ADOLESCENT HEALTH DOMAIN SUMMARY/OVERVIEW FY22 ANNUAL REPORT

 

DOMAIN CONTRIBUTORS

 

Adolescent Health Program– Division of Child and Family Health - Repro Health Unit

Resource Mothers Program - Division of Child and Family Health - Repro Health Unit

Injury and Violence Prevention Program – Division of Prevention and Health Promotion

School Health - Division of Child and Family Health

Local Health Districts

 

DOMAIN OVERVIEW

 

ADOLESCENT HEALTH PROGRAM:  Adolescent Health Program (Sexual Risk Avoidance Education, Title V): Positive youth development programs that build protective factors among participants that will make them less likely to initiate sexual activity.

 

RESOURCES MOTHERS PROGRAM:  Resource Mothers (TANF, Title V): Adolescent health program providing support services to pregnant and parenting teens and their families This unit works closely with the 35 LHDs to provide over $3.5 million in annual funds to support their local maternal and infant health programs and initiatives, providing quarterly recorded meetings via webinar platform for technical assistance and allow LHDs to share lessons learned across LHDs and programs. 

 

YOUTH SUICIDE PREVENTION: The Injury and Violence Prevention Program (IVPP) focuses on efforts to address youth suicide through training youth-serving professionals and organizations to comprehensively screen for suicide risk and refer affected youth to immediate care.  IVPP coordinates gatekeeper trainings in partnership with James Madison University.  IVPP also facilitates the Prevention Interagency Advisory Group (SPIAG) and is currently updating the Commonwealth of Virginia Suicide Across the Lifespan Prevention Plan.

 

SCHOOL HEALTH PROGRAM: VDH School Health Nurse Consultant (SHNC) partners and collaborates closely with the Virginia Department of Education (DOE) and their School Health Nurse Consultant to serve elementary through high school students enrolled in public, private and parochial schools in the Commonwealth.  The program aims to provide technical assistance and professional developmental training opportunities to the school systems, particular to school-based medical professionals and families, and also to develop and update certain guidelines relevant to mandated services noted in the Code of Virginia.

 

VDH LOCAL HEALTH DISTRICTS:  Each of VDH’s 35 local health districts (LHDs) receive Title V funds to drive and support maternal and child health programmatic initiatives at the local level.

 

STATE ACTION PLAN UPDATES
	PRIORITY 1   Reproductive justice and support:  Promote equitable access to choice centered reproduction-related services, including sex education, family planning, fertility/grief support, and parenting support
OBJECTIVE	By 2025, reduce the rate of mistimed pregnancies from 25.3% (PRAMS 2018) to 21.8%
PERFORMANCE MEASURE	SPM 4 – Pregnancy Intention: Mistimed or Unwanted pregnancy (wanted to become pregnant later or never)

 

Adolescence and young adulthood are considered "critical periods" in the Life Course, and struggle with a wide range of health care needs related to social, economic, and environmental factors. Adolescents suffer from worsened health outcomes, particularly if they are of lower socioeconomic status, a minority background, and have unmet mental health needs. Providing appropriate and comprehensive health services to adolescents, particularly related to reproductive justice and support, are important.

 

In Virginia, the 2021 adolescent pregnancy rate (aged 15-19) was 15.8 per 1,000 births (Virginia Vital Statistics System). According to PRAMS, births among adolescents 15-19 are largely unintended; however, the trend in unintendeness among this age group is on a decline. Although maternal deaths are rare among this age group, when compared with births among women aged 20 and over, infants of adolescents have a higher prevalence of preterm birth, low birthweight, and maternal complications, as well as higher rates of mortality. 

 

Five-year Virginia pregnancy-associated mortality rates for adolescents (age <20)
	White	Black	Other
2017-2021	3	4	1

 

 

Despite the declining birth rate for adolescents aged 15-19, differences continue to occur in the mortality of infants born to teenagers by race and ethnicity and cause of death. Nationally, in 2017–2018, infants of teenagers aged 15–19 had the highest rate of mortality (8.8 deaths per 1,000 live births) compared with infants of women aged 20 and over (NCHS Data Brief).  Mortality rates were highest for infants of non-Hispanic black teenagers (12.5 per 1,000 live births) compared with infants of non-Hispanic white (8.4 per 1,000 live births) and Hispanic (6.5 per 1,000 live births) teenagers. The mortality rate of infants born to non-Hispanic black teenagers related to preterm birth and low birthweight (284.3 deaths per 100,000 live births) was more than double the rate of infants born to non-Hispanic white teenagers (119.2) and three times the rate of infants born to Hispanic teenagers (94.4).

