Annual Report Fiscal Year 2019:  This section provides a summary of Federal Fiscal Year 2019 (FFY19) activities, accomplishments, and challenges related to National Performance Measures (NPMs) and State Performance Measures (SPMs) (2016-2020) for the Adolescent Health Domain.

 

Priority	Performance Measure	ESM (if applicable)
Promote Preventive and Quality Care for Children and Adolescents	NPM 10: Percent of adolescents with a preventive services visit in the last year (National Survey of Children’s Health (NSCH))	ESM 10.2:  # QI cycles completed by participating practices

 

Adolescence is the period following the onset of puberty during which a young person develops from a child into an adult. A number of events take place during this time, such as assuming responsibility for health habits, initiating risky behaviors, and a series of psychological, social, emotional, and physical changes. Bright Futures guidelines recommend that adolescents have an annual checkup from ages 11-21, as this may help adolescents adopt or maintain healthy habits and behaviors. The visit should cover a comprehensive set of preventive services, such as a physical examination, immunizations, and discussion of health‐related behaviors.

 

Strategy 1:  Implement adolescent-centered environment assessment process in Wyoming clinics to improve adolescent-friendly environment

 

To improve the quality of the adolescent clinical environment with a long-term goal of increasing the number of well visits among youth and young adults, the Youth and Young Adult Health Program (YAYAHP) continued its partnership with the University of Michigan to implement the 18-month Adolescent Centered Environment Assessment Process (ACE-AP) within four pilot clinics between 2017 and 2019. The ACE-AP is a facilitated, comprehensive self-assessment and guided improvement process that includes customized resources, recommendations, technical assistance, and implementation plans using Plan, Do, Study, Act improvement cycles. The ACE-AP addresses 12 key areas of adolescent-centered care, listed below along with the number of clinics that chose to work in each key area:

 

• Access to Care (3 of 4 clinics)
• Adolescent Appropriate Environment (4 of 4 clinics)
• Confidentiality (4 of 4 clinics)
• Best Practices and Standards of Care (4 of 4 clinics)

• Reproductive and Sexual Health (4 of 4 clinics)
• Behavioral Health (4 of 4 clinics)
• Nutritional Health (3 of 4 clinics)
• Cultural Responsiveness (3 of 4 clinics)

• Staff Attitudes and Respectful Treatment (3 of 4 clinics)
• Adolescent Engagement and Empowerment (2 of 4 clinics)
• Parent Engagement (2 of 4 clinics)
• Outreach and Marketing (0 of 4 clinics)

 

The first cohort of clinics completed a baseline self-assessment of their organizations’ environment, policies, and practices related to youth-friendly services to identify opportunities for improvement. Then, they met with the University of Michigan to identify and implement quality improvement initiatives and incorporate Bright Futures into practice in selected clinics. Clinics received up to $2,000 to implement a change within their clinic to become more adolescent-friendly (e.g. tablets 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 visiting their clinic.

 

One common need identified across all four ACE-AP pilot clinics was information and guidance related to adolescent consent and confidentiality. In addition to the consent and confidentiality guides developed by the Center for Adolescent Health and the Law, the University of Michigan summarized Wyoming consent and confidentiality laws to create a handout for participating clinics.  

 

In addition to four clinics completing the ACE-AP, six clinic providers among three of the four participating clinics completed the Maintenance of Certification Part IV, which was established in 2000 by the American Board of Medical Specialties on Adolescent Confidentiality to improve the delivery of confidential care to adolescent patients. Clinics used grant funds to purchase items improving the youth friendliness of the environment, such as tablets and accessories, computer hardware, educational brochures, pamphlets, posters, and charging stations. Through the provided training and technical assistance, three of the four participating clinics saw improvement in ten of the 12 key areas. Some areas experienced as much as a 50% increase. 

 

In summer 2019, YAYAHP released a mini-grant Request for Application (RFA) to recruit the second cohort of clinics to implement the ACE-AP model. Two clinics applied and a review committee selected both to participate. The two participating clinics are the Cheyenne Children’s Clinic-Laramie Street and the University of Wyoming Family Medicine Residency Program at Casper/Educational Health Center of Wyoming-Casper.

 

One of the key challenges of this project for both cohorts has been maintaining engagement of a large and diverse team of stakeholders. The Youth and Young Adult Health Program Manager (YAYAHPM) keeps team members engaged through email communication and in-person meetings as appropriate.  

