Domain: Adolescent Health

Planning for October 2023-September 2024

Objective

By 2025, increase the percentage of adolescents who received a preventative medical visit in the past year by 10%.

National Performance Measure

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

An annual preventive well visit can help adolescents adopt or maintain healthy habits and behaviors, avoid health‐damaging behaviors, manage chronic conditions, and prevent disease, including mental health issues. Additionally, they can play a role in preventing adolescent suicides.

Minnesota’s goal for the FY2024 is to have 82.3% of adolescents (12-17 years) have at least one preventative medical visit in the past year.

Evidence-Informed Strategy Measure

(ESM 10.2) Percent of well-visits where depression screenings are occurring for adolescents enrolled in Minnesota Health Care Programs (MHCP)

Although helping young people prevent depression, suicide, and other problems is a community-wide effort, primary care providers are well situated to discuss risks, provide screening, and offer interventions. Offering screening and follow-up at preventive visits helps ensure that young people receive mental health services and support.

Minnesota’s goal for FY2024 is for 69.8% of well-visits for adolescents enrolled in Minnesota Health Care Programs (MHCP) to include depression screenings.

Community-Identified Priority Need: Adolescent Suicide

For more information on the importance of Adolescent Suicide on the lives of people living in Minnesota, see the Adolescent Health 2022 Annual Report.

Strategies and Activities

A.  Strategy A: Empower Youth, Young Adults, Families, and Communities to Meaningfully Engage in Creating Solutions to Prevent Suicide

1. State Level Activities
   1. Partner with MDH Suicide Prevention Unit (SPU) to Implement Identified Strategies from the MN Suicide Prevention State Plan

The MDH SPU, part of the Health Promotion and Chronic Disease Division at MDH, is responsible for the state’s Suicide Prevention State Plan (https://www.sprc.org/sites/default/files/Minnesota%20SuicidePreventionStatePlan2015.pdf) and its deliverables. Released in 2023, Minnesota’s Suicide Prevention State Plan has six main goals which include:

• Increase individuals, organizations, and communities’ capacity to develop and implement a comprehensive approach to prevention suicide.
• Promote factors that offer protection for suicidal experiences across the individual, relationship, community, and societal levels.
• Identify and support individual’s wo are experiencing mental health challenges or who are having suicidal experiences.
• Strengthen access and delivery of care for mental health and suicide.
• Connect, heal, and restore hope to those impacted by suicide.
• Improve the timeliness and usefulness of data.

The Title V program will work with the MDH’s SPU to continue development and implementation of a comprehensive statewide approach to adolescent and young adult suicide prevention. More specifically, during FFY 2024, Title V staff will connect with the SPU team to increase alignment of the Suicide Prevention State Plan with the State Plan of the Minnesota Partnership for Adolescent and Young Adult Health (see activity 1.3 of this strategy). By creating this alignment, we will be able to better work together to intentionally empower young people to engage in creating solutions to prevent adolescent suicide. 

2. Increase Help-Seeking Behaviors in Youth

According to the Suicide Prevention Resource Center, “By teaching people to recognize they need support – and helping them to find it – you can enable them to reduce their suicide risk.” To help young people, increase help seeking behaviors, we need to decrease barriers to accessing supports. During FFY 2024, Title V staff will work with partners to lower barriers youth experience when trying to obtain help by promoting self-help tools and campaigns. Additionally, Title V staff will work with partners to address social and structural environmental barriers – which might include social/emotional learning to foster peer norms around help-seeking and working to make sure that youth-serving providers (e.g., primary care providers) are providing services that are culturally-appropriate, welcoming, and convenient for teens. 

3. Partner to Implement the Minnesota Partnership for Adolescent and Young Adult Health (MNPAH) Strategic Plan

MNPAH, convened by MDH, is a group of stakeholders representing state, county, schools, community agencies, faith organizations, and those working for and with young people. The MNPAH aims to support Minnesota’s overarching adolescent health goals, which are to: 

• Improve the health and well-being of all adolescents and young adults (ages 10-25 years old); and, 
• Build and maintain strong partnerships with those interested in the health and well-being of young people.  