 

The current workforce includes few adolescent health specialists that can engage and support interventions focused on risk assessment, health promotion, and fostering of positive youth development. 

 

 

 

 

 

 

Strategy 1:  Implement evidence-based comprehensive sexual education in areas of the state with disproportionately high rates of teen pregnancy and low access to sexual health information;  Advocate for policy change that requires sex education in Virginia to be medically accurate, comprehensive, inclusive, and required

 

VDH’s Title X Family Planning program provides comprehensive family planning services at approximately 140 clinical sites across the Commonwealth, including 34 local health districts and 3 federally qualified health centers. As the nation’s only federally funded family planning program, Title X provides structure, funding, and technical support to clinics providing family planning services according to CDC’s Quality Family Planning Services guidelines. The Title X Family Planning program is not directly supported by Title V funds, but Title X compliments Title V by supporting family planning services beyond those provided by the Virginia Contraceptive Access Initiative. 

 

VDH’s Adolescent Health Program includes evidence-based positive youth development programs. VDH receives federal Sexual Risk Avoidance Education (SRAE) funds to support programs at six program sites. SRAE funds support two evidence-based curricula: Project AIM and Teen Outreach Program (TOP). VDH’s SRAE program reach was limited during this reporting period because many youth-serving organizations halted in-person programming and local health department staff were pulled to help with COVID-related tasks. While some programs were able to pivot to the virtual environment, this took time and was not possible for all sites. The SRAE program served approximately 395 youth during this reporting period. 

 

Title V funds are used to complement VDH’s long-standing positive youth development programs by a supporting a comprehensive sex education curriculum called Get Real: Comprehensive Sex Education that Works.

 

This program has been rigorously evaluated and is implemented in communities around Virginia. In the reporting period, sites served 620 students collectively. In the last fiscal year, the Virginia League for Planned Parenthood expected to serve 300 students with Get Real programs. Educators saw 295 middle school students and 69 high school students for a total of 364 youth served. Planned Parenthood of the Southeast Atlantic serves students in various locations across Virginia. The Roanoke and New River Valley programs of PPSAT sought to reach 50 students through Teen Connections this fiscal year. In total, educators taught 154 students. Eastern Virginia Medical School employed a strategy of training teachers to broaden reach has the goal of program sustainability. Last year, educators saw 86 students in their own programs. EVMS also began process of NPS School Board and Community review in fall 2022. In aggregate, VDH expects to serve 1,110 young people through comprehensive sex education in FY23. VDH also receives federal Sexual Risk Avoidance Education (SRAE) funds to support positive youth development programs at five program sites located primarily in southwest Virginia. SRAE funds support two evidence-based curricula: Project AIM and Teen Outreach Program (TOP). The objectives of positive youth development programs are The SRAE programs served approximately 1,179 youth during this reporting period.

 

Strategy 2:  Assure Resource Mothers staff are trained in the Growing Great Kids curriculum, a skills-driven program designed to promote healthy child development and strengthen protective factors for families in a home visiting setting, and increase capacity of youth-serving agencies to implement AIM4TM, an evidence-based pregnancy prevention program designed for parenting teens

In addition to its pregnancy prevention programs, VDH’s Reproductive Health Unit also provides support to young parents. Resource Mothers is an adolescent health program for pregnant and parenting teens. As part of this program, community health workers offer home visiting services to teens until their child reaches the age of one. During these visits, community health workers provide educational and emotional support to the client and her family. Resource Mothers uses two evidence based programs: Growing Great Kids and AIM 4 Teen Moms (AIM4TM).

 

Funded through federal TANF funds allocated by the Virginia General Assembly, Resource Mothers is offered at seven local implementation sites, including five local health districts, one hospital system, and one community-based organization. Title V funds are utilized to support trainings, and in October 2022, 5 participants were trained in Growing Great Kids, and 5 were trained in AIM 4 Teen Moms.

 

The Growing Great Kids program had 1,685 encounters in FY22, and there were 88 AIM4TM encounters for FY22.

