BWCH administered several adolescent-focused initiatives and placed high priority on adolescent health and addressed NPM 9: Bullying and NPM 10: Adolescent Well-Visits. The initiatives in 2020 focused on bullying prevention, teen pregnancy prevention, adolescent wellness visits, and family planning. BWCH’s Chief of Women’s Health serves as the State Adolescent Health Coordinator (SAHC) and serves as the Secretary on the National SAHC leadership team.

Bullying prevention efforts continued to target school-aged children through an awareness campaign stressing to young people that showing simple acts of intervention can make a positive difference. The messaging mobilized youth to report incidents of bullying to trusted adults and take steps to safely intervene when witnessing bullying acts. The paid media spots aired on social media, YouTube, and digital platforms such as Pandora, Fandom, etc. BWCH partnered with the Phoenix Suns basketball team for another successful campaign promoting the bullying prevention website muststopbullying.org to their fan base. The campaign included “takeover” ads of the Suns’ website and app, social media, spots during the Suns radio and television game broadcasts, and in-arena signage.

To better prepare principals, teachers, and others working with youth to understand and address bullying prevention, BWCH continued to fund activities with an internationally recognized expert on bullying to coordinate trainings with schools, school districts, and community organizations. Three trainings were offered: Bullying and Cyberbullying, Protecting against Cyberbullying, and with the pandemic closing schools and youth moving to a virtual learning environment, “Your Home Climate During the COVID-19 Outbreak” addressing how to create a positive homeschool climate during the COVID-19 outbreak, one that promotes resilience and protects children from toxic stress and cyberbullying. In 2020, 24 in-person and virtual trainings were conducted with over 697 parents, teachers, administrators, and direct-care professionals, from over 28 different school districts. In total, they represented more than 260,000 students.

With a combined funding of Title V and Lottery dollars, BWCH continued to work towards increasing the percentage of adolescents with a preventive visit by continuing to implement the University of Michigan’s Adolescent Champion Model (ACM) in Arizona to create youth-centered medical practices. The second cohort of clinics was scheduled to begin in spring 2020; however, with the onset of the pandemic and the Governor’s stay-at-home order, the start of the cohort had to be postponed to summer 2020, with activities resuming in June 2020. Early on in the pandemic, participating health centers had to prioritize critical health services and had to pause their activity on the ACM. Limitations on in-person interaction required adolescent well-checks to be postponed (unless a vaccine was needed), which resulted in a decline in patient volume. Though health centers virtually met with their ACM teams, program requirements for meeting Spark trainings could not be facilitated, as the day-to-day logistics of managing through the pandemic took priority. This also delayed the start of a third cohort, which would typically have started in the fall but had to be pushed back to spring 2021.

An e-learning module on Adolescent-Centered Virtual Care was created, which included  subject matter experts (SMEs) from past and current Champions and young adults in the video. The objects for the module included:

• Increase providers’ understanding of how to be adolescent-centered in a virtual setting;
• Best practices and the latest trends in virtual care for adolescents;
• Practical strategies and skills to implement adolescent-centered virtual care; and
• Adolescents’ perspectives on their preferences and priorities when they participate in virtual visits.

For practices not yet able to completely commit to becoming a participant of the ACM project, a Maintenance of Certification (MOC) (Appendix Q) geared toward increasing rates of adolescent well visits was developed through the ACM project. This adolescent well check improvement module was launched in June 2020 and 69 practices across the Phoenix Children's Care Network (PCCN) participated. Practice integration representatives and champion clinicians for the practices meet with the practice manager monthly.

BWCH’s Chief of the Office of Women’s Health represented ADHS in a newly convened steering committee of adolescent health and social service providers to look at how Arizona can provide health equity statewide for youth. Using ADHS’ recent Title V needs assessment data, a short-term steering committee was developed to identify priorities in the following focus areas of medical care and services, mental health, oral health, social determinants, special populations, and reproductive health. The aim was to develop a forum to connect and share best practices, identify common problems, and develop innovative strategies to overcome barriers for providing high-quality health and social services for adolescents. The group, formerly called the Adolescent Health Alliance, will continue to meet and BWCH will continue to participate and determine how it can best support this group. This steering committee may be able to serve as the core for the efforts needed to institute a statewide coalition.

