Priority: Strengthen the capacity of the health system to promote mental health and emotional well-being.
Objective 1. Increase the percent of high school students who report having a teacher or other adult in school they could talk to about a problem to 77% from baseline (75%, 2017 YRBS).
School Based Health Centers
In FY23, SBHC staff will continue to support resilience in students and the school community to respond to the collective trauma related to the COVID-19 pandemic. There will be continued emphasis on connecting with students and building a solid therapeutic alliance, which will be even more salient post-pandemic when students are more psychologically fragile. Clinicians will continue to assess for protective factors, including the presence of a trusted adult and school connectedness.
All SBHC staff (including nurse practitioners, behavioral health clinicians, and community health workers) will build upon the strategies and skills that were developed in the
Healing is in the Return training first offered in FY22, to foster a sense of belonging for students who are often polarized and to validate students using strengths-based approach. Training themes included:
- COVID-19 as a collective slow-moving trauma
- How mental health symptoms show up in the classroom, especially around learning
- Adults will struggle to help others regulate when they are not regulated themselves
- Awareness of who is included and excluded within the school community and actively working to shape a sense of belonging for students
- Key strategies around moderation, hope, and validation
- SBHC role in challenging school norms and what they can do to support students in healing from collective trauma.
Office of Sexual Health and Youth Development
In FY23, the Office of Sexual Health and Youth Development (OSHYD) will continue to provide trainings to funded organizations on positive youth development using the Search Institute’s 40 Developmental Assets framework, with the goal to increase youth protective factors. In addition, OSHYD will provide an annual Suicide Prevention Question, Persuade, Refer training to all programs as a strategy to increase protective factors among the adolescent population. During FY23, OSHYD will also continue to provide safe spaces for adolescents to explore topics such as sexuality and mental wellness as a part of its programming, including Adolescent Sexuality Education, Personal Responsibility Education Program, and Successful Teens: Relationship, Identity, and Values Education.
Objective 2. By 2025, return to the pre-pandemic baseline the percentage of middle and high school students who report feeling so sad or hopeless almost daily for 2+ weeks in a row that they stopped doing some usual activities (high school: 33.8%, 2019 YRBS; middle school: 24.3%, 2019 YHS).
School Based Health Centers
The SBHC program is reprocuring services for a new 10-year funding cycle beginning in FY23. In this procurement, there is a greater focus on leveraging a comprehensive care team with a greater emphasis on providing integrated and enhanced behavioral health care, using universal strength-based approaches to build on the resilience of youth and families, identifying and mitigating health risks, and actively addressing the impacts of racism on all children’s ability to learn and thrive. In this expanded model, funded SBHCs must have a full-time behavioral health provider onsite at the SBHC during all hours that school is in session. The new model is in response to increasing need for behavioral health services for youth, both prior to and especially as a result of the COVID-19 pandemic. SBHCs are encouraged to offer telebehavioral health services in addition to having a provider onsite full-time.
The SBHC Program will offer professional development opportunities to SBHC staff to increase their capacity to respond to the mental health needs of students and continue to foster resiliency with the students and school communities. Because MDPH is entering a procurement period with potentially new SBHCs, it will be important to re-assess the learning needs of SBHC teams and deliver training and support to meet these pressing needs.
School-Based Telebehavioral Health Pilot Program
School Health Services
In FY23, Comprehensive School Health Services (CSHS) grant activities will focus on providing specific strategies to achieve increased student connection. The following CSHS grant performance objectives have been revised to more accurately reflect the scope of school health service practice:
- Increase in the percentage of students who are identified as experiencing symptoms of depression and/or anxiety, or suicidal ideation, and are not currently receiving behavioral health care, that are referred for mental health services by school health/counseling staff (Target – increase by 10% annually).
- Increase in the percentage of students who are identified as homeless or marginally housed assessed for unmet health care needs by nursing services (Target – increase assessments by 10% annually).
- Students who have special health needs (e.g. asthma, autism, ADHD, diabetes, life-threatening allergies, seizure disorders, diagnosed mental health disorder) will have an individualized healthcare plan (IHP) developed (target – 100% IHPs developed).
- Increase in the percentage of ELL students assessed for unmet health care needs by nursing services (Target – increase assessments by 10% annually).