 

EQUITY CENTERING:  Adolescence is a time of significant physical, social, and psychological development. For youth of color, these experiences can be compounded by racism and its impact. A history of school segregation has led to many communities of color being under-resourced, for example. Health equity is essential to our comprehensive sex education programs. While rates of teen pregnancy continue to decline, disparities persist. To begin to address this, we focus attention on those most impacted by inequitable systems. Grantees provide programming in a variety of settings, including with youth in out of home care like foster care, or juvenile detention centers - both of which disproportionately impact youth of color. One of our grantees has made specific efforts to "bring programming where the people are" and established partnerships with local affordable housing authorities. This greatly increased access to positive youth development opportunities. Finally, all of our grantees have sought out professional development opportunities around diversity, equity, and inclusion. Experiences in adolescence greatly impact development and health outcomes later in life. The Adolescent Health Program focuses attention on those most impacted by inequitable systems. Our program sites have partnered with youth in out of home care such as foster care or juvenile detention centers. While sometimes consisting of smaller groups, program staff report great engagement in these settings. EVMS has made efforts to reach more African American youth in both the Middle School and High School programs by working with schools and community partners serving low-income African American communities. This group realized they must bring programming to where the people are, and established partnerships with a local affordable housing authority. They also report that based on data from previous years, they expect to enroll a significant number of youth who do not consider themselves heterosexual or who report they are unsure or prefer not to answer regarding sexual orientation."

 

Additional highlights from the work of our program sites include:

• Translating parent information program Teen Speak for Muslim parents in the Central Shenandoah area.

• EVMS open calls - innovative way of engaging public, VDH staffed able to serve on steering committee

• Successful Get Real Summer Program at Central VA Juvenile Detention Center

 

CONSUMER/FAMILY ENGAGEMENT: The Adolescent Health Program continues to seek ways of supporting program sites. This year, the Program Evaluator began creating quarterly reports for program sites. This has helped track fidelity and ensured program sites are on target to reach program goals. Community engagement is a crucial component of program implementation. Without buy-in from community members, the program cannot be successfully implemented in a sustainable way. One of our grantees found very creative ways to engage with the community outside of formal programming. Eastern Virginia Medical School began several initiatives to increase community engagement. One initiative involved soliciting contributions from community members for an Open Call contest. They chose the theme of healthy relationships, and participants earned prizes for their creative submissions. EVMS also utilized "Design-A-Thons," and Training Bootcamps, all of which invite teens to participate in a meaningful way. This action brought awareness to the community, educating about some of the issues comprehensive sex education programs cover. The Norfolk Public School Board voted to approve the Get Real curriculum in partnership with EVMS, largely thanks to their commitment to community.

 

EMERGING ISSUES:  Political pushback has emerged an especially stringent barrier to programming in recent months. As program sites seek to expand services, some publications have focused on the controversial aspects of programming. Program sites have done excellent work engaging in these conversations head on, and have provided their communities with information and transparency along the way.

 

Strategy 3: Local Health District (LHD) Strategy: conduct community/environmental scan and gap analysis regarding adolescent reproductive health – assessing community, public and private partners that provide outreach, education, and appropriate reproductive health services to adolescents

 

In collaboration with the Adolescent Health Coordinator, during Fall 2022, a survey was designed to serve as an environmental scan of each LDH, assessing the community, public and private partners that provide outreach, education, and appropriate reproductive health services to adolescents.  The survey was distributed to all 35 LHDs in January 2023. The results of the survey will influence the LHD work plans for FY24, and anticipated action includes the formation of a workgroup led by the Adolescent Health Coordinator and interested LHDs to improve access to services as well as increase quality of interactions – ensuring positive medical care experiences after making the appointment. Other goals of this project are to help build skills in communicating with young people, and increasing youth voice in decision making. 

 

 

	PRIORITY 2   Mental Health
OBJECTIVE	By June 30, 2025, decrease the rate of hospitalization for nonfatal injury per 100,000 children ages 10 to 19 from 182. 6 (HCUP – State Inpatient Databases (SID) 2015) to 124.79
PERFORMANCE MEASURE	NPM 7.2:  Rate of hospitalization for non-fatal injury per 100,000 children, ages 10-19
Evidence-based or –informed strategy measures	ESM 7.2.1 – Number of gatekeepers trained in the prevention of suicide among youth.

 

 

 

 

Strategy 1:  Provide suicide prevention trainings to professionals interacting with youth and adolescents.  

 

Reduction of suicide deaths is a continuing priority. However, death statistics vastly  underestimate the burden of intentional self-harm injuries in youth. In 2001, the Virginia Department of Health (VDH) was designated as the lead agency for youth suicide prevention in Virginia pursuant to the Code of Virginia §32.1-73.7. The VDH Suicide Prevention Program is housed in the Division of Prevention and Health Promotion (DPHP), within the IVPP. Primary efforts to address youth suicide under this program have focused on training youth serving professionals and organizations to comprehensively screen for suicide risk and refer affected youth to immediate care. 

