Annual Report Fiscal Year 2018:  This section provides a summary of Federal Fiscal Year 2018 (FFY18) activities, accomplishments, and challenges related to National Performance Measures (NPMs) and State Performance Measures (SPMs) (2016-2020) for the Adolescent Health Domain.

Strategy 1:  Implement Adolescent Centered Environment Assessment Process in Wyoming clinics to improve adolescent friendly environment.

In 2017, Wyoming joined the Association of Maternal and Child Health Programs (AMCHP) Adolescent and Young Adult Health Collaborative Improvement and Innovation Network (AYAH CoIIN) with the Wyoming Primary Care Association (WYPCA) serving as the fiscal agent for the project. Key team members attended an in-person AYAH CoIIN Summit in May 2017 to learn best practices from leading experts in the field of adolescent health and began developing a master action plan.  Implementation of the action plan continued into FFY18 and FFY19.

The YAYAHP identified the Adolescent Centered Environment Assessment Process (ACE-AP) from the University of Michigan as a strategy to improve the quality of the adolescent clinical environment with a long-term goal of increasing well-visits among youth and young adults. The ACE-AP is a facilitated, comprehensive self-assessment and guided improvement process that includes customized resources, recommendations, technical assistance (TA), and implementation plans using Plan, Do, Study, Act (PDSA) improvement cycles. The ACE-AP addresses the following 12 key areas of adolescent-centered care:

• Access to Care
• Adolescent Appropriate Environment
• Confidentiality
• Best Practices & Standards of Care

• Reproductive & Sexual Health
• Behavioral Health
• Nutritional Health
• Cultural Responsiveness

• Staff Attitudes & Respectful Treatment
• Adolescent Engagement & Empowerment
• Parent Engagement
• Outreach & Marketing

In late 2017, a ‘clinic environment workgroup’ of the Wyoming AYAH CoIIN team drafted a Request for Application (RFA) to recruit pilot clinics to implement the ACE-AP model. Wyoming Medicaid provided rates of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) visits compared to primary care visits for all Wyoming clinics.  Review of this data informed the RFA outreach and distribution plan. Clinics with low rates of EPSDT visits compared to primary care visits were contacted directly and encouraged to apply. In December 2017, the Youth and Young Adult Health Program (YAYAHP) released the pilot clinic mini-grant RFA. Four clinics applied and a review committee selected all four to participate.  The four participating clinics are Lander Medical Clinic, University of Wyoming Family Medicine Residency Program, Laramie Pediatrics, and Casper Children's Center. The clinics completed a baseline self-assessment of their organization’s environment, policies and practices related to youth-friendly services to identify opportunities for improvement and met with the University of Michigan monthly to identify and implement quality improvement initiatives. Each clinic also received up to $1,500 to implement a change within their clinic to become more adolescent friendly (e.g. iPads for completion of adolescent screening tools, privacy screens for check-in, youth-friendly posters and materials). To assure ongoing quality improvement and evaluation, each clinic collected patient satisfaction surveys from all youth and young adults ages 10-25 years visiting their clinic. Final data for this project will be available for FFY19 reporting.

One common need identified across all four ACE-AP pilot clinics was information and guidance related to adolescent consent and confidentiality. Through the AMCHP AYAH CoIIN project, the Center for Adolescent Health and the Law developed consent and confidentiality guides for all participating CoIIN states. The guides will be released in 2019.  In addition, the University of Michigan plans to summarize consent and confidentiality laws in a handout for participating clinics. 

In August of 2018, the YAYAHP Manager (YAYAHPM) attended the AYAH CoIIN close out meeting in Washington, D.C. to network and collaborate with other states and partners, discuss challenges and successes, and further develop a sustainability plan with resources from AMCHP and the National Resource Center. Following the close out meeting, the Wyoming AYAH CoIIN team conducted a site visit in Cheyenne, Wyoming facilitated by the director of the State Adolescent Health Resource Center. Representatives from the MCH Unit, pilot clinics, Medicaid, Kid Care CHIP (Children’s Health Insurance Program), WDH PHD, Wyoming Family Voices, Wyoming American Academy of Pediatrics, WYPCA, and WyHealth (Medicaid contractor) attended. The goal of the meeting was to take stock of current efforts, align goals, and discuss next steps.

