Application for FY21

For Adolescent Health, New York’s Title V program selected the National Performance Measure (NPM) 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. This NPM was selected because it aligns with both population health data indicators and concerns voiced directly by adolescents in NYS. Most teens ages 12-17 had a preventive medical (81.3%) and preventive dental (79.3%) visits in the past year, but there is room for improvement and disparities persist – only 72.1% of Hispanic adolescents had a preventive medical visit compared to 87.2% of non-Hispanic White adolescents and only 79.9% of adolescents on Medicaid had their annual visit compared to 86.9% with private insurance. Adolescents across the state discussed that their medical providers lack compassion and respect for their young patients and that youth would prefer visiting providers who are more affirming and reflective of the youth themselves.

Preventive medical visits are one part of overall wellness, but data and community input point to other areas that could help adolescents thrive, such as social-emotional wellbeing and preparation for taking on the responsibilities of adulthood. Over 30% of high school students reported feeling sad or hopeless for more than two weeks in the past year and over 10% reported that they attempted suicide. Hispanic students are more likely to report depression symptoms and suicide attempts, and there are dramatic disparities based on sexual identity as well, with 60% of students identifying as gay, lesbian, or bisexual reporting depression symptoms and 26% reporting a suicide attempt. The importance of social support and the need for more people to talk to positive mentors were frequently mentioned by adolescents. They discussed feeling socially isolated and wanting opportunities for community engagement or building a sense of belonging. Only 16.4% of adolescents without special health care needs received services necessary to transition to adult health care. And beyond assuming responsibility for their own health care, adolescents voiced a desire for education about financial literacy, healthy cooking, navigating relationships, and other aspects of adulthood.

Adolescence is often a very challenging stage in a person’s life. During this time, adolescents experience growth through physical development, cognitive development, social-emotional development, identity, and sexual development. Supporting adolescents’ health and development and helping them prepare for their futures can have a lasting impact throughout the life course. The multifaceted nature of adolescent development and wellness means the selected NPM and its associated strategies are responsive to most of the priority areas, particularly health care, social support and cohesion, community services and amenities, and awareness of resources. This NPM also aligns directly with established priorities encompassed in the NYS Prevention Agenda goals to support and enhance children and adolescents’ social-emotional development and relationships, strengthen opportunities to build well-being and resilience across the lifespan, facilitate supportive environments that promote respect and dignity for people of all ages, and other Prevention Agenda goals related to mental health and substance use.

Four specific objectives were established to align with this performance measure:

Objective AH-1: Increase the percent of adolescents, ages 12-17, with a preventive medical visit in the past year by 5%, from 81.3% in 2016-2017 to 85.4% in 2021-2022. (National Survey of Children’s Health, NSCH)

Objective AH-2: Increase the percent of children, ages 3 through 17, with a mental/behavioral condition who receive treatment or counseling by 5%, from 53.5% in 2017-2018 to 56.2% in 2021-2022. (NSCH)

Objective AH-3: Increase the percent of adolescents, ages 13 through 17, who have received at least one dose of the Human Papilloma Virus (HPV) vaccine by 8%, from 67.3% in 2018 to 72.7% in 2022 (NIS).

Objective AH-4: Increase the percent of NYS adolescents without special health care needs, ages 12-17, who received services necessary to make transitions to adult health care by 5%, from 16.4% in 2017-2018 to 17.2% in 2021-2022. (NSCH)

Four strategic public health approaches were identified to accomplish these objectives over the next five years. These are presented in the State Action Plan (SAP) Table, and each is described in more detail here, with specific program and policy activities that will be implemented to advance the broader strategic approach in the upcoming year.

Strategy AH-1: Incorporate specific activities to promote the wellness of adolescents across all Title V programs, including promoting and facilitating routine well visits, reproductive health care, oral health, and behavioral health.

Adolescence is a critical stage of development when children grow physically, cognitively, emotionally, and socially to become adults. The lifestyle choices, behaviors, and relationships established during this time can affect an adolescent’s current and future health. Routine well visits during adolescence are recommended by the American Academy of Pediatrics’ Bright Futures as one way to foster health in the present and build a foundation for wellness into the future. They are an opportunity to promote healthy behaviors, discuss risky behaviors, provide important vaccinations, and address conditions that can interfere with healthy development. Likewise, comprehensive and inclusive reproductive health care and education are opportunities to help adolescents avoid or mitigate risky sexual behaviors. Title V funded programs also provide enabling services to adolescents, such as referrals to and linkages with community services and social supports to holistically address health and wellness, including mental health and social determinants of health.

