MCAHD will continue to strive towards improving adolescent health and wellbeing during 2023-24. Adolescent domain’s action plan strategies and activities outcomes were analyzed by youth, stakeholders and MCAHD staff which provided their input to improve continuation of services for the benefit of youth health and wellbeing. 

 NPM #9: Percent of adolescents, ages 12 through 17, who are bullied or bully others

The efforts to understand and address the factors that affects youth mental health and wellbeing will continue including bullying and cyberbullying prevention.

1. Review Youth Health Promoters Project (YHPP) curriculum to incorporate additional strategies/ activities related to bullying prevention and mental health/wellbeing

During 2022-23 SISA staff, received CE workshops with accurate information about bullying/cyberbullying and youth mental health with MCAHD mental health consultant, and Rutgers University MHTTC trainer. A special workshop about two postgraduate studies “Bullying consequences in PR youth from Consulta Juvenil Youth Data Survey” and “DOE Antibullying Policies” by DOH health promotion personnel offered important information and resources. MCAHD “Respond the calling to protect children, youth and their family’s mental health” training of 7.5 hrs. was attended by all SISA staff and the 3 newly hired Coordinators received “Youth First Aid Mental Health” virtual training.

Mental health/wellbeing themes are included throughout YHPP’s three-year curriculum. SISA staff and MCAHD Curriculum specialist reviewed and completed the update of the first two years of YHPP Manual Guide “Youth Health in Action” (“Jóvenes Saludables en Acción”, in Spanish). It consists of a “script-like” format to guide the SISARC to implement each meeting using PYD and peer helping peer strategies, a list of all required materials and procedures before, during and after each meting in collaboration with DOE liaison to effectively engage and involve youth. During 2023-24 specific themes directed to bullying and cyberbullying effects in mental wellbeing, way to prevent it and how to handle day to day situations related to bullying will be included in 3rd year’s update to be completed.

During 2022-23 the ESM 9.1 was modified to Percent of Youth Health Promoters (YHP) that completed the first year who report not being bullied by September 2021-2025 and the YHPs Profile data was used to assess it. The MCAHD Profile working group of experts met to identify eight (8) questions whose answers may identify youth mental health and security hazards (“red flags”) and to refer as needed. The Guide for Profile Administration was completed and used in registered schools. Meetings with DOE Central Level managers were held to clarify schools’ doubts about the referral process. During 2023-24 the YHP 3rd year Exit Profile draft will be developed and pilot.

  2. Increase awareness about mental health/wellbeing and bullying/cyberbullying prevention in youth and adults, including parents and caregivers and healthcare providers

SISA and MCAHD MEU will continue collecting and analyzing PRYRBSS and ASSMCA’s “Consulta Juvenil” (similar survey to Monitoring the Future) data, related to bullying/cyberbullying, safety in schools, suicide ideation and other mental wellness indicators to analyze and share with YAC, SISA and interested entities. The list of government agencies, health professionals’ organizations, NGOs that work with youth and youth groups (including LGBTT+) will continue to be updated.

The communication that SISA established with SAMHSA Region 2 to help in the identification of bullying prevention Spanish language projects evolved to a steering committee to convene youth, families, and adults to work collaboratively to address youth mental health and wellbeing. The first collaborative meeting was held in November 2022 and four YAC representatives were moderators of the activity. They also presented YAC mission and their interest in working towards youth mental health and wellbeing. Three additional meetings were convened until June 2023, and youth continued to participate and moderate each one. Over 20 youth serving entities have participated in the meetings identifying youth and their family’s mental health needs, services available and how to address the gaps identified in a collaborative way. One of the 1st results of these meetings is the development of a virtual Directory or mapping of all youth mental health initiatives for the 1st time in PR. A Collective Impact approach was selected as the way to continue working as a group and next meeting will be held on August 7, 2023. Photos depict the 1st collaborative meeting’s youth participation and attendees.

