Annual Report Fiscal Year 2021:

This section provides a summary of FFY21 activities, accomplishments, and challenges related to NPMs and SPMs for the YAYAHP.

The Wyoming and U.S. rates for adolescent motor vehicle traffic (MVT) mortality have been decreasing, with the U.S. rate declining significantly since 2007. However, teens contribute to, and suffer from, the consequences of motor vehicle collisions at a disproportionate rate. The Wyoming 2018-2020 adolescent MVT mortality rate for 15-19-year-olds is 21.9/100,000, almost double the U.S. 2018-2020 rate of 11.2/100,000.

Strategy 1

Implement and expand Teens in the Driver Seat (TDS) in high schools through collaboration with statewide partners

TDS is a peer-to-peer traffic safety program that focuses on five major risk factors for adolescent car wrecks:

• Distracted driving (including texting while driving)
• Nighttime and drowsy driving
• Speeding and street racing
• Low seat belt use
• Impaired driving

The program is designed to engage adolescents in educating peers and caregivers. TDS was selected as an evidence-based strategy in part because of the YAYAHP’s participation in the Child Safety Learning Collaborative convened by the Child Safety Network. The YAYAHP has engaged with other states implementing TDS, including Nebraska, to identify common challenges and key facilitators in early stages of TDS implementation.

The YAYAHP contracted with the Texas Transportation Institute (TTI) in August 2021 to support a pilot of TDS at up to five high schools in the state. YAYAHP opened a competitive application for high schools to participate in the program, and will support TDS launch in selected schools in January 2022. The application was distributed through partners at the Wyoming Department of Transportation (WYDOT) and WDE.

The YAYAHP is working to further engage state traffic safety stakeholders, including WYDOT and WDE in promoting TDS and linking TDS to existing adolescent motor vehicle traffic safety (MVTS) work across the state.

Strategy 2

Develop MVTS guidelines and materials to promote teen driver safety in adolescent well visits

WY MCH, including the YAYAHP, is building capacity for meaningful engagement with primary care providers. The YAYAHP is supporting CHP work to engage pediatric providers in Bright Futures adoption. To align engagement efforts and accommodate provider capacity, this strategy will be delayed until later in the current grant cycle. The YAYAHP will also prioritize Prevent Adolescent Suicide Strategy 1: Promote the adolescent well visit (below), in advance of asking providers to distribute additional materials related to MVTS.

The Wyoming adolescent suicide rate is significantly higher than the U.S. rate and has been since 2007. Both the U.S. and Wyoming adolescent suicide rates have increased; however, the Wyoming rate is increasing at a faster rate. In 2007-2019, the Wyoming rate (18.0/100,000) was 2.5 times higher than the U.S. rate (7.2/100,000). In 2017-2019, the Wyoming rate (32.1/100,000) was three times higher than the U.S. rate (11.2/100,000). Suicide among adolescents continues to be a serious problem, and current statewide efforts do not focus predominantly on adolescents.

Adolescence is a period of major physical, psychological, and social development. An annual preventive well visit may help adolescents adopt or maintain healthy habits and behaviors, avoid health-damaging behaviors, manage chronic conditions, prevent disease, and identify emerging health concerns.

Strategy 1

Promote the adolescent well visit to youth (ages 10-20) through partnership with Medicaid, providers, and the Youth Council

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 to 21, as this may help adolescents adopt and 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, including mental health.

The YAYAHP has been researching evidence-based approaches to increasing the adolescent well visit. In comparing approaches focused on the patient population and approaches focused on providers, provider strategies will be prioritized.

The YAYAHP will partner with the CHP to identify and support pediatric providers to implement and adapt scheduling and communications practices to increase well visit rates, and will promote Bright Futures guidelines among pediatric providers to encourage universal mental health screening of adolescents. For this reason, the YAHAHP is discontinuing ESM 10.1, and will evaluate provider engagement through updated ESMs.

Strategy 2

Improve the ability and capacity of Wyoming clinics to provide mental health screening and care to adolescents in continued partnership with the University of Michigan Health Initiative to implement Adolescent-Centered Environment-Assessment Process (ACE-AP)

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 YAYAHP continued its partnership with the University of Michigan to implement the 18-month ACE-AP within six pilot clinics between 2018 and 2022. 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 indicator categories of adolescent-centered care, listed below, along with the number of clinics that chose to work in each category:

• Access to Care (5 of 6 clinics)
• Adolescent Appropriate Environment (6 of 6 clinics)
• Confidentiality (6 of 6 clinics)
• Best Practices and Standards of Care (6 of 6 clinics)
• Reproductive and Sexual Health (6 of 6 clinics)
• Behavioral Health (5 of 6 clinics)
• Nutritional Health (5 of 6 clinics)
• Cultural Responsiveness (4 of 6 clinics)
• Respectful Treatment (4 of 6 clinics)
• Adolescent Involvement and Empowerment (4 of 6 clinics)
• Parent Engagement (4 of 6 clinics)
• Community Engagement and Outreach (1 of 6 clinics)

In 2020 (late spring for Clinic 1 and late fall for Clinic 2), the second cohort of two 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. Clinics were eligible to receive up to $2,000 to implement changes 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 staff and provider surveys assessing the extent to which the clinic provides a youth-friendly environment and adolescent-centered care. The second cohort of two clinics completed mid-year and end-of-year self-assessments in 2021 and 2022.

Both clinics reported improvement in at least nine of twelve categories assessed by the ACE-AP, with Clinic 2 reporting improvement in all twelve. Clinic 2 had the highest improvement in communicating and supporting confidentiality in adolescent care (67% improvement), while Clinic 1 had the highest improvement in community engagement and outreach (56%).