 

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

 

CSH staff continue to send enrolled clients and their families reminders about the importance of attending annual well visits. CSH encourages all clients to have a primary care provider (PCP) but recognizes that Wyoming continues to experience a critical shortage of PCPs. Due to this shortage, CSH does not deny eligibility to any applicant based on the lack of a designated PCP. However, the encouragement of a PCP aligns with patient- and family-centered medical home recommendations and the Maternal and Child Health Unit (WY MCH) goal of expanding the spread of patient and family-centered medical homes across Wyoming. In addition, state and local staff provide ongoing care coordination for enrolled clients and their families and work to create linkages to local providers and services.

 

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

 

YAYAHP seeks to promote youth voice in the development of strategies, materials, and activities. The development of a statewide youth council brings youth voices and experience together with health programs, promoting success, increased youth engagement, and quality improvement. The YAYAHPM developed a framework for the youth council and released an RFA for the Youth Council Coordinator in May 2019. The key deliverables included:

 

• Establish, coordinate, and facilitate a statewide youth council
• Recruit members across the state
• Create supportive guidelines and documents for the council (i.e. 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, health equity, and the social ecological model
• Promote youth involvement in relevant topics (e.g. youth suicide, bullying, eating disorders, vaping)
• 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, including drafting emails to be distributed to council members on updates, clarifications, upcoming meetings and events, and data reminders (may be completed in collaboration 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 assure ongoing collaboration and information sharing on best practices and emerging issues related to youth and young adults ages 12-24 in Wyoming and other states
• Provide leadership, professional development, and social opportunities for youth
• Coordinate ongoing recruitment to promote sustainability
• Manage member leadership roles/responsibilities (e.g. social media, secretary, chair)
• Share volunteer opportunities
• Coordinate reimbursements for youth council members

 

A contract with the selected applicant was executed in January 2020, after which membership recruitment activities took place. The Youth Council had its first meeting in July 2020.

 

July 2020 public input survey respondents commented that they saw an impact on their communities through the Youth Council “physically including youth and young adults] in the decision-making process” and “increasing the equity [by] letting them have a voice [in] their goals and their goals for future teenagers, as well.”

 

Priority	Performance Measure	ESM (if applicable)
Promote Preventive and Quality Care for Children and Adolescents	NPM 12: % of adolescents with special health care needs who received services necessary to make transitions to adult health care (NSCH)	ESM 12.4: # of parent- or youth-completed transition readiness assessments completed by PHN in CSH program

 

YAYAHP partnered closely with CSH to promote evidence-based transition assessments and education among CSH clients. 

 

Priority	Performance Measure	ESM (if applicable)
Promote Healthy and Safe Relationships for Adolescents	SPM: % of high schoolers reporting zero occasions of alcohol use in past 30 days (Prevention Needs Assessment (PNA))	N/A

 

WY MCH selected the Promote Healthy and Safe Relationships priority 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 previously measured on the Youth Risk Behavior Surveillance System (YRBSS), but the Wyoming State Legislature eliminated the YRBSS in Wyoming in 2016. There is no longer an effective, statewide measure of youth sexual behavior. However, Wyoming does have a statewide survey called the Prevention Needs Assessment that includes questions about alcohol and drug use. 

 

Prior to fall 2018, Communities that Care was explored as an option to address this priority, but WY MCH ultimately decided to utilize the Collective Impact Model instead. 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 YAYAHPM attended trainings and conferences on Collective Impact, protective factors, and adverse childhood experiences 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 Block Grant, Rape Prevention and Education (RPE) Program grant, and Preventive Health and Health Services (PHHS) grant.  

 

Strategy 1:  Complete Request for Proposal process and community selection for Rape Prevention and Education (RPE) Program pilot communities to implement strategies using a Collective Impact Model

 

The YAYAHPM serves as the RPE Project Director and the MCH Epidemiology Program provides evaluation and data support for the RPE program. WY 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, YAYAHP decided to continue funding two of the pilot communities, as the third community successfully completed a community-level strategy, partnering with the local chamber of commerce and 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. 

 

In April 2019, the YAYAHPM convened stakeholders to develop the Rape Prevention and Education State Action Plan. This State Action Plan:

 

• Provides a strategic plan to implement sexual violence strategies that:
  • Use the public health approach
  • Are based on the best available evidence and data
  • Focus implementation on community/societal level strategies and prioritize increasing implementation of community/societal-level strategies to at least 50%
• Provides a strategy for identifying state and local-level data sources, including identifying and tracking sexual violence indicators
• Provides a plan for analyzing data on health disparities to identify populations of interest and address health disparities
• Develops a plan for identifying, establishing, and leveraging partnerships and resources
• Provides plans for sustaining the work of the RPE Program at the end of the five-year cooperative agreement

 

