with Measurement Resources Company to facilitate a strategic planning process. The OAHP Coordinator oversees the administrative duties of the OAHP including communication with the membership, social media orientation materials, and overseeing the implementation of the strategic plan is focusing on capacity building for OAHP, and is divided into four working groups, including increasing adult engagement, increasing youth engagement, training and education and sustainability and partnerships.  The strategic plan priorities are aligned with MCH priorities, the ODH State Health Improvement Plan along with other stakeholder plans, such as the Ohio Suicide Prevention Plan, and the strategic plans of partner agencies such as ODE and OhioMHAS.  

  

While not funded by Title V, the Tobacco Use Prevention and Cessation Program provides resources to support the objective and partners with other Title V funded programs. TUPCP provides funding to local grantees that includes working with behavioral health facilities to adopt 100% tobacco-free policies. In addition, TUPCP ran a statewide media campaign with state and local efforts to expand the reach of the paid portion of the campaign. The campaign focused on encouraging those with mental health or substance abuse to call the Ohio Tobacco Quit Line. Other collaborative and funding opportunities are in the works based on feedback received to address myths and further encourage nicotine recovery in this setting. 

 

Youth engagement has become an important component of the MCH block grant work, and a strategy was added for FY22 to engage youth. During FY21, an internal ODH workgroup was convened as a subcommittee of the adolescent workgroup to examine how youth-serving programs utilize youth voice or engage youth in programming.  The workgroup included active participation from all MCH youth-serving programs in addition to youth-serving programs from other bureaus. FY21 activities included mapping out how programs currently engage youth, discussing ideas for strengthening youth voice, and researching best practices and evidence-based youth engagement programs.  During FY22, the subcommittee completed a proposal to create a youth advisory committee through OAHP.  The proposed committee would replicate the youth advocacy fellowship component of PATCH (Providers and Teens Communicating for Health).  FY22 activities included having MCH and OAHP staff trained by PATCH, creating contract deliverables, and planning.  The project aims to start during the 2023-2024 school year.   

 

The Ohio YRBS is a CDC-supported, representative, school-based survey that has been administered every other year in Ohio high schools since 1993. The YRBS monitors health risk behaviors of adolescents including injury and violence related behaviors, substance use, tobacco, sexual behaviors, nutrition and physical activity, and other health-related behaviors. In 2019, ODH combined the YRBS with another ODH-administered, CDC-supported survey, the Ohio Youth Tobacco Survey (YTS), resulting in the YRBS/YTS. The Ohio YRBS/YTS is administered in middle and high schools across the state and as a state representative sample survey, provides valuable data for the state to inform statewide program and policy decisions on many health behaviors of Ohio adolescents. 

 

The 2021 YRBS/YTS included 16 new ACEs questions that were optional for states to add from the Centers for Disease Control and Prevention (CDC). Due to COVID-19, the survey administration was delayed from Spring to Fall 2021. Administration began with the start of the school year in 2021.  COVID-19 added additional barriers to school participation in 2021, including school staff reporting they were overwhelmed with contact tracing and other COVID-19 related activities, and an increase in parental pushback. This is similar to what other states’ YRBS Coordinators reported experiencing during their 2021 survey administration. Even with these barriers, CDC informed ODH in late 2022 that, using nonresponse bias analysis, the data was deemed representative, meaning Ohio successfully achieved weighted YRBS/YTS data for 2021.  

 

Coordination with state partners on youth data collection continues.  ODH YRBS/YTS staff, OHYES staff, and ODE staff meet regularly to discuss youth data and co-presented numerous times during FY22, including for the Anti-HIB meetings. ODH YRBS/YTS staff has also been brainstorming new ways to present and distribute YRBS/YTS data. Fact sheets with digestible infographics and charts have been developed using 2019 YRBS/YTS data with support from ODE and OHYES staff. ODH will next look to develop these fact sheets with 2021 YRBS/YTS data.  (Note:  OHYES is a school building convenience sample survey administered by Ohio MHAS.) 

 

In addition, MCH staff continue to participate in interagency discussions around youth survey coordination. Staff from OhioMHAS, ODE, and ODH have been involved in the process since 2019 and the workgroup has evolved.  In FY22, the workgroup began work on a combined website to provide visitors with a one-stop destination for all information on OHYES, YRBS/YTS, and School Health Profiles. In late FY22, the content for this site began development and the workgroup continues to meet every week. 

