Injuries among youth and teens, specifically teen suicide.

Regional Adolescent Health Coordinators will utilize Search Institute’s 40 Developmental Assets framework to increase protective factors and encourage adult youth connections in schools and communities to build and maintain positive relationships between young people and caring adults, including school personnel and caregivers.

The COVID19 pandemic had immediate and enduring effects on everyone; including schools, students, parents and communities. During a pandemic, youth ecological systems are in turmoil, with disruptions in daily routines, interruptions in information and communication across settings and drastic and abrupt changes in rules and processes. Research has shown the protective effect of positive youth development (PYD) can reduce the negative influence of traumatic situations such as COVID-19 on adolescent mental health.[1] While challenging to implement with COVID19 restrictions, the need for PYD programming and activities is more prevalent than ever.

In early 2020, the AHI partnered with West Virginia University-Parkersburg to conduct surveys in schools throughout Region 5 to assess the impact of the AHI’s PYD programming. Results show that youth attending AHI’s programming are more likely to feel their parents give them support when they need it (61% vs 43% strongly agree), more likely to get along with their parents (49% vs. 36% strongly agree), more likely to feel they get a lot of encouragement at school (31% vs. 11% strongly agree) and feel their teachers push them to be the best they can be (44% vs. 15% strongly agree).

While COVID19 restrictions and closures presented many implementation challenges, the AHI provided 71 trainings focused on positive youth development to encourage this youth-adult connectedness. This number is about half what the AHI usually conducts, however attendance for these trainings nearly tripled previous years. Over 18,000 youth, parents, professionals, and community members attended the trainings, 7,359 of which were youth. Trainings included the multi-week COVID19 focused virtual events titled Connections Matter, Finding Your Spark!, Everyone’s an Asset Builder and other asset-based programs. The AHI also provided presentations on healthy family relationships, positive stress management, school re-entry and other topics.  The AHI also helped facilitate several PYD focused events and activities for youth across the state.

Highlights include (but aren’t limited to):

·       Consequences of Choices

·       The Effects of COVID 19 on our Youth

·       Having Mindful Conversations About Difficult Topics

·       Stress Management and Positive Coping Skills

·       A Guide to Welcoming Students Back to School

·       West Virginia's Mountain State Promise, Changing the Course

·       Positive Behavior Supports at Home: A Practical Approach

·       Who will we meet in the COVID reentry?

·       I CAN OVERCOME by supporting each other

·       Positive Coping Skills and Stress Management

·       Everyday Gratitude

·      So, What's Wrong with Kids These Days? What We Can Do to Support Youth in a    Complicated World

·       In the Line of Fire: Children and Domestic Violence

·       Regulate, Relate and Create: Balancing in a World that is Off-Balance

·       Teen Boot Camp Cooking Class (5 weeks)

·       Developing Star Leaders - The Power of 1 Multiplied

·       Young Life Youth Group

·       Healthy Grand Family Training: Navigating the School System

·       Fayette 4H Adventure Club

·       I CAN BE HAPPY by facing negativity

·      Sherrard Middle School Youth Service Project: Making blankets for local foster care agencies

·       Totika (self-esteem) Game Days

 

[1] https://www.sciencedirect.com/science/article/pii/S1054139X21000227 The Impact of Positive Youth Development Attributes on Posttraumatic Stress Disorder Symptoms Among Chinese Adolescents Under COVID-19

Adolescent Health Initiative and the WV VIPP will utilize the WV YRBS and the Child Fatality Review to monitor progress on bullying and suicide measures.

The West Virginia Department of Education (WVDE) began utilizing the YRBS to collect data in 1993 and has been conducted every two years since. In 2019, the WVDE provided funding to the AHI to conduct YRBS Surveys in 116 schools across the state. The results were released in early 2020. The 2017 high school risk behavior shows a decrease in most adolescent risk behaviors including the percentage of students who have seriously considered suicide since (27% down to 19%); however this data point showed a small increase to 21% in 2019. Students who made a plan in the past year to attempt suicide continued to decline in 2019 from 1993 (20% down to 14%). However, the high school risk behavior trend summary report shows that other measures remained basically the same or increased from 1993 (unless otherwise indicated) to 2019:

·       Did not go to school because they felt unsafe (4% vs 10.5%)

·       Being threatened or injured with a weapon on school property (8% vs. 7.5%)

·       Feeling sad or hopeless every day for 2 weeks or more (30% in 1999 vs. 36.4%)

 

The middle school risk behavior trend summary report shows that several related measures remain the same or slightly increased:

·       Ever carried a weapon (41% in 2001 vs. 40.4% in 2019)

·       Were ever bullied on school property (47% in 2009 vs. 45.7% in 2019)

·       Were ever electronically bullied on school property (25% in 2011 vs. 27.8% in 2019)

·       Ever seriously thought about killing themselves (21% in 2001 vs. 24.7% in 2017)

The WVDE’s YRBS surveys and trend summary reports and other publications can be found at https://wvde.us/reclaimwv/resources/.

