III.E.2.c. Adolescent Health: Application Year (10/1/2023-9/30/2024)

State Priority Need:

Reduce Preventable Deaths in the MCH population with a focus on reduction and elimination of inequities in mortality rates.

National Performance Measure (2020 - 2025):

NPM 7.2- Rate of hospitalization for non-fatal injury per 100,000 children, ages 10 through 19.

Evidence-Based/Informed Strategy Measure (2020 - 2025):

ESM 7.2.1- Reduce count of suicide related hospitalizations in adolescents, ages 10 – 19.

With the steady increase of suicide rates among youth, the Maternal and Child Health (MCH) Division plans to continue to work with internal and external partners to increase capacity in programming, surveillance and data collection, and fatality review. MCH will continue partnership with Fatality Review and Prevention (FRP) Division, the Division of Mental Health and Addition (DMHA), and the Department of Education (DOE). The Department will compile all data and release its first annual youth suicide report in the upcoming year.

In July 2023, DMHA staff invited IDOH and other local partners and universities to attend the Black Youth Suicide Policy Academy in July 2023. SAMHSA worked with teams from Georgia, Indiana, Kentucky, Louisiana, Maryland, Ohio, Oregon, and Pennsylvania to develop strategic goals to address high rates of Black youth suicide in our state. MCH staff will continue to work collaboratively alongside other state agencies and partners to address the disparities in Black and multiracial youth suicide over the next two years.

Youth Risk Behavior Survey and School Health Profiles

The Youth Risk Behavior Survey (YRBS) and School Health Profiles (PROFILES) are the leading health surveys comparing state and national adolescent health statistics used in Indiana. These two surveys illustrate the current state of adolescent health in Indiana and the school-level resources provided to Hoosier students.  

MCH plans to begin preparation and implementation for the 2024 PROFILES cycle. MCH will begin surveying schools in January 2024, concluding survey efforts in June. The team anticipates receiving 2023 YRBS data in late-Winter/ early- Spring 2024. Until then, the MCH team will continue disseminating 2021 YRBS and 2022 PROFILES findings on as many platforms as possible. Various platforms include but are not limited to presentations, flyers, reports, and website updates.

Partnership with the Division of Mental Health and Addiction and the Indiana Youth Advisory Board

MCH has continued to grow a strong partnership with the Division of Mental Health and Addiction (DMHA). The DMHA continues to utilize the Garrett Lee Smith Suicide Prevention Grant to work alongside MCH and collaborate to address the mental health needs of adolescents under the Indiana Youth Advisory Board (IYAB).

As MCH kicks off the second year of the IYAB, the team is excited to invite the current board to serve another year. During the upcoming year, the IYAB will continue to speak on state and national platforms, advocating for youth and young adult health. Going forward, the board plans to create formal mission and vision statements at our first in-person meeting. IYAB will also begin putting plans in place for a 2025 Indiana Youth Summit. Additional planned projects include creating a Governer’s Proclamation for Adolescent Health Week, hosting webinars pertaining to lived experience, and creating social media messaging that highlights adolescent wellbeing.

Most recently, the IYAB worked alongside MCH staff to write and apply for the Office of Population Affairs Youth Resilience Challenge. The IYAB members would like to receive more training and become peer health supports to their peers and classmates. If awarded, we will apply for the next tier to continue preparing and equipping our youth with as many resources as needed.

Suicide and Overdose Fatality Review

The Suicide and Overdose Fatality Review Program (SOFR) within FRP leads two state-level pediatric suicide fatality review teams. Currently, one team is reviewing all deaths among youth ages 18 years and younger that occurred in Indiana in 2021. The second team is reviewing all youth suicide deaths that occurred in 2020. By September 30, 2024, all 2021 and 2020 cases will have been reviewed. Information gathered will be translated into formats (presentations, fact sheets, etc.) that are appropriate for various internal and external stakeholders. Recommendations from the pediatric suicide review teams are shared with internal partners at the Indiana Department of Health as well as local fatality review teams.

