MCH Block Grant FY21 Application & FY19 Report

Adolescent Health Domain

NPM-08: Physical Activity: Percent of adolescents in grades 9-12 who report being physically active at least 60 minutes per day in the past week

FY19 Annual Report

Program Activities:

The Performance Measure was achieved. The Performance Objective was 20.0% and the Annual Indicator was 19.1% (YRBS 2017).

The Utah Department of Health, Utah State Board of Education (USBE), and SHAPE Utah partnered to offer two statewide Health and PE Conferences. The Choices conference was held February 5-6, 2019 for secondary health and PE teachers. There were 283 individuals who attended this conference. During this conference attendees were able choose from 50 breakout sessions that focused on a wide variety of health and PE topics.

The Healthy Bodies, Healthy Minds conference was held on June 11, 2019 for elementary classroom teachers. There were 180 individuals who attended this conference. Twenty breakout sessions were offered that provided a wide variety of games-based activities that demonstrated the long-term benefits of play and set the foundation for creating a safe, inclusive, and respectful environment for students. Participants left the conference with ready-to-use group management tools, as well as an understanding of how to select and leverage games that support the physical, social, and emotional development of students.

Accomplishments / Successes:

During FY19, with SHAPE America, SHAPE Utah also started planning the national conference, which would have been held in Salt Lake City in 2020. Due to the COVID-19 pandemic, this conference was canceled.

Action for Health Kids also worked with USBE Jennie Earl on a Utah State Board of Education Best Practice Recess Guidance for Local Education Agencies (https://www.schools.utah.gov/file/6c5c979f-803f-4f10-ad4a-7925a3d1348a). The intent of this document is to provide elementary schools with best practice guidelines for recess. The recommendations support the USBE's Safe and Healthy Schools goal in their strategic plan.

The USBE developed a model health and wellness policy for Local Education Agencies to follow when creating new policies. The model policy outlines the best approach to ensuring environments and opportunities for all students to practice lifelong healthy habits that promote physical, mental, and social health. There were 3 1/2 internal employees, and 1 1/2 Utah Department of Health employees who created language for the model policy. This policy will go before the State School Board in 2020.

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-08:

• Strengthened the relationship between the Utah Department of Health, Utah State Board of Education, and SHAPE Utah.
• Provided professional development opportunities for all PE teachers, PE specialists, Administrators, and elementary classroom teachers to attend.
• Partnered with Utah Department of Transportation to develop Safe Routes to School programs that increase students’ ability to walk and bike to school.
• Created a State Board of Education Health and Wellness Policy for Local Education Agencies to follow.
• 87% of physical education teachers or specialists received professional development on
  physical education or physical activity in the past year.
• 77.9% of schools provide the opportunity for students to be physically active at least 60 minutes during, before, and after school.

Challenges / Gaps / Disparities:

PE teachers consistently have insufficient instructional resources and not enough opportunities to participate professional development.

Additionally, the State Board of Education does not require a certified PE specialist at the elementary level. If the scope and sequence is not taught at the elementary level, it can be a challenge for secondary PE teachers. Also, students are only required to take 1.5 USBE credits of PE in grades 9-12.

Agency Capacity / Collaboration:

Action For Healthy Kids Utah creates healthier schools by bringing all the members of a school community together, and equipping them with the tools and resources they need to make change happen. This coalition includes members representing the State Board of Education, Utah Department of Health, Utah Parent Teacher Association, and other community partners. This past fiscal year we all supported the new Utah Health Standards and Recess Guidance.

Summary Progress Report (2020) of ESMs related to NPM-08*

ESM 8.1 - Schools with CSPAP: Percent of schools within four targeted LEAs that have implemented CSPAP

Goal/Objective:

Increase percent of schools within the four targeted LEAs: Cache, Canyons, Granite, and Salt Lake, which have implemented CSPAP.

Significance of ESM 8.1:

A CSPAP is a multi-component approach by which school districts and schools use all opportunities for students to be physically active, meet the nationally-recommended 60 minutes of physical activity each day, and develop the knowledge, skills, and confidence to be physically active for a lifetime.

