Adolescent Health: Application Plan

FY 2020 Application Plan

Although completed suicide is statistically rare, Idaho continually has some of the highest suicide rates in the U.S. In 2016, Idaho ranked 8th in the nation for a suicide rate of 20.8 suicide deaths per 100,000 population. For the same year, the suicide rate for teens was 15.1 suicide deaths per 100,000 population aged 13 to 18 years old. According to the Idaho Youth Risk Behavior Survey, 21.7% of high school students had suicidal thoughts and 9.7% made a suicide attempt.

In 2016, the Idaho legislature mandated the creation of the Idaho Suicide Prevention Program (ISSP) within the Division of Public Health to address Idaho’s suicide rate, with a focus on youth education. The 2015 Title V Five-Year Needs Assessment results indicated lack of access to mental health services as a priority across the life course. However, the Title V Program did not have the capacity or a mechanism to address mental health issues for MCH populations, so it was not selected as a top priority. With the addition of the ISPP, the MCH Program has developed a partnership and identified an opportunity to allocate MCH funding for FY 2019 and FY 2020 to expand suicide education in schools.

Adolescence is an important developmental stage filled with health opportunities as well as potential health risks. During this stage, health behaviors are established that pave the way for adult well-being and impact lifelong health and longevity.  With this in mind, the MCH Program does not have a comprehensive adolescent health program and has identified an opportunity to expand programming beyond adolescent pregnancy prevention. Addressing mental health and suicide would be one piece of this. Therefore, two new objectives have been added to the state action plan: 1) By September 2020, collaborate with the ISPP to enhance suicide prevention activities for adolescents, and 2) By September 2020, develop a plan to increase the public health system’s capacity to address adolescent health issues with recommendations for strengthening and coordinating systems for adolescent health.

To address the new objectives, the existing priority of supporting “services, programs, and activities that promote safe and healthy family functioning” is being used to justify this important work.  During the 2015 needs assessment, this priority was centered around results indicating the following as priorities for families (across the life course): to develop and support healthy home environments, healthy parenting practices, and injury prevention. Therefore, this priority and the new objectives are linked with national outcome measures (NOMs) that align with “NPM 10: Adolescent Well- Visits.” The existing priority and objective discussed in the annual report will remain the same. New strategies and changes to the existing plan are highlighted below.

Youth-Led Projects and Adolescent Well-Visits

To wrap-up activities related to the Youth-Friendly Clinic Assessment Project, youth will have an opportunity to review the changes made and provide feedback to the clinics. Clinics will also analyze patient data to identify increases in youth visits.

The APP Program supports Youth-Adult Partnership (YAP) groups as a positive youth development strategy to complement APP programming. YAP groups plan and implement activities that encourage healthy choices in their schools and communities. This may include youth-led projects such as youth-friendly clinic assessments, action research or participatory evaluation, and other activities that promote reproductive health and APP program goals. Research has shown the benefits of effectively incorporating youth voices into program activities include: increased self-esteem; sense of personal control and enhanced identity development; enhanced development of life skills including leadership, public speaking, and job responsibility; strengthened communication skills with adults, peers and family; and decreased involvement in risky behaviors (Scales & Leffert, 1997). Youth-adult partnerships can serve as a unifying factor when they include authentic decision making, natural mentors, reciprocity, and community connectedness (Zeldin, Christens, & Powers, 2012).  Additionally, youth participatory evaluation has been shown to decrease youths’ feelings of alienation and increase understanding of their ability to affect change within their communities (Sabo, 2003). ESM 10.2 will be maintained to capture youth participation in future youth-led projects that are health-focused in collaboration with MCH.

Youth Suicide Prevention

The Idaho Lives Project (ILP) began October 1, 2013, with funding from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Garrett Lee Smith Memorial Act grant, and became funded by the state in 2016 as a joint project of the Idaho Department of Health and Welfare’s Division of Public Health’s Suicide Prevention Program (ISPP) and the Idaho State Department of Education. ILP trains Idaho schools with suicide prevention and wellness programs and provides support for program implementation and fidelity.  It also provides all schools with technical assistance as requested in suicide prevention, intervention, and postvention.  As suicidality needs to be treated effectively and safely, programs selected for Idaho’s schools are evidence-based in efficacy and safe messaging guidelines. For FY 2020, the MCH will collaborate with the ISPP to enhance prevention education for children and adolescents. ILP has focused efforts in middle/junior high and high schools, but will be expanding efforts in elementary schools (K-5th/6th grade) with support from MCH.