To address these goals and inspire action, the MNPAH developed a Strategic Plan with a set of priorities that include:

• ensuring access to high-quality teen-friendly health care.
• having a safe and secure place to live, learn, and play.
• developing positive connections with supportive adults.
• providing opportunities for youth to engage.
• uplifting adolescent and family-centered services.

Young people who are thriving are less likely to complete suicide, and these priorities aim to support MNPAH’s vision of Minnesota being a “place where all young people thrive”.

During FFY 2024, particular focus will be on the following activities: 

• Increasing access to high-quality, teen-friendly health care through sharing of best practices.
• Partnering with agencies to strengthen youth’s overall resiliency and well-being. 
• Working with partners who focus on adolescent mental health to highlight the need for positive connections with supportive adults. 
  4. Train Providers on Adolescent and Young Adult Mental Health Screening to Promote Positive Youth Development

Child and Teen Checkups (C&TC) 

The Minnesota C&TC Periodicity Schedule follows the AAP Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents – HRSA has funded this program since 1990. The most recent proposed changes to the Bright Futures guidelines were accepted by HRSA and published April 2023. The updated guidelines include the addition of suicide risk as an element of universal depression screening for children ages 12-21 – recommendation that will be considered in future updates to the Minnesota periodicity schedule. The AAP Bright Futures suicide risk assessment recommendation will be covered in all C&TC Best Practices Trainings.

Mental health surveillance is required at all C&TCs for all ages. This includes obtaining the child and family’s mental health history and the child’s history of exposure to trauma. Mental health screening using an approved, standardized instrument is required for age 12 through 20 years. It is critical that children with identified concerns receive or be referred for specialized services. C&TC staff play a critical role by supporting health care providers that perform well child checks with up-to-date information on evidence based best practices screening recommendations and tools to successfully do screenings and refer children and adolescents to other services they need. 

This support is provided through direct technical assistance to medical providers, clinics, and higher education programs for medical providers in Minnesota through training that includes a component on mental health screening, diagnosis, support, and referral resources. Future trainings will include recommendations to optionally include suicide questions in addition to depression screening depending on the needs for the patient and the capacity of patients. The training is offered to C&TC coordinators and Minnesota Tribes, who provide information and trainings to all their local clinics, and medical providers and nurses who are contracted with Minnesota Department of Human Services to provide C&TC screening services. Individual C&TC coordinators do community outreach and quality improvement projects that include outreach to youth around recognizing mental health concerns and connecting to services. 

Pediatric Mental Health Access Program 

In September 2021, Minnesota was awarded an American Rescue Plan Act – Pediatric Mental Health Care Access – New Area Expansion grant from HRSA. This five-year grant will help improve provider awareness of how to screen for and respond to mental health concerns in adolescents and young adults. Project goals (including that planned for FFY 2024) include: 

• Supporting a collaborative leadership structure.  The leadership structure includes an Advisory Council that has been built of the Mental Health Workgroup from the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). The council began meeting in Spring 2023 and will meet quarterly moving forward. In addition to members of the MNAAP Mental Health Workgroup, the Advisory Council includes youth and family consultants.
• Improving the quality and reach of the state’s Psychiatric Assistance Line (PAL). Minnesota has a legislatively required Psychiatric Assistance Line (PAL) that provides consultation and triaged referrals to providers throughout the state. By enhancing the service, providers will be able to receive consultation and assistance in resource connection when they have adolescents coming into their practice who may be displaying signs of suicide ideation. To increase awareness of the resource, staff from the PAL will be completing enhanced outreach to primary care providers by attending statewide conferences and other events. MDH will also assist in making updates to the PAL data system so that they are better able to account for and understand common needs of providers when receiving consultation as well as common characteristics of the children and youth who are benefiting from the consultation.
• Increasing capacity of primary care providers to screen for and respond to mental health concerns in culturally relevant and developmentally appropriate ways. The MNAAP will start a series of trainings for pediatric providers and other medical providers that will help providers feel more competent and confident in screening, assessing, and following along with mental health conditions.
• Coordinating and enhancing centralized resource directories. MDH has partnered with representatives from mental health organizations to develop and implement a Mental Health Collaboration Hub (MHCH), which is an active database that facilitates placements for youth who are boarding in hospitals and emergency departments. The MHCH launched in Spring 2023.
  5. Provide Education for those that Work with Justice Involved Youth in Community about the Importance of Mental Health Screening and Referral to Services

