ANNUAL REPORT: Adolescent Health 

Adolescence is a critical transitional period that includes the biological changes of puberty and development to adulthood.  The behavioral patterns established during these developmental periods can protect them or put them at risk for a myriad of physical and mental health conditions.  Older adolescents and young adults, including those with chronic health conditions, may face challenges as they transition from the child to the adult health care system, such as changes in their insurance coverage, legal status, decreased attention to their developmental and behavioral needs. Rhode Island identified increasing the capacity and efficiency of the adolescent system of care as one its state priority needs.  Even though NPM 12 (adolescent healthcare transition to adulthood) was chosen, RI monitors and addresses many other adolescent health issues including teen pregnancy, teen obesity, and behavioral mental/health. 

 

 

Train & support Patient Centered Medical Homes (PCMH)-Kids and adult practices, including care coordinators, on transition resources (Got Transition, transition policies, transition readiness assessment, portable medical summary).   

RI Transition Council – The Adolescent Transition Program joined the Rhode Island Transition Council (established by state law) in 2008 and continued to participate as a key partner with other state agencies, local education agencies, parents, and students to work toward the Council’s goal to enable students (including those with special needs) to successfully transition to adult life in their community. The Transition Council framework focuses on five areas of transition policy development: student focused planning, student development, family involvement, program structure and interagency collaboration. These focus areas are also addressed in the State Plan developed by the RI Transition Council with support from the National Technical Assistance Center on Transition (NTACT) institute.  RIDOH staff regularly attend Transition Council meeting and provide technical assistance, resources, and advise on health related topics.  

 

Transition Materials – The Adolescent Transition Program has developed educational materials and resources to assist RI students (including those with special needs) and their support teams in transition planning. Materials include a Youth Transition Workbook and a series of transition checklists entitled Ready? Get Set! Go! The checklist series modified (with permission) by Rhode Island, provided an online fillable format as a tool to support the accomplishment of transition activities and have been incorporated into life skills programs, service care plans, and individual education programs.  

 

Build self-determination skills among youth.   

Dare to Dream Initiative:   In May of 2009, the RI Department of Health (RIDOH) in collaboration with the RI Transition Council sponsored a statewide initiative and the first student leadership conference entitled “Dare to Dream” (D2D). Modeled after the Dare to Dream initiative developed by the State of New Jersey, the goal of the conference was to provide a forum for high school students (including those with special needs/disabilities) to begin to explore transition from school to adult life and develop self‐determination and self‐advocacy skills. Held on a college campus within the State of RI, the student led leadership conference provides youth with a forum for skill building through peer led workshops addressing topic of relevance to adolescent transition and workforce development.  This past year, RIDOH launched Dare to Dream 2.0 Youth Conference on May 23, 2019 at the University of Rhode Island which was attended by over 486 students and 190 teacher/support staff from 45 different schools. The conference was supported by two (2) partner state agencies including: the RI Office of Rehabilitation Services and RI Department of Education to provide programming to address social emotional health, exploration of personal strengths, and tools for resiliency. The 2019 conference themed ‘My Abilities, My Superpower’, featured engaging guest speakers, as well as an array of interactive workshops centered on knowledge and skill building. The format was designed to empower students, help them to identify and build on their strengths through teambuilding, while incorporating fun activities such as music, dance, yoga, fitness, and photography. The D2D Youth Conference scheduled for May 2020 required rescheduling due to the COVID-19 crisis and the movement of the Rhode Island School System to virtual learning.  Planning for the next annual youth conference will be resumed in accordance with the scheduled return of Rhode Island schools to on-site learning.   

 

Employment First - In 2014, Rhode Island rolled out the Employment First Initiative to promote community-based, integrated employment as the first option for employment services for individuals with special needs and disabilities. The Employment First initiative encourages youth with special needs and disabilities in transition to pursue real work experiences while working with community-based supports.  Rhode Island is part of the national movement toward a greater emphasis on community employment that echoes a general shift toward services designed to integrate individuals with special needs/disabilities into their communities to afford them the same opportunities as people without special needs/disabilities.  The RIDOH has supported Employment First since initial roll-out and throughout this grant reporting period through the development and implementation of youth initiatives. The RIDOH Youth Advisory Committee, Youth Internship Program, and Dare to Dream Youth Conference are included in these initiatives that provide youth with special needs and disabilities with information, resources, and experiences that promote successful transition to employment and independence. 

 

Youth Advisory Council – In 2013, the RI Department of Health (RIDOH) implemented a Youth Advisory Council (YAC) to provide youth/ young adults, ages 14-24, with a forum for connection to other youth and an opportunity for leadership skills development.  Since the inception, the YAC has advised and collaborated with various RIDOH programs affecting the health, wellness, and transition of youth (including those with special needs/disabilities).   