Sources of Strength™ (Sources) is one of school-based, evidence-based programs implemented by ILP. Sources is an upstream program and has been found not only to reduce suicide but also to decrease other risky behaviors. Sources is one of the most robustly researched suicide prevention programs in existence and is the only peer-based suicide prevention program that was listed on the National Registry of Evidence-based Programs and Practices. For FY 2019 and FY 2020, funding from MCH will provide for an additional 10 new schools trained each year in the Sources program.

The PAX Good Behavior Game® (GBG), “is a set of strategies to help students learn important self-management skills while collaborating to make their classroom a peaceful and productive learning environment. it makes managing classrooms [1st and 2nd grades only] much easier… [and is] a powerful evidence-based practice, consisting of proven instructional and behavioral health strategies used daily by teachers and students in the classroom.” This universal preventive approach not only improves classroom behavior and academics, but also provides a lifetime of benefits for every child by improving self-regulation and co-regulation with peers. Funding from MCH will allow for the GBG to be piloted in 10 to 35 1st and 2nd grade classrooms and expands ISPP efforts to a younger population.

Youth Mental Health First Aid™ (YMHFA) “is designed to teach parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human services workers, and other caring citizens how to help an adolescent (age 12-18) who is experiencing a mental health or addictions challenge or is in crisis. Youth Mental Health First Aid is primarily designed for adults who regularly interact with young people. The course introduces common mental health challenges for youth, reviews typical adolescent development, and teaches a 5-step action plan for how to help young people in both crisis and non-crisis situations. Topics covered include anxiety, depression, substance use, disorders in which psychosis may occur, disruptive behavior disorders (including AD/HD), and eating disorders.”  MCH funding will support one additional school training in YMHFA.

Through collaboration with ISPP, the MCH Program will expand the reach of an existing public service announcement (PSA) focused on suicide awareness and prevention among adolescents and their caregiver/parents. The 30-second video will feature the MCH logo and will be shown on TV stations across the state in fall 2019.

Comprehensive Adolescent Health

During the 2019 and 2020 program years, the MCH program will allocate funds to start a focused effort on raising awareness of adolescent health and to build workforce capacity to incorporate best practices when working with youth.

In May 2019, the IFPP and APP Program hosted a workforce training, “Adolescent Health Training for Public Health Professionals,” that was facilitated by YLI for public health staff and community partners. This training helped participants identify examples of youth development principles within the context of their work, and assess their readiness to implement youth engagement strategies. Participants also had the opportunity to connect across programs within the Division of Public Health and find potential points of collaboration to reach youth more effectively.

Katherine Humphrey, MCH Adolescent Health Coordinator, will lead program staff in a strategic planning process to examine how to increase attention to adolescents as a group within the state public health system, how to increase the public health system’s capacity to address adolescent health issues, and how to promote healthy youth development approaches and best practices. This may include the exploration of developing new partnerships, education, tool kits, or social media campaigns to raise awareness about the need for adolescent well-visits, as well as other identified health priorities that impact youth.

In summer 2019, youth focus groups will be conducted by seven public health districts in communities across the state of Idaho. This activity will gather youth voice to inform the MCH needs assessment, and will provide essential consumer feedback to ensure priorities identified are those most needed.

Other Adolescent Programming

The APP Program will maintain other programming described in the annual report section with minimal to no changes and implement SRAE programming as described below. Digital media campaigns to promote Let’s Talk Month and Teen Pregnancy Prevention Month will be conducted in October 2019 and May 2020.

The primary goal of the SRAE Program will be to reduce adolescent pregnancies and to increase the delay of sexual activity among Idaho adolescents ages 10-14 in the selected service areas. To help attain this goal, the program will focus on two main objectives: to increase access to abstinence sexual health education in rural areas of six public health districts, and to provide parent engagement education to increase protective factors to help youth avoid high risk behaviors that may lead to unplanned pregnancy and sexually transmitted diseases.

To increase and promote abstinence sexual health education, the SRAE Program will partner with six local public health districts in Idaho. The health districts will implement either Making a Difference! (MAD) or Draw the Line / Respect the Line (DTL/RTL) student curriculum in a school or community setting to youth ages 10-14. The SRAE Program will prioritize implementation sites that reach rural and Hispanic youth in Idaho.

SRAE funds will also be used to provide parent engagement education to increase protective factors among Idaho youth. The SRAE Program will partner with six local public health districts to provide the parent education programming in local communities. The health districts will implement either the Families Talking Together curriculum or the Bridging the Gap dinner event. The programming will be provided to Idaho parents and caregivers of youth ages 10-14 in a small group format where parents learn communication skills that can help impact adolescent sexual decision-making, along with the importance of developing healthy friendships and the role of monitoring and supervision. The SRAE Program will prioritize implementation in rural communities and areas with a high Hispanic population.