In 2020, Guam Title V will continue to employ strategies in relation to National Performance Measure # 10 – Percent of adolescents with a preventive health visit to advance the quality, relevance, and uptake of available services. The alignment of Guam’s priority need to promote and enhance adolescent strength and skills supports new strategies to help program decision-making and design.

The transition from being a child to a self-reliant young adult represents one of the most dynamic, broad and influential periods of human development. The young adolescent body undergoes more developmental changes than at any other time. The extent of these changes makes the period somewhat risky; given behaviors established during this time often extend into adulthood. At the same time, the teen years represent an ideal time for interventions, largely for the same reason. Well-health visits provide a critical opportunity for providers to influence health and development and alter an adolescent’s trajectory toward more positive long-term outcomes.

Most adolescent morbidity and mortality are preventable. According to the Archives of General Psychiatry, half of lifetime cases of mental health disorders begin showing symptoms by age 14. Both the American Academy of Pediatrics and the American Medical Association recommend comprehensive annual check-ups for adolescents.

Adolescent annual well care is an important opportunity to build a trusting relationship between the teen and the provider and an opportunity to promote the strengths of the adolescent and his/her healthy development. However, some parents and adolescents do not see the value in a well-child exam. Moreover, adolescents feel awkward and uncomfortable going to a “baby doctor” and have concerns over confidentiality. A key approach to increasing preventive visits is to further develop adolescent care practices that are intentional and thoughtful in welcoming and caring for all adolescents.

Title V will collaborate with Guam Department of Education (GDOE) school nurses to increase adolescent referrals by school nurses for sexual health services. Development of resources, education of school nurses and promoting collaboration will begin to improve adolescent knowledge of and motivation to use resources related to sexual health.

The past ten years, GDOE has had an Annual Conference for School Nurses. Topics related to adolescent health needs and provisions of services are regularly included in each conference. Topics have focused on teen suicides, healthy sexual relationships, adolescent health needs and other emerging health care trends such as mental health and crisis assessment of preteen and teens and the opioid crisis.

Strengthening the approaches school nurses use to make  reproductive health referrals for adolescents is a best practice in improving reproductive health outcomes for youth. Clinical family planning services funded by Title X will continue to be a source of primary care for adolescents by providing sexual and reproductive health services in a safe and confidential space. Title X is guided by the Office of Population Affairs Program Policy 2014-02 Confidential Services to Adolescents. Improving the sexual health of adolescents is a public health priority due to the potentially serious health consequences that may occur when they do not have access to appropriate health education, healthcare resources, or support to help them make informed decisions and minimize risky behaviors.

The Guam Department of Education’s PREP Program will continue to implement the Be Proud/Be Responsible curriculum. This sexual health education curriculum includes the five principles of social and emotional learning skills: self-awareness, self-management, social awareness; relationship skills and decision-making. The Be Proud/Be Responsible curriculum also includes parent engagement activities to increase communication of sexual health and health decision making amongst families.

The HPV vaccine has the potential to save thousands of lives from HPV-related cancers. The Immunization Program in collaborating with Guam Cancer Cares has raised awareness about the importance of the HPV vaccine in an effort to reduce cancers on Guam. The Immunization Program will continue to work with Guam Cancer Cares to promote the message about cancer prevention through social media and public advertising. Furthermore, the GDOE school nurses will continue the school-based voluntary HPV vaccination program.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), cultural competence means being “respectful and responsible to the health beliefs and practices, and cultural and linguistic needs of diverse population groups.” A key compound of quality adolescent care is the extent to which services are delivered in a developmentally appropriate adolescent-friendly and confidential manner.

Students who are perceived as different by other students are more likely to be bullied. These more vulnerable students include LGBT youth, students with physical, mental and learning disabilities; and students who are targeted for differences in race, ethnicity, and religion.

MCH will build on the bullying prevention by continuing to engage with partners involved in bullying prevention efforts. Going forward, our focus will be to continue to form partnerships and collaborations with our community partners. When appropriate, MCH plans to pursue opportunity to join in the conversation and planning efforts to ensure the message of bullying prevention as a public health issue is brought to the table and should be considered in any public health strategic planning efforts.

One of the resources available for adolescents experiencing relationship, bullying, depression, or thoughts of suicide is the Crisis Hotline, a number that is available to teens and parents. MCH will work with other stakeholders to assess the availability of prevention and behavioral health treatment options and identify strategies for increasing awareness and availability of the Crisis Hotline.

MCH Title V will work with the Guam Behavioral Health and Wellness Center to identify opportunities for providing Applied Suicide Intervention Skills Training for program staff and Project Bisita home visitors. ASIST is a two-day, two-trainer, workshop designed for members of all caregiving groups. Family, friends, and other community members may be the first to talk with a person at risk, but have little or no training. ASIST can also provide those in formal helping roles with professional development to ensure that they are prepared to provide suicide first aid help as part of the care they provide.

The emphasis is on teaching suicide first aid to help a person at risk stay safe and seek further help as needed. Participants learn to use a suicide intervention model to identify persons with thoughts of suicide, seek a shared understanding of reasons for dying, and living, develop a safe plan based upon a review of risk, be prepared to do follow-up, and become involved in suicide-safer community networks. The learning process is based on adult learning principles and highly participatory. Graduated skills development occurs through mini-lectures, facilitated discussions, group simulations, and role-plays.

MCH looks forward to establishing and cultivating a partnership with Project Inspire to address ways to support children who are experiencing family-related trauma that ultimately impacts their performance at schools. Throughout 2019, Project Inspire will release public service announcements, focusing on saving lives, and teaching residents how to get help that is available. The group will create messages with the guidance of Guam Behavioral Health and Wellness Center.

Victim Advocates Reaching Out (VARO) will continue to provide developmentally appropriate services to adolescents in the school setting and will work to identify training needs and other resources to provide quality, evidence-based informed services to adolescents. VARO is a non-profit volunteer based organization that provides crisis intervention, advocate, education, and public awareness and prevention activities in the areas of sexual assault, domestic violence, dating violence, stalking and other violent crimes. Primary prevention education is based on addressing the underlying issues that result in rape and sexual violence and many include some the following topics: bullying and sexual violence, consent, and coercion, dating violence, drug-facilitated rape, gender roles, and health relationships.

GALA will continue to bring health awareness, substance abuse prevention, and youth empowerment programs to schools and community centers. Their programming includes Storytelling for Empowerment, an evidence-based substance abuse and suicide prevention curriculum; a health and wellness program; and a Summer Power Camp that includes arts and crafts, physical fitness, and substance abuse and wellness workshops for school-age youth.

GALA relies on strong collaboration with a wide range of schools and community partners – including the University of Guam, Title V MCH, victim advocacy services, village mayors – to identify youth who could benefits from their services.