Injuries among youth and teens, specifically teen suicide.

Regional Adolescent Health Coordinators will utilize Search Institute’s 40 Developmental Assets framework to increase protective factors and encourage adult youth connections in schools and communities to build and maintain positive relationships between young people and caring adults, including school personnel and caregivers.

The AHI Director and community-based AHCs have a longstanding association with the WVDE and have facilitated many training sessions for school administrators, teachers, school nurses, and other school personnel on positive youth development (PYD) models, including Risk and Protective factors and the Search Institute’s 40 Developmental Assets®. Moreover, school personnel serve on the AHI’s eight regional “asset teams.” This existing affiliation will support the efforts of local education agencies in carrying out WV Board of Education Policy 4373 – Expected Behavior in Safe and Supportive Schools, which sets forth unacceptable behaviors that undermine a school’s efforts to create a positive school climate/culture. Policy 4373 classifies bullying as a Level 3 offense. The regional AHCs will utilize existing formal and informal partnerships to implement research-based, effective models for the prevention of bullying and harassment in schools and communities.

In early 2020, the AHI partnered with West Virginia University-Parkersburg to conduct surveys in schools throughout Region 5 to access impact of the AHI’s PYD programming. Students who had participated in AHI’s programming had consistently higher numbers of protective factors and a marked reduction in risk behaviors. Based on these results, the regional AHCs will continue to utilize Search Institute’s 40 Developmental Assets® framework and their Sparks curriculum to incorporate positive youth development to increase protective factors and encourage adult-youth connections in schools and communities.

Adolescent Health Initiative and the WV VIPP will utilize the WV YRBS and the Child Fatality Review to monitor progress on bullying and suicide measures.

In 2019, the WV Department of Education (WVDE) provided funding to the AHI to conduct YRBS surveys across the state. The AHI, working with the WVDE and other partners, began disseminating the results throughout the state in early 2020. The AHI plans to again partner with WVDE to conduct new surveys in 2021. The OMCFH realizes the importance of sharing available data in a usable format so other stakeholders can identify and implement programming in addition to what the Office is able to support and conduct. Successful prevention activities require monitoring available so the Office may make appropriate adaptations when necessary.

Also, in 2019, the AHI began conducting youth needs assessments and Child PTSD Symptom Screeners in teen pregnancy prevention curriculum classes. To date, over 2,000 screeners and assessments have been conducted. The AHI will continue to collect data from these assessments throughout 2021 to identify youth needs, make necessary referrals for services and steer program efforts.

Community based Adolescent Health Coordinators will identify and coordinate the implementation of research-based models for prevention of bullying and harassment in schools and other youth serving organizations.

The AHI and the VIPP partnered to provide a statewide training on the Green Dot bystander program in 2015. The Green Dot strategy is a comprehensive bystander intervention that capitalizes on the power of peer and cultural influence across all levels of the socio-ecological model. Since that time, the AHI has worked with community and school partners to implement Green Dot but recognizes the Green Dot model is not the best fit for all schools. In the coming year the AHI will work with schools to expand evidence-based programming by identifying, providing the necessary training and implementing bystander and prevention interventions best suited for each school’s needs.

In the Fall of 2017, the AHI partnered with the DHHR’s Bureau for Behavioral Health and Health Facilities to certify all the regional AHCs as Mental Health First Aid instructors. The AHCs began trainings in FY2018 and expanded to offer graduate course credits through Concord University in FY2019.  In addition to YMHFA, the AHCs offer trainings in Adverse Child Experiences (ACE) and Trauma Informed Schools evidence-based models. In FY2020, challenges with COVID19 not only changed the traditional training model but also prompted the retirement of 3 of the 8 regional AHCs.  In the coming year, the AHI will seek the necessary training for new staff and will work with existing staff to develop virtual training programs.  

Several years ago, the AHI partnered with the VIPP and the WV Foundation for Rape Information and Services (FRIS) to develop WV’s Sexual Violence Prevention Training and Resource Toolkit: A Guide for Working with School-Aged Children, a comprehensive, 220-page set of evidence-based resources and strategies for preventing violence in school-aged children (Kindergarten through 12th grade). The AHI and FRIS have provided several toolkit trainings across the state since 2015 and will continue to do so in the coming year. In 2019, the WVDE began working with the Prevention Collaborative (a statewide coalition of violence prevention partners, including FRIS, VIPP and AHI) to develop a body safety toolkit for schools. In the coming year, the Prevention Collaborative will work to develop online training on utilizing the new toolkit. The toolkit can be found at: https://wvde.us/leadership-system-support/body-safety-and-sexual-abuse-prevention-toolkit/body-safety-education-toolkit/

The VIPP will disseminate relevant data on the topic of non-fatal suicide trends for 12-17 year olds in the state.