BWCH participated in the state leadership team for the Comprehensive School Mental Health Collaborative Improvement and Innovation Network (CoIIN) Project, spearheaded by the Arizona Department of Education (ADE), which included representation from state partners such as the Governor’s Council on Youth, Faith and Family, Arizona State University, Arizona Health Care Cost Containment System (AHCCCS), and First Things First, as well as a parent and youth representatives. The state team worked to assist ADE and its seven participating schools to improve the quality of comprehensive school mental health systems and strengthen the sustainability and growth of evidence-based models of school-based health services. The state team served as a steering committee to share resources and opportunities to enhance mental health services for youth. The CoIIN project was timely and came on the heels of Arizona SB1468, passed in the 2019 state legislative session, which requires guidance counselors, teachers, principals, and other school staff who work with 6th-12th grade students in public and charter schools receive suicide prevention training.

Plans for 2020 included the development of Youth Advisory Groups to provide guidance, assist with planning, and lead adolescent-focused projects. The project was postponed to June 2021 with the release of a solicitation to begin funding groups in January 2022. This extra time allowed the Bureau more time to research, better prepare, and ensure the success of the youth groups, not only in serving their communities but in having a true youth voice in state-led youth initiatives.

The Teen Pregnancy Prevention (TPP) Program continued to receive both state lottery and federal funds to provide three (3) strategic approaches across the state—Abstinence, Abstinence Plus, and Parent Education—to reduce and prevent teen pregnancy by implementing evidence-based and evidence-informed curricula. ADHS managed 34 contracts with services delivered by county health departments and community-based organizations in all 15 counties of the state and two Tribal Nations - White River Apache and Pascua Yaqui. The program focuses on providing services to youth 11-19 years of age with an emphasis on populations with higher teen pregnancy rates: American Indian, Hispanic, African American, and youth in foster care.  While the program was offered statewide, the emphasis was to provide services in communities with high teen birth rates and/or communities that are underserved or unserved.

Due to the increasing rates of COVID-19, Arizona Governor Doug Ducey announced a statewide school closure through an Executive Order from the end of March 2020 until the end of the 2020 school year. As a result, teen pregnancy prevention (TPP) services were immediately disrupted. A few programs and schools within the state were equipped to continue providing services via an online format, but for the most part programs were cancelled for the remainder of the school year. To continue programming and strategic activities for youth in schools and other sites that are in a virtual learning environment, a sustainability plan was developed. The guidelines provided in the plan were intended to assist TPP contractors to effectively leverage resources and gain the overall capacity to adapt to changing needs, resulting from the impacts of the pandemic and for any other public health emergency. The Sustainability Plan drew together a variety of state and national resources that provided guidance on how to successfully deliver engaging, virtual programming while remaining compliant with state and federal requirements.

TPP utilized state lottery dollars to fund 14 county health departments and two tribes (White Mountain Apache and Pascua Yaqui) through a contract with the Inter Tribal Council of Arizona.  These contractors provide Abstinence Plus programming to youth. The federal Personal Responsibility Education Program (PREP) funds supported six additional contractors to provide evidence-based Abstinence Plus services and education on topics that will facilitate youth transition to adulthood. Abstinence Plus providers delivered services to a total of 7,978 youth.

Abstinence education services were provided through classroom instruction by six community-based organizations funded with state lottery dollars and seven additional organizations funded through the federal Title V State Sexual Risk Avoidance Education (SRAE) grant. Abstinence providers delivered services to a total of 6,388 youth.

SRAE and lottery-funded Abstinence Plus and Abstinence programs provided education to 442 parents. Parent education sessions provide information to help parents/guardians facilitate conversations with their youth on sexual health topics as well as other topics, such as healthy relationships.

In an effort to meet the ongoing need for professional development, the TPP program coordinated a virtual summer training series between the months of May through August for contractors and partners. TPP hosted several curricula certification trainings and topical trainings related to working with youth, such as positive youth development, gender inclusivity, and human trafficking.

With support from the Governor’s Office, ADHS launched a project intended to increase access to screening and treatment to control the spread of STDs among adolescents and other populations in Arizona. As part of this project, ADHS hosted a stakeholder meeting where TPP was identified as a key partner that could help implement defined steps, develop implementation strategies, and define timelines and outcomes. TPP participated in this stakeholder meeting and provided input within various breakout groups to help the STD Control Program to better understand how to address root causes of disease and identify strategies to streamline efforts to link persons more efficiently to prevention and screening resources. An Action Plan was later developed based on the recommendations and strategies from the stakeholder meetings to help control the spread of STDs in Arizona.

