Adolescent Health, Application Year FY 24 

 

Within the adolescent population domain key issues emerged from the 2020 needs assessment process and informed the selection of priorities to address adolescent suicide and substance use. The rates of tobacco use, depressive episodes, and suicide among adolescents has increased, as well as the rates of drug overdose deaths among young adults. Ohio’s most recent YRBS data, collected in 2021, shows 43% of Ohio high school students reported feeling so sad or hopeless during the past year that they stopped engaging in normal activities and over one in five (22%) Ohio high school students seriously considered suicide during 12 months prior to the survey. Female students, Black students, Hispanic students, and students who identify as Gay, Lesbian, or Bisexual were more likely to report seriously considering suicide. In 2021, 23% of Ohio high school students reported current alcohol use and 13% reported current marijuana use. Vaping is also a significant concern among adolescents, with 35% of Ohio high school students reporting they have tried an electronic vapor product and 20% reporting they currently vape. The priorities have underpinnings in adolescent mental health and approaches to address both priorities will be coordinated using a systems approach that reduces risk and increases protective factors. 

 

Emerging Issues 

Since conducting the needs assessment, the COVID-19 pandemic exacerbated the mental health needs of adolescents and underscored the importance of the selected priorities. With the disruption to school, extracurricular, and social activities due to stay-at-home orders and public health guidance, there is concern about the impact these factors had on adolescents, as school and community activities largely returned in-person. While well-child visits decreased across all age groups, adolescents experienced the largest drop in visits. In addition, serious mental health concerns among youth continue. In early 2022, the Surgeon General released a report highlighting the urgent need to address adolescent mental health.  The 2021 Ohio YRBS/YTS data showed increases in all the mental health and suicide indicators, demonstrating the need for continued focus on adolescent mental health.  The needs related to adolescent mental health and adolescent well-visits remain and will continue to be the key focus areas for Ohio’s FY24 block grant strategies.  

 

Priority: Increase developmental approaches and improve systems to reduce adolescent and young adult suicide rate 

 

Measures 

•       NOM 16.3- Adolescent suicide rate ages 15-19 per 100,000 

•       SPM- Rate of nonfatal intentional self-harm ED visits and hospitalizations ages 15-19, per 100,000 (VIPS) 
•       ESM: None developed at this time 

 

The SPM was selected to track intentional self-harm, an important indicator for the NOM as suicide attempt is a risk factor for completed suicide, and intentional self-harm without wanting to kill oneself might also result in unintentional suicide. ESM development for this SPM will be explored during FY 24. 

 

Objective 1: By 2025, reduce risk and increase protective factors for adolescents. 

Strategies: 

1. Implement evidence-based adolescent resiliency projects through MP grant. 

2. Continue MCH participation in existing prevention workgroups and coalitions, such as Ohio Anti-Harassment, Intimidation, and Bullying (HIB) Initiative. 

3. Provide resources, technical assistance and professional development to health professionals working in the school and early childhood level to support resiliency and decrease HIB. 

4. Support programming in local communities for professionals and community members on preventing violence and identifying and responding to victims of violence through SADVPP. 

 

Addressing risk and protective factors will continue to be a strategy in FY 24 and beyond.  The adolescent resiliency projects began as a component of the Maternal and Child Health (MP) program and went through a three-year grant program.  The program was moved to the Women and Family Health Section in Spring 2022 to better align adolescent health programming within the MCH work.  A new, competitive grant solicitation will be released in Spring 2023, with the opportunity for 4-6 community-based organizations or local health departments to apply.  The program will include a train-the-trainer model to infuse knowledge on Adverse Childhood Experiences (ACEs), trauma and resiliency into the communities.  The targeted population to be trained will be adults working in the community with adolescents, with an emphasis on highest need communities and highest need adolescents.  In addition to increasing awareness of ACEs and trauma, one outcome is to increase the number of trusted adults available in communities.  Connecting to a caring adult is one of the most important factors in developing resilience, and Ohio’s 2021 YRBS/YTS data shows that less than half of Ohio high school students (43%) report they most of the time or always have an adult they can go to talk about their feelings. 

 

In addition, MCH staff will continue to participate in existing statewide coalitions and workgroups. Workgroups include the Ohio Anti-Harassment, Intimidating, and Bullying group, which is led by ODE, the Ohio Prevention Partnership (which includes both the Child Injury Action Group and Youth Suicide Subcommittee), ODE’s Whole Child Advisory Group, the Ohio Interagency Council for Youth (OICY) and Linking Systems of Care for Ohio Youth.  In addition, MCH staff and partners will build upon work started during the ASPIRE learning collaborative to continue assessing shared risk and protective factors both internally and externally, working towards alignment of state agency work on Adverse Childhood Experiences (ACEs). In FY22, ODH assembled an internal ACEs workgroup and is currently working with ODH Leadership to determine next steps for the work.  