Once 2021 and 2020 reviews are complete, SOFR will restructure the pediatric suicide review team. One team will work to review any cases not already covered by local CFR teams. The other team will serve as a working group, inclusive of local and state representatives from education, mental health treatment, public health, suicide prevention coalitions, government, law enforcement, child welfare, medicine, and pathology backgrounds, to advise and support the implementation of youth suicide prevention recommendations.

Currently, FRP and MCH staff are collaborating to develop a comprehensive youth suicide report, which will contain findings from local SOFR teams, Youth Behavior Risk Survey results, and hospital-based suicide attempt data. Once finalized, this report will be disseminated to internal and external partners. Any additional pediatric suicide fatality review findings will be added to future reports.

SOFR also plans to continue to expand throughout the state, with the goal of coverage in all 92 Indiana counties. There are currently 31 local SOFR teams covering 32 counties in Indiana.

Child Fatality Review 

Child fatality review (CFR) is a critical public health process that aids to examine the circumstances and risk factors associated with unexpected child deaths. Analysis ultimately leads to recommendations on how to best prevent future deaths from occurring. Legislation enacted in 2013, IC 16-49, required multidisciplinary child fatality review (CFR) teams to be implemented at the local level, with coordination and support to be provided by IDOH. Each local team is required to review all deaths of children under the age of 18 years of age that are sudden, unexpected, or unexplained. All deaths are assessed by the Indiana Department of Child Services (DCS), in addition to all deaths that are determined to be the result of homicide, suicide, accident or undetermined. Individual local teams are required to submit an annual report to the IDOH Division of Fatality Review and Prevention (FRP). Annual reports encompass and summarize the child fatality reviews completed, identified needs, risk factors and any prevention action recommendations that were made. Information from the local reports is included in a mandated annual report to the Indiana legislature.     

FRP staff will continue to provide ongoing guidance, training, and technical assistance to CFR Teams across Indiana. There are currently 67 local CFR teams covering all 92 counties across Indiana. In the next reporting period, FRP has the goal of completing 90% of reviews for deaths that meet the inclusion criteria. FRP will continue to collaborate with local fatality review teams in order to effectively obtain all necessary reports and medical records, to successfully conduct in-depth, evidence-based reviews.

The information will provide complete and accurate data for entry into the National Center for Fatality Review and Prevention-Case Reporting System (CRS). Data regarding adolescent injury and fatality can then be analyzed and disseminated to communities. With this information, evidenced-based and targeted interventions can be made to reduce the number of adolescent deaths.

As an unfunded mandate in Indiana, local communities remain challenged by the tasks associated with CFR and the requisite data entry. This network of volunteers contributes their time to gathering records, preparing cases for review, facilitating meetings, and completing data entry of cases. The local CFR teams are expressing an immense demand for FRP, which translates to the need for expanded training opportunities. FRP collaborates closely with CFR teams and actively participates in state-wide review meetings. During these meetings, FRP offers guidance to ensure that teams are conducting thorough and effective reviews, identifying risk factors and disparities with their communities. Additionally, FRP provides support and technical assistance in accurately classifying child fatalities. Furthermore, FRP ensures that recommendations made by the CFR team are effectively communicated to the local Community Action Team (CAT) or prevention coalition, enabling appropriate prevention actions to be implemented.  

In areas where there is no local CAT or prevention group, FRP remains committed to closely collaborating with CFR team members and community stakeholders to identify trends related to child fatalities. FRP will persist in introducing prevention initiatives within local communities' and offering assistance in accessing resources for child injury and prevention. Furthermore, FRP will continue its efforts to address mental health challenges and address service gaps that may contribute to adolescent suicidal behavior in partnership with the CFR teams.

FRP will reach out to CFR teams and extend support via telephone communication, emails, virtual visits, virtual meetings and in-person meetings. The FRP staff will consistently strive to aid teams in identifying cases, offering data assistance, delivering comprehensive review training, and providing ongoing support across the state. FRP additionally intends to sustain its engagement efforts with teams, ensuring the timely completion of reviews that are effective and accurate. Moreover, FRP aims to enhance quality of recommendations and foster proactive prevention actions within their respective communities. FRP will also continue to train CFR team members on the data entry process, stressing the importance of gathering and entering records accurately.