Arizona’s Sexual Violence Prevention Strategic Action Plan for 2020-2025 put forth strategies that focus on increasing access to developmentally appropriate sexual violence prevention education for children in grades K-12 in addition to diverse, underserved communities. Due to a severely delayed procurement process in awarding new contracts due to the COVID-19 pandemic in 2020, the new five-year contract period began in November 2020. Despite the challenges, seven sub-recipients representing all regions of the state of Arizona are continuing to implement strategies to support the Rationale Approaches and Evidence sections of the CDC STOP SV Technical Package that are specific to preventing sexual violence in communities. Additionally, the Sexual Violence Prevention Program developed a Sexual Violence Prevention Toolkit aiming to educate people who work with victims of sexual violence or domestic violence, particularly during this critical time of the global COVID-19 pandemic, to better serve those who may be experiencing sexual violence or intimate partner violence. The toolkit will be translated to Spanish in 2021. The toolkit was developed using CDC-funded Public Health and Health Services Block Grant sexual violence prevention funds.

The Sexual & Domestic Violence Program, now located in the Bureau of Chronic Disease and Health Promotion was not able to develop the Arizona Prevention Leadership Cohort and activities as originally planned due to the grant funding cycle ending in January 2020 and a severely delayed procurement process preventing new contract awards from being executed. The COVID-19 pandemic also caused programmatic disruptions due to school and business closures during the reporting period. However, new five-year contract awards were executed in November 2020 with sub-recipients represented from the Northern, Eastern, Southern, Western, and Central regions of the state, including the state domestic and sexual violence coalition and university systems.

Several County Health Departments, using Title V funds provided through the Maternal and Child Health Healthy Arizona Families Intergovernmental Agreement (MCH HAF IGA), implemented strategies to decrease the incidence of injury among youth in their communities. Four counties (Apache, Navajo, Pinal, Yuma) implement Battle of the Belt, a program that promotes seat belt usage and good driving habits in school communities. Typically, each school develops its own activities and conducts four on-campus seat belt checks per year. The educational messaging for the program is developed by the youth to ensure buy-in from their peers. The Injury Prevention Program in the Bureau of Chronic Disease and Health Promotions works directly with the Counties to implement this program. School closures due to the COVID-19 pandemic disrupted programming for the 2020-2021 school year. In fall 2020, the Injury Prevention Program Manager and the Title V Block Grant Program met with MCH HAF IGA program managers from the four counties to develop a knowledge, attitudes and practices (KAP) survey on students’ seat belt use that could be used in place of the on-campus data collection activity. Unfortunately, in fall of 2020 none of the partner schools were open to implementing the Battle of the Belt program due to their focus on the challenges of the remote learning environment and stress around the decision of when to open for in-person instruction. County partners hope that the survey will be used in 2021.  

In summer 2020, three counties (Coconino, Pima, Pinal) met to strategize and coordinate teen safe driving messages (i.e., education on the importance of not texting while driving, etc.). The Arizona Title V Program is trying to take a more proactive role in coordinating peer-to-peer learning and collaboration across counties for the strategies and activities being implemented under the Title V-funded MCH HAF IGA. Unfortunately, this is another prevention activity that was sidelined as COVID-19 incidence and deaths rose in the fall of 2020, and county health department staff were pulled into the pandemic response (e.g., contract tracing, vaccine rollout, testing referral, etc.).

Four counties (Pima, Pinal, Yavapai, Yuma) are working on bullying prevention strategies through MCH HAF IGA funding during state FY21 (Jul 2020-Jun 2021). In addition, Maricopa County is working to provide guidance and support for school professionals to use trauma-informed approaches to better understand and address ACEs. In 2020, all four counties continued to meet with participating schools and different bullying prevention workgroups and coalitions. Unfortunately, due to COVID-19-related school closures and other disruptions, none were able to provide bullying prevention training for students or school staff. Pinal and Pima counties adapted the bullying curriculum for the virtual platform; however, when Pima County offered this virtual training to over 600 K-12 schools (and advertised it through other listservs and groups), not one teacher signed up. Pinal County also shared a number of social media messages on bullying/cyberbullying and caring for your mental health in a virtual environment via Facebook, Twitter and Instagram. Maricopa County released an RFQ in October 2020 to award grant money to schools to implement trauma-informed strategies on their campuses.