 During the last Title V reporting period, the YAC membership included sixteen (16) youth who met monthly from September 2019 through March 2020 to participate in educational and training sessions that   focused on: professional development, soft skills building, and project event planning/ facilitation. Meeting agendas also included presentations from skilled professionals on topics including CPR/First Aid, strengths discovery/building, emotional resiliency/stress relief, and self-advocacy. In addition to regular meetings, Advisory youth were provided with monthly leadership opportunities through volunteer participation at various community youth events including summits, conferences and focus groups.   

   Despite the meeting year ending early (due to COVID) necessitating the cancellation of several significant planned events (Youth Transportation Training, Dare to Dream 2.0 Youth Conference), the YAC had a stellar year. Highlights included: “Youth Voice” presentations to the RIDOH MCH Policy Committee and a City Summer Work Readiness Program. Several members also worked on a workshop session presented at the National CityMatch Conference held in Providence, RI entitled “Can You Hear Me Now, Ensuring Youth Voice through Youth Advisory Councils”.  In addition, a YAC member was also nominated and selected to be the AMCHP Ryan Colburn Scholarship winner for her work as a youth advocate with a disability.    

RIDOH Youth Internship Program - The RIDOH Youth Internship program places transition age students including those with special needs/disabilities throughout the Department in various program areas. The Internship Program is designed to assist RI high school students in career exploration and to allow them to become familiar with the expectations and norms of a real work setting.  Over the past year, the RIDOH Youth Internship Program provided seven students from various Transition Programs and Academies throughout the state with opportunities to practice job skills in a real work setting.  The participating Rhode Island schools included: Central Falls High School Transition Program (2) students; Lincoln High School Transition Program (1) student; Providence Autism School to Tomorrow Academy (1) student; West Bay Collaborative Transition Academy (1) student; Shea High School (1) student: and William Tolman High School (1) student. The RIDOH programs that participated in providing internship placements for the students  included: Center for Preventive Services (Family Planning, Immunization, Woman Infants & Children); Center from Health Promotion (Traumatic Brain Injury); Center for Health Data & Analysis; Center for Healthy Homes; Health Equity Institute; and the Distribution Center. A waiting list for students whose internship was scheduled to begin in March 2020 was unfortunately interrupted by the COVID 19 pandemic emergency.   

The RIDOH Internship Program “Promising Practice” award by AMCHP and the Pulse newsletter article was utilized to promote the program and foundation to other state agencies and non-profit organization.    

 LINK: http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/
RIDOH%20Intership%20Program.pdf  

http://www.amchp.org/AboutAMCHP/Newsletters/Pulse/JulyAugust2019/Pages/
State-Internship-Program-for-CYSHCN-Pays-Dividends.aspx  

 

Teen Outreach Program (TOP) - Teen Outreach Program (TOP) - TOP has served approximately 700 youth since 2013.  The program served 149 youth in the 2019 – 2020 program and it is estimated that the program will serve at least 200 youth in 2020-2021.  In terms of program success, overcoming the barriers of school district administration and accessing youth in the classrooms during the school day were quite significant.  This year, youth from Tri-County Community Action’s TOP club in North Providence, worked in collaboration with local and regional Substance Abuse Prevention Coalitions to organize an activity in four local liquor stores. Students placed stickers, warning about the dangers of underage drinking, on cases of alcohol. Their story was featured on the front page of The Valley Breeze, a local newspaper. Connecting for Children and Families held a donations drive for their local animal shelter at a Woonsocket Middle School. The students created signs to hang around the school and decorated donation boxes. The drive was successful, and the Facilitator was able to donate many boxes of cleaning supplies, pet toys, blankets, and dog and cat food to the local animal shelter. Many partners were able to adapt their clubs to reach students virtually during the COVID-19 pandemic. Virtual meetings allowed a space for students to discuss their concerns about COVID-19, connect with others, and continue community service-learning projects.   

 

Princes 2 Kings (P2K) – P2K is a youth mentorship program that combines academics and tutoring in Science, Technology, English, Art, and Math (STEAM), athletics, cultural enrichment activities, and workforce development for program participants year-round. Supported by a grant from the Federal Office of Minority Health,  P2K is a collaborative effort between the RIDOH, the Boys and Girls Club of Providence, Roger Williams University, and Brown University School of Public Health.  The primary objective of P2K is to address low high school graduation rates (a key social determinant of health), among Hispanic, Black, and Southeast Asian males 12 to 18 years of age. Low graduation rates are associated with a number of poor economic and health outcomes (e.g., poverty, poor mental health, teen pregnancy, and chronic disease). 