FRP is committed to maintaining a close partnership with the Department of Child Services (DCS) to ensure all local CFR teams are equipped with timely notifications of child fatalities occurring in their jurisdictions. In doing so, CFR teams will be able to strive for timely reviews with complete and accurate data collection and entry. FRP will also consistently follow up with local teams to offer support, resources, and technical assistance, as needed. CFR teams across the state continue to recognize and focus on ways to provide prevention action to reduce infant, child, and adolescent mortality in their communities.  

FRP plans to continue providing technical assistance to existing CATs while forming new CATs in counties deemed ready to implement prevention efforts. CATs will continue to engage with a variety of stakeholders in the community to eliminate system gaps and barriers. CATs will continue to use data from FRP epidemiologists to inform prevention efforts, while utilizing recommendations from local fatality reviews. Prevention efforts will include but not be limited to drowning, substance use, and fire safety. FRP community coordinators will continue to foster a network with first responders statewide, providing trainings when necessary. 

Sudden Unexpected Infant Death (SUID)/Sudden Death in the Young (SDY) 

The Sudden Unexpected Infant Death (SUID)/Sudden Death in the Young (SDY) Case Registry is another program under FRP. This program addresses adolescent health by conducting in-depth reviews of children who die suddenly and unexpectedly, often as a result of undiagnosed genetic conditions. The SUID/SDY Case Registry plans to review deaths of adolescents and offer no-cost genetic testing to the families and living siblings. In 2024, this program will begin implementing primary and secondary prevention strategies throughout the state by providing Automatic External Defibrillators (AEDs) to schools. In addition, thorough training will be administered to school staff on how to use and maintain this equipment. The SUID/SDY Case Registry will also partner with local foundations to provide low-cost heart screenings to children and young adults in Indiana. 

In May 2023, Senate Bill 369 was passed in Indiana. This legislation requires Automatic External Defibrillators (AEDs) to be present and accessible within a radius of three minutes of any school activity. Schools are also required to create action plans with training and drills so that individuals are aware of an AEDs location and how to use them properly. This legislation, which takes effect on July 1, 2023, was a grassroots effort led by families of children who died suddenly and unexpectedly during athletics on school grounds. However, the legislation does not provide funding for schools to put these life-saving prevention measures into place. FRP will provide support to the implementation of this new legislation that will benefit adolescents living with potentially undiagnosed congenital heart defects and children and young adults who may be affected by sudden cardiac arrest. 

Handle with Care 

The Division of Fatality Review and Prevention (FRP) continues to identify opportunities to increase collaboration among communities to enhance capacities for resilience and protective factors, mitigating potential outcomes associated with adverse childhood experiences (ACEs). FRP leads the Handle with Care (HWC) initiative, continuing to expand programming to communities across the state. HWC is a collaborative approach identifying at-risk children at the scene of potentially traumatic incidences, providing a “heads up” to the teen’s school to better support the teen through a trauma-sensitive environment. Law enforcement and other first responders are trained to provide trauma-informed support on scene where EMS, fire, or law enforcement respond when an adolescent is present. When present, a confidential notification including the teen’s name, age, and the words, “Handle with Care” is sent to the teen’s school to provide a “heads up” that they may need additional supports during school and to provide trauma-sensitive support, as needed. This notification is distributed to staff who may encounter the teen the next day to ensure they are watching for atypical behavior from the student and can respond appropriately. The notification system is designed to be discrete and does not include incident-level information to reduce any bias in potential responses provided due to knowledge of an incident. School staff are trained to provide trauma-informed support as needed and to not ask questions or try to gather information about the event. If school-based interventions are not enough, the school will connect the student and their family to mental health services.  