ESM 8.1 Progress Report:

We found that providing a CSPAP training during a professional development day was successful. Teachers are already committed or mandate to attend, so we did not have to worry about coordinating a substitute. Having district buy-in to CSPAP also helped provide leverage as to the topic during the professional development learning session. We will continue to promote components of CSPAP during the statewide Secondary Health and PE Conference, elementary Healthy Bodies, Healthy Minds Conference, and promoting the CDC e-learning opportunities. 

ESM 8.2 - Professional Development for Local Education Agencies (LEAs): Number of LEAs receiving professional development and technical assistance to establish, implement, and evaluate the Comprehensive School Physical Activity Program (CSPAP).

Goal/Objective:

Increase the number of LEAs receiving professional development and technical assistance to establish, implement, and evaluate the CSPAP.

Significance of ESM 8.2:

Professional development is designed to actively engage learners. Teachers who attend professional development about physical activity, and who incorporate movement during the school day, will increase student opportunity to be active for 60 minutes a day.

ESM Progress Report:

The focus of the Comprehensive School Health Program (CSPAP) will still continue as we move forward. The EPICC Program, USBE, and SHAPE Utah will continue to provide professional development opportunities to Local Education Agencies, schools, administrators, and teachers to implement components of CSPAP.

*NPM-08 has been dropped following the 2020 MCH Needs Assessment. As we move forward, we will not be reporting on this National Performance Measure. However, we will continue the work on increasing the percent of school aged students who are physically active for 60 minutes a day, as we move our focus to reducing the percentage of adolescents who are bullied on school property. We will create the school environment to that support proactive approaches to prevent bullying on playgrounds such as teaching empathy, creating an inclusive community, developing youth leaders, and encouraging positive attitudes.

MCH Block Grant FY21 Application & FY19 Report

Adolescent Health Domain

SPM-04: Suicide: The rate (per 100,000) of suicide deaths among youths aged 15–19

FY19 Annual Report

Program Activities:

The Performance Measure was achieved. The Performance Objective was 21.5 and the Annual Indicator was 21.3.

Strategy 1:  Evaluate the Utah Violent Death Reporting System, National Child Death Review Database, Prevention Needs Assessment, and the Youth Risk Behavior Survey for their usefulness in monitoring suicide.

Applicable surveillance systems have been evaluated every year using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The results of the yearly system evaluation are kept on file. Utah has seen an increase in the sensitivity of ICD-10 codes in suicides, homicides, and deaths of undetermined intent. This adds to the value of the Utah Violence Death Reporting System (UTVDRS) in providing counts that are more accurate for the manner of death. The VIPP epidemiologists meet monthly to review timeliness measures to ensure continuous program improvement. The sensitivity and predictive value positive of ICD-10 codes in determining the suicide manner of death was 98% and 100% in 2018 and 99% and 100% in 2019, respectively. In 2018, there were 813 UTVDRS cases. Of these, 98.65% had death certificate completion, 98.15% had ME completion, and 79.34% had LE completion. In 2019, there were 774 UTVDRS cases. Of these, 28.42% had death certificate completion, 28.17% had ME completion, and 10.85% had LE completion.

Suicides and the circumstances around suicide have been highly utilized by the Utah Suicide Prevention Coalition. Fact sheets are regularly updated and distributed to partners, the State Office of Education submitted legislative reports using UTVDRS data, the Suicide Fatality Review used data from UTVDRS to identify cases for review, and the state suicide plan is currently being updated using the most recent UTVDRS data. We partnered with several local mental health authorities to provide data for local suicide fatality reviews.

The Office of the Medical Examiner has a Suicide Prevention Research Coordinator. This person works closely with the doctors, and has been reviewing suicide cases, as well as conducting psychological autopsies on questionable cases, to help determine the manner of death. We have been able to work with this person as well to be able to gain access to suicide notes for abstraction of medical examiner cases. We will also be able to have access to any psychological autopsy reports or notes he generates for specific cases. 

Strategy 2: Continue to review all youth suicides in Child Fatality Review and develop recommendations and prevention strategies.