 

The external stakeholder group for this work has been the Ohio Adolescent Health Partnership (OAHP).  Historically, ODH provided staff support for OAHP.  In FY22, after an extended vacancy in the adolescent health coordinator position, MCH contracted with an individual to serve as the OAHP Coordinator.  The contract includes managing communications, creating orientation materials, securing speakers, engaging youth and continued education materials, and managing workgroups.  In addition, MCH funds were used to contract with Measurement Resources Company (MRC) to facilitate a strategic planning process with OAHP.  The strategic plan resulted in four workgroups: Engagement, Youth Engagement, Education/Training and Partnership/Sustainability.  The OAHP coordinator will oversee the workgroups and monitor the progress of the strategic plan.  Additionally, OAHP and ODH will coordinate youth engagement activities.   

 

Additional agency work for FY24 includes addressing risk and protective factors including school nurse and early childhood training, continued community-level work by Sexual Assault and Domestic Violence Prevention Program (SADVPP) and work from the Reproductive Health and Wellness Program, as well as Sexual Risk Avoidance Program. 

 

The ODH School Nursing Program provides school nurses, schools, and school communities with resources to advance the health and academic achievement of students. The program provides technical assistance, creates resources, manages the School Nurse Bulletin Board communication system, collects data regarding school health needs and services, and provides extensive professional development for licensed nurses working in the school setting. 

  

The professional development offered by the School Nursing Program includes a library of online independent study courses housed in OhioTRAIN. The program hosts three Regional School Nurse Conferences, one summer conference, and one three-day New School Nurse Orientation each year. Nursing continuing education contact hours are offered for all professional development courses and conferences. 

 

The program is implementing two projects in the coming year. The School Nurse Clinic Start-Up Kit project will assist those school districts who would like to hire a school nurse with the equipment and supplies needed to establish a clinic in the school.  The Diversity, Equity, and Inclusion (DEI) Facilitator project will contract for the services of a facilitator to convene a group of stakeholders to develop recommendations to increase the diversity of the school nursing workforce in Ohio.  The ARPA funded 6 special project nurses that provide additional support within five identified regions of the state will continue until June of 2024. 

 

The School Nursing Program initiated a pilot program to support school nurses in their first year of practice, called “School the Nurse.” Twenty-five nurses were selected from participants who attended the 2022 New School Nurse Orientation and volunteered their time. Virtual meetings are held monthly with topics that have included immunization reporting, health screenings, clinic set-up, infectious diseases and others that provide essential knowledge for novice school nurses. On average, eight to ten nurses attend the meetings every month and have provided consistent positive feedback highlighting the value of this critical information. Expansion for “School the Nurse” is currently in the planning process.   

 

SADVPP will continue to implement strategies to end sexual violence including changes to school and workplace policies, social marketing campaigns, community mobilization efforts, and educational programming - In partnership with the Ohio Alliance to End Sexual Violence and eleven local sexual violence prevention programs.  

 

FY24 activities include supporting survivors of sexual violence by updating, maintaining, distributing, and educating users about the protocol for sexual assault evidence collection; supporting crisis services in eight agencies to provide services to African/African American/Black, Asian/Asian American, and Latinx survivors of sexual violence and providing technical assistance and training opportunities for rape crisis centers and others who work with survivors on ways to increase effectiveness in working with survivors from specific communities.  

 

In addition, SADVPP will work with local health departments, community health centers, and other health and public health service providers to integrate a trauma informed approach to services and promote individual and community resiliency related to trauma. 

 

ODH’s Reproductive Health and Sexual Risk Avoidance Education programs provide education to adolescents. ODH Reproductive Health grantees received additional funding to work with faith-based agencies to provide educational programming to youth on healthy life choices, such as healthy life choices and reducing risk.  For FY24, the Reproductive Health program awarded additional funding for special populations, which can include adolescents, for 15 subrecipients and the faith-based deliverable to five subrecipients.  The Sexual Risk Avoidance Program is in year three of a five-year continuation grant that targets 11-14-year-olds and reflects the commitment of ODH to facilitate programming that is designed to meet the distinct and unique needs of each local community. The goal of the program is to increase the number of youth who abstain from sexual activity and other related risky behaviors to reduce out-of-wedlock births and sexually transmitted infections and encourage positive youth development messages that promote good decision making and healthy behaviors. 