In 2021, FRP received a federal grant through the Office of Victims of Crime (OVC) to support the program’s implementation within two Indiana counties. Since the adoption of the program in Indiana in 2021, HWC has spread to nine counties including 27 school districts. Current efforts to expand HWC are occurring in an additional 19 counties with two counties expected to begin receiving notifications by the start of the 2023-2024 school year. FPR continues to support each county through technical assistance and training, ensuring each school district implementing the program is adequately positioned to begin receiving HWC notifications and responding appropriately without causing further harm for adolescents exposed to trauma. Funding through the OVC solicitation will expire in September 2023. FRP continues to identify additional funding opportunities to support the program’s implementation, as well as to build a trauma-informed framework for the state to further support teens and their families. 

In order to adequately support HWC implementation, a trauma-informed framework is necessary for a community-wide approach to supporting teens exposed to trauma. FRP has begun to explore opportunities for collaboration both at the state and local levels to implement a trauma-informed framework. In addition to these efforts, FRP has recognized the need for trauma-informed law enforcement training, as well as establishing equitable pathways for teens and their families who have been exposed to trauma. Securing additional funding will be necessary to continue to provide state-level support in building a trauma-informed framework to address individual community capacity to support teens exposed to trauma. If awarded the CDC’s ACE’s grant, IDOH will continue the expansion of HWC and work to create trauma-informed communities.

State Priority Need:

Promote Physical Activity through policy improvements and changes to the built environment.

National Performance Measure (2020 - 2025):

NPM 8.2: Percent of adolescents, ages 12 through 17 who are physically active at least 60 minutes per day.

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM8.2: Number of schools participating in an activity (training, professional development, policy development, technical assistance, PA in-school programming, PA before and after school programming) to improve physical activity among adolescents (12-17).

ESM8.2.2: Percent of adolescents ages 12-17 impacted by improvements to the built environment.

Physical Activity remains a major concern among Indiana teens. To make the biggest impact, MCH plans to continue to partner with the Division of Nutrition and Physical Activity (DNPA) who has been primarily responsible for implementing strategies to increase physical activity in youth, ages 12 – 17. 

Physical Activity Minutes

DNPA will support Playworks in conducting at least two types of training opportunities:

• Two trainings (TBD) at Vigo County School Corporation
• Team Up Program (at five elementary schools: Crooked Creek, Winchester Village, Abraham Lincoln, Clinton Young, and Brookview)
• Recess Reboot (Northaven Elementary School): four-day on-site training
• Trainings (TBD and number of training(s) TBD) at Boys and Girls Club of Morgan County 

Each program listed produces at least 30 minutes of physical activity instruction, daily.

GOAL University:

DNPA will contract with GOAL University to continue offering healthy lifestyles afterschool programming (physical activity and nutrition education) in southern Indiana rural counties. The tentative plan is to partner with school corporations in Monroe County (Monroe County Community School Corporation and Richland Bean Blossom School Corporation), Owen (Spencer-Owen School Corporation), Greene (Bloomfield School District), and Lawrence (North Lawrence Community Schools) Counties, with a goal to expand to Morgan and Brown Counties. Developing new and sustaining partnerships with school corporations, healthcare providers and youth-serving agencies will become a responsibility of the GOAL University Program. Another goal is to partner with Vincennes University instructors and students so GOAL University can be implemented in Dubois and/or Orange Counties.

 

Physical Activity Minutes

While the time varies slightly each week due to the unique lesson plans, students typically spend about 30 minutes (of the 60-minute program) being physically active. The breakdown of a weekly program is below:

• Goal Setting and Checking: 10 minutes (sedentary)
• Nutrition Lesson: 25 minutes (15 minutes sedentary, 10 minutes active)
• Physical Activity Lesson: 25 minutes (5 minutes sedentary, 20 minutes active)

Community Mini-Grants:

DNPA will support five community mini-grants impacting adolescents, ages 12-17. The programs that these community mini-grants support range from being classroom-specific to community-wide initiatives. They provide schools, educators, and students the resources to be physically active both in and out of school. DNPA will provide the opportunity for each entity below to fund their program throughout the 2023-2024 year.

Below is the anticipated reach of each grantee’s program impacting youth ages 12-17.