In addition to services provided to students with CSHS grant funds, the MDPH School Health Unit will also continue to support school health staff who have been dramatically impacted by the COVID-19 pandemic. School health staff report high levels of burnout, and the Commonwealth has seen an increase in school health staff turnover, including chronically unfilled positions. To address these issues, CSHS has implemented several workforce training and development activities. During FY22, CDC awarded MDPH a two-year public health workforce development grant with 25% of the grant ($10M) specifically intended for the school health workforce. Forty-two schools and school districts received $100,000 to retain and hire school health staff; this support will continue at least through FY23. The School Health Unit has also worked with a professional development vendor (BU SHIELD) and other agencies to provide school health staff with workshops around self-care, managing difficult conversations, as well as an entire school mental health series. Additionally, MDPH partnered with the Department of Mental Health, which has grant funds available to support health care workers, to provide a weekly virtual drop-in support group for school health staff.
Office of Sexual Health and Youth Development
In FY23 the Office of Sexual Health and Youth Development’s (OSHYD) Adolescent Health programs will continue to adapt and implement flexible program models which allow them to address the mental health needs of youth. There are several internal and external factors contributing to poor mental health among adolescents such as housing instability, increased family responsibilities, the racial reckoning in the United States and global conflicts. OSHYD programs serve as a consistent safe place for youth to process their feelings and access resources. Program strategies will include using funding to support the basic needs of young parents such as rental/utility assistance, dedicated spaces to de-compress and speak with peers about their feelings, and weekly staff wellness check-ins.
The Sexual and Reproductive Health Program’s core values include providing confidential youth-friendly and trauma-informed care. In FY23, through its training center, MDPH will provide training and technical assistance on these critical values for the provision of services for adolescents. Completing an e-learning module on the program’s values will be a required element of each contract. In addition to the curation of a collection of resources for providers on the topic, the training center will develop a tool kit to support providers to address the mental health needs of their adolescent clients. Oversight will occur during monthly meetings with contracted health centers.
Objective 3. By 2025, return to the pre-pandemic baseline the percentage of middle and high school students who seriously considered attempting suicide in the past 12 months (high school: 17.5%, 2019 YRBS; middle school: 11.3%, 2019 YHS)
School Based Health Centers
In FY23, SBHC care teams will continue to use the Multi-Tiered System of Supports (MTSS) framework to support students and school communities post-pandemic. Staff will demonstrate heightened awareness of behavioral red flags among students in the clinical high-risk category, including those at risk of suicidality. Staff will operationalize the learnings on preparing emergency plans in response to dynamic and shifting levels of acuity.
Suicide Prevention Program
In FY22 a hosting issue arose making the free, online suicide awareness and prevention training for school personnel, The “S” Word: The Role of Schools in Preventing Suicide, unavailable. In FY23 the Suicide Prevention Program will evaluate the training and determine if this is an appropriate time to update and find a new hosting site or if the training will need to be completely rebuilt. The training is designed to provide school personnel with a better understanding of how suicide prevention fits within the role of educators, increase their ability to recognize and identify students that may be at risk of suicide, how to promote protective factors that can help to reduce the risk of suicide, and how to respond to students identified to be at risk.
Child Fatality Review
In FY23, IPCP will support local team performance by issuing program-wide guidelines, which will lay out standard operating procedures for case selection, case review, and recommendation drafting, and will help local teams identify stakeholders and subject matter experts who can assist teams in evaluating suicide cases. To facilitate implementation of practices in the guidelines and strengthen connections between local child fatality review teams, IPCP will convene a community of practice starting in FY23. IPCP anticipates that, through monthly meetings, the community of practice will identify areas where teams can provide mutual support, as well as areas where IPCP can provide tailored technical assistance, particularly around suicide prevention.
Priority: Promote equitable access to sexuality education and sexual and reproductive health services.
Objective 1 (SPM 2). By 2025, decrease the Latinx teen birth rate of 26.0 per 1,000 Latinx women aged 15-19 to 16.0 per 1,000 to reduce the inequity between Latinx and White youth.
Objective 2. By 2025, decrease the gap between the Black and White teen birth rates to less than 2 times higher.
Office of Sexual Health and Youth Development
The Office of Sexual Health and Youth Development’s FY22 programmatic plans were significantly delayed as a result of internal staffing shortages and managing the impact of COVID-19 among youth-serving agencies. In FY23, the Adolescent Sexuality Education Program (ASE) will focus on reaching Black and Latinx youth, using the following strategies: leveraging peer leaders to recruit youth within their social networks to participate in ASE programming; hosting focus groups with Black and Latinx youth to identify organizational and cultural barriers to program participation; and offering staff professional development opportunities on topics such as how to recruit and retain youth, exploring the impact of racial identity development, and building authentic relationships with youth.