 

Objective 2: By 2022, develop a plan for MCH to support implementation of Ohio Suicide Prevention Plan among targeted youth population. 

1. Increase MCH representation on State Suicide Plan implementation team. 

2. Identify gaps in state programming that would fit within MCH work. 

3. Explore programs that MCH can support. 

4. Coordinate work within MCH to align with state plan and external partner programs. 

 

The selection of reducing youth suicide as a priority coincided with the release of the State of Ohio Suicide Prevention Plan in 2020. The state plan created a youth suicide subcommittee to focus specifically on activities in Ohio related to youth suicide prevention. The MCH Adolescent Health Coordinator participates in the youth suicide subcommittee, which is close to finalizing a youth suicide strategic plan. Implementation of the plan will begin in 2022 and MCH will continue to support and align with the strategies in the plan. FY21 and FY22 were planning years for MCH to identify where gaps exist, and support could be used.   MCH is working on finalizing a plan to support the implementation of the Ohio Suicide Prevention plan, including all the collaborative work that has been done throughout the first two years of this grant cycle.   

 

A large part of this work has centered around the Adolescent and Young Adult Behavioral Health (AYA-BH) CoIIN.  ODH was invited by AMHCP to participate in the CoIIN after identifying reducing youth suicide as a priority in the action plan.  The Ohio team is led by ODH MCH Adolescent Health Coordinator and includes MCH and VIPS staff, along with ODE, OhioMHAS, Ohio AAP, the Ohio Association of Community Health Centers, and Nationwide Children’s Hospital, who asks as the recruitment partners for the practices involved in the QI/clinical arm of the project.  The team spent much of FY22 mapping out adolescent behavioral health and suicide prevention activities and discussing gaps and barriers.  Ohio has a robust mental health system, with great partnerships occurring at the school and community level.  Knowing this and due to the partners on the team, the Ohio CoIIN team chose to focus on partnerships with pediatricians or clinical providers.  The project officially ended at the conclusion of 2022, but the Ohio CoIIN team will continue to meet monthly.  Ohio plans to apply for HRSA’s Pediatric Mental Health Access Grant and will utilize the CoIIN team to assist in the development of the project.   

 

In FY22, ODH MCH contracted with the Ohio Chapter of the American Academy of Pediatrics (Ohio AAP) to address many health topics for children and adolescents. FY22 activities have included holding focus groups with parents and providers to get feedback on resources on a variety of topics.  In addition, AAP offered monthly webinars which have included adolescent mental health, immunizations, ACEs, and other topics.  FY23 activities for the grant include Quality Improvement (QI) projects on a variety of topics for the QI, including ACEs and adolescent depression screenings.  ODH plans to continue the contract with AAP in FY24.   

  

Additionally, MCH will continue to work with the Violence and Injury Prevention Section who will be contracting with Ohio AAP to expand the behavior health screening quality improvement project into counties with the highest rate and number of suicides and attempts (ages 11-24) in Ohio. This project includes both screening and providing resources to adolescents and families for high-risk responses, to include information on reducing access to lethal means using Ohio AAP’s Store It Safe program. This program is a 4-step process that includes screening using a validated tool, advising families to use a barrier to store potentially lethal means, family discussions with teens, and emergency referrals for life-threatening concerns.  This project includes Quarterly trainings will also be offered during FY24.  

 

Priority: Increase protective factors and improve systems to reduce risk factors associated with the prevalence of adolescent substance use 

 

Measures 

•       SOM- Percent of high school students who have used alcohol within the past 30 days (YRBS) 
•       SOM- Percent of high school students who have used marijuana within the past 30 days (YRBS) 

•       SOM- Percent of high school students who have used cigarettes, smokeless tobacco (i.e., chewing tobacco, snuff, or dip), cigars, pipe tobacco, hookah, bidis, e-cigarettes, or other vaping products during the past 30 days (YRBS/OYTS) 
•       NPM 10: Percent of adolescents (12-17) with a preventive medical visit in the past year 
•       ESM: Percent of schools in Ohio that have a School-Based Health Center that offer health services to students.  