• Judah Ministries:
  • Potential Reach: 120 youth and adolescents; ages 6-12 years of age
  • Program: Provide 8-10 swimming lessons through Summer Enrichment Program (classes will be 45-60 minutes in duration) at local YMCA and Indy Parks and Recreation pools.
     
• YMCA of Portage Township:
  • Potential Reach: 500 youth and adolescents; ages 6-17
  • Program: Provide swim lessons, basketball, kickball, SEL activities, and sensory camps for youth and adolescents with autism.
     
• White River Valley Middle School:
  • Potential Reach: 210 students in grades 6th-8th
  • Program: Provide physical activity afterschool program and create a new space for daily movement (including sensory supplies); provide PD training (CSPAP) to staff, and redesign PE curriculum.
     
• Firefly Children and Family Alliance:
  • Potential Reach: 325 youth and adolescents; ages 6-17
    Program: Expand 3BFit yoga programming and provide new boxing program for the youth and adolescents residing in two Firefly Children and Family Alliance shelters located in Marion County.
     
• Garrett Keyser-Butler Schools:
  • Potential Reach: 10-15 (Girls on the Run); 80 for yoga and mindfulness; 20-30 for skate and bike club; grades 1st-8th
  • Program: Provide Girls on the Run Program; yoga and mindfulness programming, and afterschool skate and bike club

 

• Lasting Change, Inc.:
  • Potential Reach: 100 male adolescents; ages 13-18
    Program: Expand physical activity programs: soccer, disc golf, basketball, and baseball for at-risk male adolescents at two school academies – one located in Jasper County and the second located in Kosciusko County.

 

Current Activities

Through staff time funded by Title V, DNPA has created the Project AWARE Goes to the Park Grant. This state-level grant is funded by the federal Project AWARE Grant awarded to the Indiana Department of Education by the Substance Abuse and Mental Health Services Administration (SAMHSA). The Project AWARE Goes to the Park Grant offers funding and technical assistance to community organizations to promote youth mental health in natural environments, such as parks. Four grantees will be conducting unique youth summer programs that incorporate both mental health programming and opportunities for physical activity in outdoor settings. Four other grantees will provide professional development opportunities to their staff related to mental health that will help incorporate mental health programming into their regular interactions with school-aged youth. Three grantees will provide both youth programs and staff professional development.

Wellness Policies

DNPA will offer a free opportunity for school corporations and charter schools to submit their school wellness policy for DNPA’s Child Wellness Coordinator and Youth Physical Activity Coordinator for review. They will utilize the WellSAT 3.0 Quantitative Assessment Tool to score and provide an in-depth feedback letter including strengths and suggested ways to improve their wellness policy language. 

Schools Mini Grants

DNPA will support 4 school mini grants through the Healthy Schools Grant Program, a three-year grant that will fund programs that improve student physical activity minutes and nutrition. While grantees are still deciding on their Year 2 activities, the maximum reach is below:

• Culver Community School Corporation
  • Maximum reach: 379 students in grades 7-12
  • Program: Will expand their current district garden and incorporate produce into the cafeteria and backpack program for underserved students.
• Western Wayne Schools
  • Maximum reach: 346 students in grades 7-12
  • Program: Will implement an online ordering system where a healthy snack and physical activity can be ordered for classroom celebrations.

Professional Development Trainings

DNPA provides professional development trainings to all K-12 PE teachers and before and after school professionals in the state of Indiana. For 2023 professional development trainings, DNPA will contract with PL3Y, Inc to offer four one-day PD trainings in Terre Haute, Indianapolis, Fort Wayne, and South Bend in September. Each PL3Y, Inc. training will focus exploring new games that develop fundamental movement skills and learn about Teaching Games for Understanding (TGfU), a student-centered approach that develops decision-making and skill acquisition through game-based activities. Participants will discover the benefits of mindfulness and learn practical strategies to promote focus and well-being through dance, brain breaks, indoor recess activities, and more. The goal of each training is to leave participants empowered with practical ideas to improve physical activity and physical literacy in the youth and adolescents they serve.

 

Built environment strategies.

