Adolescent Health

Plan for the application year: Oct 2023 - Sept 2024

For the current five-year cycle, the Adolescent domain selected NPM 10, The percentage of adolescents, ages 12-17, with a preventive medical visit in the past year. This NPM aligns with the priority, “increase connection to behavioral and mental health information, training and resources for parents and caregivers, and providers who serve women, adolescents and children.” Child maltreatment, interpersonal violence, and mental health continue to be pressing need areas for Alaskan adolescents. NPM 10 relates to WCFH work, in partnership with the workforce and school-based health centers, to connect youth with competent health care providers able to identify and respond to risk factors, and to provide youth-centered preventive health information.

Healthy relationships and prevention of interpersonal violence continue to be a priority for WCFH work in the adolescent domain. In response to this need, the SPM, percentage of adolescents with 3 or more adults (besides their parent/s) who they would feel comfortable seeking help from, was developed. This measure aligns with two priorities from the five-year needs assessment: (1) “Increase safe and healthy relationships” and (2) “Improve social supports, with a focus on wellbeing and resilience, to prevent and reduce the impact of ACEs.”  The SPM also aligns with the Healthy Alaskans 2030 framework. Youth’s positive connections with three to five supportive adults is one of the main shared protective factors against suicide risk, substance use, violence, and early sexual behavior/teen pregnancy.

The ESM for the adolescent domain is the percent of students who have a comprehensive wellness visit at school-based health centers (SBHC). The SBHC model consists of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care, mental health clinicians and dental care. Research has demonstrated SBHCs’ impact on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths’ academic performance by increasing student attendance. This integrated model can ensure that students requiring a sports physical to join school sports also receive a comprehensive wellness visit, including screening for risk factors.

NPM Strategies:

10.1: Increase the number of youth centered clinics (or number of clinics participating in a QI initiative).

Using $1,000,000 from the Alaska CDC Healthy and Equitable Communities Grant, WCFH will contract with a national organization to disseminate grants and provide technical assistance to communities that will support the planning, implementation, and expansion of school-based health centers in Alaska. It is estimated that this initiative will serve school districts via approximately 15 grants ranging from $30,000-$80,000 each. WCFH will continue to provide support to SBHCs in Alaska, as funding allows, through the marijuana tax revenue funds coming from the Office of Substance Misuse Addition & Prevention.

In addition, WCFH will support the formal establishment of an Alaska School-Based Health Center Alliance (network of Alaska School-based health centers) to affiliate with the national School-Based Health Alliance. At the present time, there are seven school districts in Alaska that have school-based health centers including: Juneau School District, Anchorage School District, Lower Kuskokwim School District, Mt. Edgecumbe Boarding School, Lower Yukon School District, Bristol Bay School District, and Petersburg School District.

10.2: Support the Alaska Coalition for Healthy Teens and Young Adults.

The Alaska Coalition for Health Teens and Young Adults (ACHT-YA) will continue to offer coordination for collaborative projects that impact statewide adolescent health measures related to the intersection of sexual health promotion and interpersonal violence prevention. This work includes collaboration with partners on effective public health interventions, capacity building for adolescent health/school health educators, best-practices for community-based and school- based implementation of comprehensive sexuality education and programming, evaluation, parent and college student engagement, and outreach to under and unserved communities.

10.3: Collaborate with partners to facilitate continuing education, workforce development and increased coordination of health service supports between providers in all settings who work with adolescents.

The Title V-funded School Health Nurse Consultant (SHNC) oversees the School Health and School Nursing Program which provides continuing education for school nurses through online trainings and annual conferences. Education related to trauma-informed care for school nurses and counselors is planned along with support areas of helping students with chronic illness for the 2023-2024 school year. Continued facilitation of the School Health Nurse Advisory Committee (SHNAC), which works to address the health and safety needs of students by ensuring quality school nursing and health service guidance is in accordance with national and state guidance and utilizes evidenced-based practices. To meet the needs of school districts nursing and health services, SHNAC will have five work groups to advance the following goals for the 2023-2024 school year: 1. Raise public awareness of the value of school health and nursing services for school communities and students. 2. Practices for addressing student wellness and healthy bodies with families. 3. Post-COVID pandemic student and staff mental health and wellbeing. 4. Immunizations: Bringing students up-to-date post-COVID pandemic. 5. Forms and publications review and updates. A community of practice group for rural school nurses will also take place bi-monthly to allow for collaboration and support related to school health concerns and challenges faced by rural school nurses. The school nurse online orientation class will also be reviewed and updated. The SNHC and SNHSP, through support from the Section of Chronic Disease & Health Promotion’s School-Based Interventions to Promote Equity and Improve Health, Academic, and Well-Being of Students grant, will partner with the Alaska School Nurse Association for the annual Alaska school nurse conference. This conference provides current educational offerings to improve student health, academic achievement, and emotional wellbeing through nutrition, physical activity, and the management of chronic conditions in schools.