P2K is divided into two components: Academic Year Program and Summer Enrichment Program. The Academic Year Program coincides with the Providence Public School District’s calendar. The summer program consists of a Civil Discourse program where P2K youth engage with local activists, lawyers, and environmental specialists to discuss the impact of environmental justice issues on the local community. The Academic Year Program is held at the Boys & Girls Clubs of Providence South Side Clubhouse where activities take place three days per week (Tuesday, Wednesday, and Thursday) with optional Saturday field trips. During the week, activities run from 4:00 PM to 8:00 PM with an optional teen hour from 8:00 PM – 9:00 PM. Due to COVID-19, programming has shifted to virtual engagement and food delivery to program participants.   

 

Initial evaluations efforts have found that P2K has high levels of acceptability from program participants and their families as well as strong support from community members and organizations.  Further findings suggest that P2K is meeting the academic, emotional, and social needs of program participants.  Further evaluation efforts will determine how the program supports achievement of improved grades and behavior.  Currently, there are 64 participants in the P2K program. 

 

Girls Empowerment Mentoring Support (RI-GEMS) – RIDOH seeks to reduce the impact and prevalence of violence and trauma among at-risk young women of color through opportunities to learn skills and gain experiences that contribute to positive social environments and healthy life choices.  RI-GEMS is an innovative approach to empower young women of color to achieve academically and become leaders in their community.  This year RI-GEMS provides year-round mentoring, academic support, and leadership development programming to a cohort of 62 young women of color who attend two middle schools in Providence, RI. The academic-year component of the program emphasizes academic performance and developing social and non-violent skills. The six-week summer component of the program focuses on summer learning loss prevention, community building, and social and emotional learning.  This work builds on the successful RIDOH funded P2K program.   

 

Develop a Web-based resources (ri.medicalhomeprotal.org) to provide a consumer-friendly way to navigate the CYSHCN system of care that includes robust transition resources. 

 

The Medical Home Portal(MHP) - www.medicalhomeportal.org is an online resource established by the RI Department of Health (RIDOH) to provide a one-stop-shop for comprehensive diagnostic, education, specialty care, social service, and resource information to improve the system of care and health outcomes for CYSHCN.  The MHP addresses specific informational areas for: Diagnosis and Conditions; Physicians and Professionals; and Parents and Families. The MHP was developed in 2016 through a partnership between the RIDOH and the University of Utah and has been an on-going contractual collaboration since to build the RI Resource component of the portal directory that includes state specific provider and service information.  As of June 2020, the number of listings in the RI Service directory was 755.   

 

The RIDOH convenes an Advisory Committee comprised of families, partner state agencies, community stakeholders, health professionals, and advocates to provide guidance and oversight of the MHP. In addition to the Advisory Committee, the RIDOH also participates as a member of the Medical Home Portal ‘s State Partners’ Advisory Board to ensure content integrity, an   improved avenue for resource navigation, and a mechanism for user feedback/utilization tracking. The MHP recently benefitted from a collaboration with experienced families of CYSHCN for enhancement of the RI Emergency Preparedness section of the MHP to provide Crisis Preparedness Tips for Families of Individuals with Special Needs/Disabilities and a Crisis Preparation Passport.   

  

Resulting from the 2020 pandemic crisis, a Covid-19 Section was incorporated into the MHP to share vetted information on health insurance, safety guidelines, community supports, and tools to help families and professionals caring for CYSHCN.    

The past grant reporting period showed a dramatic increase in users among families and professionals and has been visited over 13, 000 times. Data collection is captured through google analytics for monthly reporting on number of users, type of device used, and top twenty (20) viewed pages and state locations.   

 

 

 Youth and Young Adult Leadership in Health Equity Zones (HEZs) 

At the start of the 2019-2020 reporting year HEZs were surveyed to assess their interest and needs around youth/young adult development and leadership (Y/YALD). The results indicated a need to train adults in authentic youth engagement while furthering opportunities for youth leadership and development across the HEZ Initiative. A HEZ wide Youth Advisory was formed, and all agreed that what was needed was funding for a Youth Engagement Consultant (YEC) to elevate youth voice in all priority areas within the HEZ network by providing assessments and recommendations. The HEZ YEC would also  be responsible for collaborating with the HEZ youth engagement advisory to assess HEZ strategies concerning youth engagement. It was also agreed that the HEZ YEC would assist in developing a resource library of best practices and tools to initiate/improve youth engagement, maintain consistent communication with the Rhode Island Department of Health (RIDOH) HEZ leadership and other relevant staff, implement quality improvement measures to improve HEZ efficiency and outcomes in relation to youth voice, and will assist in youth engagement policies and programs as appropriate. The work of this group was put on hold in early March due to COVID-19. 