 

The SOMs were established to align with measures from the State Health Improvement Plan and will measure the impact of Ohio’s efforts to address adolescent substance use priority. The selected NPM aligns with the priority as adolescent preventive medical visits provide key opportunities for screening, education, and referral on numerous topics including mental health and substance use. The prior ESM measure monitored rates of adolescents served by Medicaid with well visits, which is an important measure for this work.  However, it was replaced with the new ESM, which measures schools in Ohio that have a School-Based Health Center (SBHC).  SBHCs are an evidence-based strategy to increase access to care for students, particularly low-income students.   

 

Objective 1: By 2025, increase percent of adolescents with a preventive medical visit in past year by 3% 

Strategies: 

1. Continue collaborative efforts to convert sports physicals to comprehensive well-visits. 

2. Partner with payors to incentivize the well-visit. 

3. Partner with Medicaid and Education to support School-Based Health Care initiatives. 

4.  Increase the number of schools in Ohio with School-Based Health Centers.  

 

School-based health care has emerged as a priority for many programs and agencies in Ohio, especially for populations of youth that have barriers to accessing a primary care provider. In FY22, ODH partnered with the Ohio Department of Education and leveraged CDC Workforce Development funds with ODE funds to offer 26 million dollars to fund fourteen school-based health center projects across Ohio.  These one-time funds were to expand existing or create new school-based health centers in priority counties and school districts in Ohio.  While MCH funds are not used to fund the initiative, MCH staff participated in the planning and development of the request for proposals and participated in program discussions.  In addition to funding SBHCs, funds were used to contract with Nationwide Children's Hospital, through a competitive application process, to implement a training academy for the SBHC funded agencies.  This work will continue into FY24.  Finally, funds were also used to contract with the Ohio School-Based Health Alliance.  The Alliance provides important opportunities for training, technical assistance, and collaboration among school-based health centers across Ohio and is a key component of sustainability of the SBHC work. 

 

A no-cost extension was granted for the project, so the fourteen funded projects will continue until June 30, 2024, providing services to 18 counties and 32 school districts, including seven rural districts. In addition, the FY 24-25 state budget for Ohio has 7.5 million dollars allocated to support SBHCs. I ODH and ODE will continue to support SBHC efforts, the two training academies, Nationwide Children’s Hospital and Alliance, to all funded agencies for SFY24 and 25.   

 

ODH’s Office of Rural Health also provides support for SBHCs in rural areas through a contract with Nationwide Children’s Hospital, which will continue in SFY24 and 25.  

 

Objective 2: By 2022, develop plan for promoting comprehensive adolescent well visit that includes: 

Strategies: 

1. Provider education/training for comprehensive well-visit emphasizing the connection between physical health and mental health, substance use including tobacco, trauma, and appropriate screenings and referrals to services (Bright Futures). 

2. Partnership between programs that can mutually promote comprehensive well-visit (e.g., state immunization). 

3. Reviewing state/systems-level policies to assure equitable access to and uptake of high-quality well visit. 

 

Cross-program partnerships and coordination will benefit adolescent well-visits and school-based health centers. ODH programs such as Rural Health and Office of Health Equity are involved in supporting SBHC initiatives. The ODH Immunization Program continues to be primarily focused on the COVID-19 response, but MCH plans to continue coordinating work with Immunization Program staff during the coming year. One coordinated project is a planned media campaign addressing immunizations and well-child visits.   

 

In addition, the previously mentioned contract with Ohio AAP is working to address needs around provider education and quality improvement from many ODH programs.  

MCH adolescent health staff have participated on the advisory board for the Midwest Adolescent Health Project from the Adolescent Health Initiative since round one in 2019.  For round three, which kicked off in March 2022, three Ohio sites are participating, including two SBHCs.  One of the identified priority areas for the Ohio sites is adolescent well-visits.  

 

Objective 3: By 2025, increase coordination and capacity of state and local partnership to support adolescent mental health and reduce adolescent substance use, including tobacco use. 

Strategies: 

1. Identify existing collaboratives and build MCH representation and support. 

2. Collaborate with partners to conduct an environmental scan of current community prevention work, including risk and protective factors, at state and local levels, including youth led prevention programs. 

3. Explore with partners development of system for tracking and supporting mental health provider partnerships in schools. 

4. Analyze existing data to identify priority populations and disparities. 

5. Continue trauma-informed care efforts with public health partners (SADVPP). 

6.   Explore cross-program opportunities with TUPCP for youth tobacco use prevention and cessation (e.g., cross-program referrals, cross-program promotional/marketing opportunities). 

