ADOLESCENT HEALTH DOMAIN

Nebraska Annual Report for the 2018-2019 Year

 

In this section, Nebraska MCH Title V reports on the accomplishments and activities in the Adolescent Health Domain for the period October 1, 2018 to September 30, 2019. This represents the fourth year of activity in the Title V five-year needs assessment cycle.  The numerical sequence of headings used below references the narrative format found on page 35 of the Title V MCH Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Eighth Edition.

 

The Nebraska Priorities in the Adolescent Health Domain with 2018-2019 NPM, SPM, and ESM statements are as follows:

• Unintentional injury among youth, including Motor Vehicle Crashes.

NPM: Rate of Hospitalization for non-fatal injury for adolescents age 10 – 19 years.

ESM: The percentage of schools participating in a motor vehicle passenger safety seat campaign.

 

• Sexually Transmitted Diseases among Youth.

New - SPM: Number of adolescents, age 12 to 17 years with a preventive medical visit in the past year.

 

• Obesity/Overweight among youth including food insecurity and physical inactivity.

New - SPM: Percent of adolescents, age 12 to 17 years who are physically active at least 60 min. per day. 

 

1. Context: the State of this Population Domain 

One characteristic of the adolescent health landscape is the constant change occurring in context, resources, direction, and opportunity.  Fortunately, Title V in Nebraska is equipped with a young, agile and growing program staff who demonstrate their persistence and capacity for collaboration.

 

In 2018-2019 changes occurred in funding for the NDHHS Reproductive Health Program, by not receiving federal Title X Family Planning funds.  While disruptive to the status quo, funding did go to Nebraska Family Planning, an association of community-based partners dedicated to ensuring that all Nebraskans have access to family planning and reproductive health services. Building on the success of the Adolescent Health Program in Omaha, a philanthropically-funded effort to reduce STDs among Omaha Youth, the Adolescent Sexual Health Coalition was formed in Lincoln-Lancaster County.  Convened by the local public health department, the group provides an opportunity for the Adolescent Health Program staff to participate with partners and stakeholders to build on the success of the efforts in Omaha, sixty miles away. 

 

The Adolescent Health program joined with other lead partners to convene the annual Healthy Youth Nebraska conference on September 18, 2018.  This cross-sector activity for youth-serving professionals statewide brings together individuals from schools, community organizations, juvenile justice, and child welfare in a positive youth development theme. In addition to this statewide conference, the Adolescent Health Program offers ongoing skills-building opportunities to better serve youth.  In 2018-2019, the Adolescent Health program delivered the following topical trainings:  It’s That Easy! An Educator’s Workshop to Support Parent-Child Communication; Sexual Health Education 101 for Mental Health Practitioners; and helped promote Rights, Respect, Responsibility: A K-12 Sexuality Education Training Session.

 

In previous reports and applications of the current five-year Title V cycle, Nebraska has discussed the significance of the Omaha Adolescent Health Project, a philanthropically-funded project initially launched to lower Omaha’s rate of STDs among adolescents.  Title V has had primarily an observer’s role, yet the project remains significant in impact and important to Nebraska.  Of particular note relevant to 2018-2019 is that in October 2018 the Omaha Women’s Fund became a grant-making organization beyond Omaha with the investment of $5.6 million in thirteen community based organizations across the state, “to make all forms of birth control accessible to women ages 25 and under.”

 

On other fronts, Nebraska has benefitted from a recent expansion of scope and mission by the Omaha-based Children’s Hospital.  In 2017-2018, Children’s established the Center for the Child and Community, based in Lincoln, Nebraska.  The vision of the Center is to empower communities to value and support the health, safety, and well-being of every child so that all children have the opportunity to reach their full potential.  One of the key strategies identified by the Center is in the area of Obesity Prevention, and another is School Health and Wellness – both relevant to Title V priorities and activities.  In the 2018-2019 program period, the Center for the Child and Community expanded further to become the primary subrecipient of the Nebraska Department of Education, designated to implement Nebraska’s CDC-RFA-DP18-1801 grant project, entitled “Improving Student Health and Academic Achievement through Nutrition, Physical Activity, and the Management of Chronic Conditions in Schools.”