 

Changes to the built environment: the Tactical Urbanism Grant Program

DNPA will continue to grant funds to organizations implementing pedestrian safety measures demonstrating the ability to create safer, healthier neighborhoods by promoting activity-friendly routes for biking and walking to everyday destinations for children and adults. Grantees were selected by a competitive application process with grant amounts up to $10,000. Grant projects include new pedestrian crosswalks, traffic calming installations, traffic speed reduction improvements, and a tactical urbanism guidebook for Indiana communities. The following grantees were awarded Tactical Urbanism Demonstration Grants in 2023 spanning from May – September. Additional communities will be funded from May – September 2024.

Current activities for tactical urbanism:

Nora Neighborhood Alliance: City of Indianapolis, MSD Washington Township

This tactical urbanism demonstration project will improve safe walking and bicycling for children and adults accessing nearby schools, shopping, and other destinations crossing 86th Street on the Monon Trail in the Nora neighborhood in Indianapolis. The project will include traffic calming and pedestrian safety countermeasure demonstration projects at the existing Monon Trail crossing to slow traffic and increase safety. Two fatalities of trail users crossing 86th Street have occurred at this location in the last year, creating a clear need for demonstrating safety measures at this intersection.

Reach:  5,395 adolescents ages 12-17

Michiana Area Council of Governments: South Bend Community School Corporation

The project will include the preparation of an Indiana tactical urbanism project guidebook that addresses best practices for implementing demonstration projects in urban and rural areas. The guidebook will help to further reduce barriers to implementing tactical urbanism projects, particularly in underserved rural communities, creating safe access for walking and bicycling to everyday destinations for children and adults. It is anticipated that the grantee will utilize the completed guidebook to implement at least six tactical urbanism projects in the summer of 2024 within the north-central Indiana region.

Reach: 7,070 adolescents ages 12-17

Current Activities for Bicycle/Pedestrian Planning

Changes in the built environment to promote Physical Activity

Title V funding will be used to promote increased levels of physical activity at the community level through changes to the built environment. DNPA will provide funding to communities to hire consultants to prepare community-wide bicycle and pedestrian master plans to help create safe routes to everyday destinations for walking and bicycling. Technical assistance will also be provided to stakeholders and Purdue Extension Community Wellness Coordinators at the local, regional, and state level to identify opportunities to make changes to the built environment supporting physical activity. Technical assistance activities include providing guidance to stakeholders for the planning and installation of multi-use trails, safe pedestrian crossings, bikeways, safe routes to schools and parks, and complete streets. This work will enable adolescents, ages 12 – 17, to walk and bicycle to school or the library safely while also getting in their recommended amount of physical activity.

City of La Porte: La Porte Community School Corporation

The grantee will hire a consultant to help the city to prepare a Trails, Greenways, and Blueways Master Plan that will contribute to achieving the community's vision by identifying specific streetscape enhancements that prioritize safety and ease of non-motorized transportation. The Plan will also identify opportunities to enhance the Blueways network connections between each public waterbody and the trails network. The plan will identify opportunities for walking and bicycling connectivity to everyday destinations for children and adults to entertainment, retail, public institutions, recreational areas, and downtown. The main goal of the Plan is to allow safe movement and access to healthy transportation options throughout the city.

Reach: 2,416 adolescents ages 12 – 17

 

Eskenazi Health Indianapolis: Indianapolis Public School Corporation

The grantee will prepare a “small area or neighborhood plan" in Indianapolis that promotes walking and bicycling for children and adults to everyday destinations such as schools, parks, and shopping to include a focus on Creating Safe Routes in three neighborhoods that contain Eskenazi Health Centers. The proposed project and planning effort will highlight opportunities to connect safe routes and trails more directly to health center sites. This planning effort will enhance both safe access to healthcare and facilitate programming opportunities such as Eskenazi Health Wellness Walks that encourage physical exercise. The planning effort is part of the Health Equity Zone initiative, in which Eskenazi Health will conduct in depth community engagement, facilitating focus groups with staff, patients, and neighborhood resident leaders. This outreach will be complemented by Eskenazi Health’s Community Health Workers and Community Weavers, a newly created role that connects community partners to each health center location.