 3. Develop a comprehensive project that incorporate youth, parents and school communities that promote school connectedness, respect, healthy relationships and equity to eradicate bullying, to be implemented in a YHPP school in collaboration with DOE

On October 11, 2022, SAMHSA Region II Regional Administrator and Assistant met in person with MCAH personnel to discuss their interest in collaborating to create a comprehensive project or intervention based in PR youth mental health & wellness needs. This collaboration will continue to identify culturally and language appropriate initiatives and their participation in the collaborative meetings for youth mental health.

The DOE is participating in the collaborative meetings to youth mental health /wellbeing and will continue meeting with SISA staff to develop the comprehensive project using the initiatives identified and the information provided by new stakeholders.

4. Develop Youth Intervention Guides to promote resilience and reduce youth trauma after stressful events

During 2022-23 SISA used “YHPP Intervention Guide after a Hurricane” after Hurricane Fiona and the floods that followed in September 2022. It included elements to reduce trauma and promote resilience.

A Basic Intervention Outline Guide will be developed, with the collaboration of MCAHD Mental health Counselor and MHTTC trainer to be used after other unexpected events.

5. Develop and disseminate an Emergency Preparedness and Response Guide that takes into account the needs of adolescents and young adults

The list of Emergency Preparedness Guidelines developed by government and NGOs will continue to be updated and evaluated by SISA for youth inclusion. The communication with DOH Emergency Preparedness Division will be established to include essential YAC’s voice and participation in the development of an Emergency Preparedness and Response Guide directed to youth in DOH.

NPM 10: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year

1. Empower youth to adopt healthy behaviors through Positive Youth Development (PYD) initiatives

Youth Health Promoters Project (YHPP):

During July – August 2022, the 3 newly hired SISA Reg Coordinators received capacity building about SISA Program history and fundamentals (socioecological model, PYD, peer helping peers) for adequate YHP implementation at schools, YHPP 1st year theoretical and practice of meetings, including Profile Administration Guide. Monthly meetings and CE will continue to increase workforce capacity, YHP implementation and update knowledge about youth health/wellbeing of all youth including LGBT+ & YSHCN.

Academic year 2022-23 began face to face implementation of YHPP in 51 schools in 44 municipalities island wide and a total of 732 enrolled YHPs, 380 in 1st year (6th grade) and 278 its 2nd year (7th grade). Even though unexpected natural events and structural school buildings reconstruction to become seismic resistant challenged YHPP implementation, SISA RCs managed to overcome them. The YHP Profile was administered to enrolled participants and data collected will be analyzed.  

Meetings with newly appointed DOE Central Level officials were held to continue and improve YHPP implementation. Options discussed included the development of 5 year DOH & DOE MOU instead of the DOE endorsement letter, create workshop to DOE liaisons about the Project, and Profile referral process. An MOU draft was sent to DOE in January 2023 to be assessed for approval.

The YHPP’s Coordinators’ Manual is under evaluation for update, looking forward to be assessed as a promising initiative. 1st and 2nd Year YHPP curriculum were completed. Third year will be completed with the inclusion of new mental wellness and bullying prevention activities in 2023-24.

MCAHD will continue to collaborate with DOE to implement YHPP and look forward to reestablishing YHPs activities with their peer after pandemic.

Youth Advisory Council (PRYAC):

YAC will continue to provide MCAH and DOH input about youth health/wellbeing policies and initiatives including youth annual healthcare visit. During 2022-23 advisors continued to meet in youth-adult alliance face to face and virtually. Committees continued to meet virtually in accordance with their developed Plan.

In August 2022, a special “ropes like” day activity was held with the PR Boys Scout Reserve at Guajataka summer camp facility to promote teamwork, develop trust, and strengthen partnership to continue YAC’s work.

Advisors were moderators and active participants in all youth mental health collaborative meetings held in 2022-23 and will continue to provide their input and work together with other youth, families, and adults to improve youth mental health in PR.

During 2022-23 YAC 1. Participated as ushers and moderators in SRAE Youth Summit held in August 2022 in a southern municipality. 2. In alliance with PR Suicide Commission provided information to passerby’s in an educational booth during Suicide Prevention Week in a well-known SJ Shopping Mall, 3. One advisor participated in PR Title V BG Review meeting.