 

Nebraska continues to be challenged by the rate of youth suicide in the state, indicative of larger issues of access to care, mental well-being, challenges in the education system, and more.  As systems of care work has matured in the early childhood care and education arena, as well as in Nebraska’s Behavioral Health System of Care, it is clear there is a need for a coordinated and comprehensive system of care and services for adolescents across the state, that includes mental as well as physical, social, and educational well-being.  

 

Also of note is the retirement, in the summer of 2019, of Carol Tucker, RN, NCSN, Program Manager of the Title V- funded DHHS School Health Program.  The position is now filled by Andrea Riley, RN, BSN.  The School Health Program represents numerous opportunities to work with school nurses and others in the state to address health issues of adolescents with and without special health care needs.

 

2. Summary of programmatic efforts and use of EBP to address each priority need 

 

Unintentional injury among youth, including motor vehicle crashes.

2018-2019 Objectives and Strategies

 

Planned strategies for this priority during 2018-2019 included collaboration between the Injury Prevention Program and the Title V School Health Program to increase the flow of prevention education to schools and increase the number of schools participating in Teens in the Driver Seat. 

 

• Objective A9a: Increase by 10% the percentage of teen drivers wearing seat belts in the Teens in the Driver Seat school survey. 

 

Summary of programmatic efforts:

The School Health Program collaborated with the Nebraska Injury Prevention Program to disseminate to school nurses materials aimed at parents of students age 12-16 years about teen driver safety and graduated drivers’ licensing (GDL) laws, including opportunities for schools to participate in the evidence-based Teens in the Driver Seat school-based motor vehicle safety promotion program.

 

Information from the Nebraska Teen Driving Experiences Survey show that for the period 2014 to 2019 seatbelt use improved, with a significant decrease in the percent of youth answering “yes” to whether they have ridden in or driven a vehicle without wearing a seatbelt.

 

• New: Objective A9b: Increase by 6 schools per year the number of Nebraska high schools participating in evidence-based safe driver promotion activities. (Previously, increase by 10% the percent of Nebraska high schools participating in safe driver promotion for teens.)

 

Summary of programmatic efforts:

Through collaborative efforts between the School Health and Injury Prevention Programs, 35 schools participated in Teens in the Driver Seat in 2018-2019 compared to 30 schools in the 2017-2018 school year.  The School Health Program continued to share information as provided by the Injury Prevention Program on the school nurse listserv.  In 2019, the question arose: to what extent are school nurses making use of, or disseminating to parents/caregivers or others, these materials?  The Title V Action Plan for 2019-2020 develops such a line of inquiry for the School Health Program to assess the extent to which dissemination of information through the school health listserve prompts action by the school nurse.

 

Use of Evidence-based Practice in this Priority Area:

According to the CDC (https://www.cdc.gov/motorvehiclesafety/seatbelts/facts.html  12/23/2019) for adults and older children (who are big enough for seat belts to fit properly), seat belt use is one of the most effective ways to save lives and reduce injuries in crashes. A total of 23,714 drivers and passengers in passenger vehicles died in motor vehicle crashes in 2016.  More than half (range: 53%-62%) of teens (13-19 years) and adults aged 20-44 years who died in crashes in 2016 were not buckled up at the time of the crash.

 

For Teens in the Driver Seat as an intervention, the TDS website (https://www.t-driver.com/) cites the following:

Teens in the Driver Seat® program surveys show risk awareness levels increasing by up to 200 percent. Cell phone use at Teens in the Driver Seat® program schools has been shown to drop by 30 percent, and seat belt use has gone up by over 14 percent.

 

A rigorous 20-county control group analysis for Texas indicates the program results in an average decrease of 14.6 percent in injury and fatal crashes (total) where the program has been sustained for three or more years.

 

The evidence review available on the website www.mchevidence.org for injury prevention directs users to a guide produced by the Children’s Safety Network, entitled “Evidence-based and Evidence-informed Strategies for Child and Adolescent Injury Prevention” (https://www.childrenssafetynetwork.org/sites/childrenssafetynetwork.org/files/Evidence-Based%20Strategies%20FINAL.pdf 12/23/2019).  In this document, evidence-based strategies for reducing teen driver deaths include the following:

• For reducing crash rates: Graduated driver licensing (GDL) laws and enforcement; and
• For reducing riding with drinking drivers: Universal school based instructional programs (effective in reducing riding with drinking drivers).

 

Both of these evidence-based intervention strategies are in place in Nebraska.

