Adolescent Health

Application Year 2023

Overview: Adolescents in the District face many challenges from poor mental health to engaging in high-risk behaviors resulting in substance use, STI transmission, and pregnancy to lacking adequate access to critical health care services. Such health indicators and clear disparities experienced amongst adolescents in DC helped to guide FY23 programmatic planning. Strategies to improve physical, social, emotional, and behavioral health of

students, as well as minimize the effects of poverty and other adverse childhood experiences will assist District youth with achieving optimal health, educational, and life outcomes.

Priority 1: Reducing grief and trauma-related symptoms among children and adolescents

Objective 1: Increase the percent of adolescents age 12 to 17 with mental health needs who received counseling from 59.1% to 65% by 2026

Strategies:

• Provide accessible mental health programs in school-based health centers and community-based organizations
• Provide training for behavioral health professionals

Priority Measures:

• Revised – State Performance Measure 3: Mental Health- Increase the percent of children and adolescents, ages 3-17 with mental health needs who received counseling
  • Rationale – To enhance the data collection of the performance measure, we are shifting away from collecting numbers and embracing proportion to better understand how DC Health is reaching the population.

Activities:

In FY23, the Wendt Center for Loss & Healing will continue the Resilient Scholars Project, a community-based mental health program that creates pathways to healing and health for low-income, minority children and adolescents from underserved neighborhoods of the District who are impacted by trauma and grief. The project partners with schools and other child-serving organizations in the lowest income Wards of DC to provide intensive, evidence-based trauma and grief therapy to students affected by violence, racism, abuse, deaths of loved ones, poverty, and other Adverse Childhood Experiences (ACEs). The project also provides specialized trauma and grief training to build the capacity of District public and public charter school systems to effectively support traumatized and grieving students. The priority area for this program is Mental Health including Grief and Trauma-Informed Care. This project will focus on increasing access to effective mental health care through the provision of high-quality, evidence-based mental health services in school-/community-based or virtual settings to low-income children (ages 6-21) exposed to trauma and grief and through specialized training services informed by evidence-based practices that expand the capacity of the school workforce to effectively support trauma- and grief-impacted children. The Wendt Center anticipates partnering with school and community-based organizations.

In FY23, as part of the Pediatric Mental Health Care Access Grant (PMHCA), DC Health will continue to partner with DC DBH to expand the services of the existing DC Mental Health Access in Pediatrics (DC MAP) program through the provision of pediatric mental health care telehealth access and continuous quality improvement as well as extend collaboration with regional and national partners. Telehealth expansion of existing pediatric mental health care access will address the following challenges and priority areas: 1. timely detection, assessment, treatment and referral; and, 2. integration with school-based health centers (SBHCs) and providers.

For FY23, PMHCA’s priority area one focuses on timely detection, assessment, treatment and referral. By September 2023, goal one is to increase the utilization of DC MAP by enrolled pediatric primary care providers (PPCPs) by 5%, with objective one to increase the percentage of PPCPs that participated in cultural competency trainings from 58% to 70% by September 2023. Key Activities are outlined below:

• Implement professional development (i.e., Project ECHO or similar) to increase comfort and knowledge for PPCPs who use telehealth support from DC MAP.  Provide cultural competency training to assist PPCPs to address stigma for better patient outcomes.
• Utilize LICSW to provide direct MH assessment, treatment, psychoeducation and care coordination for an individual or family who have been identified. 
• Utilize child psychiatrist to provide direct mental health provider to pediatric primary care provider consultation regarding diagnosis and medicine management.
• Provide Telehealth trainings for participating DC MAP PPCPs at regular intervals and training on the referral system developed to link patients to school-based MH support.
• Track connections to care and referrals with an enhanced data tracking system.
• Monitor PPCP practices (through quarterly review of utilization) regarding their telehealth service availability.
• Ensure that DC MAP clinicians provide telehealth trainings for PPCPs on select MH topics for site-specific trainings.
• Conduct surveys of experiences with telehealth from all practices and from families.
• Provide timely and accurate evaluation reports of DC MAP Telehealth Expansion program over the course of the performance period according to the timeline below.

Further, PMHCA’s priority area two is focused on integration with School-Based Health Centers (SBHCs) and providers. By September 2023, goal one is to establish the referral system and protocol to link patients to SBHC mental health support via telehealth. To achieve this, objective one is to complete the integration and expansion of DC MAP at the pilot school sites by December 2022; objective two is to establish the referral system and protocol to connect patients to mental health support via telehealth at the SBHCs by December 2023; and, objective three is to complete the first evaluation report on the SBHC referral system by September 2023.