 

Engaging Youth in Community Planning 

In 2018-2019 the RIDOH Youth Advisory Council (YAC) collaborated with the Pawtucket/Central Falls HEZ (PCFHEZ) evaluation team to recruit participants for a young adult focus group  “Community Conversations: Help solve the substance use in Central Falls and Pawtucket.”  Youth leaders from the community participating in this project identified opioid education and awareness as a need, and became part of the PCF HEZ Opioid Action Plan. This plan incudes substance use education for youth, and positive social opportunities and employment opportunities for youth and young adults. The PCFHEZ offered substance use education programs that reached 216 students at local schools. In a post-presentation survey, 91% of students reported that the presentation helped them understand how opioids affect the body, and 92% of students reported feeling very or somewhat confident that they would be able to help someone in the case of an overdose. The PCF HEZ also developed plans to strengthen their collaborative by establishing a youth engagement taskforce (work group) to identify specific needs for youth and youth serving organizations in PCFHEZ. 

 

Engaging Adolescents in Community Assessments 

The Cranston Health Equity Zone, a new HEZ in their first year of development, engaged youth and young adults in their initial community assessment process. They developed a teen focused survey and collaborated with a middle school within their target area to administer the survey to students. This resulted in incorporating teen input around education, safety, and health for their community into the Cranston HEZ 2020-2021 workplan to bring trauma informed training to schools in the Cranston HEZ. 

 

The East Providence Health Equity Zone, another new HEZ, also engaged youth and young adults in their initial community assessment process. In response to their findings, the EP HEZ plans to establish  a Youth Health and Wellness  workgroup to further explore and to develop plans to address areas of concern identified by the youth, including bullying and substance misuse. 

 

Engaging Adolescents in Health/Wellness 

The Woonsocket Health Equity Zone continues to provide sex education curriculum to all ninth grade students at Woonsocket High School and ongoing, open-door support from the sex education provider. Additionally, the HEZ has partnered with a local school-based community organization and the RIDOH Adolescent Health Program to develop Family Planning messaging via social media. The local school-based CBO also provides a holistic health and wellness curriculum with a leadership component requiring students to develop a health or wellness related leadership strategy  to present to their community or school. The program awards .25 credit when students complete the program. This ongoing work in the HEZ has contributed to a 30% reduction in teen pregnancy since 2014.  

 

Statewide Adolescent Health Strategic Plan – Rhode Island’s Adolescent Health Strategic Plan utilizes Healthy People 2020 and Maternal and Child Health’s Title V performance measures as a guide in identifying these health priorities. This plan discusses each health priority by presenting an overview of the issue and providing a snapshot on how it is affecting different segments of the adolescent population. The Adolescent and School Health program at RIDOH identified overarching goals and guiding principles that support the plan.  The eight key areas each have specific goals and objectives needing action to improve the health status of adolescents in RI through 2022. The goals and objectives were developed based upon existing data, current research, identified gaps, and by integrating initiatives supported by collaborating partners. Best practice strategies for achieving the goals and objectives will be discussed in the strategic plan to address the unique health needs of adolescents.  Currently the version is in its final draft, and circulated for editing and final comments.  

 

Social Media Marketing and RIghtTime App – In 2019-2020, the Center for HIV, Viral Hepatitis, STD and TB Epidemiology (CHHSTE) continued its collaboration with RIDOH’s Family Planning Program to promote the RIghtTime app. The mission of this app is to help adolescents and people of all ages and genders to navigate an increasingly complicated landscape of information surrounding sexual health. In 2019-2020, we continued promotion of the app and raised awareness about HIV/STD prevention, testing, and treatment through social media, as well as through tabling at athletic and community events (such as Pawtucket Red Sox and Providence Bruins games, the Rhode Island All-State High School Sports Awards, Rhode Island Pride, and the Washington County Fair). We have also continued building partnerships with healthcare providers, community organizations, and educator organizations such as the Rhode Island Healthy Schools Coalition, the Rhode Island School Nurse Teacher Association, and the Rhode Island Association for Health, Physical Education, Recreation, and Dance and presented workshops and training opportunities promoting RIghtTime as a sexual health resource for youth, educators, and parents.  

 

RIDOH Partnership with RI Healthy Schools Coalition - During 2019-2020, RIDOH continued to work with the RI Healthy Schools Coalition (RIHSC) to engage school districts in assessing and implementing positive change related to Adolescent Sexual Health (ASH). Efforts continued to focus on raising greater awareness of Adolescent Sexual Health as a part of comprehensive health education, developing policy, and providing school committee members, administrators, educators and nurses with tools and resources to improve education and access to services in their schools. During the past 12 months, RIHSC: 

 

•       Presented an Adolescent Sexual Health workshop for RI School Committee members, in coordination with the RI Association of School Committees (RIASC), with 24 highly engaged attendees, representing 19 RI school districts, which served as an introduction to the need and urgency of improving adolescent sexual health. Attendees returned to their district school and wellness committees to secure support for next steps. 
•       Developed an Adolescent Sexual & Reproductive Health Assessment Tool, based on the National School Health Index and RI specific regulations and data points, to help districts self-assess policy, practice and professional development around this topic. 
•       Developed accompanying Resource Sheets for the Tool to provide information and possible action steps for improvement. 
•       Created ASH in the Schools: The Basics for district stakeholders, a document that explains/reinforces the importance of adolescent sexual health in schools and introduces the Assessment Tool. 
•       Provided technical assistance to two school district wellness committees (Pawtucket and Smithfield) as they completed the self-assessment and identified next steps. 