 

Sexually Transmitted Diseases Among Youth

2018-2019 Objectives and Strategies

 

Planned strategies for this priority during the 2018-2019 included work by the School Health Program to increase the knowledge of school nurses about school-based sexual health referral systems, sexually-transmitted diseases and communication skills for sensitive topics; completing the Nebraska Adolescent Health Strategic Plan, and developing opportunities to improve youth-friendly clinical practices among reproductive health providers.

 

• Objective A10a: By 2020 increase by 10% the percentage of teens with a past year medical visit through adoption of youth-friendly clinical practices.

 

Summary of programmatic efforts:

The School Health Program followed activities in 2017-2018 with Nebraska School Nurses by repeating a survey regarding school nurse knowledge of topics related to sexual health referrals for youth.

 

The second survey sample was smaller than the original survey sample, and conducted in one activity with school nurses at a statewide conference.  The comparison of results, by the proportion responding “true” to the statement, is shown below. Results show an increase in the percent of school nurses identifying that their schools have policies or guidelines for sexual health referrals. A lesser proportion stated in 2018-2019 that their communities are adequately served by sexual health services for adolescents, an unsurprising results given confusion regarding whether services were still available and how to access them due to changes in Nebraska’s Title X funding and lead agency. Of greatest encouragement in the results was the percentage of the audience in 2018-2019 responding to the survey who stated they were knowledgeable about community resources for sexual health referrals than they were a year ago.

 

Statement	2017-2018	2018-2019
My school has written policy regarding referrals for students to sexual health services.	15%	19%
My school has written guidelines regarding referrals for students to sexual health services.	17%	22%
Adequate services for sexual health care are available for adolescents in my community.	54%	49%
I am knowledgeable about Nebraska laws concerning an adolescent’s legal right to access sexual health services without parental consent.	45%	44%
I know where to refer a student for a free pregnancy test and counseling.	72%	71%
I know where to refer a student who has experienced sexual violence.	75%	78%
I am aware of my legal rights and responsibilities as a school nurse in the matter of protecting student confidentiality.	83%	73%
I am aware of my legal rights and responsibilities as a school nurse in the matter of disclosing sexual health information about students to my school administrator.	47%	44%
I am aware of my rights and responsibilities as a school nurse in the matter of disclosing sexual health information about students to their parents.	41%	44%
The information about at the 2019 conference helped me increase the number of sexual health referrals I have made.		18%
I know more about community resources for sexual health referrals than I did a year ago.		35%

    

 

• Objective A10b: By 2020, increase by 10% the number of youth-serving medical practices adopting youth-friendly standards.

 

Summary of programmatic efforts:

In late 2018 into 2019, Adolescent Health Program staff assumed the responsibility of crafting an implementation plan for the strategic priorities identified by the Nebraska Adolescent Health Advisory Committee. Implementation developments began by focusing on reproductive health care access.  Staff began to create an implementation framework for youth-friendly clinical practices in the setting of reproductive health clinics serving adolescents.  The implementation plan including expected timeframes was completed during this period.  The Adolescent Health Team identified Douglas County Health Department’s clinic as a likely pilot site.

 

Nebraska Adolescent Health Advisory Council Strategic Priorities:

Goal 1: Access to Health Information and Utilization of Services.

Goal 2: Youth have access to comprehensive, medically accurate, developmentally-appropriate sexual health information.

Goal 3: Encourage providers and educators to adopt technology to disseminate health information.

 

Significant to program development during this period, Title V in Nebraska increased investment in public health reproductive health services through the DHHS Reproductive Health Program, formerly funded with Title X federal funds.  As a result, more staff, more clinic-based relationships, greater program reach occurred for the Adolescent Health program, with the Reproductive Health program evolving a greater focus on Title V priorities. The adolescent health team has identified the Douglas County Health Department’s clinic as a likely pilot site for testing best practices in youth-friendly clinic services.

 

Use of Evidence-based Practice in this Priority Area:

When considering the use of evidence-based practice in the priority area of reducing STDs among adolescents in Nebraska, the resource www.mchevidence.org offers evidence primarily focused on adolescent well-visits for preventive health care, which may or may not be a visit inclusive of, rather than specific for, reproductive and sexual health services.  The summary of evidence includes the following:

“The following trends emerged from analysis of peer- reviewed evidence...