The Division of Infant, Child and Adolescent Health (ICAH) and its Violence and Injury Prevention Program (VIPP) are the current recipient of a CDC-funded cooperative agreement to develop surveillance and data dissemination for nonfatal suicide related outcomes, including intentional opioid overdose.  WV is currently ranked 8th in the nation in suicide, and one of the leading causes of child fatality in our state is intentional injury/suicide, especially among adolescents.

Leveraging the work of the CDC Emergency Department Surveillance of Nonfatal Suicide Related Outcomes Cooperative Agreement (ED-SNSRO), the ICAH and its VIPP will disseminate ongoing data findings related to nonfatal adolescent suicide trends and counts to key state stakeholders in the area of adolescent health, including the: OMCFH Adolescent Health Initiative, OMCFH Adolescent Pregnancy Prevention Initiative, State Department of Education, Prevent Suicide WV (state suicide prevention coalition), WV Foundation for Rape Information and Services (state sexual assault coalition), and the Bureau for Behavioral Health (state substance abuse authority).

Transition

Provide academic detailing to pediatric primary care physicians on the importance of adopting a transition policy including Got Transition’s resources: Six Core Elements of Health Care Transition sample tools and measurements.

The WV CSHCN Transition Improvement Charter was developed to increase the percent of adolescents with and without special health care needs who received services necessary to make transitions to adult health care.  The WV CSHCN Healthcare Transition Services is a systems-based service provided by the WV CSHCN Program.  The purpose of WV Healthcare Transition Services is to ensure that children with special health care needs receive coordinated, comprehensive care within a medical home, as well as the needed services and supports to make transitions to adult life. Although the Charter was developed in 2018, opportunities exist to implement quality improvement and service redesign in ways that could fundamentally improve healthcare coordination services for WV children.  To ensure these efforts are successful, there is a need to build and sustain the ability of pediatric primary care practices to engage in academic detailing on the importance of adopting a transition policy including Got Transition’s resources: the Six Core Elements of Health Care Transition sample tools and measurements.

The CSHCN Healthcare Transition Improvement Team developed a Healthcare Transition Policy endorsed by the WV CSHCN MAB for use with the CSHCN Healthcare Transition Services as part of the medical provider practicum for the medical home.  The CSHCN care coordinators utilize the development of the transition policy as a tool to elicit input from children and families and to educate all practice staff about the approach to transition, the policy, the Six Core Elements of Health Care Transition 3.0 and the distinct roles of the children, family, and pediatric and adult health care team in the transition process.  The policy includes a transition time frame, an explanation of the practice's transition approach, and details the legal changes that take place in privacy and consent at age 18.  Once the policy is complete at the practice level it is shared with children and families beginning at age 12 and publicly posted.  The policy also serves as a structure for practice evaluation.

The CSHCN Program will collaborate with the HealthCheck and the AAP to survey WV physicians to determine if a transition policy is utilized or if a best practice has been identified for the primary care practice.   When education opportunities are identified the CSHCN Program will enlist WV HealthCheck who maintain a strong network of partnerships and collaborations among all healthcare systems to start a health care transition process. HealthCheck will disseminate materials to pediatricians across the state which will include the contact information for the regional CSHCN Care Coordinator who will introduce WV CSHCN Transition Services.  The services include an introduction of an organized clinical process for pediatric practices to facilitate healthcare transition preparation, transfer of care, and integration into adult-centered care, as well as support and facilitation of a medical provider practicum with clinical tools intended to help educate the medical home and initiate transition services.  Services materials disseminated by the WV HealthCheck Program will include the Got Transition Six Core Elements implementation guide and Got Transition Transitioning Youth to an Adult Health Care Clinician packet.

Complete transitions readiness assessment for all enrolled CSHCN starting at age 14.

Additionally, WV CSHCN Transition Services include the assessment of  a child’s readiness to transition to an adult approach to care using the got transition, Transition Readiness Assessment for Youth, a standardized transition/self-care assessment tool to engage children and families in setting health priorities, addressing self-care needs to prepare them for an adult approach to care at age 18, and navigating the adult health care system, including health insurance. CSHCN Program care coordinators use the results to develop with children, their families and the medical home, the CSHCN Program Plan of Care, Transition Plan.  Using a monthly report identifying children that are 11 years 6 months of age, the CSHCN Program care coordinator contacts children in their caseload for enrollment in West Virginia CSHCN Healthcare Transition Services. The CSHCN Program care coordinator provides the Got Transition Readiness Assessment for Youth and the Transition Readiness Assessment for Parents/Caregivers for completion.  The results are discussed at the transition appointment and a Transition Plan is developed.  When receiving support from the West Virginia CSHCN Healthcare Transition Services team the child’s medical home will be assessed for participation in the medical provider practicum.   The CSHCN Program care coordinators will conduct regular transition readiness assessments and will be notified of children who are 11 years and 6 months old. The CSHCN Epidemiologist will identify enrolled CSHCN who have received a transition readiness assessment between the age of 11 years and 6 months and 12 years and 3 months or within 3 months after enrollment to the program if enrolled after the age of 12. CSHCN Program care coordinators will also be notified of children who have not received a transition readiness assessment within these parameters.