The key programs that work to support adolescent wellness and help connect adolescents to needed services include Comprehensive Adolescent Pregnancy Prevention (CAPP) Program, Sexual Reproduction Avoidance Education (SRAE), Children and Youth with Special Health Care Needs (CYSHCN), School-Based Health Centers (SBHC), Family Planning Program, and Sexual Violence Prevention programs.

The NYS Title V program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:

• Through CAPP, provide information to adolescents and parents on the offering and arranging of adolescent sexual health reproductive services. The federally funded Personal Responsibility and Education Program (PREP) also provides this information, in partnership with the Title V program.
• Through SRAE, provide medically accurate and complete sexuality health education services to youth.
• Through CAPP, PREP and SRAE, increase access to health care services for adolescents through a referral process that includes confirmation as permitted while ensuring confidentiality.
• NYSDOH staff, including Title V funded staff, and community youth-serving organizations provide trauma-informed education and training on social emotional wellness and positive youth development for children and adolescents  
• Within the Title V program, enhance collaboration between adolescent serving programs, including CAPP, SRAE, SBHC, and CYSHCN, to promote holistic adolescent health through provision of comprehensive physical exams and anticipatory guidance, including body mass index (BMI), behavioral health, oral health and reproductive health, for adolescents with and without special health care needs.
• Collaborate with internal, including NYSDOH AIDS Institute and Bureau of Immunization, and external, NYS HPV Coalition, stakeholders to promote HPV vaccination with clinical providers.
• Refer adolescent parents to family planning providers for contraception and birth planning, including SBHCs, where available.
• Promote access to confidential reproductive health care services and preventive medical visits for adolescents, including through SBHCs, where available. Family planning providers deliver counseling and services related to contraception, promotion of healthy relationships, preventive medical care, and preconception/interconception health.
• Promote healthy relationships and sexual violence prevention using policy change, protective environment strengthening, healthy social norms reinforcement, and skill-building to address individual, relationship, community, and societal risk and protective factors. Focus on groups experiencing disproportionate burden of sexual violence, including communities of color, adolescents and young adults, domestic violence victims, those experiencing low income, people affected by alcohol and drug abuse, and LGBTQIA+ persons.
• Promote adolescents’ social-emotional wellness and positive developmental assets through established Title V programs.

Strategy AH-2: Promote supports for adolescents to gain the knowledge, self-efficacy, and resources they need to prepare for and transition to adulthood.

For young adults, with or without special health care needs, the transition to adulthood is a crucial time in their development. Young adults may move away from their parents, transition to adult health care, become increasingly sexually active, continue their education, and/or start a career. Navigating these transitions can be difficult for youth as their independence continues to grow. Often, an increased sense of independence can lead to an increase of unhealthy risky behaviors. Title V programs will provide youth with support to help prepare for and navigate this transition.

The Title V Program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:

• Ensure adolescent providers have a mechanism in place to provide adolescent-related health care service referrals to other providers of health care services, including substance abuse (e.g., alcohol, tobacco cessation), mental health issues, and intimate partner violence.
• Refer adolescent parents to family planning providers or SBHC for contraception and birth planning.
• Support pregnant and birthing adolescent parents in attending prenatal, postpartum and well-baby appointments.
• Promote access to confidential reproductive health care services and preventive medical visits for adolescents. Family planning providers provide counseling and services related to contraception, promotion of healthy relationships, preventive medical care, and preconception/interconception health.
• Ensure adolescent-serving programs provide training on adulthood preparation subjects, such as, healthy relationships, effective communication, career and education opportunities, health care transition, and financial literacy for adolescents with and without special health care needs to prepare them for a transition into adulthood.

Strategy AH-3: Apply public health surveillance and data analysis findings to improve services and systems related to children's health and health care.