• Expanded insurance coverage appears to be effective.
• Patient reminders appear to be somewhat effective.
• There is insufficient evidence of the effectiveness for school-based health centers.”

 

In the evidence review of the County Health Rankings “What Works” feature (https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies?search_api_views_fulltext=sexual%20health&items_per_page=10&page=1 ) there is strong evidence supporting the following interventions to promote sexual health of adolescents:

• Comprehensive risk reduction sexual health education (scientifically supported);
• School-based health centers (scientifically supported);
• Condom availability programs (scientifically supported);
• Behavioral interventions to prevent HIV and other STIs (individual, group, and community-level interventions to provide education, support, and training that can affect social norms about HIV and other STIs – scientifically supported);
• Extra-curricular activities for social engagement (scientifically supported); and
• School-based social and emotional instruction (scientifically supported);

 

While few if any Nebraska schools permit condom distribution, a review of the scientifically supported interventions above suggest the role of the school nurse as being strategically positioned to influence the spread of other evidence-based approaches listed.

 

Obesity/Overweight Among Youth including food insecurity and physical inactivity

2018-2019 Objectives and Strategies

 

Planned strategies for this priority during 2018-2019 continued to evolve and transform as Title V seeks viable approaches to this priority that originally encompassed three populations: women of childbearing age, children, and adolescents.  Now nested in the adolescent population domain, Nebraska has moved in this priority from interventions ranging from place-based community planning to increase physical activity (the pilot group using the guide selected lead exposure of children as their community concern), to forming a small group to work in the Children’s Healthy Weight CoIIN in order to frame innovative approaches to increasing physical activity of children at school. The CoIIN activity evolved to a specific focus on youth age 12-17 years with Individualized Education Plans. The small group was particularly interested in inclusion practices for youth with special needs transitioning from school-based to community-based vocational and life skills programs. 

 

• New - A11: By 2020, increase community supports for healthy and active living for children and adolescents. (Previously, increase community supports for engagement on built environments to support healthy and active living for children and adolescents.)

 

Summary of programmatic efforts:

Relevant to this priority in both the Adolescent and Child Health domains, several efforts occurred during the 2018-2019 program period.  A small group process to participate in the Children’s Healthy Weight CoIIN, sponsored nationally by the Association of State and Territorial Nutrition Directors, developed a shift of focus from children to adolescents, specifically youth in high school with special health care needs.  The topic the group agreed to explore was inclusive and adaptive practices of schools in physical activity and physical education programs, and also in community-based settings for other youth in transition programs.  This effort in turn merged with work in the Nebraska Department of Education to rewrite and update physical education curriculum guidelines for the state. The DHHS School Health program continues to participate in the curriculum development process.

 

The School Health Program also continued engagement with the Nebraska Whole School, Whole Community, Whole Child (WSCC) Institute, an entity coming about through Nebraska’s award of a CDC School Health Grant (1801) to the Nebraska Department of Education.  The WSCC effort is relevant to the priority in both the child and adolescent population domains for its focus on School Wellness Policies (required by federal law of schools participating in the free- and reduced- student meal program) and working with schools to develop and carry out implementation plans for their school wellness policies, including emphasis on healthy food and on physical activity for students throughout the school day.  The level of activity in 2018-2019 involved two meetings.

 

In another programmatic area of activity related to this priority occurs, the Title V School Health Program is a key partner in Nebraska’s CDC-RFA-DP18-1801 grant project, entitled “Improving Student Health and Academic Achievement through Nutrition, Physical Activity, and the Management of Chronic Conditions in Schools.”  While grant-related interventions are occurring in eight rural schools in the state, the scope of the vision of project implementers is much broader.  The Nebraska Department of Education was the successful applicant and, upon award, entered into a relationship with the new Center for Child and Community that is part of Children’s Hospital in Omaha.  The Center for Child and Community is a very active resource with growing scope in Nebraska, including educational events for school nurses drawing on medical expertise at Children’s Omaha.  