•       Created a RI Sexual Health Education Requirements Summary document for districts to more easily see provisions pertaining to ASH, with information extracted from the 3 extensive documents that dictate all health education standards, requirements and educational outcomes for RI schools. 

 

Vaccinate Before You Graduate (VBYG) – RI has conducted school located vaccination (SLV) clinics every year since 2001 through our Vaccinate before You Graduate (VBYG) program.  VBYG is a “catch-up” school-based vaccination program initially targeting high school seniors but has expanded in recent years to include all students in middle school and high school.  The goal of the program is to ensure that students have access to all routinely recommended vaccines and are fully immunized before graduating from high school and entering college and/or the workforce.  All vaccines recommended for adolescents by CDC’s Advisory Committee on Immunization Practices (ACIP) including influenza are available through the VBYG program.  The program has been acknowledged for its innovative approach to improving adolescent access to vaccines and has helped in our work towards reaching state and national immunization goals.  In 2018, RI was recognized for achieving the highest adolescent immunization coverage rates compared nationally at the National Immunization Conference. During school year 2019-2020, a total of 95 schools participated in VBYG program.  A total of 1,825 students received one or more vaccines through the program and 3,776 vaccine doses were administered. With the early closure of schools due to the COVID-19 response, less clinics were held and therefore less students were vaccination than previous years.   

 

Conference on Youth Sexual Health Education - In partnership with the RI HIV & STI Prevention Coalition, RIDOH hosted the seventh annual RI Conference on Youth Sexual Health Education (CYSHE) on May 10, 2019.  CYSHE reached over 100 youth serving providers to improve professional capacity to address the sexual health needs of youth in a positive, safe and supportive environment with improved knowledge, comfort, skills, and resources.  The key note speaker was Lorena Olvera Moreno, PhD, MEd, MPsT, is an educator and Fulbright awardee with more than 10 years of experience within the fields of sexuality education, reproductive justice, and reproductive health. Her talk “Honoring Marginalized Communities through Intersectional Sexuality Education” recognized the complexities of oppressed young people’s sexual and reproductive lives, and described the framework of intersectional sexuality education as it applies to youth. 

 

The Violence and Injury Prevention Program (VIPP) -  

collaborates with RI Student Assistance Services to implement a 12-session emotional regulation pilot program in two middle schools. This intervention targeted students who were referred by school professionals. In addition, the MCH Program supported work with the Brain Injury Association of RI to provide ImPACT Neuropsychological Baseline Testing to high school youth who participated in school sports and youth athletic leagues. This program also provides concussion recognition and brain safety informational presentations to athletic trainers, coaches, parents, school professionals and middle and high school age youth who participated in school sports and youth athletic leagues.  

 

The VIPP in collaboration with Day One, the states only rape crisis center, has created two initiatives for college professionals and students. The RI Cross Campus Collaborative on Sexual Assault Prevention consists of Title IX and Sexual Assault Prevention professionals from the 11 colleges and universities in Rhode Island. The collaborative meets monthly to share best practices, conduct process and outcome evaluation trainings, and has participated in an American Public Health Association (APHA) training on on-campus sexual assault prevention planning. The second initiative created is the RI Student Collaborative on Sexual Violence, which includes undergraduate and graduate students from the 11 colleges in Rhode Island. The student collaborative hosted sexual assault prevention fundraisers and implemented a student led sexual assault prevention rally. 

 

Youth Sport Concussion Prevention Program (YSCPP) – Title V provided Venture Capital funding  to offer neuropsychological baseline testing (NBT) to middle and high school age youth ages 11-18 who participate in school sports and youth athletic leagues. This project proposes the use of the ImPACT neuropsychological baseline test to capture a baseline for youth athletes. ImPACT is a web-based 20-minute test that measures attention span memory, problem solving, and reaction time that can reveal a wide range of deficits in neuropsychological functioning. This test is easy to administer by computer, is relatively inexpensive to administer, and provides a database that can be used to monitor youth who are affected. In addition, the program provides concussion safety informational presentations to athletic trainers, coaches, parents, school professionals and middle and high school age youth ages 11-18 who participate in school sports and youth athletic leagues.  Between October 1st, 2019 through June 31st, 2020. The Youth Sport Concussion Prevention Program was implemented in 18 schools in a variety of ways. Six out of the eighteen schools only participated school in concussion education presentation activities.  508 students aged 11-18 completed baseline ImPACT testing. The Program is working on implementing a universal return to learn protocol called REAP which focuses on concussion management for schools. By implementing REAP the Youth Sport Concussion Prevention Program will be able to help not only student athletes but any student who suffers a concussion. 