 

Other Efforts Supported by Title V MCH 

Youth Homelessness 

State Fiscal Year 2020 marked the first time ODH received funds through the state budget (the General Revenue Fund, GRF) to address youth homelessness. The budget line item was specific to addressing homelessness in individuals aged 14-24, with particular emphasis on homeless youth who are pregnant.  Funding was continued through the GRF for SFY22 and 23, which will result in continued funding for the 13 agencies that currently receive funding. Title V does not currently fund this initiative, but the Adolescent Health Coordinator oversees the youth homelessness grants. ODH’s funding for this initiative enabled local agencies that serve homeless youth to implement innovative strategies to reach and assist this difficult and vulnerable population. The funding can be used for services not typically covered by traditional federal funding for homelessness. In FY21, ODH contracted with the Coalition on Homelessness and Housing in Ohio (COHHIO) for technical assistance with the program.  The contract aims to enhance the data collection to determine more details about the youth experiencing homelessness who are being served, what services are being provided, and program outcomes. In addition, COHHIO provides ODH guidance on program planning and technical assistance, and training opportunities for the funded agencies.  During FY22, COHHIO and ODH worked to get all funded programs connected to the Homeless Management Information System (HMIS) or a comparable database to ensure consistent data collection across the project.   All programs were successfully able to report on the required data elements for FY22.   During FY22, 1,085 unique individuals were served through the ODH youth homelessness grant.  During FY22, 854 youth served exited the program.  Of those youth, 58% exited to permanent housing.  Most of those exits were to rental by clients with no ongoing housing subsidy.  In other words, many of the youth were able to cover their rent upon exit.   FY23 will build upon the work of the program and will include a monthly Community of Practice to allow the subgrantees to learn from each other and share best practices.   

 

Hearing and Vision  

The Ohio Department of Health (ODH) Children’s Hearing and Vision Program sets the screening requirements and guidelines for school-based preschool and K-12 schools. These requirements include grades that are routinely screened each year; equipment that is acceptable to use; specific hearing and vision tests that are needed to perform the screenings; and the referral criteria. Schools providing medical services are required to screen school-aged students for vision screenings. Regular school hearing and vision screenings are essential to identifying children at risk for hearing or vision loss. In addition to establishing school screening requirements, the program conducts annual reporting of hearing and vision screening data to determine compliance with screening requirements, plan statewide vision and hearing screening training, establish and revise Ohio hearing and vision screening guidelines, and provide resources for Ohio’s schools.   

 

According to the preliminary data from the 2021-2022 Annual Hearing Screening Report, adolescents and high school students were fifth grade (75%), ninth grade (62%), and eleventh grade (58%). The 2021-2022 Annual Hearing Screening Report also identified the highest percentage of a required grade to complete follow up after a referral was followed by first grade (18 percent), kindergarten (13 percent) followed by third grade (13 percent), preschool (13 percent), followed by fifth grade (14 percent), then ninth grade (9 percent) and eleventh grade (8 percent). 

 

ODH Asthma Program (ODH AP)   

While not funded by Title V, the ODH APworks within the BCFH to improve outcomes related to asthma and improve health equity and has relationships with Title V-funded programs. In Ohio children, there are racial, educational, and economic disparities in asthma prevalence. Non-Hispanic Black children in Ohio visit the emergency room for asthma at a rate more than 5 times that of non-Hispanic White children. Hispanic children visit the emergency room for asthma at a rate nearly double that of non-Hispanic White children. Black children have experienced higher rates of asthma-related inpatient hospitalizations when compared to White children. In 2020, Black children and adolescents experienced asthma-related hospitalizations at a rate more than five times the rate experienced by White children and adolescents (11.0 per 10,000 vs. 2.1 per 10,000). Moreover, while not as pronounced as the racial disparity observed among children, male children experienced consistently higher rates of asthma-related ED visits when compared to female children. In 2020, male children experienced an asthma-related ED visit rate of 41.6 per 10,000 compared to a rate of 27.7 for female children.  

  

To address these disparities, the ODH AP has a significant focus on equity and addressing systemic factors that contribute to poor health outcomes for children with asthma. The ODH AP mission is to engage individuals and entities intentionally and consistently across sectors and disciplines to build capacity and promote health equity to eliminate disparities, improve quality of life, and achieve optimal health outcomes for people with asthma in Ohio. ODH AP strategies focus on promoting inter- and intra-agency collaboration and strategic partnerships to address factors associated with asthma-related disparities; fostering opportunities for healthcare providers and stakeholders to learn about health equity, cultural competence, implicit bias, and structural racialization; and enabling stakeholder engagement to promote community-level approaches to reducing asthma disparities.