 

During the reporting period, IVPP continued to coordinate gatekeeper trainings in partnership with James Madison University as the Campus Suicide Prevention Center of Virginia (CSPCVA) in the prevention of suicide among youth. “Recognizing and Responding to Suicide Risk” and “CAMS: Collaborative Assessment and Management of Suicidality” which equip clinicians with the skills to screen, assess, and refer for suicide risk, providing counseling in a flexible, empathetic, and non-judgmental way. Additionally, the Center facilitates and coordinates regular Mental Health First Aid, ASIST, and safeTalk trainings. Promoting suicide intervention skills training to directors of graduate programs in counseling, psychology and applies social work across Virginia continued during the project period. The IVPP and JMU recommended that first year students take ASIST and second year students take the CAMS 3-hour overview. The center currently has 7 programs that have made ASIST a part of their standard curriculum. During the reporting period, 1,404 gatekeepers across Virginia’s campuses and universities were trained by the CSPCVA. 

 

The IVPP Youth Suicide Prevention Program uses partially funded Title V staff time and effort to advance a comprehensive statewide suicide prevention program. 

 

 

	PRIORITY 3 Strong systems of care for all children:  Strengthen the continuum supporting physical/socioemotional development (i.e., screening, assessment, referral, follow-up, coordinated community-based care)
OBJECTIVE	By June 30, 2025, increase the proportion of adolescents, ages 12-17, in Virginia who are engaged in transition services to adult health care from 11.6% (NSCH 2017-2018) to 14.2%
PERFORMANCE MEASURE	NPM 12:  Percent of adolescents with and without special health care needs, ages 12 through 17, who received services to prepare for the transition to adult health care.
Evidence-based or –informed strategy measures	ESM 12.2:  Percentage of Virginia school divisions reporting into the VDOE school health data system

 

 

 

The Virginia Department of Health (VDH) School Health Nurse Consultant (SHNC), through interprofessional collaboration, supports VDH's goal of becoming the healthiest state in the nation. The School Health program collaborates with school nurses, school divisions, and community stakeholders to:

• Support school based initiatives with the implementation of evidence-based interventions to increase vaccination rates of Virginia’s school age population
• Provide oral health services in the school setting
• Expand access to healthcare in schools
• Manage chronic conditions
• Improve access and care for youth mental health
• Address the social determinants of health to support Virginia’s students be academically successful.

 

Strategy 1:   Provide resources and professional development opportunities to school nurses

 

IMPROVED GUIDELINES FOR USE OF ABLUTEROL IN SCHOOL

VDH’s partnership with Virginia Department of Education (VDOE) supports all of Virginia’s children and improves health outcomes: The 2021 General Assembly passed HB 2019, which amended and reenacted §§ 8.01-225,  22.1-274.2, and 54.1-3408 of the Code of Virginia, relating to public elementary and secondary schools’ possession and administration of undesignated stock albuterol inhalers and valved holding chambers. VDOE, along with the SHNC, convened a group of stakeholders from the VDH Division of Pharmacy, school nurses, school staff, local health departments, Virginia Association of School Nurses and Virginia Chapter of the American Academy of Pediatrics and other community stakeholders to develop specific training need and requirements for the administration of undesignated stock albuterol. This workgroup was tasked with developing a model policy, best practices, albuterol standing order template, respiratory distress algorithms for school staff, procurement process for medication and training modules for school staff on the use of undesignated stock albuterol in the school setting.

 

 

* 2020-2022 Data Collection: Only 55 of the 131 school divisions in Virginia reported data to VDOE

 

The “Virginia School Health Guidelines” was revised to reflect the workgroup’s  recommendations.  Even though the percent of children with and without special healthcare needs, ages 0-17, who have a medical home (NPM 11) increased by 7.90% from the previous school year, according to the VDOE 2021-2022 school year data, this collaboration addressed gaps in access to healthcare many of our children with and without special healthcare needs experience and expanded access to life saving emergency medication.

 

 

 

 

 

 

 

SCHOOL NURSE STAFFING LEGISLATIVE-MANDATED WORK GROUP

 

School nurse staffing in the 131 school divisions remains relatively unknown because public schools are not required to report data to VDOE. Since 2019, only 55 school divisions have consistently reported staffing data. The 2021-2022 data demonstrates, Registered Nurses (RN) providing direct services decreased 1.10% from 2020-2021. The reason for this decrease in RN staffing is unknown.