 

 

Pediatric Psychiatry Resource Network (PediPRN) -  

Pediatric psychiatry Resource Network (PediPRN) - Rhode Island’s children and adolescents face significant challenges in accessing timely and affordable mental health care. In response to this need, the RIDOH is working in conjunction with the Emma Pendleton Bradley Hospital to expand its existing child psychiatry access program, the Pediatric Psychiatry Resource Network (PediPRN). The project’s mission is to improve access to behavioral health care for Rhode Island children and adolescents by integrating psychiatry into the state’s pediatric primary care practices. To achieve its mission, PediPRN uses a telephonic integrated care model to improve access to quality behavioral health expertise. This service is free and provides all Rhode Island pediatric primary care providers assistance with the mild to moderate mental health care needs of their patients. PediPRN focusses on creating a culture of empowerment for pediatric primary care providers. The clinical team works closely with providers offering CME opportunities, educational e-blasts, an updated website with assessment and educational resources on pediatric behavioral health topics, and ongoing support during telephonic consultations. In addition, PediPRN implemented the delivery of training, mentoring and education to PPCPs in the PediPRN Intensive Program (PIP) with the goal of creating a group of practitioners embedded in each of their home practices who will serve as local experts on various behavioral health topics. The PIP program has completed it’s first year and a second cohort of physicians has begun in 2020. Additionally, PediPRN has expanded its capacity as a resource to providers during COVID-19 an has started hosting “office hours” to physicians via zoom. Providers can speak with a staff psychiatrist, or with each other, about topics to support behavioral health treatment in their practices. This additional resource is meant to provide additional support to providers during these unprecedented times. 

 

Emotional Regulation Intervention Project –The Rhode Island Department of Health Violence and Injury Prevention Program in conjunction with the Rhode Island Student Assistance Program (SAP) aim to provide a wide range of prevention and early intervention services to high risk adolescents. The intervention will be implemented by master's-level counselors who will provide a Prevention Education Series (PES); individual and group counseling for students enrolled in; and referral to community-based social service and mental health agencies. The intervention was piloted during the ’17-’18 school year in which SAP counselors were trained in Project TRAC, a developmentally tailored emotion regulation training program designed for middle school students. The focus of the program is to help students 1) become aware of the connection between emotions and behaviors (especially risk behaviors), 2) improve recognition of when one is having a strong emotion, and 3) learn strategies for managing emotions in moments when they are making decisions.   

 

The 2018 Title V MCH Venture Capital Funding allowed the Violence and Injury Prevention Program (VIPP) to scale up the implementation of the Emotional Regulation Intervention Project from two to five schools. During the 18-19 school year the SAP hosted a two-day emotional regulation intervention training for five counselors returning and new who showed interest in the Emotional Regulation Intervention Project.  The Emotional Regulation Intervention Project implemented five 12 session workshops in five different school districts in Rhode Island. The number of students who participated varied between three and eight students per group. The Emotional Regulation Intervention Project served 31 students but the pre and post surveys were only completed by students who received parental approval before the start of the workshop. The evaluator will analyze the pre-post survey data and develop a report by September 2019.  In efforts to sustain the intervention the VIPP will work with the Emotional regulation consultant to adapt the 12-session workshop into strategies that can be implemented by teachers in the classroom.  In addition, the VIPP was able to obtain additional funding through the Rape Prevention Education grant to implement seven workshops in the 19-20 school year.   

 

Mental Health Consultation within early care and education-Through a partnership with DHS, child focused mental health consultation is available statewide. RIDOH is currently working with DHS to sustain its program focused mental health consultation to childcare as well. In 2020, several mental health professionals from Bradley Early Childhood Research Center, who are also early childhood mental health consultants, developed and delivered a training on how to become a child care mental health consultant with the goal of expanding the capacity of the system overall.  

 

Parent education and support for children and their families: Three communities were supported to implement Incredible Years groups for families in the communities. Anticipated outcomes include, improved parenting, increased social emotional competence, and decreased behavior problems. In the longer term, RI expects to see improved school readiness, improved social-emotional functioning, and healthier families. 