Reach:  8,833 adolescents ages 12 – 17

 

State Priority Need:

Access to High-quality, family-centered, trusted care is available to all Hoosiers.

National Performance Measure (2020 - 2025):

NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year.

Evidence Based/Informed Strategy Measure (2020 - 2025): 

ESM 10.1: Knowledge, Behavior, and Confidence Change in Physicians managing Adolescent Health Concerns.

To continue to increase access to adolescent focused health care, MCH will continue and finish Cohort 2 of the Adolescent Champion Model. 

Adolescent Champion Model 

IDOH MCH partnered with the University of Michigan’s Adolescent Health Initiative (AHI) in early 2021 to implement the Adolescent Champion Model (ACM). The model has been implemented and replicated in many states and aims to create a teen-friendly health care environment. It helps to ensure providers feel comfortable and confident when seeing teen patients while also encouraging clinics to implement changes to the physical office space and staff behavior to be more welcoming and engaging with youth. MCH is supporting the clinics to make the change by covering contracting costs to The University of Michigan and by providing a stipend to each clinic to pay for professional development or supplies to create the changes. As one can imagine, these major changes require time, so each cohort of clinics and providers will be involved with the ACM for 18 months.

 

The first cohort in Indiana started July 1, 2021, and the second cohort started March 1, 2022. Both are currently on track to finish the program by December 2022 and August 2023, respectively. During this time, clinics will follow the implementation calendar set by AHI including trainings, check-ins, and data collection. Healthcare providers and staff will be trained in a variety of adolescent topics such as consent laws for the state, confidentiality best practices, adolescent brain development, non-verbal communication bias, and cultural responsiveness.

 

MCH is planning to secure funding to continue this program in the future. Throughout the program, MCH has received feedback from current participants about the enjoyment and success of the programs. There has also been interest from other clinics in participating in future cohorts. If funding is secured, MCH plans to do a call for Letter of Intent for all future cohorts and work with our network of partners including our Title V partners to spread awareness of the call.

 

State Priority Need:

Strengthen Mental, Social, and Emotional Well-being through partnerships and programs that build capacity and reduce stigma.

State Performance Measure (2020 - 2025):

SPM 4: Number of youths served with a Positive Youth Development curriculum, ages 12 – 17.

The Title V Needs Assessment emphasized the importance of prioritizing optimal health and well-being for adolescents and young adults (AYAs) in Indiana. MCH plans to continue to continue implementation and search for new opportunities to provide Positive Youth Development curriculum across Indiana.

Teen Pregnancy Prevention 

To help reduce risky behaviors in youth and implement the Office of Population Affair’s Teen Pregnancy Prevention Tier One grant, MCH has partnered with six implementing organizations to deliver the Botvin LifeSkills ® Training program, provide access to Parent Cafés and Teen Cafés, and continue implementation of the Adolescent Champion Model (above). MCH was awarded this grant on July 1, 2020, and ends June 30, 2023.

 

With the current grant ending in June 2023, MCH has reapplied to the Teen Pregnancy Prevention Tier One. The plan was to implement the same three-pronged approach programming that has been done in the last three years. However, MCH and partners spent considerable time over the past three years listening to participants and facilitators regarding the positive and negative aspects of the Botvin LifeSkills ® curricula. If re-awarded, MCH plans to work with the developers at Botvin LifeSkills® to create approved adaptations that keep to the fidelity of the program while making changes that could increase participant engagement and enjoyment. Unfortunately, MCH received the news that the application was not selected for funding over the next five years. MCH will continue to look for other funding sources and opportunities to implement these successful programs with our local implementation partners.

 

Sexual Risk Avoidance Education

The MCH team continues to provide guidance and oversight to the Sexual Risk Avoidance Education Program (SRAE) and its six sub-grantees. Over the last year, the MCH division has reviewed and evaluated over 15 positive youth development programs to look at the effectiveness of current programming.