The C&TC team will continue to provide training available upon request that covers the unique health challenges and needs of Justice Involved Youth and the importance of ensuring that Medicaid eligible youth receive appropriate screening, including mental health screening, during C&TC visits. 

6. Partner with Youth-Serving Community Organizations to Identify Policies and Practices to Support Adolescent Mental Health and Well-Being

In 2021, MDH launched the Reimagine Black Youth Mental Health Initiative in collaboration with the Brooklyn Bridge Alliance for Youth– supported through a federal grant from the Office of Minority Health. This is a policy demonstration grant that engages local partners to identify, assess, implement, and evaluation specific policies that will improve Black youth mental health. The Reimagine Black Youth Mental Health Initiative has three goals: 

• Improve Black youth mental health. 
• Design a process that includes Black youth and communities in policy development.  
• Implement a Mental Health in All Policies Approach. 

The Reimagine Black Youth Mental Health Initiative is set to continue through FFY 2026. In FFY 2024, a state resource team on Black Youth Health and the Reimagine Black Youth Mental Health Advisory Council will collaborate to support sustainability and scaling effective practices and policies highlighted through this effort. Through the Mental Health in All Policies approach, the Advisory Council will partner with Black youth in community to identify and implement policies in the following priority policy areas:  

• Employment 
• Recreation 
• School Policies 
• City Policies 
• Policing 
• Healthcare.
  7. Support Schools to Identify and Partner with Community Resources to Access Appropriate and Timely Services for Youth

Adolescents and young adults spend a great deal of time in education-related activities; and schools can play a vital role in adolescent suicide prevention efforts. The effectiveness of prevention efforts in schools is often tied to community partners, who can offer their expertise around signs and symptoms of suicidality in adolescents within their communities. During FFY 2024 Minnesota’s Title V program will support the development of connections between schools and community partners to promote suicide screening, assessment, referral, and follow up in schools through the MN School Based Health Alliance, the MN Department of Education (MDE), and other programs at MDH. 

B.  Strategy B: Expand and Improve Postvention Supports

1. State Level Activities
   1. Provide Support through Trainings and Technical Assistance to Communities Dealing with the Impact of a Death from Suicide

Postvention training and technical assistance is a proactive planning tool to promote healing and reduce risk in the event of a suicide or sudden death. The SPU provides training and technical assistance to communities that are dealing with the impact of a death from suicide. 

One example of a training that is sponsored by MDH is the Connect Suicide Postvention Training. Connect is a half day training that focuses on engaging and building capacity for key service providers who will be involved in responding to a suicide or other sudden death in a community. More information on the Connect Suicide Postvention Training can be found on their website at: https://theconnectprogram.org/available-services/reduce-suicide-risk-and-promote-healing-suicide-postvention-training/. During FY2024, Title V staff will help promote this training (and additional technical assistance as needed) to providers and community leaders – especially as it relates to adolescents and young adults. 

During FFY 2024, the MDH Suicide Prevention Team, and Postvention subcommittee of the MN State Suicide Prevention Taskforce, will finalize the development of a Minnesota specific Postvention training. The goal of the Minnesota specific postvention training is to increase the number of communities participating in the training and implementation process of postvention within their respective communities. Title V staff will assist the MDH SPU in promoting this training once it is finalized. 

