Action Plan FY2024 Adolescent Health

Healthcare Reform

Vermont FCH developed supporting materials on Clinical and Community Strategies to Improve Adolescent Well Care Rates that have been and will continue to be distributed widely to ACOs and Unified Community Collaboratives. We hope to explore leverage points with Vermont’s health reform system given that adolescent well care visits are an ACO measure.

Collaboration Between Schools and Medical Homes

VDH School Liaisons and the Vermont Child Health Improvement Program (VCHIP) will provide ongoing TA to school nurses to facilitate connections between schools and medical homes.

• Work will be ongoing to maintain and strengthen partnerships between schools and medical providers locally. 
• These partnerships may continue to address the planning for school recovery efforts from the COVID-19 pandemic, be a local resource for schools for COVID-19, and other health related questions by using the most current public health information and address acute needs related to chronic health conditions care plans, promote COVID-19 vaccination for eligible youth, or illness that may reflect COVID-19 symptoms.
• Additionally, VCHIP (through the Youth Health Improvement Initiative) plans to conduct a landscape analysis of current local quality improvement or other programmatic touchpoints between schools, health systems, and interested parties across the state to inform future implementation efforts and opportunities (for future project work) in this collaboration space between schools, healthcare, and public health. 
• The VT AAP chapter plans to do a “road show” next year hosting regional dinners around the state to pull together schools, providers (and other community partners) with a theme of collaboration as well. 
• FCH is exploring the possibility of hosting a conference in the spring of 2024 with the theme of collaboration between primary care and schools. If funds are available and we can move forward with this event, we would do so in partnership with the VT AAP chapter and VCHIP to align efforts, messaging, and opportunities.

School-Based Health Centers

FCH plans to continue its work to engage providers and school partners regarding school-based health centers (SBHC).

• FCH will continue to identify its role regarding providing infrastructure and convening support to school-based health centers around the state. We anticipate an increased partnership with VCHIP around this space. 
• We will continue to attempt to complete and build upon our assessment of SBHC across the state, examine opportunities to establish connections to primary care medical homes, and opportunities for common indicators and measures across centers.
• FCH will continue to reach out to new, emerging, and existing SBHCs to maintain what we’re calling the Vermont’s SBHC Peer Collaborative. We plan to build upon information gathered during collaborative calls to help direct the future of our FCH support related to this work. We will use these opportunities to highlight FCH Title V and EPSDT priorities and explore opportunities to encourage participants to consider objectives and measures that align with FCH priorities (such as adolescent well care).
• Additionally, we will continue to explore opportunities to engage the School Based Health Alliance, and continue to use this national resource to learn more about SBHCs. We will begin to network with national partners and build relationships for possible technical assistance and resource sharing. One of Vermont’s adolescent health leaders was invited to participate in the School Based Health Alliance State Leader’s monthly call, an opportunity to hear about issues happening nationally, to learn from this leadership community, and to share resources.
• Thanks to steps taken over the last few years to implement telemedicine opportunities in primary care (during the pandemic), we want to explore the types of school linkages that could be continued, made, or sustained to increase access and connection to primary care in the school setting.
• FCH will partner with the Youth Health Improvement Initiative at VCHIP to continue to develop and implement an assessment tool for our existing SBHCs, to identify common assessment measures of SBHC implementation and desired outcomes and consider training and development opportunities with SBHCs. Additionally, we want to gather youth perspectives on SBHCs.  Competing priorities for schools and providers at these sites impacted participation in surveying opportunities, but we plan to continue our assessment and identify new partners as more schools consider SBHC’s.
• We partner with our School Liaisons in the Local Health district offices to support gathering information about sites, and plan to consider ways to more easily gather and maintain site information on a recuring basis. 
• FCH also partners with the Office of Oral Health at the Health Department in relation to their 802 Smiles program which supports school-based oral health access.

State School Nurse Consultant and School Health Services

FCH will continue to fund stipends for school nurses participating in Vermont’s School Nurse Advisory Committee. The primary role of the School Nurse Advisory Committee is to:

• Review and update the Standard of Practice: School Health Services Manual.
• Maintain and update the new school nurse orientation.
• Strengthen school nurse workforce development.

In the upcoming year, the State School Nurse Consultant (SSNC) and the School Nurse Advisory Committee plan to:

• Revise the format of the Standards of Practice: School Health Services Manual and create documents that support student, family, and school community physical and mental health and resilience.
• They will also evaluate and revise the current new school nurse orientation content and the Essential School Health Services framework.