In FY23, the partnership between DC Health and DC DBH will continue to implement the PMCHA project– a Memorandum of Understanding (MOU) was signed between the agencies in FY22. In FY23, Paving the Way will continue to serve as a subcontractor of DBH to implement DC MAP, and strategic planning of the expansion and partnership with the School Based Health Centers will also continue. The District of Columbia Title V MCH Advisory Council members will serve as advisory board members for the project. DC Health will partner with School Health Services Program (SHSP) to incorporate in-house school behavioral health supports with the SHSP’s telehealth program plans for DC Public Schools (DCPS) and Public Charter Schools (PCS). DC Health will also utilize SHSP’s local funding to expand quality assurance and quality improvement programming efforts, including ongoing outreach and advocacy on all levels. DC Health and DBH will also continue partnerships with the Department of Healthcare Finance (DHCR), to strengthen access to behavioral health resources by minimizing barriers with billing and medical homes for the individuals accessing the service.

In FY23, beyond PMHCA, the School-Based Health Center (SBHC) program will also continue to contribute to the reduction of grief and trauma-related symptoms among children and adolescents by improving access to and utilization of behavioral health services. The SBHCs are staffed with mental health clinicians who follow their own policy and procedures. They also adhere to DC Health’s protocols by working with school nurses, administrators, and staff to ensure access to behavioral health services and care coordination through the behavioral health referral process for students and families.

In FY23, through the Resources and Education for Adolescents in Community Health (REACH) program, Children’s National Medical Center will continue addressing the widening medical and psychosocial disparities due to COVID19. Project-REACH will continue implementing a multipronged teen friendly program facilitated through the primary care medical home. The priority focus area is Mental Health Including Grief and Trauma-Informed Care. Children’s National anticipates partnering with community-based organizations. In FY23, the program will remain focused on the following goals:

• Based on human centered design, expand and evaluate evidence-informed, teen friendly social approach to disseminate culturally appropriate information on general healthy behaviors, reproductive health, mental health, accessing resources, life skills and other topics identified by youth for youth ages 13-19 years in Washington, DC.
• Implement evidence-based/evidence-informed virtual group education for teens (13 – 19 years) annually to include the following:
  • 16-week longitudinal educational series – This was previously a 20-week long program but shortened to increase adolescent participation for the duration of the learning sessions and increase retention.
  • Weekly reproductive health education sessions.
  • Bimonthly mental health education sessions.
• Facilitate continued access to youth friendly services within the primary care medical home for non-parenting and parenting teen ages 13-19 annually. This will be achieved by providing care coordination and implementing closed loop referral processes.
• Service patients ages 13 – 21 through the mobile medical program (and when indicated CHCTHEARC). This activity will replace a previous one involving a social media campaign as the mobile medical van will also conduct outreach along with healthcare access.

Priority 2: Enhancing positive youth development for adolescents to decrease high-risk behaviors

Objective 1: Reduce births to teens ages 15 to 19 from 15.6% to 10.4% by 2026

Strategies: Provide accessible pregnancy prevention programs within schools

Performance Measures:

• Revised - State Performance Measure 4: Teen Pregnancy Prevention- Decrease the percentage of live births to teenagers ages 15 to 19 

Activities:

In FY23, Crittenton Services of Greater Washington will continue to provide oversight for DC Health’s Teen Pregnancy Prevention Program. DC Health’s Teen Pregnancy Prevention (TPP) Program will continue expanding its focus to incorporate a more inclusive approach for Adolescent Health. The program will address two of the state’s top priority needs: Mental Health including Grief and Trauma-Informed Care and Positive Youth Development. Program participants will continue to receive enhanced knowledge regarding existing contraception methods, how to access them, and how to appropriately use them. TPP grantees will also expand the implementation of One Key Question® at the grantee sites. Crittenton Services of Greater Washington anticipates partnering with school and community-based organizations.

Objective 2: Increase the percentage of adolescents (aged 14-21) participating in the Youth Advisory Council by 300% by 2026.

Strategies: Provide the youth with opportunities to become leaders and advocates within their community

Performance Measures:

• Revised - State Performance Measure 5: Increase the percentage of adolescent engagement through tailored adolescent health programs including a Youth Advisory Council and curriculum implementation
  • Rationale – To enhance the data collection of the performance measure, we are shifting away from collecting numbers and embracing proportions to better understand how DC Health is reaching the population.