WCFH continues to have close collaboration and communication with school nurses and pediatricians through such channels as Pediatric Grand Rounds, school nurse conferences, and electronic communication including a website and listserv.

The School Health ECHO will continue to provide current education on school health topics for school nurses, local providers, and school administrators and teachers. Ten sessions will be developed and provided virtually in the 2023-2024 school year. This ECHO is provided through a collaboration between the Department of Education and the Division of Public Health. The WCFH part-time pediatrician will support the Title V School Health Nurse Consultant related to content and presentations at the School Health ECHO. Two School Health ECHO sessions will be dedicated to rural school districts without formal school health or nursing services to meet specific identified needs in supporting student health and chronic disease management in their communities where access to medical care is limited and SBHC and school nurse services are not available.

The Oral Health Program provides national, Federal, and State resources to oral health providers serving all youth, including those with special health care needs.

10.4: Support school nurses and school-based health centers in encouraging all youth to establish a medical home and have consistent visits.

School nurses will be encouraged to collect data on annual health history forms regarding whether the family has a medical and/or dental home for their children. School nurses will provide resources for those without access to medical or dental homes, especially those that are uninsured or underinsured. School based health centers encourage families to have a medical home and can coordinate with the child’s private health care provider for any services received at school.

10.5: Promote youth health literacy and access to preventative medical visits (whether through school nurses, the Fourth R, adult preparation skills curriculum, healthy life skills or with community partners) including education on the importance of a well visit and oral health.

School nurses will continue to discuss with students and families the importance of preventative health visits. Information will be shared with school nurses on ways to increase communication with students and families in this area. Schools with school-based health centers will continue to encourage and provide comprehensive medical visits to the underserved students and those that do not have a medical home.

The WCFH Adolescent Health Program intends to gather additional feedback from clinicians and disseminate the clinician’s module of the youth health literacy curriculum, Coaching Youth Health Literacy. The youth health literacy curriculum was adapted by Nemours for Alaska and within an established contract, WCFH co-developed module five for clinicians working with adolescents. The health literacy curriculum focuses on empowering youth, including those with special healthcare needs, to access health care throughout their transition to adult health care through lessons, and supplemental training.

The Oral Health Program has released a youth oral health information and resources campaign, Your Mouth Matters, urmouthmatters.org, in partnership with community oral health providers and organizations to maximize oral health literacy and emphasize the importance of a dental home for youth and families. This campaign also links youth with nicotine and tobacco quit line support programs, and HPV vaccination resources.

10.6: Increase adolescent preventive health visits for youth covered by Medicaid and disseminate data and information regarding adolescent healthcare visits.

The Early Periodic Screening, Diagnostic and Treatment (EPSDT) program, also known as the Alaska Well Child Program, is to ensure that all Medicaid and Denali Kid Care-eligible children receive healthcare. The EPSDT program’s focus is on promoting the physical, mental, social, emotional, and behavioral health of all Medicaid/Denali Kid Care-eligible children under age 21.

The Adolescent Health Unit Manager will continue to participate in monthly pediatric team meetings between WCFH and Medicaid related to well-child visits and data dissemination. In the next year, WCFH wants to increase collaboration with the Section of Public Health Nursing and has identified the need for a targeted educational campaign, both in schools and healthcare facilities, emphasizing the long-term benefits of regular comprehensive check-ups – not just sports physicals.

The Adolescent Health Program will continue work to promote the reduction of logistical barriers related to youth friendly clinics and work to ensure convenient appointment scheduling, transportation assistance, and minimizing wait times at healthcare facilities and assuring each youth has a medical home.

10.7: Promote the use of a private online or virtual, personally guided, comprehensive risk assessment screening using a validated and standardized instrument prior to adolescent wellness visits that includes behavioral health questions.

Using an online risk assessment screening tool prior to wellness visits can help open conversations about behavioral health while screening for multiple risks. This helps to guide discussion and counseling to focus on topics and needs that are most relevant for the youth. Standardized, validated tools enable individual changes to be measured over time and clinic population risk trends can be identified.

WCFH will continue to encourage all school-based health centers to adopt risk assessment screening tools of this type to be administered prior to wellness visits. Two school-based health centers are receiving state funding to support implementation of a Rapid Assessment for Adolescent Prevention Services (RAAPS) screening tool.