The SSNC will continue to work with stakeholders and school nurses to identify, create, and disseminate training and support opportunities for school nurses statewide.  They will continue to work with the Northeastern University School Health Academy to support School Nurse Leadership training and collaboration.  

Office of Local Health Designees

Health Department School Liaisons and Family and Child Health Coordinators promote Bright Futures 4th edition with school and primary care providers. Liaisons will continue to look for opportunities to promote the concept of annual preventive care for all school-aged students with an emphasis on the adolescent population as measured by our annual School Nurse Report. Additionally, Liaisons will continue to promote strategies with school nurses to increase awareness and promotion of annual well care visits (in partnership with VCHIP).

Partnering With Schools: Ongoing COVID-19 Pandemic Response[WN(1]

The Health Department will continue working closely with schools to monitor the current situation and evidence-based practice recommendations related to COVID-19 pandemic recovery.

• Central office staff, in collaboration with the Office of Local Health School Liaisons, will be available to provide technical assistance and support the transition out of the public health emergency.
• We will continue to emphasize the importance of schools and provider offices strengthening relationships and communication to ensure the best outcomes for students and families.
• Schools and provider offices will be encouraged to develop, maintain, or improve the way they communicate to ensure students and families are accessing preventive care (including adolescent well-care), addressing chronic illness care, and coordinating on acute needs.
• The Health Department will continue to collaborate with providers to support local level health-related information needs for their communities (e.g., be available to present information or answer questions locally) in alignment with public health messaging.
• The Health Department will continue to coordinate and collaborate with the Agency of Education for the 23-24 school year to ensure optimal health outcomes for Vermont’s youth.

Sports Clearance

FCH previously worked with VCHIP through the youth health improvement initiative, finishing an updated sports clearance form that highlights the importance of annual well care. The Vermont chapter of the American Academy of Pediatrics and Vermont Academy of Family Physicians reviewed this form and shared it with the Vermont Principals Association’s Sports Medicine Advisory Council. We planned to roll it out during the previous three school years, but there were delays and this activity was later put on hold due to the early closure and ongoing emergency response of schools due to the COVID-19 pandemic. The past school year focused on renewed efforts to reconnect with schools around non-COVID-19 topics, promoting school nurse leadership, and reestablishing more pre-pandemic program activities with our school partners. We plan to review the current iteration of this document to update it using plain language and health equity lenses to ensure a product that is easily understandable and continues to highlight the importance of an annual well care visit (especially for the adolescent population). We hope to do this in partnership with VCHIP and the VT AAP chapter (in consultation with school nurse partners).

Youth Health Improvement Initiative and VT RAYS

Vermont continues to partner with VCHIP’s YHII to improve adolescent and young adult (AYA) health care throughout the state and supports opportunities for meaningful youth engagement. 

• We will continue to collaborate with VT RAYS to inform activities related to services or resources for the AYA population and incorporate AYA voices into project work. 
• Additionally, the team will explore and strategize opportunities to advance the health of Vermont’s children through partnerships with and services in the school setting.  These partnerships may address areas including promotion of adolescent well care visits, addressing substance misuse and treatment, including nicotine addiction, behavioral health concerns, or other youth health concerns identified by school nurses and the communities. 

UP for Learning, Getting to ‘Y’, and Personal Power and Community Connections

FCH will continue to promote healthy behaviors among youth through an empowerment model by promoting UP for Learning’s Getting to ‘Y’ program (GTY). Increasing access to GTY is an opportunity for students across Vermont to take a lead in bringing meaning to their own Youth Risk Behavior Survey data by taking steps to strengthen their school and community based on their findings by addressing risks and promoting strengths. FCH also continues to support Personal Power and  Community Connections (P2C2) described elsewhere in the report. UP for Learning aims to increase access to the program by continuing to expand their regional training model to more locations across Vermont.

Partnership with PATCH

FCH plans to continue an effort to partner with VCHIP’s, Youth Health Improvement Initiative to explore the use of the  Wisconsin-based, PATCH (Providers and  Teens Communicating for Health) program to promote the use of, PATCH for Teens Toolkit. This program provides school health educators, health-related professionals, youth workers, and other adults the materials and resources needed to teach young people about their rights and responsibilities in health care settings. Our hope is that this curriculum can be delivered in a health class and will empower youth to access their primary care provider and develop the skills to help them access recommended preventive care and acute care as needed. In 2023-2024 we will assess readiness for implementation of PATCH and work to integrate this into our future efforts.