 

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* 2020-2022 Data Collection: Only 55 of the 131 school divisions in Virginia reported data to VDOE

 

 

Action taken to improve the MCH workforce by the 2021 Virginia General Assembly:

The 2021 Virginia General Assembly, in budget Item 137 (Paragraph T) of the 2021 Appropriation Act (i.e., Chapter 552):   T. The Superintendent of Public Instruction shall convene a workgroup to make recommendations on the desired qualifications and training for school personnel providing health services in schools. The workgroup shall include at least: (if) three local school division representatives, including one superintendent; (ii) two members of a local school board; (iii) school personnel
providing health services, including contracted personnel from a local health department, personnel with varying levels of nursing credentials, and personnel without nursing credentials. and (iv) two members of the Board of Education. The recommendations shall be submitted to the General Assembly no later than October 1, 2021. Such recommendations shall detail any necessary legislative or budgetary changes to implement the recommendations.

 

SHNC participated in this workgroup of community stakeholders charged with making recommendations on the qualification and training for school health personnel providing health services in Virginia schools. The recommendations include:

 

1. Direct the Board of Education to establish a definition of “school nurse” and
“unlicensed assistive personnel” that includes education, licensure, and/or certification requirements. 

2. Ensure that every Virginia elementary and secondary school is served by a full-time Registered Nurse (RN) as their school nurse.
 

3. Allow currently employed LPNs serving as school nurses to maintain employment as a school nurse with a five-year “grace period” to pursue/complete licensure requirements to become an RN.
 

4. School divisions should allocate LPNs and/ or UAP to provide supplemental health services to large schools (over 750-1000 students) and schools with high populations of students with special health care needs.  

5. Strengthen the comprehensive availability of school health services information by requiring the annual collection of school health data from all Virginia school divisions.  
 

SHNC and the School Health Specialist, with VDOE, collaborate to provide professional development opportunities and training for school nurses to improve critical workforce development. The school nurse workforce is supported by providing education, training, guidance, technical assistance, and resources to private schools, and public school divisions across the Commonwealth. Monthly meetings with school nurses and quarterly meetings with school nurse coordinators via zoom and in-person are well-attended (average 200 participants). These meetings provide updates, guidance, and opportunities for school nurses to collaborate on school health issues. 

SUMMER INSTITUTE FOR SCHOOL NURSING

The Summer Institute for School Nursing (SISN) offers networking opportunities, education, training, and professional development for Virginia’s school nurses. SISN 2022 had 176 participants and awarded 2,552 contact hours. All 176 school nurses received a Mental Health First Aid Certification. The Mental Health First Aid certification course materials were supplied by the Virginia Nurses Association, further promoting, and strengthening of optimal mental health and well-being through partnerships and programs (SPM 6).

Overall, conference participants were satisfied with the program. On a scale of 1(very dissatisfied) to 5 (very satisfied), 54.6% of the participants rated the overall program a five and 33.9% rated the overall program a four.

SHNC will continue to break down barriers, use quantitative and qualitative data collection, advocate for school nurses and school health programs that address internal and external challenges. SHNC will use feedback from school nurses and community stakeholders to enhances school health programs.

CDC PUBLIC HEALTH WORKFORCE GRANT

The Virginia Department of Health (VDH) was awarded $50,920,959 under the CDC Public Health Workforce Grant. Twenty five percent ($12,730,240) has been designated for school-based initiatives to support school health staff. This grant program, implemented by VDOE, available to all 131 public school divisions, is called the School Based Health Workforce. As of May 2022, 94, of the 131, school divisions applied for grant funding and were awarded a total of $6,217,313.07 on September 2. 2022. VDOE identified two priority areas:

 

1. Recruiting and Retention: Grant funding can be applied to activities that support the recruiting and retention of school nurses. This can also include activities that support the working style of current Registered Nurses (RNs). The VDOE-approved activities include:

• Software/electronic medical records (EMR) enhancements and/or purchases as necessary

• Enhancements can also include upgrades to equipment or hardware (e.g., audiometers)
• Recruiting and hiring
• Wellness expenses for school nurses
• Professional development.