7. New strategy: Increase youth voice and engagement in ODH youth-serving programs.  

 

A law was passed in Ohio that required all school districts in Ohio to report prevention-focused programs, services, and supports.  The Ohio Department of Education conducted its first annual prevention services survey of all schools in Ohio during the school year 2019-2020.  The report was released in late 2021 and the second annual report was recently released.  In addition, as part of the Youth Suicide Prevention Plan, a survey of suicide prevention work was conducted.  MCH will continue to review these reports, in lieu of conducting a separate environmental scan.   

 

The ODH TUPCP will continue specific and meaningful steps toward protecting Ohio youth from tobacco companies and the health effects associated with using their products. Currently, using CDC funds, ODH funds 29 local health departments as tobacco control subgrantees throughout the state. These local health departments work on several youth-focused tobacco prevention initiatives- such as passing local youth-focused prevention policies, improving, or adopting tobacco-free policies in schools and public spaces, tobacco/nicotine prevention and education efforts, and promotion of the youth-centered cessation program, My Life My Quit. In addition, the program will be funding additional subgrantees as tier 1, who will focus on building capacity for tobacco and nicotine prevention in their area. The new Tier 1 and 2 grant cycle will begin July 1. 

 

In late 2022, Ohio received confirmation from CDC that the 2021 YRBS administration resulted in weighted data. Analysis of this most recent data is ongoing and will be an important activity for FY24.  2021 is the first year to include ACEs questions on the survey and FY24 activities will include deeper analysis of the data, along with examining disparities.  

 

Youth engagement has become an important component of the MCH block grant work, which is why a strategy was added to engage youth.  During FY22, the internal ODH youth engagement workgroup created a proposal for leadership that recommended ODH replicate the youth advocacy fellowship component of the Providers and Teens Communicating Health (PATCH) Program, which is a promising practice in AMCHP’s Innovation Hub. MCH signed an agreement with PATCH to replicate the program. The PATCH replication will be a partnership between ODH MCH and OAHP and the OAHP facilitator and MCH Adolescent Health Coordinator will co-lead the group.  FY24 will include the first implementation of the program, as recruitment for youth is scheduled to start at the beginning of the 2023 school year.  

 

Other Efforts Supported by Title V MCH 

Ohio Youth Risk Behavior Survey/Youth Tobacco Survey (YRBS/YTS) 

The Ohio YRBS is a CDC-supported, representative sample, school-based survey that has been administered every other year in Ohio high schools since 1993. The YRBS monitors health risk behaviors of adolescents including injury and violence related behaviors, substance use, tobacco, sexual behaviors, nutrition and physical activity, and other health-related behaviors. In 2019, ODH combined the YRBS with another ODH-administered, CDC-supported survey, the Ohio Youth Tobacco Survey (YTS), resulting in the YRBS/YTS. The Ohio YRBS/YTS is administered in middle and high schools across the state and provides valuable data, representative of the state, to inform program and policy decisions on many health behaviors of Ohio adolescents. 

 

The 2021 YRBS/YTS included 16 new ACEs questions that were optional for states to add from the Centers for Disease Control and Prevention (CDC). Due to COVID-19, the survey administration was delayed from Spring to Fall 2021. The 2023 YRBS/YTS will also include the 16 ACEs questions and will be administered during the fall of 2023.  FY23 activities will include questionnaire development through the YRBS/YTS advisory committee. 

 

MCH staff have also participated in a multi-agency workgroup around coordinating youth survey work across the state. In FY22, a project manager was identified through the state and has guided the multiagency group through planning and timeline development.  The group is currently focused on developing a shared website to provide a single destination for the public to access information on youth survey work completed in Ohio. The project goal is titled, “Ohio Youth Surveys”, and the site was published in the Summer of 2023.  

 

Youth Homelessness 

SFY24 and SFY25 will be the third consecutive biennium that Ohio has allocated funds in the General Revenue Fund (GRF) budget for ODH to address youth homelessness.  A competitive solicitation was released for ODH to award grant funds to agencies to provide comprehensive services for youth ages 14-24 who are experiencing homelessness, with particular emphasis on pregnant youth experiencing homelessness.  ODH’s funding for this initiative enabled local agencies that serve homeless youth to implement innovative strategies to reach and assist this difficult and vulnerable population. The funding can be used for services not typically covered by traditional federal funding for homelessness. ODH contracted with the Coalition on Homelessness and Housing in Ohio (COHHIO) in FY21/22 to enhance the data collection to obtain more details about the youth experiencing homelessness who are being served, what services are being provided, and program outcomes.  Coordination with state and local stakeholders who also serve youth experiencing homelessness or similar populations has increased since ODH received the funding and further coordination with internal and external partners will be examined in FY23.