Substance use in youth/teens.

Partner with medical providers to align with best practices in prescribing controlled substances to ensure optimum outcomes.

In a cursory review of the 2018 NSCH, the prevalence of Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity Disorder (ADHD) in WV is 15.8% for children age 3-17 (NCHS, Child and Family Health Measures, Indicator 2.7).  However, in some WV counties with the highest rates of substance use disorder and resulting overdose fatality, prescribing data indicates that as many as 1 in 4 children in the same age range are currently prescribed a stimulant.  Scholarly literature has shown a correlation between stimulant use in childhood and an increased potential for development of a substance use disorder in adulthood, especially in cases where stimulants are prescribed without an applicable corresponding mental health diagnosis.  As WV leads the nation in opioid overdose fatality, this is a vitally important issue to the current and future health and viability of our state and its maternal and child health population.

In coordination with the WV Board of Pharmacy (BoP), the Division of Infant, Child and Adolescent Health (ICAH) and its Violence and Injury Prevention Program (VIPP) will use data from the National Survey of Children’s Health (NSCH) and the WV PDMP, also known as the Controlled Substance Monitoring Program (CSMP), to inform surveillance and corresponding outreach and education activities to increase the awareness of controlled substance use among adolescents ages 12-17.  Consideration will be given to providing current best practice information to pediatric care providers about the potential future implications of stimulant use in adolescents, as well as internal work with our Title XIX agency to review and potentially improve medical review and prior authorization considerations for this vulnerable pediatric population.  The ICAH and the VIPP will also solicit input and support for data and its dissemination from key stakeholders in adolescent health, including the: Governor’s Early Childhood Advisory Council (ECAC), Governor’s Advisory on Substance Use, OMCFH Pediatric Medial Advisory Board, OMCFH Adolescent Health Initiative, OMCFH Adolescent Pregnancy Prevention Initiative, State Department of Education, and Bureau for Behavioral Health (State Substance Abuse Authority).

Provide educational information and resources to youth, parents, schools and the community about the harmful affects of drug abuse and misuse, safe storage and disposal of prescription medications and prescription monitoring in the home.

In 2017, West Virginia began collecting data on adolescent prescription misuse on the Youth Risk Behavior Surveillance (YRBS) survey. When compared to the 2017 YRBS, the survey in 2019 shows a very small, but statistically insignificant decrease in prescription misuse among high school students (12.5% down to 11.7%). However, the data shows prescription misuse nearly doubled for middle school students from 2017 to 2019 (3.6% to 6.7%).  While this is not enough data to be considered a trend, it is concerning.  According to the Substance Abuse and Mental Health Administration (SAMHSA), prescription misuse is the fastest growing drug problem in the United States that is “profoundly affecting the lives of young people.” (www.samhsa.gov/homelessness-programs-resources/hpr-resources/teen-prescription-drug-misuse-abuse) Nationally, prescription and over-the-counter drugs are the most commonly misused substances by Americans age 14 and older, after marijuana, alcohol, and tobacco cigarettes. (https://teens.drugabuse.gov/drug-facts/prescription-drugs#topic-5)

A common misperception is that prescription drugs are safer or less harmful than other kinds of drugs. However, there are short- and long-term health consequences that are particularly harmful to a developing adolescent brain and body. The prefrontal cortex (impulse control) and outer mantel (understanding rules/laws) of our brains continue to develop until we reach our early- to mid-twenties. Our brains are becoming hardwired during adolescence; negative behaviors developing into neuropathways (like addiction) can become lifelong problems. 

Educating adolescents and their parents about the risks of drug misuse and abuse is a major component to combating the problem. Research shows 1 in 4 teenagers believe that prescription drugs can be used as a study aid and nearly one-third of parents believe that attention-deficit/hyperactivity disorder (ADHD) medication can improve a child’s academic or testing performance, even if that child does not have ADHD. The Adolescent Health Initiative (AHI) will educate parents, children, schools and the community on the impact of prescription drugs not only on the developing brain but also adolescent behavior. As with any mind-altering drug, prescription drug misuse can affect judgment and inhibition, putting adolescents at greater risk for sexually transmitted infections, using illicit drugs and engaging in other risky behaviors.

Research also shows that two-thirds of teens who report abusing prescription medication get it from friends, family and acquaintances, including their home medicine cabinets. Providing education on proper storage and disposal is important to prevent misuse, not only in the home but in the community. (https://drugfree.org/prescription-over-the-counter-medicine/)

Prescription monitoring is also an important factor in preventing abuse. There has been increased legislation and public pressure requiring doctors and pharmacies to better monitor how (and how often) they prescribe drugs. While provider education is key to preventing over prescribing, prescription drugs must also be monitored in homes and the community.  The AHI will educate parents, grandparents, school personnel and the community on how to safeguard their medications, monitor their use and prevent theft and/or misuse.