The Utah Multidisciplinary Child Fatality Review Committee (CFRC) reviewed 100% (n = 66) of all suicide related child fatalities statewide during the reporting period. Data from these reviews include recommendations, which are submitted to a national child death review database.  Over the last few years, youth suicides have been increasing in Utah, leading the VIPP to request epidemiological assistance from the Centers for Disease Control and Prevention (CDC) in 2017. Their findings were reported to the Utah Department of Health in November 2017. The full report can be accessed here: http://health.utah.gov/vipp/pdf/Suicide/CDCEpi-AidReport.pdf

As a result of this study, Governor Gary S. Herbert created a Youth Suicide Task Force in January 2018. This task force, chaired by Lt. Governor Spencer J. Cox and Rep. Steve Eliason (Sandy), was charged with identifying priorities, and then to report back on effective programs, tools, and methods in youth suicide prevention in Utah. The report from this task force was submitted to the Governor in February 2018. You can access the report here: https://drive.google.com/file/d/1nKp7kpGF7PpKF962fIDIUyQM6uiiIih9/view
 

This task force report was used to implement or continue some recommendations on youth suicide prevention. One of the recommendations was SafeUT, a statewide crisis and safety tip-line/app for youth that provides real-time crisis intervention through texting and a confidential tip program. This free mobile app provides students anonymous and confidential two-way communication with SafeUT crisis counselors or school staff. Licensed clinicians are available 24/7 in the CrisisLine call center to respond to all incoming chats, texts, and calls. These professionals provide supportive and crisis counseling, suicide prevention, and referral services. Gatekeeper training was provided through QPR (Question, Persuade, Refer) and Mental Health First Aid which are courses intended to train “lay gatekeepers” or “lay mental health first responders” (e.g., parents, teachers, ministers, coaches, advisors, caseworkers) who are strategically positioned to recognize and refer someone at risk of suicide. QPR is the mental health analog of CPR, a rapid, effective approach to a crisis that could lead to potentially fatal self-harm. Mental Health First Aid is both more expansive and intensive, teaching how to identify, understand, and respond to signs of mental illnesses and substance use disorders.

Strategy 3: Identify and target surveillance data for policymakers, schools, local health departments, etc.

School Health Profiles provides a snapshot of health-related education, policies, and programs in Utah schools. The Centers for Disease Control and Prevention, in collaboration with the Utah Department of Health, developed a questionnaire and conducts a survey of secondary schools every other year. The profiles help state and local education and health agencies monitor and assess characteristics of school health programs. They include information on policies related to physical education, tobacco-use prevention, nutrition, asthma management, health services, and violence and injury prevention. Recommendations for violence and injury related efforts to suicide include efforts to align school policies with the best available evidence.

Strategy 4: Develop, staff, and conduct a youth suicide fatality review with partners.

All suicides are reviewed monthly in Child Fatality Review. Additionally, youth suicides have been the focus of several suicide fatality reviews. Goals of the review are 1) to ascertain unique or emerging risk factors, 2) identify diagnoses more in patients who die by suicide, 3) identify risk to others associated with the decedent (contagion, clusters, first responders, informants, etc,), 4) identify system issues that may have contributed to lack of recovery or treatment, and 5) identify foreseeability/preventability of the death.

Over the last few years, suicide by firearm in youth have been increasing. Efforts to promote means restriction and firearm safety among adults who own firearms is of paramount importance, in addition to promoting protective factors such as connectedness among youth.

Researchers at the Harvard T.H. Chan School of Public Health carried out a Utah Suicide Prevention and Gun Study. The study linked data from Utah’s Violent Death Reporting System to criminal background checks, concealed carry permit status, and hospital data to learn, in greater depth, about opportunities to prevent suicide overall and firearm suicide in particular. The study can be found here: https://dsamh.utah.gov/pdf/suicide/Suicide%20and%20Firearm%20Injury%20in%20Utah%20-%20Final%20Report.pdf

Strategy 5: Produce and disseminate a yearly Youth Suicide Fact Sheet.