For the 2019 YRBS data, two analyses occurred: a trend report for middle and high school students and risk behaviors and sexual identity for high school students only. Students that identified as gay, lesbian, or bisexual are at greater risk for bullying and consequences associated with it. Some of the questions where gay, lesbian, or bisexual students reported greater risk are listed in the table below. The following results compare 2017 and 2019 data. While they show some progress, they are still alarming and illustrate that youth who identify as gay, lesbian, bisexual are at greater risk for bullying and the consequences associated with bullying:

Community based Adolescent Health Coordinators will identify and coordinate the implementation of research-based models for prevention of bullying and forms of violence in schools and other youth serving organizations.

Bullying is unwanted aggressive behavior, either physical or verbal, among children where there is an actual or perceived imbalance of power. True bullying involves aggression that is repeated or has the potential to be repeated. Bullying has been linked to many negative outcomes including criminal violence, mental health impacts, substance abuse, and suicide. Victims often suffer from anxiety and depression (including suicide ideation), physical ailments, and decreased academic achievement. Perpetrators often engage in violent and abusive behavior as adults, abuse drugs or alcohol, and engage in other risky behaviors. Bystanders, or those who witness acts of bullying, are also more likely to have mental health problems, suffer from depression and anxiety, and engage in substance abuse. There are three types of bullying:

Verbal bullying is saying or writing mean things. Verbal bullying includes:

·         Teasing

·         Name-calling

·         Inappropriate sexual comments

·         Taunting

·         Threatening to cause harm

Social bullying, sometimes referred to as relational bullying, involves hurting someone’s reputation or relationships. Social bullying includes:

·         Leaving someone out on purpose

·         Telling other children not to be friends with someone

·         Spreading rumors about someone

·         Embarrassing someone in public

Physical bullying involves hurting a person’s body or possessions. Physical bullying includes:

·         Hitting/kicking/pinching

·         Spitting

·         Tripping/pushing

·         Taking or breaking someone’s things

·         Making mean or rude hand gestures

In FY 2017, the AHI’s regional AHCs began meeting with school personnel and administrators to introduce the idea of a bystander intervention and discuss evidence-based program implementation, as this approach requires commitment by school personnel and the community. Program implementation of the Green Dot program began with 6 schools in FY2018 and has expanded to 30 schools utilizing Green Dot and other comprehensive bully prevention curriculum programs in FY2021.

In 2016, the AHI’s surveyed over 6,000 adolescents and their parents on the topic of bullying.  The survey data indicated adolescents felt “social” was the most prevalent type of bullying, versus physical or verbal bullying. In response to this data, the AHI and the VIPP partnered to provide Media Literacy and Digital Footprint trainings across the state. Additionally, the AHCs began promoting the three-year, online module program Cyber Civics Curriculum for Middle School Students.

Also in 2017, the AHI partnered with the DHHR’s Bureau for Behavioral Health and Health Facilities to certify all of the regional AHCs as Youth Mental Health First Aid trainers. Youth Mental Health First Aid (YMHFA) is an 8-hour course that teaches you how to identify, understand, and respond to signs of mental illnesses and substance use disorders. Since that time, the AHCs have also become certified trainers in ACEs (Adverse Childhood Experiences), Trauma Informed Schools and Handle with Care (HWC). Research shows that trauma can undermine children’s ability to learn, form relationships, and function appropriately in the classroom. HWC programs support children exposed to trauma and violence through improved communication and collaboration between law enforcement, school agencies and community agencies, and connects families, schools and communities to community services. The AHI conducted 36 YMHFA and HWC trainings in FY2021 with a total 2,948 participants.

To assist with compliance of WV House Bill 2535, commonly referred to as “Jamie’s Law” requiring public middle and high school administrators to disseminate and provide opportunities for all middle and high schools to discuss suicide prevention awareness information, the AHI provided two Darkness to Light: Stewards of Children trainings. This evidence-based training utilizes bystander intervention sexual abuse prevention strategies.

In addition to the above, the AHCs provided training, technical assistance and helped facilitate implementation for the following programs:

·           Too Good For Drugs and Violence

·           Second Step

·           Botvin Life Skills

·           Signs of Suicide

·           SafeTalk Suicide Prevention

In total, 6,712 youth, parents, school staff and community members attended the AHI’s 59 trainings and workshops. The AHI also posted 111 messages, links and resources on social media; and disseminated 10,115 brochures, life-line cards, fact sheets and other literature on bullying prevention, suicide prevention, depression and mental health, violence prevention, cyber safety and ACEs.

 

The VIPP will disseminate relevant data on the topic of non-fatal suicide trends for 12-17 year olds in the state.

Due to the global pandemic within the last reporting year, data related to non-fatal suicide has been affected as populations did not seek health care services at usual points-of-care, specifically emergency departments, in early to mid-2020.  As such, data products on trends were not developed, but will be as data becomes more consistent.  Epidemiology staff integral in development of such relevant data for dissemination have also been heavily involved in supporting data around the pandemic and its response.

 

Transition

Provide academic detailing to pediatric primary care physicians on the importance of adopting a transition policy including Got Transition’s resources: Six Core Elements of Health Care Transition sample tools and measurements.

