School Based Health Centers

DPH will partner with the School Based Health Centers to develop strategies to educate parents on the importance of well child visits, including sending flyers/brochures out with annual enrollment packets and dissemination of information through local SBHC advisory boards. DPH will also partner to ensure SBHCs are engaged in health education activities on the individual and group levels, and will provide direction and training regarding adherence to Bright Futures as a required standard for all DPH funded SBHCs. Outreach and health education through the School Based Health Centers will be inclusive of nutrition and physical activity.

A DPH SBHC staff is the designated State Adolescent Health Coordinator who is a member of the National Network of State Adolescent Health Coordinators (NNSAHC), participates in community of practice calls focusing on different aspects of adolescent health and shares information on best practices, resources and educational opportunities with other state programs within and outside of DPH, SBHC staff, community providers and other interested parties.

Strategies will be implemented to promote adolescent well-child visits, principally through the School Based Health Centers. DPH Title V will partner with the Medical Home Advisory Council, the School Based Health Center Association, and the School Based Health Center Advisory Committee to develop strategies to educate district and school administrators, and other local stakeholders about creating comprehensive local wellness policies that include creating a healthy school nutrition and physically active environment. Information will be shared with SBHCs on Medical Home Initiative extended services and respite in order to connect families to the services they may need for their children. A list of minimum standards for all SBHCs in CT was developed by the Advisory and initial plans for adoption into a regulatory structure are underway.

SBHCs will continue to complete Results Based Accountability report cards by town and are required to have a separate RBA for each discipline provided within their contract (Medical Services, Mental Health Services, and Dental Services).  SBHC period reporting will be done electronically in Survey Monkey.  Electronic reporting will make it easier for SBHC sites to report as well as easier for DPH to compare data across all SBHC sites.  

In the coming year DPH plans to purchase the 4 What’s Next program for the high schools funded by DPH that have a SBHC. Technical assistance was provided to the SBHCs from the Jordan Porco Foundation on the 4 What’s Next program. 4 What’s Next is a primary prevention program that builds resilience in high school students by giving them the tools to handle stress and distress now and in their future.  Over the course of 5 modules, students learn and understand what distress looks like for them and develop or strengthen an internal locus of control related to their mental health and emotional wellbeing. They will gain skills for psychological resiliency such as coping skills and help-seeking, and learn how to apply these skills to better manage conflict, time, and money as examples. 

The School-Based Health Alliance and the National Center for School Mental Health invited states to apply to participate in a 12-month Collaborative Improvement and Innovation Network (CoIIN) focused on making measurable improvements in the health and mental health of students during the 2019-2020 school year. Participating state teams in this CoIIN will have the opportunity to advance the quality of their school health and/or mental health services by networking with other state teams, receiving expert technical assistance and coaching, sharing best practices and lessons learned, and tracking progress toward key benchmarks and improvement goals, including: Improving the quality and sustainability of health and mental health services delivered to students in schools; Expanding access to school-based health and mental health services to a greater number of children and adolescents; and working with state leadership to increase policies and programs that promote quality, sustainability, and growth of school-based health services. Connecticut applied with three sponsoring organizations and a total of eight SBHC sites.

The State Adolescent Health Coordinator will attend Project AWARE Advisory Group Meetings. The purpose of this initiative is to improve behavioral health, academic functioning and social-emotional outcomes for students who have or are at risk of developing behavioral health needs, including serious mental illness. This will be achieved through improved family and school staff knowledge about behavioral health, early identification of students with behavioral health needs, and improved access to evidence-based, culturally appropriate practices. The CT State Department of Education selected three districts (Middletown, Naugatuck, and Windham) for developing comprehensive mental health services.  Middletown and Windham are also towns that have DPH funded SBHCs.      

Mental health services are a priority within the SBHCs and experienced adolescent health clinical staff who provide medical, mental/behavioral health services are employed. One focus is suicide prevention among adolescents. Title V distributes 1 Word 1 Voice 1 Life suicide prevention awareness campaign materials developed by the CT Suicide Advisory Board (CT-SAB) throughout all programs. Question, Persuade, Refer (QPR) suicide prevention training is available to partners working with adolescents, including high schools, SBHCs, DCF foster parents, and numerous care coordination and family advocacy partners upon request. DPH will support the suicide-crisis information and referral line through United Way’s 211 Infoline and will partner with DMHAS and DCF to provide sustainability to crisis line services, of critical importance related to the national Zero Suicide model. DPH will continue to work with contractors, in partnership with the CT-SAB, to implement trainings that address the risk factors related to suicide ideation and the reduction of stigma in mental health help seeking as well as to conduct strategies to reduce access to lethal means of suicide, including provider training and suicide prevention signage in high risk areas. In addition, DPH will continue to partner with Child Health and Development Institute and CT Children’s Medical Center to promote Educating Practices In the Community (EPIC) training on suicide prevention for pediatric providers, including the School Based Health Centers.

DPH will partner with the Department of Mental Health and Addiction Services (DMHAS) to train SBHC staff in the use of the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach to identifying, reducing and preventing problematic substance use disorders in adolescents served.