The Personal Responsibility Education Program (PREP) will also continue its effort to serve Black, Latinx, LGBTQ youth and other marginalized youth populations that traditionally have not had access to sexuality education. In FY23 PREP will explore strengthening its partnerships with the Department of Elementary and Secondary Education (DESE) to include additional school districts with a focus on those that have no additional state or federal funding to deliver sexuality education services.
ASE, PREP, and the Successful Teens: Relationship, Identity, and Values Education (STRIVE) Initiative will work closely with local school-based health centers and sexual and reproductive health services to strengthen the link between sexuality education programs and clinical services to help support youth access to HIV/STI testing, contraceptive counseling, and other clinical services. In FY23, OSHYD will pilot an education referral program in two communities between an ASE and PREP agency with a local school-based health center and sexual and reproductive health agency. OSHYD plans to provide referral and partnership development trainings to the organizations involved in the pilot. If successful, OSHYD will replicate this activity in other communities.
OSHYD also plans to host a State of Sexual Health Education summit in FY23 to bring together key stakeholders and nontraditional partners to identify gaps in access and opportunity for alignment of sexuality education in the Commonwealth for populations such LGBTQ youth, youth with intellectual and developmental disabilities, and other populations of young people who have not traditionally been well-served by sexuality education programs.
Finally, OSHYD is committed to integrating and centering youth voice in its efforts. In FY23, OSHYD will launch a youth advisory board. Five young people will be engaged to inform future program designs and shape the youth internship program. Additional details about this initiative are described in the family, father, and youth engagement priority within the Crosscutting domain.
Objective 3. By 2025, provide training to 75% of Adolescent Sexuality Education and Sexual Reproductive Health program grantees on the integration of reproductive justice principles into delivery of sexuality education and/or sexual and reproductive health services.
Office of Sexual Health and Youth Development
In FY23, OSHYD will continue to operationalize its core values of racial justice, health equity, reproductive justice, trauma-informed care, sustainability, youth development, and evidence-based/data-driven programming with a focus on centering racial justice and reproductive justice through its partnerships and services. Reproductive Justice framework trainings will be offered annually to MDPH-funded organizations. ASE and PREP programs will be required to participate in these trainings and develop reproductive justice action plans to support the integration of reproductive justice principles into their service delivery.
Funded agencies will submit their action plans and receive technical assistance from OSHYD annually. OSHYD anticipates the following types of activities may be included in the agencies’ action plans in FY23: organizational training on racial bias, history of the birth control pill development, exploration of agency policies that may pose a barrier to accessing services, development of a community advisory board to support the reproductive justice initiative, and curricula adaptations supportive of reproductive justice. These curricula adaptations may include acknowledgement of the history of contraceptive development ensuring that youth are aware of the kernels of truth behind some “myths” about contraception, particularly those that are common in communities of color. The integration of reproductive justice principles into sexuality education will be an ongoing and iterative process.
Objective 4. By 2025, 85% of females under age 25 will be screened for chlamydia at SRHP-funded clinics.
Sexual and Reproductive Health Program
In FY23, the Sexual and Reproductive Health Program (SRHP) will launch the new 10-year program cycle, from FY23-FY32. Fourteen agencies were selected from a competitive procurement process in FY22. The procurement is based on the new SRHP Core Values and Program Standards, which emphasize evidence-based guidelines, including the Quality Family Planning guidelines, the Quality STD Clinical Services guidelines, and the STD Treatment guidelines. The updated Core Values also emphasize the delivery of adolescent-friendly services, including protecting the confidentiality of adolescents and others who are not the primary subscribers on their insurance plans.
In FY23, SRHP will be supported through an updated data system that collects and reports demographic and service information, extracted from contracted providers’ electronic medical records. In addition, the SRH training center will provide training and technical assistance to both MDPH-funded vendors and other SRH providers throughout the Commonwealth that do not receive direct funding from MDPH. The training center will share best practices, clinical updates, and emerging trends with a wide SRH safety net service audience.
All SRHP activities, including training and technical assistance provided by MDPH staff and the new SRH training center, are expected to be supported by both state funds and Title X funds. After two years out of the Title X program, MDPH was awarded funding and returned to the federal program as of April 1, 2022 under a newly revised program regulation.
SRHP will continue to incorporate into contract management the collection and reporting of chlamydia testing data and monitor progress towards meeting this objective. SRHP will provide technical assistance regarding chlamydia testing during monthly meetings with contracted agencies, and additional training during semi-annual statewide provider meetings.
Objective 5 (NPM 10). By 2025, increase by 2% from baseline (92.3%, NSCH 2017) the percent of adolescents who have a preventive medical visit in the last year.