Activities:

In FY23, the Healthy Babies’ Life Empowerment Program will continue to equip vulnerable, low-income District adolescents, ages 12-17, with evidence-based health education and life skills training to help them build stable lives. The priority area for this program is Positive Youth Development. The annual estimated reach is 150 low-income adolescents in the District in Wards 5, 7, and 8. Healthy Babies’ Life Empowerment Program anticipates partnering with school and community-based organizations.

In FY23, this program will focus on the following two main goals:

1. Utilizing the Sisters Informing Healing Leading Empowering (SIHLE), Making Proud Choices, and Real Essentials as evidence-based curricula, reduce teen pregnancy/STIs among 150 District youth (ages 12-18).
2. Increase high school graduation/higher education attainment with retained program participants within 6 months of program completion.

In FY23, the Men Can Stop Rape (MCSR) will continue the implementation of Women Inspiring Strength and Empowerment (WISE) and Men of Strength (MOST) Clubs in support of the Title V Program priority area for Positive Youth Development. The Clubs utilize effective strategies for achieving the DC Department of Health’s goal to increase the percentage of adolescents aged 12-17 that engage in tailored programming on health and life skills topics. In addition, MCSR anticipates partnering with school and community-based organizations. In FY23, WISE and MOST will continue to focus on the following four goals:

• Implement and sustain WISE and MOST Club programming that engages 700 youth and adolescents ages 12-17 at 14 school locations in weekly programming about health, life, and career skills topics.
• Engage 700 Club members in the development and implementation of Community Strength Projects that demonstrate their increased understanding of health, life, and career skills topics and share this learning with the broader community.
• Train 25 professionals to implement WISE and MOST Club programming, become trainers in their own communities on the role of engaging men and boys in gender-based violence prevention and to develop bystander intervention and consent skills amongst youth-serving professionals and key stakeholders.
• Deepen the effectiveness and sustainability of programming that produces statistically significant changes in attitudes, behaviors, and relevant outcomes for adolescent health.

In FY23, the DC Health Youth Advisory Council (YAC) will continue the development and implementation of program activities in alignment with DC Health’s mission, the Positive Youth Development approach, and the tenets of the YAC Framework (Relationships and Inclusion, Education, Health and Wellness, Leadership and Advocacy, and Employment and Entrepreneurship). The YAC will continue to target District of Columbia youth ages 14-21 that attend a District of Columbia Public or Public Charter High School and/or are enrolled in college or post-high school program in the District of Columbia. The YAC aims to increase its membership target to 30 youth from all 8 DC wards.

In FY23, the DC Health YAC will focus on implementing the activities below to achieve program goals:

• Identify youth development topic areas and develop activities to align with one or more of the core components of the DC YAC Framework that supports priorities identified by the Maternal and Child Health Advisory Council and Title V Community Needs Assessment. In FY22, the Youth Health Summit (hosted on May 21, 2022) reiterated the importance of prioritizing mental health, violence, sexual health, and substance use topics in FY23 YAC programming and raising community awareness.
• Facilitate interactive meetings and trainings on these topics related to youth development in partnership with community-based organizations, other District agencies, and other DC Health programs to build YAC member capacities as needed. YAC programming will continue virtually and possibly transition to a hybrid or in-person programming model. Implementing a hybrid model may help address some challenges the YAC encountered in FY21 and FY22 in maintaining YAC member engagement and retention.

• Create and integrate interactive and participant-driven activities that encourage lifelong learning and scholarship for YAC members.

• Expand and build the YAC’s partnerships and community networks by sustaining existing partnerships and establishing formal relationships with schools, other youth organizations, government agencies, and other DC Health programs to extend the reach and impact of YAC’s community outreach and advocacy activities. Anticipated partnerships include but are not limited to Public and Public Charter High Schools, DC School-Based Health Centers, and various youth-serving organizations such as the ones at Department of Behavioral Health and Children’s National Hospital.
• Maintain the DC Health YAC’s social media account to increase the reach and scale of YAC activities and advance youth engagement, including communicating important YAC events and co-creating content with YAC members to spread awareness on key youth health issues in the District.
• Plan and implement the FY23 YAC Summer Youth Advisor (SYA) program. The SYA program will continue to build the leadership skills of the YAC members and prepares them to contribute to the design and planning of program activities for the fall.