 

In addition to these collaborative and developing efforts in Nebraska, the School Health Program in Nebraska occupies a unique space with partners in efforts and responsibilities with regard to school health screening practices, inclusive of height and weight screening.  As a result, the School Health Program not only brings competencies and resources related to accurate and valid screening practices, but also organizes a (voluntary) data system for the pooling and assessment of statewide screening data, the only source of data inclusive of a population as broad and diverse as public school enrollment. The current School Health Screening rules and regulations for Nebraska, along with statutory citations, are located here:  https://www.nebraska.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-173/Chapter-07.pdf The reports of the School Health Screening Program are available here: http://dhhs.ne.gov/Pages/School-Health-Data.aspx . In September 2018, the BMI surveillance report was made available: http://dhhs.ne.gov/MCAH/SchoolR-2016-2017StudentBMISurveillanceReport.pdf  The school health data project of 2018-2019 involved chronic health conditions at school, and is not yet published.

 

Systems integration, effective communication, and cross-sector collaboration become even more vital to assure project efforts and resources of all invested in school health are aligned to maximize results in all these areas.

 

Evidence-based practice in this priority area:

The website www.mechevidence.org indicates that the evidence base for the NPM of increasing physical activity in populations remains under development. 

 

Referring to County Health Rankings and Roadmaps, What Works feature, as retrieved 9/3/2020, the site organizes review of evidence on “diet and exercise” into six general headings of types of effective interventions:

• Increase access to healthy food options;
• Create opportunities for active living;
• Promote broad approaches to increasing physical activity;
• Provide physical activity information education;
• Promote healthy eating; and
• Reduce access to unhealthy foods.

 

Several evidence-based approaches are supported in County Health Rankings and Roadmaps that are pertinent to the child and adolescent populations include:

• Multi-component obesity prevention interventions (scientifically supported);
• Adequate access to places for physical activity (scientifically supported);
• Community-based social support for physical activity (scientifically supported);
• School fruit and vegetable gardens (scientifically supported);
• School nutrition standards (scientifically supported);
• Individually-adapted physical activity programs (scientifically supported);
• Safe routes to school (scientifically supported); and
• School breakfast programs (scientifically supported).

 

Two considerations emerge from this review.  One, many of these activities involve school and community collaborations and engagement.  Second, none involve measurement of height and weight, or the provision of weight management counseling, at school.  Instead, interventions are designed to encompass the whole population in healthy nutrition and physical activity, not singling out individuals who are obese.

 

The evidence base was used in 2019 to determine there was insufficient rationale for continuing school-based screening of height and weight or Body Mass Index in Nebraska schools.  While the data are indisputably of interest to state child health advocates, there is little evidence to provide a rationale for doing so.  Findings came from two primary sources.  In the US Preventive Services Task Force Recommendation Statement, June 20, 2017; Screening for Obesity in Children and Adolescents; US Preventive Services Task Force Recommendation Statement  https://jamanetwork.com/journals/jama/fullarticle/2632511 , screening for obesity is recommended in the clinical practice setting, where effective interventions are made available, which overall are of moderate benefit and minimal harm. In community settings, such as schools, the Community Preventive Services Task Force recommends behavioral interventions to reduce sedentary screen time among children 13 years and younger.  It found insufficient evidence to recommend school-based obesity programs to prevent or reduce overweight and obesity among children and adolescents.  The CDC recommends 26 separate community strategies to prevent obesity, such as promoting breastfeeding, promoting access to affordable healthy food and beverages, promoting healthy food and beverage choices, and fostering physical activity among children.  None include height and weight measurement.

 

Another source for consideration was the Centers for Medicare and Medicaid child core measures.  In 2019 the child core measure for BMI measurement in clinical settings was modified from BMI measurement along to BMI measurement with Counseling for Nutrition and Physical Activity for Children/Adolescents. The addition of the two components for counseling for nutrition, and counseling for physical activity, suggests the function of measurement alone is not useful for obesity control in individuals or populations.

 

3. Alignment of NPMs, ESMs, SPMs, SOMS with priority needs 

 

Unintentional injury among youth, including Motor Vehicle Crashes.

NPM: Rate of Hospitalization for non-fatal injury for adolescents age 10 – 19 years.

ESM: The percentage of schools participating in the “Teens in the Driver Seat” program.

 

The ESM selected for this NPM is aligned with the priority.  In 2018-2019 the ESM statement was modified slightly in wording to specify the “Teens in the Driver Seat” program, rather than a previous more generic phrase about a motor vehicle passenger safety seat campaign.  The ESM identifies schools as influencing safe driving behavior among adolescents.  It has been a challenge to select the correct magnitude of the work (a few schools, all schools, adolescent population) and understand schools, school districts, or school nurses as the respondent (denominator) versus youth.