C.  Strategy C: Reduce Access to Lethal Means

1. State Level Activities
   1. Partner with Providers and Others who Interact with Youth At-Risk for Suicide to Routinely Assess for Access to Lethal Means

Minnesota’s Title V staff will partner with the SPU to implement reducing access to lethal means strategies identified in the Minnesota Suicide Prevention State Plan, including the following:

• Develop policies and procedures for providers to routinely assess for access to lethal means, as well as to provide recommendations for clients/patients on safe storage – inside and outside the home.
• Partner with community-based substance abuse prevention programs on medication take-back events, as well as messaging around safe storage of medications and chemicals as an overdose prevention strategy. 
• Develop standard messaging around risk for suicide and the importance of being alert to signs of suicidal behavior in a loved one, as well as safe storage of firearms. 

D.  Additional Related Activities

1. State Level Activities
   1. Promote Healthy Youth Decision-Making Through Implementation of High Quality, Medically Accurate, and Evidence-Informed Programming

Minnesota Personal Responsibility Education Program (MN PREP)

In January 2023, MDH awarded grants to six organizations to implement MN PREP. Over the next two years (2023-2025), MDH will oversee, provide technical assistance to, and conduct fidelity monitoring with the six grantees to ensure program requirements and grantee needs are met. Staff will collaborate with the University of Minnesota Prevention Research Center to provide train-the-trainer trainings to MN PREP instructors and additional MDH staff, as well as provide technical assistance and curricula training to all MN PREP grantee staff.  MN will partner with grantees to convene focus groups to include MN PREP participants and other youth from our targeted populations, including: young people ages 14-21 who are transitioning out of centers, LGBTQ+ youth, homeless youth, youth in alternative schools, and youth of color and American Indian youth – many of which are at higher risk of suicide. By partnering with the PREP grantees, we will be better able to reach youth who are more vulnerable to suicide with prevention and help seeking messaging, at risk for substance use, STI, and teen pregnancy with education to promote healthy relationships, financial literacy, and healthy life skills and to delay sexual activity and reduce pregnancy and STIs among youth. 

Minnesota Sexual Risk Avoidance Education Program – Minnesota Healthy Teen Initiative

Minnesota’s Healthy Teen Initiative (HTI) program, funded through the federal Title V State Sexual Risk Avoidance Education (SRAE) grant, links program participants to services provided by local community partners that support the safety and well-being of youth. HTI will target funding to at least four grantees in the state serving populations experiencing the greatest disparities in teen pregnancies and STIs through the implementation of high quality, medically accurate, evidence-informed programs to promote healthy youth development, sexual avoidance, and to delay the onset of sexual activity in youth 10-14. Youth from these populations will also benefit from prevention and help seeking messaging to decrease their risk of suicide. Additionally, the HTI will continue to implement evidence-informed programs that reach parents of, and adult mentors that interact and/or work with youth ages 10-19.

Additionally, MN PREP & MN SRAE/HTI staff will participate on the planning committee for the annual Adolescent Health Summer Institute (AHSI), Reproductive Health Update (RHU), and the Adolescent Health Summit (AHS) Conferences. MDH will provide sponsorships and facilitate workshops with the other sponsoring agencies of these events to offer topical expertise, planning and guidance to identify and partner with community-based resources.

2. Integration of Mental Health Services within School Based Health Centers (SBHCs)

In collaboration with Minnesota Community Care Clinics (MCC), Mankato State University PONDS Clinic, Minneapolis School Based Clinics, and White Bear Lake School District’s Bear Care Rise Up School Based Clinic, Title V staff will support the integration of mental health services, innovation of screening services and tools, and expansion of services for school based health centers across the state. 

Additionally, MDH and MN SBHA are working collaboratively with the National SBHA, the University of Minnesota, and the five entities overseeing SBHCs in Minnesota to develop dataset tools that will be made available to schools that are in the planning process for developing a SBHC. The tools will track students’ health services that are used for planning and recovery efforts from COVID-19, including depression screening and referrals to mental health providers.