Grantees will continue implementing positive youth development programming around the state for the next year to come. Focused on healthy relationships, communication skills, negotiating skills, and more, our partners can reach over 16,000 youth per year with this programming, which is over 1,000 more than the previous year. IDOH will continue its partnership with Health Care Education and Training (HCET), who provide training and technical assistance, and started to evaluate the work of grantees as well as provide fidelity monitoring services. HCET has worked to improve sexual and reproductive health outcomes since 1994 and serves multiple states in the Midwest Region. Over the next year, the MCH team will continue to review curricula and create a more streamlined approach with the next application year for SRAE. This will include 3-4 curricula for the grantees to choose from instead of each grantee picking their own. We hope to see increasing numbers like this past year.

MCH recently applied for additional SRAE funds to continue the expansion of this programming across the state. As interest grows in the Life Skills Curriculum and Teen Café model, we hope this funding will reach even more youth and young adults throughout the state. 

Youth Voices & Engagement

As previously mentioned, the IYAB is a statewide board that works to address youth needs regarding access to care and services, mental health, and minority health. Over the last year, the board has had members attend the Adolescent Health Initiative (AHI) conference and present a poster presentation, Association of Maternal and Child Health Programs (AMCHP) conference, speaking at Indiana’s Public Health Day, and many other opportunities.

The IYAB will launch the second year of the board in July 2023, with members from the first year coming back. Over the course of the first year, members laid the groundwork for years to come offering a unique experience of starting a board from the ground up. In light of that, it is important that the same board serve for another year to better explore opportunities such as evaluating programs such as the states Sexual Risk Avoidance Education program (SRAE), Teen Pregnancy Prevention Program (TPP), and Title V programs. The board will continue to explore and give feedback on Indiana’s position in access to care and services, minority health, mental health, and sexual and reproductive health.

Rape Prevention and Education

The Office of Women’s Health within the Indiana Department of Health has now merged with MCH. This merger brought in new programming, including our Rape Prevention and Education program. This program and its staff now sit under the Adolescent Health Team.

In an effort to prevent sexual violence (SV), the state distributes CDC granted funding from the Rape Prevention and Education (RPE) Program to local and statewide organizations implementing SV primary prevention programming. These programming strategies focus on preventing first time victimization and perpetration of SV. In RPE funded programs, the MCH team uses the promotion of mental, social, and emotional well-being of adolescents as a vehicle for SV primary prevention. We aim to break the cycles of violence in communities by showing adolescents what it means to be in supportive relationships, to have and set healthy boundaries, and to create safe spaces for themselves and others.

The RPE MCH team currently provides RPE funding to five different organizations to support the implementation of their SV prevention programming. Three of our partners work primarily with adult populations and the other two organizations implement programming targeting youth. Over the next year, RPE will continue to implement programs to serve youth and look to potentially expanding reach than the previous grant year.

Department of Corrections

MCH has continued to grow its partnership with the Indiana Department of Corrections – specifically the team and facilities that serve youth and how to address their health and well-being.

As a result of Indiana legislation, the statewide Youth Justice Oversight Committee was established by the legislature in 2022 (see HEA 1359 or Ind. Code 2-5-36-9). The Chief Justice of Indiana appointed members to: (1) Develop a plan to collect and report statewide juvenile justice data. (2) Establish procedures and policies related to the use of certain screening tools and assessments. (3) Develop a statewide plan to address the provision of broader behavioral health services to children in the juvenile justice system. (4) Develop a plan for the provision of transitional services for a child who is a ward of the department of correction. (5) Develop a plan for the juvenile diversion and community alternatives grant programs.

The committee worked over the past year to draft proposed guidance to the commission and the legislative council by July 1, 2023. The Youth Justice Oversight Committee (YJOC) completed the Final Report and submitted it to the General Assembly and Commission on Improving the Status of Children (CISC) at the end of June 2023. This report is the combined work product of the YJOC full committee and workgroups, which includes recommendations on best practices and next steps for enhancing Indiana's youth justice system. IDOH MCH staff served on this committee and will continue to engage with the juvenile detention centers across the state as changes are implemented. IDOH will continue to offer support to these partners and youth over the year to come.