 

Sexually Transmitted Diseases among Youth.

New - SPM: Number of adolescents, age 12 to 17 years, with a past year preventive medical visit. 

 

In 2018-2019, Nebraska switched from an NPM (Percent of adolescents age 12 through 17 years with a preventive medical visit in the past year) and ESM (Percent of school nurses knowledgeable of sexual health services in their community) to an SPM for this priority area, and removed the ESM.  Nebraska has worked over the last few years to link the priority stated by stakeholders, STDs among youth and women of childbearing age, to the NPM of adolescents having a past year medical visit.  Some tension has persisted in this linkage, in terms of selecting strategies appropriate to the priority, to the NPM, or to both.  In 2018-2019, Nebraska relieved some of that tension by removing the evidence-based or –informed strategy measures. 

 

The continuing connection between STDs and preventive medical care in this priority through the SPM provides alignment and reinforcement with cross-cutting strategies to improve health insurance coverage and address structural determinants of health and equity, leading to improvements in access to health care not only in screening, referral, and treatment for STDs but in other areas as well, such as prenatal care and mental health care.  

 

Obesity/Overweight among youth including food insecurity and physical inactivity.

New - SPM: Percent of adolescents, age 12 to 17 years who are physically active at least 60 minutes per day.

 

In 2018-2019, Nebraska switched from an NPM (Percent of adolescents who are physically activity at least 60 minutes per day) and ESM (Five or more communities are identified by a state-level assessment as potential sites to implement the safe play environment community toolkit) to an SPM for this priority area, and removed the ESM.  As noted, work in the priority area of obesity spanning three Title V populations has been an iterative and evolving process.  In the adolescent domain, the previous focus on a community toolkit for place-based public health, originally designed with obesity prevention in mind, shifted to a focus on lead exposure in the hands of a pilot community group.  Title V had no wish to circumvent the expressed will of community stakeholders and as a result has disconnected the toolkit named in the ESM in the previous year from this priority.

 

The SPM continues to align with the interest and engagement of the school health program in several important collaborative and cross-sector activities relevant to improving physical activity and healthy nutrition for youth:

• The Nebraska Whole School, Whole Child, Whole Community effort to improve implementation of School Wellness Policies in Nebraska Schools;
• The Nebraska Department of Education curriculum review process for health and physical education curriculum standards; and
• The Nebraska Department of Education’s CDC 1801 grant, a multi-year public and private effort to improve healthy nutrition, physical activity, and chronic health condition management at school.

 

4. Progress in achieving established performance measure targets along with other programmatic impact 

 

Results-based Accountability (RBA) Measures

In 2018-2019, the decision was made not to include RBA measures in the Title V application, but to keep them as internal team measures. An important lesson about RBAs carried into 2018-2019 was to reduce the total number of RBA measures assigned to staff, and to increase focus and specificity of the measures. 

 

Unintentional injury among youth, including Motor Vehicle Crashes.

 

2018-2019 Results Based Accountability (RBA) measures Unintentional injury among Youth, including Motor Vehicle Crashes
	Planned for 2018-2019 (not included in application)	Achieved 2018-2019
How much did we do?	How many messages were sent to schools by the school health program manager regarding teen driver safety?   How many new schools participated in the Teens in the Driver Seat program?	6     35, increased from 31
How well did we do it?	Number and percent of school partners providing positive feedback about the activity.   Number and percent of materials produced for teen driver safety meeting CLAS and literacy standards.	Data not solicited       2 – GDL and Driving the Message.  Spanish.  6th grade reading level.
Is anyone better off?	Is there measured improvement in seat belt use or distracted driving in Teens in the Driver Seat surveys?	TDS five year report 2014-2019 numerous indicators show statistically significant improvement, such as driving without a seat belt (35.4% in 2014 and 33.2% in 2017-2018). Other indicators do not meet the test of significance, such as texting or talking on a cell phone while driving (67.9% texting and 77.4% talking in 2014, with 65.6% and 71.7% respectively in 2017-2018).