 

2. Educational Development: Currently, not every school in Virginia has a Registered Nurse. To assist in increasing the number of RNs in schools and the number of skilled school health personnel, the School Based Health Workforce Grant can be used to fund programs that support school nurses with further education. The VDOE approved activities include:

• Training for Mental Health
• Scholarships
• National Certification expenses for bachelor prepared RN’s
• Reimbursement for nursing academic classes
• Per-diems (following General Services Administration (GSA) guidelines) for lodging, meals, and incidentals related to the above activities

 

Strategy 2:   Maintain data capacity for school health immunization data

 

The SHNC, in partnership with the Virginia Department of Education (VDOE), community stakeholders and school nurses from across the Commonwealth, address family needs such as food security, dental care, behavioral health, and overall safety. Building capacity and establishing partnerships increases and ensures our most vulnerable students remain healthy, safe and read to learn.

 

 
 

 

The COVID-19 Pandemic decreased access to routine healthcare, including dental care, increased conditional enrollment rates of our students, and created challenges to access the required TB screening for school enrollment. The SHNC supports Virginia families by establishing internal and external partnerships for community outreach with multiple organizations coming together to address lack of access to healthcare, barriers and immunization gaps created secondarily due to the COVID-19 pandemic.  Virginia’s immunization rates are still not at pre-pandemic levels. According to the Code of Virginia § 22.1-271.2, private and public school divisions are required to report their student immunization status at the beginning (October 15th) of the current school year. This report is known as the Student Immunization Status Report (SIS) and includes the number of kindergarten, seventh grade, and twelfth grade students admitted to school with documentary proof of immunizations, the number of students who have been admitted with a medical or religious exemption and the number of students who have been conditionally admitted to a school​.

 

According to the SIS report, immunization rates have increased slightly from 2021 to 2022. Many local health departments employ Immunization Action Planners (IAP). IAPs are task with coordinating and supporting vaccination efforts by partnering with school nurses to prioritize vaccine access and provide opportunities for children to receive required vaccines for school enrollment. Many of our school based vaccination clinics target rising 7th and 12th grade students because these students are less likely to see a healthcare provider on a regular basis and are required to have at least one dose of HPV, Tdap, meningococcal conjugate vaccines for school enrollment per the Code of Virginia  § 32.1-46 - Immunization of Children Against Certain Diseases. Seasonal influenza and COVID vaccines are not required for school enrollment but are recommended and offered at the same time during many of these vaccine events.  

 

These school-based clinics have provided families with vaccination opportunities and increased the: 

• Percent of children, ages 6mo-17 years who are vaccinated annually against seasonal influenza (NOM 22.2) 
• Percent of adolescents, ages 13-17, who have received at least one dose of the HPV vaccine (NOM 22.3)
• Percent of adolescents, ages 13-17, who have received at least one dose of the Tdap vaccine (NOM 22.4) 
• Percent of adolescents, ages 13-17, who have received at least one dose of the meningococcal conjugate vaccine (NOM 22.5) 

 

At the state level, communication strategies for school immunization requirements have proven to be successful in reaching Virginia families and consist of engaging with Superintendents through the partnership with the Virginia Department of Education (VDOE), training of school nurses, establishing data exchange between the Virginia Immunization Information System (VIIS) and school electronic health records, updating frequently VDH’s websites (Division of Immunization, School Health and Healthy Back to School) and the development of immunization resources including an annual HPV information letter to parents of rising 7th graders/families, infographics, tool kits and playbooks. All together our communication strategies, successful partnerships, and increased access to vaccines have improved Virginia’s adequately immunized vaccination rates. In 2022, 7th grade student adequately immunized vaccination rates increased by 4.8% and 12th grade student adequately immunized vaccination rates increased by 8.1% from the previous year vaccines have improved Virginia’s adequately immunized vaccination rates. In 2022, 7th grade student adequately immunized vaccination rates increased by 4.8% and 12th grade student adequately immunized vaccination rates increased by 8.1% from the previous year.

 

 

 

 

 

 

Strategic communication efforts targeting families continue to be a collaborative effort between VDH Division of Immunization, SHNC, VDH Office of Epidemiology, VDOE, and the Virginia Chapter of the American Academy of Pediatrics (VA AAP). The Healthy Back to School campaign and website provides families with short videos encouraging well child visits, a Back-to-School Checklist for parents to prepare their child for the upcoming school year and immunization resources including an immunization event locator.

SHNC has developed strong partnerships, over the past three years, with VDOE, local health departments, school divisions, VHIT, and Virginia Health Catalyst. These partnerships have provided families, school nurses and school health staff with resources and opportunities to promote health, increase access to healthcare and improve a child’s academic success. Two recent collaborations are highlighted below:

 

The development and implementation of the 2023-2027 VHIT Action Plan for Virginia. The Action Plan consists of four priorities areas to increase HPV vaccination rates:

• Decrease community disparities in HPV vaccination.
• Improve delivery of evidence-based strategies in providing HPV vaccine.
• Increase HPV data quality and sharing.
• Increase awareness of the burden of HPV-related cancers in men and women.