FCH Adolescent Health Team

The FCH Adolescent Health Team will continue to inform the work outlined below. The Team meets monthly and at times invites other partners from across the Health Dept, AHS, and community partners to join discussions to ensure coordination and collaboration across the variety of topics areas our work encompasses. In the coming months we will also reconvene with our other health department colleagues who work on adolescent health: staff from our chronic disease prevention unit, emergency preparedness and injury prevention, and the division of substance use programs.  There are also opportunities for collaboration with other state partners, including the Department of Mental Health, the Department for Children and Families, and the Agency of Education. Our Adolescent Health Team is working to identify priorities, assess the impact of COVID on our programs and partners, and identify next steps for our shared efforts related to adolescent health and wellbeing.

Injury Prevention/ Suicide Prevention

Vermont FCH will continue to participate in the Vermont Suicide Prevention Coalition, with the Department of Mental Health, Agency of Education and Vermont’s Designated Agencies. Additionally, the Department of Health increased its capacity to address suicide prevention in Vermont by receiving a comprehensive suicide prevention grant from the CDC and a Garret Lee Smith Youth Suicide Prevention Grant.  Vermont FCH actively engages in the planning and implementation of these grants, as well as representing FCH on the suicide data subcommittee.  We increased data capacity from the NVDRS (violent death analysis) and the ED-SNSRO (suicide surveillance in emergency departments) grants that is informing our programs.

In partnership with the Vermont Child Health Improvement Program (VCHIP), FCH will collect and report on quality improvement data from pediatric practices on depression screening and will promote suicide screening in primary care using the nationally recognized Zero Suicide. FCH continues to build upon its partnership with DMH by ensuring that leadership from both departments meets bimonthly to support enhanced coordination and collaboration around shared priorities. FCH will continue to prioritize BIPOC and LGBTQ youth in suicide prevention policies and programming. FCH holds a lead role in the VT Child Fatality Review Team and will assist with review of deaths by suicide and formation of relevant recommendations, with a focus on community and school based postvention response.

Personal Responsibility Education Program 

As we look toward the next fiscal year, we are revamping our PREP program. The FCH Adolescent Health Program Manager is working in partnership with Vermont Afterschool (VTA), which is a statewide nonprofit dedicated to ensuring that the children and youth in every Vermont community.  VTA will operate at an umbrella organization for PREP. We are looking to reenergize our PREP program and bring on new PREP sites while focusing on equity by offering PREP throughout all regions of Vermont.

• On board new implementing sites across the state.
• Facilitators to attend Making Proud Choices curriculum training.
• Implementing sites will participate in quarterly community of practice meetings.
• Needs assessments will be conducted to inform the training needs of the implementing sites.
• Implementing sites will participate in up to four training courses as identified by the needs assessment.

For a sixth year we will contract with pediatrician and adolescent medicine specialist, Dr. Erica Gibson, who provides training and TA to our PREP program staff, and the broader sexual health education stakeholder group efforts. This year, Dr. Gibson will also continue to provide training and TA to VT Afterschool Inc.

• Dr Gibson will plan and deliver up to six (6) educational sessions annually to health educators, community-based youth serving staff, afterschool personnel, and others involved in sexual health education. Sessions can be in person or remote, as circumstances allow.
• Participate in at least two (2) professional development events for health educators annually. 
• Write two (2) articles for the School Nurse Bulletin on current issues pertaining to adolescent health.
• Participate in Sexual Health education Stakeholders group as her schedule allows.
• Other topic areas of focus of Dr Gibson’s work will be gender affirming care for trans youth and disordered eating.

Partnering with the Agency of Education on Sexual Health Education Stakeholders’ Group[SI(2]

The VT Dept of Health continues to be engaged in a robust body of work with the Agency of Education and a variety of community partners related to sexual health education in the state. The Sexual Health Education Stakeholders’ Group is intended to promote support and resources for sexual health education for adults who work with and care about youth, and to collaborate across organizations and agencies to improve youth sexual health and education in Vermont. Members represent AOE, the Health Department, Planned Parenthood of Northern New England (PPNNE), Outright VT, VT Cares, VT Network, PreK - 12 health educators, and a pediatrician who specializes in Adolescent Medicine and sexual and reproductive health. The group is dedicated to identifying priority topics in sexual health education and delivering professional learning and resources that support high-quality sexual health education.