 

The Rhode Island Youth Suicide Prevention Project (RIYSPP) - works with a broad range of partners to implement a combination of strategies aligned with the 2012 National Strategy for Suicide Prevention that are focused on lowering youth (10-24) suicide death and attempt rates. The three primary interventions associated with this project are: 1. Training youth and adults across the State in evidence-based gatekeeper training programs, 2. Training counselors/school crisis team members from schools across the state in a novel streamlined crisis evaluation assessment tool/protocol and connecting them to clinicians (via the Kids’ Link line at Bradley Hospital) who can help them triage and connect students in crisis with a local mental health provider, and 3. Implementing RI’s first systemic linkage of non-health organizations with mental health using various strategies in order to coordinate and share resources for the assessment, referral, treatment, and provision of follow-up care with wrap around services for at-risk youth, including sharing de-identified data. Also, the project maintains a statewide Youth Suicide Prevention Coalition with representation from all priority populations and funded/non-funded partners and works to promote suicide prevention principles to all Rhode Island residents.  VIPP is currently working to rollout the SPI Youth Suicide Prevention work to every public-school district in the state.  The VIPP has also implemented the Emotional Regulation program in one Health Equity Zone middle school (Westerly).  The VIPP has also participated in the HRSA funded Collaborative Office Rounds grant, whereby the HEZ has received the funding  and training  is targeted to local pediatricians.  The VIPP also participates with the Bristol Health Equity Zone through their suicide prevention subcommittee.    

 

Statewide Plan for Improving Behavioral Health - The Governor signed an executive order (Executive Order 18-03) which charges state agencies with “develop[ing] an action plan to guide improvements to RI’s adult and pediatric behavioral healthcare systems” and reporting back to the Governor by November 30, 2018. To do this work, the Governor’s Office has asked to convene a small group of liaisons from RI State agencies to develop this action plan, in collaboration with their agencies, agency directors, and the Governor’s Office. 

 

PCHM-Kids SBIRT Learning Collaborative- The PCMH-Kids is an initiative of the Care Transformation Collaborative of Rhode Island (CTC-RI) which is a statewide multi-payer patient centered medical home initiative.  CTC-RI is co-convened by the Executive Office of Health and Human Services and the Office of Health Insurance Commissioner.  RIDOH MCH leadership participates PCMH-Kids leadership planning activities, committee meetings, and work groups. PCMH-Kids was founded in 2015 as a pediatric primary care patient-centered medical home initiative that is driven by data, quality care and collaboration. Practices receive financial support and technical assistance to achieve NCQA recognition as a patient-centered medical home, meet state established clinical quality measures, and participate in quality improvement activities on important child and youth health topics.  Cohorts of practices enroll for three years.  In January 2019, the third cohort of pediatric practices signed on. Currently there are 37 pediatric and family medicine practices participating in the PCMH-Kids initiative, including 260 primary care providers and trainees, covering over 110,000 lives, and representing more than 80% of the state’s pediatric Medicaid population. PCMH-Kids successes include:  

•       Improved developmental screening of all children age 9-30 months from a baseline of 41% screened to 85.9% screened which is fundamental to the Governor’s Children’s Cabinet third grade reading readiness initiative 
•       Improved obesity screening and counseling from a baseline of 55% to 85.8%  

•       Developed and implemented a pediatric specific high-risk framework to identify children and families that would benefit from care coordination services 
•       Reduced Emergency Department usage by 2.5% compared with non-PCMH practices 

 

Practices have also embraced a pediatric vision of care coordination and integrated behavioral health, using a model that includes practice-based social workers as care coordinators.  Accomplishments in integrating behavioral health services into primary care include: 

•       ADHD screening, diagnosis and treatment plans 

•       Maternal post-partum depression screening:  baseline of 22% to 87% with implementation of  referral protocols for intervention 
•       Screening, Brief Intervention, Referral, and Treatment (SBIRT) in the adolescents with 75 providers with a total pediatric population of ~34,000 

 

In 2020, RIDOH will continue collaborating with the CTC to support PCMH-Kids practices in integrating Family Home Visiting within the Medical Home and doing joint care coordination for families facing adversity.  

 

RIDOH MCH programs work closely with PCMH-Kids to support medical home efforts.  KIDSNET, the state’s integrated child health information system, works with providers to create reports that practices can use for patients care.  Practices can utilize this centralized database to identify children in need of newborn hearing screening, immunizations, lead screening, developmental screening, Kindergarten readiness screening as well as participation in other early childhood programs such as WIC, Family Home Visiting Programs, and Early Intervention. KIDSNET recently worked with PCMH-Kids to develop a new practice report to identify newborns and young children with medical and family risk factors that would benefit from care coordination and referrals for supports. In March 2019, the RIDOH Family Home Visiting program and PCMH-Kids collaborated in applying for a Healthy Tomorrows Partnership for Children grant to improve communication between primary care and home visiting programs and implement a process for integrated care coordination.  Funds will be awarded in March 2020 for this five-year project.  

 

RIDOH Healthy Summer Toolkit for Youth Program Leaders - Between late spring and fall of 2019, multiple RIDOH programs contributed health information and links to health resources as part of a new bi-weekly newsletter. Multiple issues disseminated health information and resources about insect and animal bite disease prevention, youth mental health resources, emergency preparedness for youth, smoking/vaping/substance use prevention, and sun/extreme heat safety, among others. Later summer/early fall editions also served as back-to-school resource editions.  