Data-driven, evidence-based practice is essential to achieving public health goals for NYSDOH and the NYS Title V program. Across all Title V funded programs, continuous effort is needed to enhance the collection, analysis, and sharing of data to inform the planning and implementation of programs and policies. Sharing data with stakeholders, including providers and community members, is critical to raise awareness, empower community action, and facilitate quality improvement efforts at all levels. 

The combination of public survey data gleaned from sources like NSCH and the Youth Risk Behavior Survey (YRBS) with data from NY’s Adolescent Sexual Health Needs Index (ASHNI), Vital Statistics and other data systems provide information to identify areas throughout the state with the most pressing health needs for youth.

The Title V program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:

• Collaborate with the US Census Bureau and HRSA to conduct an over-sample of NYS 2021 National Survey of Children’s Health for NYS to allow for enhanced sampling of Black/African-American, Hispanic, and CYSHCN.
• Title V staff will continue to use publicly available and internal surveillance data to identify adolescent needs and/or health behavior trends to support optimum adolescent health and development and determine funding areas for NYSDOH adolescent health procurements.
• Through ACT CCA trainings, webinars, and web posts, provide information and education to youth-serving organizations.
• Explore collaborative opportunities with the NYSDOH Division of Chronic Disease Prevention’s (DCDP) Bureau of Chronic Disease Evaluation and Research (BCDER), which works with the NYS Education Department, to review and share information gathered through the YRBS.

Strategy AH-4: Apply a health equity lens to Title V activities to address social determinants of health and reduce disparities that impact adolescents’ health and well-being.

Adolescent health outcomes are impacted by the social determinants of health (SDOH), or the conditions in which people are born, live, work, play, learn, and age. SDOH include factors like socioeconomic status, education, community environment, employment, social supports, and access to health care services. Systematic differences in the distribution of power and resources due to racism and other biases are root causes of inequities in access, availability, and quality of SDOH. All ten priorities that emerged from community members' input during the needs assessment revolve around SDOH and inequities. These factors and inequities impact the health outcomes of both individuals and entire communities. Adolescents who participated in the listening sessions and focus groups were aware of how things like quality housing, safe communities, employment, and community services affect their health and well-being and that of their families and were well aware of the inequities in the access and quality for their communities. They discussed seeing their parents struggle and wanting change for their parents and for themselves as they near adulthood. Strategies focus on involving stakeholders who are representative of populations impacted by health inequities, particularly engaging and collaborating with youth, to inform program planning and implementation and policy development.

The Title V program will lead the following specific program and policy activities to advance this strategy over the upcoming 2020-21 year:

• Collaborate with other state agencies and youth-serving organizations on adolescent-centered priorities through the Youth Development Team (YDT).The YDT includes representation from NYSDOH, Office of Children and Family Services (OCFS), Council on Children and Families (CCF) and the Developmental Disabilities Planning Council (DDPC) in coordination with youth-led organizations.
• Ensure that NYSDOH health equity teams review materials before being widely disseminated to youth and youth-serving organizations
• Collaborate with youth through focus groups and community forums for direct input with state initiatives and special projects.
• Involve stakeholders that are representative of the populations most impacted by racism and health inequities in programmatic decisions.
• Through NYSDOH adolescent providers, issue information on locally available resources and provide referrals specific to addressing the SDOH with adolescents from populations impacted by disparities. 

The NYS Title V Program established two Evidence-Based Strategy Measures (ESMs) to track the programmatic investments and inputs designed to impact NPM 10:

ESM AH-1: Percent of youth-serving programs that provide training on adult preparation subjects, such as accessing health insurance, maintaining their routine preventive medical visits, healthy relationships, effective communication, financial literacy, and adult health care for adolescents with and without special health care needs to prepare them for a transition into adulthood.

Data for this measure will come from biannual reports and annual data requests submitted by local adolescent health providers. Baseline values for this measure will be taken from a 6-month program period of 10/1/2020-3/31/2021. Improvement targets will be determined after the baseline has been established.

ESM AH-2: Percent of youth-serving programs that engage youth, particularly youth representative of populations impacted by health disparities, in program planning and implementation.

Data for this measure will come from biannual reports and annual data requests submitted by adolescent health providers. Baseline values for this measure will be taken from a 6-month program period of 10/1/2020-3/31/2020. Improvement targets will be determined after the baseline has been established.