 

Capacity building and quality improvement to support school based initiatives are underway with the implementation of evidence-based interventions to improve HPV immunization rates in Virginia. VDH’s annual HPV letter is distributed to school nurse coordinators, through VDOE channels, and disseminated to families/parents of rising 7th graders. The letter, along with educational resources (infographic below), is available in English and Spanish and provides families with information on the Code requirements for school entry and education on the benefits of adolescents receiving the HPV vaccine.

 

School divisions are encouraged to partner with local health departments, hospital community outreach programs, and pharmacies to provide opportunities for students to receive their required 7th grade dose of HPV for school enrollment and catch-up vaccines for students requiring additional doses of the HPV series before the start of the new school year.

 

HPV rates have increased by 3.1% from 2021 to 2022. The VHIT Action Plan outlines steps to increase the percent of adolescents, ages 13-17, who have received at least one dose of the HPV vaccine (NOM 22.3).

 

 

 

 

The Healthy Back to School website information can be found below:

 

 

 

 

 

 

 

 

A programmatic success was the launch of a pilot program, in the spring of 2022, designed to increase MenACWY vaccination rates. The overall goal of the pilot program was to increase the percent of adolescents, ages 13-17, who have received at least one dose of the meningococcal conjugate vaccine (NONOM 22.5). The SHNC, in collaboration, with Harrisonburg City Public Schools (HCPS) and Central Shenandoah Health District partnered to expand access to healthcare and promote health by providing a school based MenACWY immunization clinic. This school-based vaccine clinic provided an opportunity for rising seniors to receive the one dose of MenACWY required for school enrollment. The clinic was scheduled for two hours during the school day, before summer break, around the Virginia Department of Education (VDOE) testing windows, exams, school sporting events and prom. Since this school located vaccination clinic was held during school hours, no transportation was needed for students, parents did not need to miss work and school officials were able to stand in loco parentis. This program was extremely successful, 38% of the targeted student population received the one dose of the meningococcal conjugate vaccine required for school enrollment. HCPS was selected to pilot this immunization program because of their robust school health program led by highly qualified registered nurses. 11.2% of HCPS (KG-12 grade) students identify as immigrants (born outside the U.S., with fewer than three years in U.S. schools)​, many families lack transportation and access to vaccine opportunities. The purpose of this pilot program was to address the social determinants of health and established a framework to make school age vaccinations more accessible to all families by coordinating immunization efforts through strong school, local health department, community partnerships, and to strengthen access to vaccinations and health promotion.

 

The pilot program objectives were achieved:

• A framework was created for meeting the health needs of the community that is sustainable and easily replicated.
• Access to immunization health services was streamlined.
• The number of adequately immunized students enrolled in HCPS increased.

       

https://www.cdc.gov/mmwr/volumes/71/wr/mm7116a1.htm

https://www.vdh.virginia.gov/immunization/datamanagement/sisreports/

The success of this pilot program has led to the development of a MenACWY playbook, providing Virginia’s school divisions with step-by-step guidance and best practices for school-based immunization clinic:

.   

https://www.vdh.virginia.gov/content/uploads/sites/58/2022/11/MenACWY-Final-Playbook8-18-2022.pdf

 

EQUITY CENTERING:

School-based health programs support equitable access and improve health outcomes by addressing the social determinants of health and reducing barriers to children receiving care.

 

Many students are missing school-required immunizations for multiple reasons, including transportation, cost of services, insurance status, scheduling conflicts and are unable to acquire access to routine healthcare resulting in the student receiving a conditional enrollment. Harrisonburg City Public Schools (HCPS) partnered with SHNC and VDH Central Shenandoah Health Department to address barriers and provide immunization opportunities for students during school hours. As seen in the chart below, 11.2% of HCPS (KG-12th grade) students identify as immigrants (born outside the U.S., with fewer than three years in U.S. schools)​, there are high numbers of students whose primary language is not English and 100% of students are eligible for free lunch. Many HCPS families lack transportation and access to vaccine opportunities. HCPS 2021 uninsured rate among children is 5.5%-6.9%. The data strongly suggest the correlation between poverty, as a determinant of health, and equitable healthcare. HCPS and Central Shenandoah Health Department’s school-based vaccination pilot program addressed the social determinants of health and established a framework to make school age vaccinations more accessible to all families by coordinating immunization efforts through strong school, local health department and community partnerships. HCPS is scheduled to open a school-based health center in spring 2023.