 

 

As a result of the 2020 Needs Assessment, RI’s MCH has selected a different priority.  Several of the programs and projects will be continued within RI’s MCH programs or continued within the new 2020-2025 Priorities.  The following programs/projects will be sustained in the following manner:

 

Got Transition - RIDOH will continue using best practice and guidance from GotTransition and the National Collaborative on Workforce and Disability-Youth (NCWD-Youth) and the National Academies of Sciences, Engineering, and Medicine recommendations in the Promise of Adolescence: Realizing Opportunity for All Youth, will continue to collaborate with partner state agencies - RI Department of Education (RIDE), Office of Rehabilitation Services (ORS), Department of Children, Youth, and Families (DCYF), and Behavioral Health and Developmental Disabilities Hospitals (BHDDH), the Health Equity Zones (HEZ), and other community stakeholders to promote and implement the following for transition age youth: 

•       Forums focused on building youth leadership, development, and mentoring skills in the areas of social and emotional well-being and the Dare to Dream Student Leadership Conference. 
•       Increase the statewide presence of the RIDOH Youth Advisory Council (YAC) and promote youth engagement in the HEZ. 
•       Provide transition education and resources to PCMH-Kids/PCMC-Adults 

•        Youth Resource and Opportunity Mapping 
•       Promoting youth participation on State Agency Advisories and Councils- focusing on statewide systems i.e. Children’s Cabinet, Healthy Transitions, Transition Council, RI Special Education Advisory Council 

 

Dare 2 Dream 2.0 - RIDOH will continue to build on past success of the 12th annual Dare to Dream Conference. Through a continued collaborative effort with the University of Rhode Island Center for Student Leadership and Development and partner state agencies, the RIDOH plans to design a conference program that will promote social/emotional health, well-being, and resiliency skill building for a second year in a row.   

 

RIDOH Youth Internships - RIDOH will continue to provide internship opportunities for students with special needs/disabilities (ages 16-21) to provide work exploration/experiences in public health programs for students enrolled in RI Transition Academies, District High School Transition Programs, and vocational learning programs that include pre-employment transition services and community work placement.   The RIDOH will also increase efforts to expand the Department programs that will provide internship placements within their program areas for students who need to have the opportunity to become familiar with the norms of a work setting and explore various job skills. Prior to the start of the 2019/2020 school year, the RIDOH Internship Program will conduct internship orientation sessions to identify potential students for participation in the program.  

 

Youth Advisory Council (YAC)- RIDOH will continue to expand the opportunity for youth to participate with the Department in an advisory role. Monthly meeting address 3 focus areas:  professional development and training, group soft skills building, and project/event planning and facilitation. Members of the Youth Advisory Council will participate in the RIDOH Title V Needs Assessment planning for incorporation of the youth. The YAC will continue to have significant role in the 2020 Dare 2 Dream 2.0 Student Leadership Conference. 

 

Sexual Health - During the next year RIDOH plans to continue the collaboration with RIDE and encourage sexual health education in schools. The adolescent sexual health workgroup is in the process of assessing the current landscape of adolescent sexual health services in Rhode Island and prioritizing additional topics to focus on. RIDOH plans to continue the relationship with Providence Community Health Centers to improve STD screening among adolescents as well as extend the relationship through the Rhode Island Health Center Association.   

 

Youth Engagement - The RI-GEMS initiative will adapt three locally and nationally recognized evidence-based and promising practice models: Girls Circle Afterschool Program; Upward Bound Summer Enrichment Academy; and Racial Justice Training to achieve the program objectives outlined in this grant.  Each of these three models is connected to three core components of RI-GEMS: 

1.   Girls Circle Afterschool program & other enrichment activities  

2.   RI-GEMS Summer Enrichment Academy (Similar to Upward Bound) 

3.   Racial Justice Training and Adult Education  

 

Violence and Injury Prevention - RIDOH plans to continue its work to address distracted and impaired driving policies; improve the implementation of return to learn protocols; and continue to implement the middle school emotional regulation pilot program. Second, the program plans to continue its groundbreaking work with school crisis teams and diversion of youth from hospital ED’s when proper screening and consultation indicate it can be safely done through a community mental health center.  In collaboration with Day One, RIDOH will continue to implement the Your Voice, Your View bystander intervention workshops in middle and high schools in Rhode Island.    

 

Positive Youth Leadership/Development and Youth Involvement in the HEZ 

To build on the momentum of the RIDOH Youth Advisory Council and to advance the necessity for meaningful engagement of youth as experts about their needs and priorities, RIDOH is exploring strategies to increase the youth involvement through the HEZ Initiative.  Plans include: “Community of Practice” models for Youth Engagement, HEZ Youth Advisory Councils, Statewide Youth Engagement Opportunities mapping, and forums for youth investment via the Dare to Dream Initiative and other events.