In FFY17, a ‘consumer education workgroup’ of the AYAH CoIIN developed two surveys for youth and young adults and their parents/caregivers. The survey seeks to collect youth and parent views about well visits (e.g. barriers, knowledge about well visits) in order to inform future well visit promotion efforts.  Data from 50 parents/caregiver surveys was used to inform program efforts, promotional campaigns, and educational materials developed to increase well-visits. The YAYAHPM plans to administer a survey to youth/young adults in Fall 2019 to further inform program efforts.

One of the key challenges of this project is maintaining engagement of a large and diverse team of stakeholders. The YAYAHPM keeps all members of the larger team engaged through frequent e-mail communication and in-person meetings as appropriate. 

Strategy 2: Send well-visit reminders to Children’s Special Health (CSH) Program clients

CSH program staff continue to send enrolled clients (and their families) reminders about the importance of attending annual well visits. A requirement of the CSH program is that clients have a primary care provider in addition to the specialists needed to care for the child or adolescent’s special health need(s). This aligns with medical home recommendations. State and local staff provide ongoing care coordination for enrolled clients and their families and work to identify a local primary care provider in cases where a family may not have one or needs a new provider. 

Strategy 3:  Develop statewide youth council to ensure youth voices are included in decisions related to program development, implementation, and evaluation. 

The YAYAHP seeks to promote youth voice in the development of strategies and products, and development of a statewide youth council will bring youth voices and experience together with health programs, promoting success, increased youth engagement, and quality improvement. In Fall 2018, YAYAHPM partnered with an MCH Unit intern to research best practices related to youth engagement and review previous WDH plans to launch a statewide youth council. The YAYAHPM developed a framework for the youth council and released an RFA in 2019.  The key deliverables included:

• Establish, coordinate, and facilitate statewide youth council
• Recruit members across the state
• Create supportive guidelines and documents for council (ie. application, agreements/expectations, code of conduct, council description/informational letter)
• Work with youth to provide feedback on WDH program materials and implementation as "outlined" by the YAYAHPM
• Work with YAYAHPM to provide training on public health, social determinants of health, and the social ecological model
• Promote youth involvement in relevant topics (ie. youth suicide, bullying, eating disorders, vaping, etc)
• Plan and create youth council agendas and materials
• Attend and facilitate council meetings (encourage and promote youth facilitation and involvement)
• Manage all youth council communication to include drafting e-mails to be distributed to council members on updates, clarifications, upcoming meetings and events, and data reminders-can be in conjunction with council members
• Work with YAYAHPM to provide positive youth development training for youth and adults working with youth
• Regularly communicate with youth and young adults to ensure ongoing collaboration and information sharing on best practices and emerging issues related to youth and young adults (12-24) in Wyoming and other states
• Provide leadership/professional development/social opportunities for youth
• Coordinate ongoing recruitment to promote sustainability
• Manage member leadership roles/responsibilities (ie social media, secretary, chair, etc.)
• Share volunteer opportunities
• Coordinate reimbursements for youth council members

A review team is currently reviewing applications.  A contract for youth council activities will be in place before FFY20 begins. 

See CSHCN Annual Report. 

The “Promote Healthy and Safe Relationships” priority was identified due to Wyoming’s high teen birth rate, early initiation of sexual activity, incidence of teen dating violence, and alcohol and drug use prior to sexual activity. Most of these activities were measured on the Youth Risk Behavior Surveillance System (YRBSS). In 2016, the Wyoming State Legislature eliminated the YRBSS in Wyoming. There is no longer an effective, statewide measure of youth sexual behavior. However, Wyoming does have a statewide survey called the Prevention Needs Assessment which includes questions about alcohol and drug use.

In 2017, the YAYAHPM identified Communities that Care (CTC) as the primary strategy to address this state priority need and SPM. CTC is an evidence-based framework that uses prevention science to increase protective factors in communities. Youth from CTC communities are more likely to delay initiation of alcohol and tobacco use. Program staff held multiple exploratory calls with the University of Washington between Fall 2017 and early 2018 about possible implementation in Wyoming. In addition, the YAYAHPM worked to inform all stakeholders about the framework as well as gain momentum for applying this framework. Due to staff turnover, lack of stakeholder buy-in, and sustainability concerns, plans were suspended in Spring 2018.  The most significant barrier of CTC implementation was the requirement that local implementing agency staff dedicate at least .5 FTE to the CTC model. Local infrastructure and project funding was insufficient to meet this requirement.

