I. Overview of Approach to Adolescent Health Domain

 

The Bureau of Family Health’s (BFH) approach to addressing Adolescent Health will continue to focus on two priorities: reducing rates of child and adolescent mortality and improving mental, behavioral, and developmental health outcomes. The BFH will aim to increase access to mental health services, increase protective factors, and utilize other strategies to provide adolescents in Pennsylvania (Pa.) with the supports they need.

 

As part of this effort, the BFH is evaluating the extent to which new and existing programs advance adolescent health priorities in the state. In addition to assessing program efficacy, the BFH is also seeking public input on strategies that stakeholders perceive as important within their communities or networks of care. The public input survey conducted as part of ongoing needs assessment activities is one way that the BFH seeks public feedback on special topics or strategies and, this year’s survey again asked respondents for their feedback on two specific adolescent health strategies: community-based mentoring programming and sexual health services at drop-in centers in schools. This type of feedback will be useful as the BFH continues to assess and adapt programming to meet the ever-changing needs of adolescents in the state.

 

The BFH entered into a grant agreement with Penn State Health Milton S. Hershey Medical Center to develop and facilitate a Youth Advisory Council (YAC). The YAC will advise the Department on relevant issues to improve health outcomes and increase protective factors for youth. Youth representatives on the YAC will serve as leaders to educate, advocate and form partnerships to create positive change across all MCH populations. The priority of the council, facilitators and youth alike, will be to ensure that the Department and other adolescent-serving agencies are making programmatic and policy decisions reflective of the communities being served and beneficial to the population at large, including adolescents. The YAC, comprised of three regional councils representing the eastern, central, and western portions of Pa, was developed to provide a forum for youth involvement in community, organization, and program development at both the statewide and regional level utilizing a youth-friendly framework. 

 

II. Other Federal Funding and State-Funded Activities/Future Efforts

 

In addition to Title V-supported activities, the BFH addresses disparities in teen pregnancy and teen birth rates through the Personal Responsibility Education Program (PREP). Funded by the Administration for Children and Families, PREP aims to reduce teen pregnancy rates among youth who have disparate risks and educate youth on abstinence, contraception, and adulthood preparation subjects. Evidence-based curricula are implemented in settings serving at-risk, high-need youth including drug and alcohol facilities, residential treatment facilities, and community-based health or human service agencies.

 

The BFH also implements the Teen Outreach Program (TOP), funded by the Title V Sexual Risk Avoidance Education Grant. TOP promotes abstinence from sexual activity among youth through an evidence-based approach that aims to affect positive youth behavior change and improve outcomes for youth. The program implements strategies to build protective factors for participants and promote the optimal transition of youth from middle childhood to adolescence.

 

III. Priorities

 

Priority: Improve mental health, behavioral health and developmental outcomes for children and youth with and without special healthcare needs

 

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

 

Strategy: Improve the mental and behavioral health of youth while increasing access of care for youth through Health Resource Centers (HRCs)

 

Objective: Annually increase the number of youth ages 12-17 utilizing HRC services by two percent each year

 

ESM: In schools with an HRC, the percent of youth within that school utilizing the HRC services

 

ESM: Number of referrals provided to school and community-based resources

 

ESM: Percent of visits that include counseling

 

Health Resource Centers (HRCs) will continue to provide medically accurate education and counseling services. Services provided include sexual and reproductive health education, confidential individual counseling, screening for sexually transmitted infections (STIs), pregnancy testing, referrals and linkages to family planning services, and distribution of safer sex materials, such as male and female condoms and dental dams. HRCs are primarily located in school settings, but a small number are in clinical community-based programs in areas where schools are not an option due to varying reasons. The services provided through HRCs aim to improve the mental and behavioral health of adolescents and children while improving access to care by adolescents and children in alternative settings such as schools.

 

AccessMatters operates the 47 HRCs in 10 counties (Philadelphia, Delaware, Berks, Lackawanna, Lycoming, Dauphin, Fayette, Beaver, Lehigh, and Venango) throughout Pa. through funding from Title V. It is anticipated these HRCs will remain operational in 2024 with no additional HRCs opening unless one of the current HRCs closes. All areas where HRCs are operating represent areas with high rates of teenage pregnancies, high rates of STIs, and high rates of youth leaving school before graduation.

 

HRCs are staffed by an experienced counselor, social worker, or health educator trained to encourage clients’ critical thinking around sexual activity and to promote healthy relationships and behaviors regarding human sexuality. Services offered through HRCs will allow youth to develop healthy coping skills when making decisions regarding their sexual and reproductive health, thereby improving their mental and behavioral health outcomes. Results from Pennsylvania’s Title V public input survey conducted in 2022 reaffirm this strategy’s importance. Of the 35 survey respondents who answered a question asking about the importance of sexual health services in schools, most respondents indicated that such services were very important (77%) or important (14%) in their community or network of care.