This fact sheet includes information showing the rates of suicide deaths for ages 10-17 and 18-24, by age and sex. The fact sheet also contained circumstance data to better understand circumstances around suicide, and provided information on warning signs, risk factors, protective factors, prevention tips, and resources. Further data on youth firearm suicides show that 91% of firearm suicides among youth under 18 occurred at home, most of the guns used in youth suicides belonged to the family (68%) or the youth (19%), rifles and shotguns accounted for 62% of rural youths’ firearm suicides, and Utah’s youth suicide rate is similar to its neighbors, but significantly higher than the nation’s. The 2018 Suicide Fact Sheet can be found here: http://www.health.utah.gov/vipp/pdf/Suicide/SuicideInUtah2018.pdf

Strategy 6: Continue distribution of firearm locks and firearm safety brochures to families of teens.

Local health departments distributed 2,413 gunlocks to community members throughout Utah. Gunlocks can be obtained free of charge from any health department, mental health authority, local police station, or by contacting the VIPP. The most recent brochure that is disseminated to communities can be found here:  http://www.health.utah.gov/vipp/pdf/UTVDRS/gun-safety.pdf

Strategy 7: Provide at least five evidence-based suicide prevention-training sessions to teens and/or their families.

During the reporting period, LHDs provided several suicide prevention-training sessions as part of their suicide prevention activities targeting children and their parents. These evidence based suicide prevention programs included 98 community sessions with 2,527 reached.

As a result of data and evaluation efforts, the following implications for prevention have been determined, with parents/guardians having legal authority over nearly 9 out of 10 of the firearms used in suicides of youth under 18, parents are key to prevention; urging parents to lock their guns may not entirely address the youth firearm suicide issue if their teenagers know where the keys are, or indeed own a gun and control the keys, a more useful message may be to lock all guns and ensure children and teens don’t have access to the keys or combination; when a youth is struggling with a mental health or substance abuse problem or life crisis, storing guns away from home may be prudent, parents may be unaware that youth can use long guns to take their lives; some parents who do lock their guns may be unaware their child can defeat the lock; and clinicians, gun owners, and others could work together to develop messaging and storage
options that are sensitive to local values and realities.

Strategy 8: Increase the number of public health partners that are active in suicide prevention activities.

We were fortunate enough to be able to fund all thirteen of Utah's local health departments to provide some level of suicide prevention coordination in their communities. We continue to partner with traditional and non-traditional partners to advance suicide prevention throughout the state. For example, we have a strong partnership with the Utah Shooting Sports Council to provide prevention and messaging around safe storage of firearms.

Accomplishments / Successes:

The Violence and Injury Prevention Program recorded several accomplishments and successes towards addressing adolescent suicides during the reporting period. As a result of VIPP’s request for epidemiological assistance from the Centers for Disease Control and Prevention in 2017, Governor Herbert created a Youth Suicide Task Force in January 2018. This task force, chaired by Lt. Governor Spencer J. Cox and Rep. Steve Eliason (Sandy), was charged with identifying priorities, and then to report back on effective programs, tools, and methods in youth suicide prevention in Utah. The report from this task force was submitted to the Governor in February 2018. You can access the report here: https://drive.google.com/file/d/1nKp7kpGF7PpKF962fIDIUyQM6uiiIih9/view

That report led to several suicide prevention bills and funding allocation from the Utah State Legislature. Unfortunately, the legislature has not allocated any funding to primary prevention of suicide.

The Youth Suicide Prevention Coordinator serves as the Utah Department of Health’s Executive Director’s designee on the SafeUT Commission. The SafeUT App, is a statewide resource that anyone, though particularly targeted to youth, can download on their phones to chat with a crisis counselor 24/7 or put in an anonymous tip if they are worried about a friend. This App receives thousands of tips/chats from Utah youth and is available throughout Utah.