SPM Strategies:

2.1: Develop a Fourth R and Healthy Relationships Plus Program online training that includes additional resources for parents and educators on facilitating healthy relationship conversations with youth.

The WCFH Adolescent Health Program continue to create an online interactive facilitator training for Fourth R and Healthy Relationships Plus Program for teachers and parents to be able to receive adequate training in providing the Fourth R and Healthy Relationships Plus lessons with fidelity and support. The purpose of the online training is to provide usable information, resources, and strategies to facilitate conversations on various health topics including sexual health, mental health, and substance use, with youth both in the classroom and within the home environment. This training will incorporate as many of the original training aspects of the in-person training but in a virtual format that will be on-demand for schools and school districts. This work was initiated in 2022 and will is using, a free open-source software package, called Moodle, which is a learning platform or course management system designed to help educators create effective online courses.

2.2: Support statewide training and dissemination of comprehensive violence prevention curriculum for coaches and athletes.

The WCFH Adolescent Health Program will partner with the Alaska School Activities Association to continue implementation of a statewide training of trainer’s programs for Alaska’s athletic coaches. Coaching Boys into Men (CBIM) is an evidence-based prevention program that trains and motivates high school coaches to teach their young male athletes healthy relationship skills and that violence never equals strength. This comprehensive violence prevention curriculum for coaches and their athletes was developed by Futures without Violence. The curriculum provides high school athletic coaches with the resources they need to promote respectful behavior among their players and help prevent relationship abuse, harassment, and sexual assault. The curriculum consists of a series of coach-to-athlete trainings that illustrate ways to model respect and promote healthy relationships. The curriculum instructs coaches on how to incorporate themes associated with teamwork, integrity, fair play, and respect into their daily practice and routine. The Alaska School Activities Association will continue to implement Athletes As Leaders for high school athletes on girls’ sports teams. The program aims to empower student athletes to take an active role in promoting healthy relationships and ending sexual violence. Athletes are encouraged to be leaders in changing social norms at school (and beyond) to a culture of safety and respect. The program is suggested to be used in conjunction with the prevention program for boys' teams, Coaching Boys into Men which is currently being implemented in the State of Alaska. This work supports healthy relationships, preventative medical visits, access to resources and caring adults. These interventions are funded by CDC Rape Prevention Education dollars.

2.3: Maintain statewide dissemination of Teen Speak publications and adolescent-focused motivational interviewing skills training and resources for supportive adults, parents, caregivers, and clinicians.

Research supports Motivational Interviewing as an approach to help youth decrease substance use, reduce stress, reduce condomless sex with multiple-partners, improve eating habits, increase exercise – and even to reduce injuries and hospitalizations. In collaboration with the Possibilities for Change, the Adolescent Health Program paid for an additional 100 attendee seats for virtual training and provides follow-up skills training both in person and virtually to synthesize learning into real-life application. This project works to improve the abilities of clinicians, parents, and supportive adults to identify risks, communicate more effectively with youth, and motivate them toward healthy decisions. 8 CMEs or CEUs are made available through Beaumont Health, which is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC). Previous collaboration with Possibilities for Change enabled Adolescent Health Program staff to continue offering virtual and in-person skills trainings, books, and workbooks, all which has been possible through a reimbursable services agreement with the Division of Public Assistance using Temporary Assistance Funding.

2.4: Increase meaningful connection between youth and supportive adults through YAHA by collaborating on the programs and projects that target youth.

The Youth Alliance for a Healthier Alaska (YAHA) has begun recruiting for its 14th year in Public Health. In the 2022-2023 session, YAHA collaborated with the national suicide and crisis line and the Division of Behavioral Health on a suicide prevention campaign using youth art called the 988 Create campaign. YAHA plans to develop this campaign further in the coming year. In 2023-2024, YAHA will be focusing on strategic planning and continued work with the UAA Institute of Circumpolar Health Studies and the Division of Behavioral Health.

2.5: Support and collaborate with Division of Behavioral Health and other agencies working on suicide prevention and mental health.

The WCFH Adolescent Health Program will collaborate with the State of Alaska, Division of Behavioral Health, Suicide Prevention Program in the implementation of the State of Alaska Zero Suicide Initiative. The Zero Suicide framework is a comprehensive approach to suicide care by health care systems with the aspirational challenge and framework for system-wide transformation that is proven to reduce deaths by suicide. The State of Alaska Zero Suicide Initiative aims to increase access to suicide specific psychotherapy resources, improve risk assessment and follow-up care across the state of Alaska health care systems.