 

The BFH is currently evaluating the HRC program to assess the program’s impact and determine future funding. This process will determine if the program continues as is, or if the program needs altered to achieve more successful outcomes. The evaluation will conclude prior to the end of the current HRC program cycle, which ends in June 2025.   

 

Strategy: Improve interpersonal relationships among youth through staff training and implementation of the Olweus Bullying Prevention Program (OBPP) for Community Youth Organizations

 

Objective: Annually increase the number of community-based organization staff trained in a bullying awareness prevention program by five percent each year

 

ESM: Number of community-based organization staff trained in the OBPP

 

ESM: Number of youth participating in the OBPP at a community-based organization

 

Youth violence and bullying are major public health issues for individuals, families, and communities. Both are complex problems which, over time, can lead to poor developmental, health, and social outcomes for targets, bystanders, and aggressors. Solutions require widespread, sustained prevention and intervention efforts targeting individuals, families, schools, and communities.

 

There is no single cause of bullying among children. Individual, family, peer, school, and community factors can all place a child or youth at risk for bullying. These factors work individually as well as collectively to contribute to increasing the likelihood a child will bully others. Family risk factors for bullying include a lack of warmth and involvement on the part of parents, overly permissive parenting (including a lack of limits for children’s behavior), a lack of supervision by parents, harsh, physical discipline, parent modeling of bullying behavior, and victimization by older siblings. Peer risk factors for bullying include having friends who bully and having friends who have positive attitudes about violence. Additionally, some aggressive children who take on high status roles may use bullying to enhance their social power and protect their prestige with peers. Conversely, some children with low social status may use bullying to deflect taunting and aggression that is directed towards them, or to enhance their social position with higher status peers.

 

The Olweus Bullying Prevention Program (Olweus or OBPP) model is an evidence-based approach currently being used by school districts across the state. The BFH worked with Clemson University to develop a training and certification program for Olweus in community youth organizations (CYOs) to supplement current Olweus activities across Pa. There are currently 8 CYOs, selected through competitive Request for Applications (RFAs), implementing OBPP, including providing staff with ongoing training. These CYOs will continue implementation through calendar year 2024. The ongoing sustainability of the program is being evaluated due to a combination of factors, including significant staff turnover and the disallowance, by Clemson, of subcontracted staff to administer trainings.  

 

The BFH will track the number of community-based organization staff trained in OBPP, as well as the number of youths participating in the OBPP at a community-based organization. This ESM has been revised as the number of individuals able to be trained in OBPP is constrained by the number of community-based organizations funded. An OBPP goal is to have all staff at the implementation site trained in OBPP, including direct care staff, support staff, and others, to improve the social climate at that agency.

 

Strategy: Increase the dissemination of information to youth through social media and other technology-based platforms

 

Objective: Annually increase the number of users who access SafeTeens.org by two percent each year

 

Objective: Annually increase the number of text messages received on the SafeTeens Answers! text line by two percent each year

 

ESM: The number of users who accessed the SafeTeens.org site

 

ESM: The number of teens referred to in-person counseling or health services through the SafeTeens Answers! text line

 

In 2024, the BFH will continue to increase Pa. adolescents’ access to sexual and reproductive health care services by maintaining and expanding SafeTeens.org. The website will continue to provide medically accurate sexual and reproductive health information that connects teens to local health centers. The website provides teen-focused features and updates on several topics including human development, healthy relationships, decision-making, disease prevention, abstinence, sexual orientation, and gender identity, all with an emphasis on encouraging teens to use local health centers.

 

Additionally, the BFH will continue to support the toll-free SafeTeens textline, a text-based hotline that fields questions from respondents and provides factual responses and referrals to local community partners as appropriate. To increase usage of the hotline, coordination with local and statewide youth programs will be heightened to establish a more youth led approach to education and advertising. Additionally, the use of social media will be bolstered to promote Safeteens.org to direct youth to the hotline. The grantee responsible for the management of both the website and the hotline continues to submit quarterly data including the number of calls received, most often asked questions, number of hits on the website, and the most searched questions. The BFH will track the number of users who accessed SafeTeens.org, and the number of teens referred to in-person counseling or health services through the text line as the key measures of success for these initiatives.

 

Strategy: Individuals working in the field of drug and alcohol or brain injury will have a greater understanding of the correlation between substance use and brain injury

 

Objective: Increase the number of brain injury and opioid trainings provided to substance use and brain injury rehabilitation programs by 1 per year

 

ESM: Number of substance use and brain injury professionals receiving brain injury and opioid training

 

The BFH will continue to provide the Brain Injury and Opioid Initiative to deliver a training curriculum focused on the correlation of ABI and opioid use. The BFH will partner with the Brain Injury Association of Pennsylvania to deliver training to professionals who serve adolescents and are within the brain injury and drug and alcohol fields on a statewide level. The Brain Injury and Opioid Initiative will focus on those impacted by opioid misuse by providing outreach, education, and technical assistance to health and human services personnel who work with or are likely to encounter individuals with a brain injury or their family members. Through the training program, the outcome will be to improve the mental health, behavioral health, and developmental outcomes of adolescents with brain injuries and opioid use by increasing the knowledge base of both substance use and brain injury professionals to identify when the correlation between brain injury and opioids needs addressed.