Summary of successes and accomplishments on “Moving the Needle” in relation to SPM-04:

• We collaborated with community partners in the planning, implementation, and
  evaluation of two Youth Mental Health Screening nights in a local health district for junior high and high school students and pre-kindergarten and elementary students, 145 youth and their families attended the events. The events were held to provide access to mental health screening for youth, to link them with appropriate service providers and treatment, and to serve as an early intervention for those in need. Screenings were provided at no cost. As a result of the event, twenty-one follow-up appointments were made and forty-three referrals were given. Every family was given a Youth Services Directory, which contains nearly 150 local services such as medical treatment, counseling, self-care, support groups, classes, crisis lines, etc.
• Suicide prevention activities were emphasized in local health department contracts. During the reporting period, LHDs provided several suicide prevention training sessions as part of their suicide prevention activities targeting children and their parents. These evidence based suicide prevention programs included 98 community sessions with 2,527 reached. Finally, LHDs distributed 2,413 gunlocks to residents in their communities.
• VIPP has focused on shared risk and protective factors to address many violence and injury prevention topics in the state. We have developed a strategic plan focusing on this shared lens and have engaged LHDs in this effort. Identified overarching themes for VIPP’s state strategic plan include, encourage social norms that promote safety and health, improving access and utilization to physical and behavioral health care, enhance the physical environment to improve safe and healthy living, improve the socioeconomic conditions for Utahns, and promoting individual, family, and community connectedness.
  
  As a result of this work, VIPP has continued to be able to engage non-traditional partners, has been instrumental in informing state level work on shared risk and protective factors, has implemented primary prevention trainings to local communities in Utah, has presented on national webinars, had several abstracts accepted to present on this topic, and provided technical assistance and guidance on this approach to reducing child injury deaths in the state.
• The VIPP requested epidemiological assistance from the Centers for Disease Control and Prevention (CDC) in 2017. Youth suicide data was analyzed to better determine trends, common precipitating factors for suicide, and risk and protective factors for suicidal behaviors unique to Utah youth. Their findings were reported to the Utah Department of Health in November 2017. The full report can be accessed here: http://healt h.utah.gov/vipp/pdf/Suicide/CDCEpi-AidReport.pdf
  
  As a result of the report, Governor Herbert created a Youth Suicide Task Force in January 2018. This task force, chaired by Lt. Governor Spencer J. Cox and Rep. Steve Eliason (Sandy), was charged with identifying priorities, and then to report back on effective programs, tools, and methods in youth suicide prevention in Utah. The report from this task force was submitted to the Governor in February 2018. You can access the report here: https://drive.google.com/file/d/1nKp7kpGF7PpKF962fIDIUyQM6uiiIih9/view
  
  That report led to several suicide prevention bills and funding allocation from the Utah State Legislature. Unfortunately, the legislature has not allocated any funding to primary prevention of suicide.

Challenges / Gaps / Disparities:

The adolescent disparity in suicide continues to be investigated to help understand contributing factors associated with the suicide mortality rate among youths. In 2018, VIPP again proposed to add questions the 2019 SHARP survey to measure sexual orientation and its association with suicide and other violence-related outcomes, which have been accepted by the school districts.

Over the last few years, suicide by firearm in youth have been increasing. The year 2018 saw the highest rate recorded for firearm suicide deaths (13.25 deaths per 100,000 youth ages 15-19). Efforts to promote means restriction and firearm safety among adults who own firearms is of paramount importance, in addition to promoting protective factors such as connectedness among youth. In addition, technology as a risk factor for suicide needs to be explored.

Agency Capacity / Collaboration:

Suicide prevention is a cross-program effort involving injury prevention, substance abuse, mental health, and other health professionals. VIPP partnered with multiple agencies and entities to address the suicide prevention among adolescents performance measure. VIPP contracted with all thirteen local health departments to implement evidence-based suicide prevention programs and activities to reduce risk factors and promote protective factors associated with suicide. Local health departments participate on their local suicide prevention coalitions as well as the Utah Suicide Prevention Coalition to coordinate efforts, share successes, and implement best practices. VIPP co-chairs this statewide coalition with the suicide prevention coordinator with the Department of Substance Abuse and Mental Health. 

The four state suicide prevention coordinators, from the Division of Substance Abuse and Mental Health, the Utah State Board of Education, the Utah Chapter of the National Alliance on Mental Illness, and VIPP work together very closely to plan and implement state efforts to prevent suicide and suicidal behaviors as well as leverage resources.

Utah is changing its prevention approach to center around increasing protective factors and reducing the risk factors that most impact violence and injury related outcomes at all levels of the socio-economic model.