The State of Alaska will provide technical assistance to medical care facilities implementing the Zero Suicide framework, provide statewide provider training in the evidence-based practice; Collaborative Assessment and Management of Suicidality (CAMS), in fall 2023 and develop resource support and system development with Zero Suicide projects. The Adolescent Health Program will receive funding from the Division of Behavioral Health to support the ongoing media promotional roll out of the 988 project.

The MCDR Program Manager participates in the statewide Suicide Prevention Community of Practice, which is co-facilitated by the Division of Behavioral Health statewide suicide prevention coordinator and ANTHC. This activity provides opportunities for data and prevention recommendations from the multidisciplinary review of adolescent deaths from suicide to be shared with practitioners at all levels of suicide prevention throughout the state. The statewide suicide prevention coordinator and a representative from the injury prevention program at ANTHC are both engaged in MCDR as subject matter experts in the review of fatalities among adolescents from suicide. MCDR will continue to review deaths among adolescents from all causes. Suicide is the leading cause of mortality among Alaskan youth, and this will continue to be an area of focus for the MCDR program, with review of these cases completed by panels of specialized subject matter experts including adolescent mental health clinicians, primary care providers, and prevention experts from the Division of Behavioral Health and Tribal Health. The MCDR Epidemiologist analyzes factors in adolescent mortality including social determinants of health and trauma histories which can provide insights for prevention. Findings from these analyses and the committee’s prevention recommendations will be presented as conferences, workgroup meetings and other opportunities arise. The Epidemiologist will work on an online dashboard during the coming year which will allow for rapid and accessible dissemination of committee recommendations.

2.6: Address multiple forms of violence including youth violence, teen dating violence, and adverse childhood experiences (ACEs) for teens and young adults ages 13-24.

Alaska was awarded a CDC-funded youth violence prevention grant, titled Prevention Violence Affecting Young Lives (PREVAYL), With support through this award, Alaska will implement two complementary violence prevention strategies aimed at addressing the community and societal levels of the social ecological model to improve adolescent health align with CDC Technical Packages for Violence Prevention. Alaska’s selected prevention strategies are to promote social norms that protect against violence through a public engagement and education campaign for youth ages 13-24 in southwestern Alaska, and to create protective environments through youth led outreach and community-norms mobilization intervention called “LeadOn!” by building youth violence prevention capacity. In the next year this work will continue to include dynamic speakers at the youth summit that teach and inspire youth to address racial and social inequities, support youth mini-grants that This work aims to address social determinants of health and racial inequity and will be carried out in partnership with Alaska Network on Domestic Violence and Sexual Assault (ANDVSA).

Maternal mortality from violence disproportionately impacts young pregnant and postpartum individuals. Based on case review data from 2016-2022, MCDR found that 47% of pregnancy-associated deaths from suicide or homicide involved decedents under the age of 25, and 29% were 19 or younger when they died. The national literature has long supported an association between pregnancy and elevated risk of violent victimization. A stratification of 2018-2019 NCHS data (Wallace et al, 2021) demonstrated that this is especially true for young women and girls, with pregnancy associated with a 65% increased risk of homicide for ages 20-24, and more than sixfold for children and adolescents aged 10-19. The same did not hold true for other age groups. In fact, pregnancy may even be associated with a lower risk of homicide for women in their early 30’s. These data underscore the need to bridge gaps between groups working on adolescent health, perinatal and reproductive health, and violence prevention. MCDR’s community-engaged work in this area is addressed in the Women’s Health/Maternal and Cross-Cutting domains, but the key intersection is acknowledged. MCDR will continue to support the Adolescent Unit’s efforts in this area by promoting interdisciplinary awareness among colleagues and audiences. For example, MCDR will continue to share information about adolescent experiences and needs when presenting to perinatal health providers. When working with partners focused on community safety and response to violence, MCDR staff and colleagues will promote awareness of reproductive control as a form of intimate partner violence and the need to ensure access to healthcare as a violence prevention strategy for adolescents.”

2.7: Facilitate access to trauma-informed professional development options for school nurses and school staff including mental health topics specific to adolescents.

Trauma-informed training will be offered to school nurses and school staff through the School Health ECHO series. This will include training on recognizing how trauma is affecting behavior and the impacts of trauma on learning and educational attainment. Resources will be provided on behavioral health supports available and how to identify and refer students for services. Additional training on trauma informed care will be offered through the School Health Collaborative annual training and the Alaska School Nurse Association’s annual conference.