The ACE-AP offers a certification at three levels--bronze, silver, or gold--if a clinic scores “Fully Implemented” in 10 (bronze), 11 (silver), or 12 (gold) pre-identified clinic measures. Clinics that do not achieve certification do so either because they are unable to achieve a “Fully Implemented” score in the necessary pre-identified measures, or because the clinic chose not to focus on implementing those pre-identified measures as part of their ACE-AP. In the second cohort, Clinic 1 achieved Bronze-Level certification and Clinic 2 achieved Gold-Level certification.

One common need identified across all six participating ACE-AP 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.

The COVID-19 pandemic significantly impacted the second cohort’s ability to focus on environmental improvements. The YAYAHP extended the timeline for the second cohort’s participation in the ACE-AP to accommodate clinics’ need to focus on safety modifications to continue to offer medical care in the midst of the pandemic.

The YAHAHP closed out the ACE-AP pilot program in March 2022. The YAYAHP will pivot to support Bright Futures adoption across pediatric providers, and support providers in increasing adolescent well visits. The YAYAHP’s work on improving mental health screening in well visits will be conducted in partnership with the PMHCA grant, which Wyoming received in October 2021.

Strategy 3

Implement and expand SOS in Wyoming junior high and high schools

SOS is “a best practice youth suicide prevention project designed to harness the power of peer social networks to change unhealthy norms and culture, ultimately preventing suicide, bullying, and substance abuse.” SOS is designed to increase help-seeking behaviors and promote connectedness between and among peers and caring adults.

The YAYAHP has partnered with the WDH WIVPP to support the expansion of SOS in Wyoming junior high and high schools. SOS was chosen because: 1) it is evidence-based to increase connectedness in school settings when implemented with fidelity, and 2) SOS is already in place in several communities in Wyoming. WIVPP funds currently support the implementation of SOS in three of 23 counties in Wyoming. The YAYAHP engaged in in-depth partnership building and needs assessment work to determine the best way to support existing SOS efforts, and leverage knowledge and expertise already in place in the state, for promotion of SOS expansion. Conversations with WIVPP staff and county-based community prevention specialists determined that hosting a train-the-trainer (T4T) workshop in Wyoming for schools to attend is an important first step in MCH support for SOS implementation and expansion. YAYAHP will host the T4T in FFY22.

Strategy 4

Develop and maintain statewide Youth Council to assure youth voices are included in program development, implementation, and evaluation

The YAYAHP seeks to promote youth voice in the development of strategies, materials, and activities. The support of a statewide Youth Council brings youth voices and experience together with health programs, promoting success, increased youth engagement, and quality improvement. One council member shared, “I grew up in Wyoming, so as a young Latina woman with a multicultural background, I understand what it feels like to be in a state that oftentimes doesn’t represent you. As a young adult now, I am able to share my own struggles and experiences to raise awareness and create a safe space.”

The Youth Council was launched in the summer of 2020, and was able to convene virtually and start work despite the COVID-19 pandemic. The council meets virtually every other week to discuss current projects and hear from organizations and agencies across Wyoming that are currently engaging in activities to promote youth wellness. The council also maintains a website to engage young adults across the state.

The Youth Council provides feedback to YAYAHP on proposed strategies and program implementation. However, given the wide range of interests and lived experiences of Youth Council members, WY MCH is looking at the possibility of engaging the Youth Council across domains or as a strategy of Domain 6 as it relates to community and family engagement.

Other YAYAHP Activities:

YAYAHP Partnership Development

The YAYAHP Manager 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
• Students Against Destructive Decisions
• Wyoming Children’s Trust Fund
• Wyoming Department of Education
• 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
• Wyoming Division of Victim Services
• Wyoming Coalition Against Domestic Violence and Sexual Assault
• Wyoming Department of Family Services

Partnership with Wyoming State School Nurse Coordinator

WY MCH entered into a formal MOU with the WDE in 2021 to support a State School Nurse Coordinator. The YAYAHP Manager meets regularly with this coordinator, and has participated in the work of the coordinator to improve health and wellness outcomes among students in Wyoming. This crosses over with child health and CYSHCN domain activities as well.

YAYAHP Manager Memberships

The YAYAHP Manager has remained an active member of AMCHP. As a member of the PHD’s Health Equity Workgroup (HEW), the YAYAHP Manager participates in HEW activities and meetings, identifies inclusive strategies for capturing data and identifying gaps in service due to disparities, and participates in WY MCH discussions related to the 6th domain priority. The YAYAHP Manager is an active participant in the National Network of State Adolescent Health Coordinators, and is a member of the third cohort of the Child Safety Learning Collaborative.

Annual Report Fiscal Year 2021 Supplement:

This section provides an interim update for FFY22 activities currently in process for the YAYAHP.

Motor Vehicle Safety

Three high schools expressed interest in the first TDS pilot, and one fully engaged in program implementation. The YAYAHP recognizes that many schools in Wyoming are still focused on recovering from the impacts of COVID-19 on their school communities and students. The YAYAHP plans to meet with the implementing school, TTI, and key state stakeholders to discuss any changes that need to be made to better support program implementation. Recruitment will then open for up to eight schools, including the current implementing site, to launch or continue TDS for the 2022-2023 school year.

Suicide Prevention

WY MCH contracted with SOS to host two SOS T4T sessions in the summer of 2022 for middle and high school staff, and key community partners, to begin implementation in several new school districts, starting in September 2022. In addition to partnering with WIVPP, the YAYAHP is working with the WDE Substance Abuse and Mental Health Services Administration-funded Advancing Wellness and Resiliency in Education project (Project AWARE) to engage Project AWARE-funded schools to participate in the SOS T4T and potentially leverage Project AWARE funds for program implementation.