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, which was developed to increase the effectiveness of violence prevention efforts statewide. In addition to the Steering Committee, the WSVPC has three workgroups: the Policy and Legislation workgroup; the Education, Training and Outreach workgroup; and the College Sexual Violence Prevention workgroup. These workgroups continue to develop strategic goals and work towards statewide shared Collective Impact efforts for sexual violence prevention. In March 2019, WY RPE and WSVPC collaborated with a contractor to create the Wyoming Rape Prevention and Education (RPE) Indicator Dashboard; its purpose is to visualize indicators and data sources that measure overarching risk (e.g. lack of employment opportunities, poverty, weak policies, poor parent-child relationships) and protective factors (e.g. access to mental health and substance abuse services, community support, empathy and concern for how one’s actions affect others, connectedness) that impact sexual violence in Wyoming. The RPE Dashboard serves as a place to store data, a method to communicate data in a meaningful way to stakeholders, and a tool used to inform future programmatic and policy decision making. In March 2019, the RPE Indicator Dashboard was made available to the public on the YAYAHP webpage. The RPE Indicator Dashboard also includes county-level data from the Prevention Needs Assessment on 30-day alcohol use among Wyoming students. In August 2019, an in-person meeting brought together council members, key stakeholders, pilot community members, and members of the Campus Consortium (comprised of the University of Wyoming and Wyoming’s eight community colleges) to receive training on Collective Impact and identify strategies to promote collaboration on the implementation of statewide primary sexual violence prevention strategies.

 

Strategy 3:  Implement comprehensive sexual education curriculum that includes content on reducing risky behaviors

The YAYAHPM serves as the Wyoming Personal Responsibility Education Program (WyPREP) Project Director and partners with the WDH Communicable Disease Unit to manage and implement WyPREP. WyPREP provides training, curricula, and support for implementation of evidence-based, medically accurate curricula in school and community-based settings. Contracts with ten organizations were active in both FFY19 and FFY20: seven school districts, two community-based, youth-serving organizations, and the 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 (2017/2018, 2018/2019, and fall semester 2019), WyPREP reached over 2,000 Wyoming youth. YAYAHP partners with the MCH Epidemiology Program for WyPREP evaluation. Each location is provided with a report card detailing the entry, exit, and knowledge survey data from its students each school year. Knowledge survey data from the 2017-2018 school year to present indicate 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. A statewide report card is produced for publication and shared with the public and policymakers. See below for an excerpt from the statewide WyPREP Report Card representing data from 473 respondents for 2016/2017 school year.

 

 

To improve program gaps identified in an evaluation conducted during the Centers for Disease Control and Prevention and Harvard School of Public Health Maternal and Child Health Program Evaluation Practicum, the YAYAHPM continues to train new facilitators and offer an annual refresher training for all current facilitators to troubleshoot issues and provide reporting information/updates. WyPREP staff are also available to provide technical assistance throughout the year.

 

One public input survey respondent said of YAYAHP’s work around healthy and safe relationships, “That is amazing! This would be very beneficial to the community and I would love to see this as a parent. I don't think schools really talk much about healthy relationships and red flags. This should definitely be taught as well as safe sex and negotiation-refusal skills.”

 

Strategy 4:  Develop or maintain statewide youth council to assure youth voices are included in program development, implementation, and evaluation

 

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

 

Other YAYAHP Activities:

 

YAYAHP Partnership Development

The YAYAHPM continued to develop and build partnerships with many youth-serving organizations, other WDH programs, and other agencies to increase the effectiveness of YAYAHP 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 of WDH
• Wyoming Highway Patrol
• Wyoming Department of Transportation
• Wyoming Medicaid
• UPLIFT
• Wyoming County Prevention Specialists
• Office of Health Equity of WDH
• Injury and Violence Prevention Program of WDH
• Communicable Disease Unit of WDH
• Immunization Unit of WDH

 

Campus Consortium

The Campus Consortium (comprised of the University of Wyoming and Wyoming’s eight community colleges), YAYAHP, WSVPC, and the Wyoming Coalition against Domestic Violence and Sexual Assault have worked to assure primary sexual violence prevention information is shared and technical assistance is provided. Preventive Health and Health Services Block Grant funds were used to support the “Be the Solution” statewide media campaign and dissemination of campaign materials to all institutions of higher learning in Wyoming. The campaign encourages change in community norms.  

 

Child Safety Learning Collaborative

YAYAHP, the Child Health Program, and the WDH Injury and Violence Prevention Program joined the Child Safety Learning Collaborative (CSLC) through the Child Safety Network to focus efforts on reducing fatal and serious injuries among infants, children, and adolescents by building and improving partnerships and implementing and spreading best practice and evidence-based approaches, especially among the most vulnerable populations. Upon review of available data and capacity, the team selected Suicide & Self-Harm Prevention and Motor Vehicle Traffic Safety (Child Passenger and Teen Driver/Passenger) as CSLC topic areas of focus for Wyoming due to alarming Wyoming rates compared to nationally. In spring 2020, the Wyoming team decided to participate in the second cohort of the CSLC. Through research and information gathered during the 2021-2025 Title V needs assessment, WY MCH decided to dedicate one priority to this topic, which directly aligns with the CSLC, and participation in the cohort will greatly enhance and inform youth suicide prevention work across the state.