National experts conducted a technical assessment of VIPP's injury infrastructure, policy, and programs in the summer of 2018 through the Safe States Alliance State Technical Assessment Team (STAT) program. The STAT assesses injury and violence prevention within the state health agency, focusing on specific roles, relationships, and performance of the designated injury and violence prevention program. The goal is to support the development, implementation, and evaluation of injury and violence prevention efforts at the state health department level by conducting an on-site, point-in-time assessment of the injury and violence prevention program, and providing recommendations for improvement.

The assessment focuses on core components of a successful state health department injury and violence prevention program, including infrastructure, data, and policy and program strategies. For each core component, Safe States Alliance has developed standards and indicators that describe the conditions that should exist within an ideal, comprehensive state health department injury and violence prevention program. The assessment often serves to refocus a participating state by requiring it to reflect on its strengths, weaknesses, opportunities, and barriers to success. The STAT process also serves to bring together different members of the injury and violence prevention community and allows individuals to share ideas for program development.

VIPP STAT recommendations encouraged VIPP to finalize the strategic plan focusing on shared risk and protective factors, prioritize staff activities to meet grant deliverables, prioritize hiring a Suicide Prevention Coordinator, develop a publications protocol, publish timelier reports, and modify LHD contracts to focus on high-impact actions.

*SPM-04 has been dropped following the 2020 MCH Needs Assessment.

Other activities in the Adolescent Health domain that contribute to improvement in the National Outcome Measures 

Utah works to adhere to the three-tier framework outlined in the MCH Block Grant guidance. While the focus of most activities is the ESM →NPM→ NOM framework, activities on improving NOMs outside of the NPMs transpires in parallel. The following programmatic activities also work to improve outcomes in this domain. 

National Outcome Measures (NOM)

NOM 16: a) Adolescent mortality rate, ages 10 through 19, per 100,000
b) Adolescent motor vehicle mortality rate, ages 15 through 19, per 100,000
c) Adolescent suicide rate, ages 15 through 19, per 100,000

In Fiscal Year 2019, MotherToBaby Utah provided education to adolescents about medications used during pregnancy or breastfeeding to treat mental health conditions. MotherToBaby Utah provided education to women, their providers, their partners, and other clients regarding the benefits and risks of medications compared to untreated mental health conditions in an effort to help women remain healthy and avoid complications that could result in adverse outcomes for women of childbearing age including adolescents.

Adolescent suicide rate, ages 15 through 19, per 100,00:  The Social Emotional Learning and Askabale Adult toolkit is a new project out of the Family and Youth Outreach Program. Its goal is to increase the ability of parents and paraprofessionals to effectively support youth with disabilities by providing professional development and parent education training. This will introduce paraprofessionals and parents to skills that build social emotional learning skills, increase positive adult-teen communication, and strengthen relationships with young people. During FY 2020 the progress included receiving internal approvals for contracting with training developers and buying the training materials, coordinating an on-line training for paraprofessionals with the SEL toolkit developers, going to the Safe and Healthy schools conference to promote the project, coordinated and hosted the in-person TEEN Speak Training of Educators workshop with developer. Between February 2020 and March 2020, FYOP worked with the SEL Toolkit developer to create four videos that explain each toolkit section. These videos are now the self-paced SEL Training for school paraprofessionals (and other school personnel). After the COVID-19 restrictions started, the in-person trainings stopped (UDOH employees are not allowed to do in-state or out of State travel so far until September 2020). FYOP reached out to the TEEN Speak developer to find out about the possibility of doing the workshops virtually. By May 2020, the TEEN Speak guide to implement the workshops via ZOOM became available. Park City School District was the first one to implement TEEN Speak workshops virtually towards the end of May. FYOP encountered internal hurdles regarding the use of ZOOM, but is going through the process to receive approval to use it. FYOP worked with the Utah Department of Technology Services to create a website where the self-paced SEL Toolkit training is housed as well as TEEN Speak training calendar and material order form. The page fyo.utah.gov will go live in mid-June. After implementing the tools that the participants learned through training, they reported that they saw improvement in the youth with whom they work.