In Fall 2018, the decision was made to use the Collective Impact Model to address this state priority instead of CTC. Collective Impact is the commitment of a group of individuals from different sectors to a common agenda for solving a specific problem, using a structured form of collaboration. It 1) establishes shared agendas and shared measurement, 2) fosters mutually reinforcing activities, 3) encourages continuous communication, and 4) has a strong backbone. The new YAYAHPM attended trainings/conferences on collective impact, protective factors, and adverse childhood experiences (ACES) to build capacity to increase protective factors as a strategy for promoting healthy and safe relationships in communities.

The following strategies related to this priority are funded with Title V, Rape Prevention and Education (RPE) Program and Preventive Health and Health Services (PHHS) Block Grant funds. 

Strategy 1:  Support Rape Prevention and Education (RPE) Program pilot communities to implement primary sexual assault prevention strategies using a collective impact model.

The YAYAHPM is the RPE Project Director, and the MCH Epidemiology Program provides evaluation and data support for the RPE program. MCH contracts with the Wyoming Coalition Against Domestic Violence and Sexual Assault (WCADVSA) to complete the work of the RPE grant in Wyoming communities. The target audience for this work is adolescents ages 12-24. Historically, three pilot communities were funded through this grant to conduct primary prevention in their local communities with a shared risk and protective factors approach. In Fall 2018, the decision was made to fund two pilot communities, as the third community successfully completed a community-level strategy, partnering with the local chamber of commerce, reaching 10,000 people. Some examples of programming implemented in the pilot communities include Coaching Boys into Men and Athletes as Leaders, which teach participants about healthy masculinity and how to be leaders in creating cultures of safety and respect. The connected risk and protective factor approach allows the program to implement strategies that will improve the overall environments for adolescents in Wyoming rather than looking at sexual violence in a silo. By leveraging Title V and RPE funds, we expect to see a broader impact on youth and young adult health outcomes. 

Strategy 2:  Build statewide capacity for sexual violence prevention among youth and young adults through the Wyoming Sexual Violence Prevention Council (WSVPC).

The YAYAHPM and MCH/Injury Epidemiologist serve as steering committee members of the WSVPC. The council was developed to increase effectiveness of violence prevention efforts statewide. The WSVPC underwent strategic planning including a revision of the vision, mission and core values. In addition, three workgroups of this committee were identified in addition to the Steering Committee. They include the Policy and Legislation work group; the Education, Training and Outreach workgroup; and the College Sexual Violence Prevention work group. These work groups continued to develop strategic goals and work towards statewide shared collective impact efforts for sexual violence prevention. In January 2018, the WSVPC held an in-person meeting which brought together council members, key stakeholders, and local media. One of the goals of this meeting was to promote the work of the RPE pilot communities and the WSVPC to key stakeholders and the public. Several news organizations picked up the event and ran stories about the work done by the WSVPC as well as the RPE pilot communities. With a focus on community/societal level strategies, FFY18 brought about a slight shift to the work of the council. The council is currently clarifying goals and strategies that support the collective impact framework in Wyoming sexual violence prevention work.

Strategy 3:  Implement comprehensive sexual education curriculum which includes content on reducing risky behaviors (e.g. alcohol use).

The YAYAHPM is the Wyoming Personal Responsibility Education Program (WyPREP) Project Director and partners with the Communicable Disease Unit (CDU) to manage and implement the WyPREP.  WyPREP provides training, curricula, and support for implementation of evidence-based, medically accurate curriculum in school and community-based settings. In FFY18, contracts with nine organizations were active; six school districts, two youth in out of home care facilities, and Wyoming Institute for Disabilities. In every community that contracts to implement WyPREP, a team of people are identified to support the implementation. This team includes: school health/physical education staff, school nurses, school counselors, public health and/or Title X nurses, and domestic violence/sexual assault program staff. This team supports the implementation and also provides a contact for youth in their community. Starting in the 2017-2018 school year to present, WyPREP reached over 800 Wyoming youth. The YAYAHP partners with the MCH Epidemiology Program for evaluation of the WyPREP program. Each location is provided with a report card detailing the data from their students each school year. A statewide report card is produced for publication and shared with the public and policymakers. From the 2017-2018 school year to present, over half of all WyPREP participants stated that they were much more likely or somewhat more likely to delay initiation of sexual intercourse in the six months following the program.