 

MCH Community Mini-Grant Program

In collaboration with the Child Health Program, YAYAHP released community mini-grants with a focus on childhood injury prevention in summer 2019. The mini-grant projects address a wide variety of injury topics including safe sleep, prescription drug monitoring, adolescent motor vehicle safety, and adolescent suicide prevention. Two of the nine organizations awarded selected strategies that targeted the adolescent population. 

 

Youth Emergency Services, Inc. (Y.E.S. House) is a regional hub for youth-based preventive, intervention, and treatment services in northeast Wyoming. Y.E.S. House utilizes a comprehensive strategy to address youth suicide and has implemented an organization-wide trauma-informed care training and philosophy. Y.E.S. House also has staff trained in adverse childhood experiences (ACEs) to conduct training for other staff and volunteers. With mini-grant funds in the amount of $7,000, Y.E.S. House was able to expand ACEs training, conducting thirteen training sessions for 491 participants across the county. Sessions were provided to over ten agencies/organizations, including local schools and prevention councils. 

 

Campbell County School District (CCSD) implemented school HOPE Squads. HOPE Squads work to change school culture around suicide by reducing stigmas and aim to identify, protect, and help suicidal students. With mini-grant funds in the amount of $4,615, CCSD established a new HOPE Squad at a local middle school and two new squads at three elementary schools. Eight new school advisors and one master advisor were also trained. HOPE Squad members worked through ten evidence-based modules of training. CCSD conducted branding, marketing, and other events/activities in the community and within schools to build positive relationships among peers, HOPE Squad members, and school faculty to facilitate acceptance of students seeking help and create a safe and non-threatening environment for all students. Funds to support sustainability have been identified through the County Suicide Coalition and approved by the school district.

 

WYOMING CAN Mini-Grant

With funding from the CDC to help advance the RPE goal of preventing sexual violence perpetration and victimization, YAYAHP developed and released a Request for Applications for Wyoming organizations to support implementation of community/societal-level primary sexual violence prevention strategies. In April 2020, two applicants were selected to receive funding; they will use a public health approach to implement and evaluate identified sexual violence primary prevention strategies based on the best available evidence at all levels of the Social Ecological Model. Activities align with the RPE Program’s State Action Plan and each address at least one of the following focus areas:

 

• Provide opportunities to empower and support girls and women
• Create protective environments
• Promote social norms that protect against violence
• Teach skills to prevent sexual violence

 

Mini-grant recipients were strongly encouraged to consider shared risk and protective factors that impact youth and young adults ages 12-24 and can be addressed at the community/societal level. Recipients were also required to use the Sexual Assault and Domestic Violence Prevention Assessment Tool. The tool, which was developed because Wyoming no longer has the Youth Risk Behavior Surveillance System (YRBSS), is informed by the CDC’s “Connecting the Dots” to include shared risk and protective factors consistently associated with both sexual assault and domestic violence. When selecting measures/items to assess established risk/protective factors, validity and brevity were guiding considerations. It contains modular content that can be tailored, and can anonymously link respondents’ surveys over time. The tool has eight domains: 

 

1. Hypermasculinity in relationships - Adolescent Masculinity in Relationships Scale
2. Delinquency - alcohol consumption content from YRBSS
3. Perceived Peer Support for Sexual Aggression - Family Life and Sexual Health Sexual Attitudes survey
4. Rape myth acceptance
5. Intimate partner violence/relationship control myths - dating and social norms items validated
6. Connectedness - school/teacher/families connectedness scales
7. Sexual assault and intimate partner violence perpetration - YRBSS victimization and perpetration items
8. Bystander intent and behavior - Coaching Boys Into Men items

 

YAYAHPM Memberships

The YAYAHPM has remained an active member of the Association of Maternal and Child Health Programs (AMCHP). Some of the components of active membership include serving as a session facilitator and moderator at the 2019 annual Federal/State Partners Meeting. In addition, the YAYAHPM serves on AMCHP’s Global Evidence-Based Practice Workgroup and the Adolescent Pregnancy Prevention annual grantee conference planning committee. As a member of the Public Health Division’s Health Equity Workgroup (HEW), the YAYAHPM participates in HEW activities and meetings, identifies inclusive strategies for capturing data and gaps in service due to disparities, and participates in WY MCH discussions related to the 6th domain priority.