The COVID-19 pandemic and consequent PHE created or exacerbated health inequalities among WV CSHCN and required the WV CSHCN Program to analyze current service delivery approaches and review current policies and procedures to determine new ways of organizing services.  This past year, the CSHCN Program reprioritized objectives and dedicated time and effort to identifying and addressing gaps in service delivery and as a result the health care transition action plan for the current grant year was delayed due to the PHE urgent priorities.

One of the urgent priorities identified by the WV CSHCN Program was to implement technologies to connect with WV CSHCN and to begin a review of all program procedures and associated documents, giving special attention to the need of accurate and reliable information about accessing needed services and protected health information during a PHE.  The WV CSHCN Program and contracted partners reviewed and revised the WV CSHCN Health Care Transition Services tools and procedures based on changes to the CMS Interoperability and Patient Access final rule and the HHS Office for Civil Rights (OCR) guidance on the HIPAA, Health Information Exchanges and disclosures of protected health information for public health purposes.

Complete transitions readiness assessment for all enrolled CSHCN starting at age 14.

The CSHCN Program’s health care transition efforts support the Healthy People 2030 objective AH-R01 to increase the proportion of adolescents who get support for their transition to adult health care. AH-R01 is a Healthy People 2030 research objective which represents a public health issue with a high health or economic burden or significant disparity between population groups but is not yet associated with evidence-based interventions. The WV CSHCN Program new pediatric-to-adult health care transition process using the evidence-driven strategies Got Transition© Six Core Elements of Health Care Transition. As stated previously, this past year, the WV CSHCN Program and contracted partners reviewed and revised all program procedures and associated documents due to the PHE.  As a result, the WV CSHCN care coordination teams completed a Transition Screening Tool beginning at age 14 to identify areas of need.  In calendar year 2020, 572 enrolled CSHCN were fourteen (14) years of age or older, and 122 (21%) children of those received a Transition Screening Tool.  This percentage will increase in the coming months as WV CSHCN care coordinators shift their focus from supporting families navigate the interruptions in services within the health care and community service systems and the challenges those systems presented during the PHE. 

As noted in the Family Partnership section, the WVUCED Parent Network Specialists (PNS) provide parent peer supports to families of CSHCN. The PNS provide opportunities for families to attend family/peer support meetings or receive training across the State, related to navigating systems of care.  These opportunities are conducted face-to-face, remotely using video conference or blogs.  This past grant year, there were ninety-three (93) opportunities for families to receive education or resources that included the transition from pediatric to adult health care.    

Substance use in youth/teens.

Partner with medical providers to align with best practices in prescribing controlled substances to ensure optimum outcomes.

The OMCFH has identified substance use in children (ages 12-17) as a priority, specifically related to the prescription of and use of stimulants to address behavioral health issues in West Virginia.  Modeled after the OMCFH's successful initiative with the WVU School of Pharmacy and its Safe and Effective Management of Pain Program (SEMPP) as funded by the Centers for Disease Control and Prevention since 2016, the Office has collaborated to begin to develop a similar education and training initiative addressing stimulant use and prescribing recommendations for children and youth.  Currently, WV Medicaid does not require a prior authorization or a corresponding diagnosis for prescription of stimulants to its eligible members ages 0-20.

 

Provide educational information and resources to youth, parents, schools and the community about the harmful effects of drug abuse and misuse, safe storage and disposal of prescription medications and prescription monitoring in the home.

In 2017, West Virginia began collecting data on adolescent prescription misuse on the Youth Risk Behavior Surveillance (YRBS) survey. When compared to the 2017 YRBS, the survey in 2019 shows a very small and statistically insignificant decrease in prescription misuse among high school students (12.5% down to 11.7%). However, the data shows prescription misuse nearly doubled for middle school students from 2017 to 2019 (3.6% to 6.7%).  While this is not enough data to be considered a trend, it is concerning.

Educating adolescents and their parents about the risks of drug misuse and abuse is a major component to combating the problem. Research shows 1 in 4 teenagers believe that prescription drugs can be used as a study aid and nearly one-third of parents believe that attention-deficit/hyperactivity disorder (ADHD) medication can improve a child’s academic or testing performance, even if that child does not have ADHD.

Prescription monitoring is also an important factor in preventing abuse. There has been increased legislation and public pressure requiring doctors and pharmacies to better monitor how (and how often) they prescribe drugs. While provider education is key to preventing over prescribing, prescription drugs must also be monitored in homes and the community.

To address these concerns and misconceptions, the AHI provided education and information to a total of 8,585 youth, parents, school staff and staff from other community or youth serving organizations. Trainings and presentations included (but not limited to):

·       I CAN BE CLEAN by staying drug free

·       Breaking the Cycle of Addiction: Hope in Recovery

·       Drug-Endangered Children Initiative

·       Consequences of Choice

·       Why Won’t My Mommy Wake Up?

·       Proper Disposal of Medications

·       Dangers of Substance Use

·       Appalachian Angels (podcast),Youth Substance Abuse Prevention

In addition, the AHI also distributed 1,150 pieces of literature, helped coordinate Red Ribbon Week activities across the state and facilitated 2 Drug Take Back events.