 

Sexually Transmitted Diseases Among Youth

 

2018-2019 Results Based Accountability (RBA) measures Sexually Transmitted Diseases among Youth
	Planned for 2018-2019 (not included in application)	Achieved 2018-2019
How much did we do?	How many activities of the NAHAC occurred?   The implementation plan for the NAHAC strategic plan is completed.   How many school nurses participated in the 2019 survey?	0     Yes.  Implementation Matrix delivered 3/25/2019     77
How well did we do it?	% of participants in NAHAC strategic plan representing minority groups, families and/or consumers.         Number and % of materials related to STD reduction meeting CLAS and literacy standards	We had an adult member from the Indian Center Youth Suicide Prevention Program; 5 youth/youth adults.  Groups involved included Planned Parenthood, OneWorld FQHC, DCHD, Women’s Fund of Omaha, Dept. of Ed. Cedars, NCHS, UNMC, Dept. of Ed.   No materials were developed during this period.
Is anyone better off?	How many evaluations were received from school nurses in 2018?	70.  82% rated as 8 or higher (on a scale of 1-10) the importance of school nurses being prepared to address sexual health issues with youth.

 

Obesity/Overweight Among Youth including food insecurity and physical inactivity.

 

2018-2019 Results Based Accountability (RBA) measures Obesity and Overweight among Youth
	Planned for 2018-2019 (not included in application)	Achieved 2018-2019
How much did we do?	Number of meetings of the Children’s Healthy Weight CoIIN.	4
How well did we do it?	How many PDSA cycles were used to invite input on the Children’s Healthy Weight CoIIN project?	1 – at which time the activity was identified as highly aligned with a curriculum guidelines re-write project at the NE Department of Education, and the efforts were merged (CHW CoIIN ended).
Is anyone better off?	Number and % of partners, participants, and audience members providing positive impact about the quality and impact of the activity.	8; 100%

 

5. Challenges and Emerging Issues

The emergence of health issues related to vaping, accompanied by the startlingly fast uptake of vaping by adolescent populations has been a vivid reminder of the importance of remaining agile when working to improve outcomes with this population.  While program staff are occupied with implementation plans of an established order, the needs of the population may shift dramatically and rapidly.  For the adolescent health program, this has served as useful reminder of the important of observing trends and emerging issues, and working with stakeholders and partners to consider how to keep the program relevant and on-point with the lives of teens and young adults.

 

6. Overall Effectiveness of Strategies and Approaches: Addressing Needs and Promoting CQI.

 

Unintentional Injury Among Youth

 

The overall effectiveness of using the school nurse list serve to disseminate communications about motor vehicle safety to reach parents, was unmeasured in 2018-2019.  While the communication channel is reliable and effective, the actions school nurses take with the information is less reliably known.  In 2019-2020, Nebraska’s action plan in the adolescent domain includes provision to test the hypothesis that using the school nurse list serve to disseminate prevention messaging to school nurses is actually a vehicle for putting the information to use with parents and others in the school community.

 

The Teens in the Driver Seat Five-year Trend Report (2014-2019) provides data and analysis by year of trends in seven school districts participating in TDS each year for five years. Numerous indicators show statistically significant improvement, such as driving without a seat belt (35.4% in 2014 and 33.2% in 2017-2018) and driving after midnight without anyone over 21 in the vehicle (2014-2015 63.5%, 2017-2018 48.6%).  Other indicators do not meet the test of significance, such as texting or talking on a cell phone while driving (67.9% texting and 77.4% talking in 2014, with 65.6% and 71.7% respectively in 2017-2018).  See the report: http://www.t-driver.com/wp-content/uploads/2018/04/TDS-Survey-Four-Year-Report-2014-2015-to-2017-2018.pdf

 

Sexually Transmitted Diseases among Youth

 

Improvements in this area are occurring through the greater engagement of the Adolescent Health Program staff, and increasing opportunities to work directly with clinical partners through established relationships between NE Reproductive Health Program and reproductive health clinics statewide.  As a result the focus is shifting away from school-based sexual health referral systems and the role of school nurses, to reproductive health clinics as a venue for engaging youth not only in sexual health but more broadly preventive health care practices.

 

Obesity/Overweight among Youth including food insecurity and physical inactivity

As noted, this has been a difficult priority area for Nebraska Title V to establish an effective foothold.  At the close of the 2018-2019 year, it is clear that Title V’s best efforts may lie in aligning the assets of Title V with evidence-based nutrition and physical education curriculum standards, and the efforts of many community stakeholders to promote the role of schools in implementing effective School Wellness Policies.