Advisors were invited to provide their voice and participate in the following meetings: 1. HIV Prevention Division meetings to update its Action Plan, 2. Juvenile Justice Prevention Group to integrate youth voices in the development of an initiative to decrease youth delinquency, 3.  PT Tobacco Free Coalition to present its Action Plan for 2023-25 and, 5 HIV Community Mobilization Committee to provide their ideas about their initiatives.  Advisors received workshops about YRBSS data, youth suicide prevention, public speaking among others.

One advisor was sponsored by AMCHP to represent PRYAC in Minnesota NNSAHC Gathering in November 2022. She was the only youth and participated in a panel about youth advisory councils and through her example, emphasized the importance of having their voice and engagement in all initiatives directed to youth. She received a special recognition by NNSACH board for being an inspiration and motivation for the creation of youth councils by AHCs in their jurisdictions.

Two advisors represented YAC in 2023 NNSAHC Meeting and AMCHP 2023 in person annual conference “Cultivating Diverse Leaders in Maternal and Child Health” from May 5 -9, 2023 in New Orleans, Louisiana. They were part of the panel “Supersizing the impact of your adolescent health workforce” in which they expressed their experiences working alongside adults in MCAHD and their contributions to Title V needs assessments, public input and collaborations to the different domain’s activities and initiatives.

YAC 2021-2023 two-year term finished and during 2023 the recruitment and selection of new members to complete YAC 2023-25 was activated. The transition meeting will be held on August 12, 2023.

2. Establish collaborations with MCAHD stakeholders to implement PR Youth Health Literacy Toolkit (YHLT) to provide knowledge about how to use the health care system

Pre and posttests of YHPP’s Year 2 meetings #8 to #12 about youth health literacy, annual healthcare visit will be used to continue the assessment of ESM 10.1 Percent of Youth Health Promoters (YHP) reached with the PR Youth Health Literacy Toolkit (PR-YHLT) that increase their awareness regarding how to use the healthcare system (pre & post survey) in Puerto Rico by September 2021-2025.

3. Increase awareness of youth health and wellbeing issues including the annual healthcare visit through educational activities and multimedia campaign

Nivel Máximo Multimedia Adolescent Mass Media Campaign: During July to September 2022, Nivel Máximo website campaign continued to be posted in social media. To increase its visibility, posters of each theme were printed to distribute them in YHPPs schools during 2022-24. As stickers is a way youth like to express themselves, each topic was created in stickers and shared with SISA RCs to distribute them to YHPs.

The YAC Adolescent Campaign committee will continue meeting to update and adapt the webpage context to be more youth friendly.

Education activities directed to youth and adults about adolescent health and wellbeing by SISARCs, CHW, and HE will continue during 2023-24

Immunizations and adolescent health and wellbeing: The collaboration between MCAHD and DOH Immunization Program will continue to maximize the education and promotion messages to dispel myths about youth vaccination and promote their immunization schedule.

Sexual and reproductive health/wellbeing education efforts directed to youth and their parents will continue through YHPP’s health promotion education activities, YAC committees, Nivel Maximo’s webpage, and MCAHD regional personnel. PR-Personal Responsibility Education Program (PREP) and Sexual Risk Avoidance Education (SRAE) ACYF grants.

MCAHD secondary TPP efforts will continue with HV and MIECHV as well as the prenatal and parenting courses directed to 1-5y/o and 6-11 y/o. 

4. Implement PR Youth Friendly Healthcare Services Guidelines in a pilot project in a FQHC.

YAC Youth Friendly Healthcare Services Committee continued meeting and included MCAHD Curriculum Consultant to review the Guide previously developed by YAC. The Guide is needed to design and establish the plan to pilot a friendly healthcare services clinic model in a FQHC.

5. Identify a Guideline directed to all youth about Transition to Adult Healthcare Services

The previous strategy Collaborate with CYSHCN Transition to Adult Healthcare Services Committee to assist all youth as they transition from pediatrics to adult centered care services in PR was modified to identify a toolkit to promote a healthy transition of all youth. A meeting with Got Transition directors was held in February 2023 to identify the toolkit for all youth they had recently released in Spanish. A follow up meeting to design next steps to pilot it in PR will be held in 2023-24.