Wyoming was selected to participate in the 2018 Centers for Disease Control and Prevention (CDC) & Harvard School of Public Health Maternal and Child Health Program Evaluation Practicum to evaluate WyPREP. Program staff from MCH, MCH Epidemiology, CDU, and the CDC MCH-Epidemiology Assignee participated in a week long training and workshop in January 2018 followed by a week in Wyoming working with two students to develop a comprehensive evaluation plan of the WyPREP program. The evaluation plan was two pronged in nature and looked to evaluate both fidelity to the model of WyPREP programming and the impacts of the program within the local communities where it is implemented. Based on evaluation findings, there have been several program improvements. Site visits have been implemented to monitor fidelity and provide feedback to facilitators. The WyPREP has improved fidelity monitoring by ensuring all facilitators are trained by WDH staff trainers. Training opportunities have been made available and refresher trainings continue to be offered to troubleshoot issues and provide reporting information/updates. WDH WyPREP staff are also available to provide technical assistance throughout the year.

Strategy 4:  Develop statewide youth council to ensure youth voices are included in decisions related to program development, implementation, and evaluation. 

See Strategy 3 for Promote Preventive and Quality Care for Adolescents priority above.

Other YAYAHP Activities:

YAYAHP Partnership Development

New in her role, the YAYAHPM worked to develop/build partnerships with many youth serving organizations, other WDH programs, and within other agencies to increase the effectiveness of YAYAH programming. Partnerships include:

• Wyoming Equality
• Wyoming Primary Care Association
• Strong Families Strong Wyoming
• Wyoming Health Council
• Boys and Girls Clubs of Cheyenne
• Students Against Destructive Decisions (SADD)
• Wyoming Children’s Trust Fund
• Wyoming Department of Education
• Behavioral Health Division (WDH)

Wyoming College Consortium

In FFY17, planning for the Wyoming College Consortium continued with the College Sexual Violence Prevention work group comprised of staff from WDH, WCADVSA, and University of Wyoming. A campus needs assessment was developed by this team and distributed to all Wyoming institutions of higher education. Eight (out of nine) community colleges and the University of Wyoming responded to the survey (90% response rate). Data from the survey included availability of sexual violence prevention and response on campus, infrastructure around Title IX and Clery Act requirements, and technical assistance needs. MCH Epidemiology analyzed the results and prepared a summary presentation which was used to inform preparations for the College Consortium in-person meeting as well as inform schools of the current state of Wyoming institutions of higher education regarding these issues. The inaugural Wyoming College Consortium meeting was held in December 2017 co-facilitated by the YAYAHPM with participation from WCADVSA, MCH Epidemiology and six institutions from across the State.

In FFY2017, the University of Wyoming implemented an inaugural campus climate survey. The survey included several questions about experiences related to safe and healthy relationships among young adults both on campus and prior to attending school. Although this represents only a specific subset of the youth and young adult population, it will be a valuable new resource available to Wyoming MCH Unit to fill in gaps for monitoring the health of young adults in Wyoming regarding safe and healthy relationship.

From FFY18 to present, the YAYAHP and the WCADVSA have worked to ensure primary sexual violence prevention information is shared with all institutions of higher learning and technical assistance is provided. In August 2019, a joint meeting will be held for pilot communities, campus consortium members, and council members to encourage the collective impact model and identify specific strategies to implement that impact the community/societal level.

Emerging Topic:  Youth Suicide Prevention

The YAYAHP, Child Health Program, and Injury and Violence Prevention Program (WIVPP) joined the Child Safety Learning Collaborative (CSLC), through the Child Safety Network (CSN), to focus efforts to reduce fatal and serious injuries among infants, children, and adolescents by building and improving partnerships and implementing and spreading best practices, especially among the most vulnerable populations. Upon review of available data and capacity, the team selected Suicide & Self-Harm Prevention (SSHP) and Motor Vehicle Traffic Safety (Child Passenger and Teen Driver/Passenger) (MVTS) as CSLC topic areas of focus for Wyoming. The YAYAHPM took lead on the SSHP topic while the Child Health Program Manager leads MVTS.

The YAYAHP also partnered with the WIVPP to apply for the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Grant Program. The purpose of the program is to support states and tribes with implementing youth suicide prevention and early intervention strategies in schools, educational institutions, juvenile justice systems, substance use programs, mental health programs, foster care systems, and other child and youth-serving organizations. It is expected that this program will: (1) increase the number of youth-serving organizations who are able to identify and refer youth at risk of suicide; (2) increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; and (3) improve the continuity of care and follow-up of youth identified to be at risk for suicide, including those who have been discharged from emergency department and inpatient psychiatric units.