School Based Health Centers
In FY23, the SBHC program will continue to work with Apex, the selected data vendor, to accurately measure preventive medical visits in SBHCs. Professional development for SBHC clinicians will continue to focus on developing care practices that are sensitive and welcoming to priority populations, including young men, LGBTQ youth, and students with disabilities. The SBHC program is explicitly communicating the expectation that preventive care visits be tailored to these populations and that specific strategies need to be implemented to intentionally recruit these students to enroll in SBHC care.
MA SBHC Quality Standards require SBHCs to conduct and document student satisfaction surveys and deliver services in response to feedback. All SBHC clients must be given the opportunity to provide student satisfaction feedback. In FY23, MDPH will implement the following performance measures:
- The percentage of SBHC client survey respondents who agree or strongly agree that they feel accepted for who they are at the SBHC (Target: 90%)
- The percentage of SBHC client survey respondents who agree or strongly agree that overall, they are satisfied with the care they receive at the SBHC (Target: 90%)
In alignment with the SBHC Program’s commitment to health and racial equity, these performance measures will be disaggregated by priority population, including by race and ethnicity, sexual orientation, and gender identity, with a target of less than five percentage points difference between groups.
Sexual and Reproductive Health Program
SRHP will ensure that contracted agencies are a source of primary care and referrals for adolescents through provision of technical assistance during monthly oversight meetings and during comprehensive on-site program reviews. In addition to CDC’s Quality Family Planning Guidelines, in the spring of 2022, SRHP launched its e-learning module through its training center that shares best practices and guidance on program specific guidelines that detail the expectation of specialized care for adolescents.
In FY23, the SRHP will launch its next 10-year programming cycle, which includes a comprehensive Training and Technical Assistance center that will provide ongoing guidance and support to contracted agencies on the recently updated program standards, including standards for services for adolescents. During monthly FY23 grant oversight meetings, the SRHP will also provide direct technical assistance to the contracted agencies regarding adolescent preventive and reproductive health care.
Priority: Prevent the use of substances, including alcohol, tobacco, marijuana and opioids, among youth and pregnant people.
School Health Services
In FY23, the School Health Unit, in partnership with BSAS, will continue to implement SBIRT screening in schools. Particular attention will be paid to increasing the number of non-public schools and schools for the deaf and hard of hearing that implement SBIRT. In FY22 the MDPH School Health Unit was able to add another public health nursing advisor who will work specifically with non-public schools, and the entities they interface with, in order to increase adherence to medication administration regulations and support implementation of screening regulations/statute.
School Based Health Centers
The SBHC program will continue to work closely with the BSAS Office of Youth and Young Adult Services to deliver professional development to SBHC staff on topics of interest. It is anticipated that there will be an ongoing need for training on co-occurring disorders (mental health and substance use) as well as new models of care that use telebehavioral health technology and community health workers in the school setting.
In FY23, the SBHC Program will require funded sites to report on the following performance measure: the percentage of unduplicated SBHC clients aged >12 years who, at least once during the school year, are screened for substance use using an age-appropriate standardized tool, receive a brief intervention and, if appropriate, referral to treatment. The target is that 75% of clients are screened, and of those screened, 100% received brief intervention and, if appropriate, referral to treatment.
The SBHC Program is working with an evaluation vendor to implement a screening methodology that is more meaningful to students and uses an app with mobile and web-based access and incorporates a modified CRAFFT-2.1N. SBHC clinicians will continued to be informed of their screening/brief intervention rates to inform continuous quality improvement activities to strengthen screening/brief intervention activities.
Additional activities to prevent the use of substances among youth
MassCALL3
During the first 12 months of the MassCALL3 initiative (July 1, 2021 – June 30, 2022), all grantees were required to: 1) conduct an assessment of needs and resources within their catchment area, 2) identify areas for improvement within the local prevention infrastructure system, 3) prioritize substance misuse prevention intervening variables and outcomes of focus – including populations and settings of focus, 4) identify a comprehensive set of evidence-based programs, policies, and practices to be implemented, and 5) create a comprehensive strategic prevention plan – including a detailed one-year workplan for FY23. Each comprehensive strategic prevention plan will be reviewed by a Prevention Contract Manager within BSAS, a representative from the state’s prevention technical assistance center (the BSAS Center for Strategic Prevention Support), and the cross-site evaluation team for the MassCALL3 initiative. Upon approval of the plan (following any required modification based on the review), MassCALL3 grantees will proceed to implement the specifications outlined in the comprehensive strategic prevention plan. MDPH anticipates final plan approvals for the majority of grantees early in FY23 and expect that these grantees will then progress to providing direct and indirect prevention services with the population(s) identified in their approved plan.
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