Children & Youth with Special Healthcare Needs

DPH will continue to partner with CT Children’s Medical Center to promote training on the Protective Factors Framework throughout the CT Medical Home Initiative for CYSHCN and for others providing services to children and adolescents. The Protective Factors Framework outlines a course of action to help families reduce stress, address risk factors and promote healthy development. This strategy will be employed to reduce risk factors associated with bullying and adolescent suicide. The training will center on implementing low and no-cost actions to support: parental resilience, social connections, knowledge of parenting and child development, concrete support in time of need, and the social and emotional competence of children.

Oral Health

In September, the Office of Oral Health (OOH) was awarded two federally funded grants to address oral health needs in Connecticut. The five year CDC cooperative agreement will assist CT to decrease dental caries, oral health disparities, and other chronic diseases co-morbid with poor oral health through school based sealant programs, community water fluoridation, surveillance, and implementing a medical-dental integration strategy at federally qualified health centers to integrate oral health and prediabetes. The four year HRSA grant will support CT’s efforts to address oral health disparities by improving the quality and accessibility of oral health services in dental HPSAs by partnering with FQHCs to implement an innovative, systems level program to improve common risk factors for pediatric obesity and dental decay by integrating nutrition screening, counseling, and referral into dental settings. During the 2019-2020 grant year, the OOH will continue oral health data and surveillance activities that guide our efforts to reduce oral health disparities and ensure a culturally competent oral health workforce. Activities will include contracting to begin CT’s second Older Adults Oral Health Basic Screening Survey and the fourth Every Smile Counts Children’s Basic Screening Survey (ESC) of CT’s kindergarten and third graders. The OOH will once again partner with the CT DPH Nutrition, Physical Activity and Obesity Prevention Program to capture BMI data (height and weight) during the ESC BSS. Both surveys will be completed and have reports disseminated by August 2023. The OOH will also be updating the Connecticut Oral Health Surveillance System (COHSS) plan, which provides data on oral disease, risk factors, and the use of preventive oral health services throughout the state. All core surveillance indicators will continue to be collected and expanded to include two new indicators (dental workforce and emergency visits). Lastly the next iteration of the CT Burden document will be developed and completed to monitor applicable state and Healthy People 2020 objectives and inform program and policy decisions.

The SEAL CT! School- Based/ Linked (SBSP/SLSP) Dental Sealant Program will continue efforts to expand and/or enhance the placement of dental sealants in DHPSA schools and schools with 50% or more Free and Reduced Meal Program participation (FARM). Over the next year, the SEAL CT! Program will continue to fund four SBSPs in 2019 and also develop and execute a strategy to increase the number dental sealant programs in FARM eligible schools. Currently dental screenings, referrals, and dental sealants are provided in 270 Connecticut schools. Over the next year, the OOH will administer the SEAL CT! Program contracts, provide program technical support to grantees, and convene the CT Dental Sealant Advisory to provide education and sharing on SBSP/SLSP best practices. The OOH will also collaborate with the CT Dental Sealant Advisory to create a comprehensive SBSP Communication Plan, a SBSP Sustainability Plan, and provide the opportunities to create culturally and linguistically appropriate dental sealant and oral health educational and policy documents to be distributed among the SEAL CT! SBSP/SLSP Programs, the Connecticut Dental Sealant Advisory membership, legislators, school administrators and staff, and parents.

Critical partnerships with other MCHB-supported programs

The Office of Injury and Violence Prevention (OIVP), Opioid and Prescription Drug Overdose Prevention Program is helping CT combat the ongoing drug overdose epidemic, including conducting ongoing statewide surveillance of fatal and nonfatal drug overdoses. Staff supporting the Opioids and Prescription Drug Overdose Prevention Program provide local-level and statewide data reports to capture drug overdose trends in CT in order to design targeted community prevention strategies and evaluate state-level interventions. CT saw a steep rise in deaths from prescription drug and opioid overdoses between 2012 and 2017. Currently, unintentional poisoning from prescription and illicit drugs is the leading cause of death from injuries in the state and makes up 93% of all non-alcohol drug poisonings. Furthermore, the impact of addiction on families is immeasurable. In the coming grant year, the OIVP will continue to support the Connecticut Interscholastic Athletic Conference (CIAC) to deliver prevention campaign messaging in an effort to target student athletes and their families. The CIAC is the sole provider of access to CT’s student athletes for championship games, which attract huge numbers of adolescents and their families. In the past year, CIAC ran multiple events that included the CT Change the Script, opioid misuse and overdose prevention, campaign messages as well as providing outreach to coaches, athletic directors, school administration, and staff.

The Youth Risk Behavior Survey (YRBS) will continue to collect self-reported information for grades 9-12 on the following: in school and electronic bullying; well visits in the past 12 months and dental visits; physical activity level by number of days in the past week; physical inactivity (screen time, TV, and electronics); height and weight to calculate BMI, obesity, and overweight; sleep on an average school night; suicide ideation, and self-rated health status.

The Behavioral Risk Factor Surveillance System (BRFSS) will continue to collect parent-reported child health information (ages0-17) on the following: information on the child’s dental visit, dental decay, and dental sealants for ages 0-17; physical inactivity (screen time, TV and electronics); and self-reported height and weight to calculate BMI, obesity, and overweight for ages 0-17.