 

 

 

The SHNC collaborated with Harrisonburg City Public Schools, and the Central Shenandoah health department to address the social determinants of health by:

 

• Removing barriers to “catch-up vaccines” required for school enrollment
• Providing the necessary “catch-up vaccines” to allow children to remain in school
• Decreasing conditional enrollment by providing opportunities for children to receive “catch-up” vaccines.

 

 

 Jeffress Trust Awards Program in Research Advancing Health Equity Partnership - Collaborative Establishment Awards (6/30/2022 - 6/30/2024)  Dr. Erin Maughan, with George Mason School of Nursing (GMU) was awarded the Research Advancing Health Equity Grant for $149,868.57. The Virginia Association of School Nurses (VASN), Virginia Department of Education (VDOE), Virginia Department of Health (VDH), community stakeholders, and regional contacts from across the Commonwealth support this partnership building grant. This partnership, known as Virginia School Health & Equity Research Consortium (VSHERC), includes the formation of an advisory group and plans provide training/professional development opportunities for school nurses, along with a Child Summit.  The objective of VSHERC’s is to increase the percentage of students in Virginia schools with a school health program that facilitates child health and does not contribute to child health inequities. 

 

The 2021-2022 partnership with the Virginia Health Catalyst targeted preventative dental services for children living in Southwest Virginia, who had less access and fewer services. Public schools partnered with 7 dental clinic teams: Bland Ministry Center & Dental Clinic (Bland, VA), Community Health Center of the New River Valley (Christiansburg, VA), CVHS: Petersburg Health Center (Petersburg, VA), CVHS: Hopewell/Prince George Health Center (Prince George, VA), Eastern Shore Rural Health System (Onancock, VA) Johnson Health Center (Lynchburg, VA), Piedmont Regional Dental Clinic (Orange, VA) to provide students in Southwest Virginia an opportunity to receive school based dental care during the school day.

 

 

 

	PRIORITY 4   Oral Health
OBJECTIVE	By June 30, 2025, increase the percentage of children, ages 12-17, who had a preventive dental visit in the past year from 88.2% (NSCH 201) to 93.5%
PERFORMANCE MEASURE	NPM 13.2:  Percent of children, ages 1 through 17, who had a preventive dental visit in the past year.
Evidence-based or –informed strategy measures	ESM 13.2.1:  Oral Health Collaborative Project links dental safety net clinics to school nurses for oral health integration.

 

Strategy 1:   Continue cross collaboration with school-based oral health programs

 

SHNC collaborated with VDOE, Virginia Health Catalyst, Delta Dental, school divisions and school nurses to provide school based dental care programs to students. School-based dental health programs address the social determinants of health, promote health, support equitable access to dental care and improved health outcomes by connecting school nurses with dental clinic staff to provide children and families with school-based dental services. During the 2021-2022 school year, Virginia’s school divisions partnered with Bland Ministry Center & Dental Clinic (Bland, VA), Community Health Center of the New River Valley (Christiansburg, VA), CVHS: Petersburg Health Center (Petersburg, VA), CVHS: Hopewell/Prince George Health Center (Prince George, VA), Eastern Shore Rural Health System (Onancock, VA) Johnson Health Center (Lynchburg, VA), Piedmont Regional Dental Clinic (Orange, VA) to provide students an opportunity to receive school based dental care during the school day. 25 schools across Virginia, increased the percentage of children, ages 1-17, who had preventive dental visits in the past year (NPM 13.2), decreased the percent of children, ages 0-17, who were unable to obtain needed healthcare in the past year (NOM25) and provided dental care and referrals to the children, ages 1-17, who have decayed teeth or cavities in the past year (NOM 14).

 

The partnership between school divisions and the Virginia Health Catalyst has provided almost 8,000 additional students access to dental care.  School nurses work directly ith dental service providers to bring school-based dental care to their students.  Dental clinics are scheduled during the school day and therefore remove the barriers of transportation and parent workday disruptions.  As of September 2022, Virginia’s oral Health Report Card received a score of C+.  The SChool Health Nurse Consultant has continued to work closely with school nurses and the Virginia Health Catalyst team to develop and implement strategies to increase the percentage of children, ages 1-17, who had a preventive dental visit in the past year (NPM 13.2) with thegoal of increasing access to dental care for all Virginia’s children and improving the 2023 Virginia Oral Health Report Care score.