The group will continue to engage in several activities:

• Provide training and support around the Essential Topics in Sexual Health Education for Vermont Health Educators.
• Develop support and resources for adults to provide sexual health education and information that meets the needs of all Vermont Youth.
• Develop resources for parents to talk with their youth.

• Promote inter-organization and agency collaboration to strengthen sex education in Vermont.
• Continue to support the implementation of the condom availability in schools’ law that went into effect on July 1, 2021. The law requires that all secondary schools in the state (grades 7-12) must make condoms available. The Health Dept and AOE will continue to work in conjunction with several community partners to create supportive materials and guidance for schools to support this implementation.

• Work to identify priority topics in sexual health education and deliver professional learning and resources that support high-quality sexual health education.
• Support PREP programs via training and TA.
• Provide education on the Essential Topics guide and develop and provide topical trainings through the VT Higher Education Collaborative and other professional development avenues.
• Continue to participate in the Leadership Exchange for Adolescent Health Promotion (LEAHP). This is a learning collaborative aimed at building state education and health policymakers’ capacity to improve sexual health education, sexual health services, and safe and supportive environments in schools through summer 2024.

Youth Services Advisory Council

FCH will continue to have leadership engaged in various partner initiatives, including tri-chairing the Youth Services Advisory Council (YSAC), which promotes shared responsibility across state and community stakeholders for achieving positive outcomes for youth and young adults in Vermont. FCH is collaborating with the Agency of Education to conduct an assessment of the current landscape related to sexual health education, and following up on activities that were recommended to the state legislature in January of 2020 for improved standardization of sexual health education.

• The YSAC will ensure the success of the Statewide Youth Council, which was enacted this past legislative session. With Vermont Afterschool and the Division of Family and Child Health, the YSAC will advise on recruitment, application, and training, and convening processes as this group coalesces.
• The YSAC will return to the pre-COVID work or examining youth and young adult outcome measures to determine next steps.
• YSAC will be tri-chaired by the FCH Adolescent Health Program Manager.

Partnership With Vermont Afterschool

FCH will continue to fund Vermont Afterschool’s work around preventing risk behaviors and promoting strengths for youth. Vermont Afterschool will be entering its sixth year of funding from FCH.

• Continue the work of the Youth Voice Coordinator and the Youth Resilience Coordinator to maintain support for youth councils across the state.
• Manage the Vermont Youth Project which supports stakeholders in specified communities to identify and implement strategies that increase protective factors and reduce risk factors for youth across the domains of school, community, family, and peers.
• Support and manage the legislatively mandated Statewide Vermont Youth Council.
• In partnership with the Vermont Child Health Improvement Program’s Youth Health Improvement Initiative, sustain a combined (VT RAYS-VT Afterschool) youth-led advisory council to address statewide adolescent and young adult health issues, including improving access and utilization of high-quality prevention health services, including behavioral health.

Other FCH Adolescent Health Representation

• FCH Adolescent Health Program Manager represents Vermont on the National Network of Adolescent Health Coordinators. The NNSAHC connects state adolescent health coordinators in state Title V/MCH Programs and other professionals who manage adolescent health programming, services, and systems in 50 states and nine territories.
• FCH Adolescent Health Program Manager sits on the Gender Affirming Care Workgroup in Vermont, which is made up of health providers who provide care to trans youth. The group meets to discuss current issues and gaps and barriers to health care that young trans people face in Vermont.
• Vermont Department of Health was recently included in a youth and community violence prevention bill.  The bill calls for the establishment of a Community Violence Prevention Program to live in FCH.  FCH will award municipalities and non-profit organizations funding to implement evidence-based violence prevention programs to reduce youth and community violence. Priority areas include communities with an increase in substance misuse, human trafficking, and gang activity. 

Health Equity

FCH will continue to identify and work with key community partners that serve Vermont’s New American population to identify outreach and engagement strategies to promote messaging around adolescent health issues, such as injury, suicide, well-visits, and other preventive health measures. After serving as the FCH COVID-19 Equity Technical Advisor and member of the Health Department’s Health Equity Action Team (HEAT), the FCH Adolescent Health Program Manager transitioned to the role of Health Equity Team Lead for FCH. This work has included, and will continue to focus on New American communities, BIPOC communities and other vulnerable populations. Through working with the Adolescent Health Team, FCH will also be able to enhance health equity efforts around adolescent health. 

Please note: Only those strategies that link with national and state performance measures are identified in the Action Plan Table for this section.

[WN(1]Completed with support of Molly.  Ilisa may want to comment as well.

[SI(2]Also a bit redundant.