In FY23, the YAC intends to make one change to how it manages logistical and program implementation. The YAC will bring on a grantee to support the design, planning and implementation of program activities. The new grantee will support increased community-based activities, partnerships, and YAC participation.

Priority 3: Improving access to healthcare among adolescents

Objective 1: Increase the proportion of adolescents 0 to 17 who have a medical home from 46.8% to 47.9% by 2026

Strategies: Encourage and empower students to utilize their school-based health centers as their medical home

Performance Measures:

• Continue - National Performance Measure 11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home
• Revised - Evidence- Based-or- Informed Performance Measure 11.1: Percent of children and adolescents with and without special health care needs referred to a medical home
  • Rationale – To enhance the data collection of the performance measure, we are shifting away from collecting numbers and embracing proportions to better understand how DC Health is reaching the population.

Activities:

In FY23, Title V will continue to provide support for District of Columbia Department of Health (DC Health) staff overseeing the locally funded School-Based Health Center Program (SBHC). During FY23, DC Health will continue to manage seven (7) SBHCs operated by four DC Health grantees – Children’s National Hospital, MedStar Health Research Institute, Mary’s Center, and Unity Health Care, Inc. –in seven DC Public high schools. In FY23, SBHCs will be open year-round and promote an adolescent-friendly approach due to evidence supporting the need for care to be accessible, equitable, acceptable, appropriate, comprehensive, effective, and efficient. All providers will continue to offer the following services: primary care, acute care, reproductive health services, oral health services, behavioral health services, and linkages and referrals including for transition planning. Students will also continue to be able to elect an SBHC site as their medical home.

Mary’s Center’s School Based Mental Health Program (SBMHP) supports children, families, and communities by promoting behavioral wellness. In Fiscal Year 2023, with Title V grant funds, Mary’s Center plans to expand the services provided through the Medical Home Identification for School-Age Children and their Families program. In FY23, they plan to continue to raise awareness of Mary’s Center and Family Support services, increase referrals and utilization of services, and increase the number of children and families who report having a medical home. In addition to these activities, they plan to offer new services such as support with insurance and benefits enrollment, working with school staff to outreach and support newly arrived families with resource navigation, screening students and families for needs related to social determinants of health, supporting existing caretaker and student groups, and expanding relationships with the school-based health center at Coolidge Senior High School in order to send and receive referrals.

In FY23, Mary’s Center Medical Home Identification for School-Age Children and their Families program plans to target the same population which includes school age children and their families in the 26 DC Public and Charter schools they currently partner with. Throughout the next fiscal year, Mary’s Center plan to continue their partnerships with 26 DC Public and Charter schools.

Objective 2: Increase the percentage of adolescents ages 12 to 17 who use transition planning services from 19.4% to 25% by 2026

Strategies: Empower and encourage adolescents to utilize school-based health centers as their gateway and guide into adult care

Performance Measures:

• Continued - National Performance Measure 12: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services to prepare for the transition to adult health care
• Revised - Evidence- Based-or- Informed Performance Measure 12.1: Percent of CSHCN provided with transition services
  • Rationale – To enhance the data collection of the performance measure, we are shifting away from collecting numbers and embracing proportions to better understand how DC Health is reaching the population.

Activities:

In FY23 Title V will continue to provide support for DC Health staff overseeing the locally funded School-Based Health Center Program (SBHC). SBHC’s will continue to be operated by Medstar Health and Children’s National Hospital across four sites to address transition planning for adolescents. At Children’s National Hospital SBHCs at Ballou and Dunbar high schools, delivery of health care transition (HCT) education to enrolled students to increase their health literacy and readiness to transition out of the SBHC upon graduation is a key goal. Transition services will be provided to students 16 years and older but will focus primarily on seniors. Similarly, at Medstar Health SBHCs at Roosevelt and Anacostia high schools, increasing access to evidence-informed transition services to students enrolled will continue to be a key goal in FY23.

Each SBHC will aim to provide an annual transition readiness assessment to students 18 years or older and enrolled at the SBHC. They will schedule students for a transition readiness visit to provide educational transition services to seniors or students transitioning to adult care. During the visit, the provider will determine the level of readiness per student and assist the student with resources of potential adult care facilities to transition care. Patients will receive resources to help them transition to adult care after the visit, such as a summary of adult doctors and contact information and summaries of their health needs.