 

SPM: Percent of children ages 6-17 who have one or more adult mentors

 

Strategy: Increase protective factors for LGBTQ-identified youth through evidence-based or evidence-informed behavioral health programs

 

Objective: Increase the percentage of LGBTQ-identified youth participating in an evidence-based or evidence-informed program who report increased positive coping strategies, specifically support-seeking, problem-solving, distraction, and escape strategies by two percent over the course of the program

 

ESM: Percentage of LGBTQ-identified youth participating in an evidence-based or evidence-informed behavioral health program who report an increase in positive coping strategies, specifically, support-seeking, problem solving, distraction, and escape strategies over the course of the program period

 

Lesbian, Gay, Bisexual, Transgender, and Questioning/Queer (LGBTQ) youth experience a high rate of health disparities compared to their heterosexual and cisgender peers. LGB youth are twice as likely to be excluded, bullied, or assaulted at school, and nearly 40% less likely to have a family member to whom they can turn to for support and transgender youth are more likely to have attempted suicide than their cisgender peers. Increasing protective factors, including family and community support and easy access to healthcare for LGBTQ youth, can help to decrease the risk for behavioral health concerns including depression, anxiety, substance use, and suicidal thoughts and behavior.

 

The BFH will continue working with Hugh Lane Wellness Foundation, Inc., and Students Run Philly Style to provide evidence-based or evidence-informed programming to enhance positive behaviors, personal strengths, and interpersonal relationships for LGBTQ youth. Hugh Lane Wellness Foundation Inc. will continue implementing the AFFIRMING Youth Project across western Pennsylvania. They will use the evidence-based intervention Mental Health First Aid to screen all youth and identify and understand youths’ mental health, suicidality, and substance use. Additionally, they will use the ALGEE (Assess for suicide, Listen nonjudgmentally, Give reassurance and information, Encourage appropriate professional help, Encourage self-help and other strategies) method to respond to any potential crisis situations that might arise with youth referred to the program. Students Run Philly Style (SRPS) will continue implementing their OUTPace program, formerly known as OUTRun, with LGBTQ youth in Philadelphia. The program pairs adults with Philadelphia youth as they train together in preparation to run a long-distance race. Students Run Philly Style will recruit 100 adult mentors who will be trained in the evidence-based SRPS trauma-informed and strength-based program that will enhance the mentor and mentee relationship and focus on best practices when working with LGBTQ youth, who currently make up 31% of youth participants.

 

Priority: Reduce rates of child mortality and injury, especially where there is inequity

 

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

 

Strategy: Implement Child Death Review (CDR) recommendations as they become available

 

Objective: Annually increase the number of recommendations from CDR teams related to preventing adolescent deaths that are reviewed for feasibility and implemented each year

 

ESM: Number of CDR recommendations implemented (adolescent health)

 

Pa.’s Child Death Review (CDR) program was developed to promote the safety and well-being of children by reducing preventable childhood deaths through review and exploration of the factors contributing to these fatalities. This is accomplished through systemic, multi-agency reviews of the circumstances surrounding the deaths of children 21 years of age and under.

 

In 2021, the State CDR team began to pilot a new prevention framework. The framework process consists of three steps: assessment; development; and evaluation. Assessment includes a review of data (CDR data and other relevant data), current prevention strategies occurring in Pa. and other jurisdictions and best practices. In 2024, the BFH will continue to use data from the local CDR teams to inform the prevention recommendation framework. Recommendations for deaths determined to be preventable will be reported to the BFH and implemented as appropriate, with a particular focus on prevention strategies that address identified social, economic, environmental, and structural factors influencing mortality rates, acknowledge the life course, and promote health equity. The goal is to increase sharing of data and findings with state and local partners to inform child fatality prevention and health promotion strategies, enhance policies and practices of systems serving children and families and promote support for concrete services and policies that help families thrive and expand community awareness of factors associated with fatalities.

 

Strategy: Young adult and adolescent males will increase their understanding of healthy relationships through evidence-based or -informed programs

 

Objective: Annually increase young adult and adolescent males receiving trainings through the Coaching Boys into Men Curriculum by 4 each year 

 

ESM: Number of young adult and adolescent males receiving trainings through the Coaching Boys into Men curriculum

 

The Male Involvement Initiative (MII) focuses on the intimate partner relationship behaviors of young men to increase their knowledge of intimate partner violence, gender equity, and bystander intervention. An RFA was issued in 2023 seeking a grantee to expand the MII program into southcentral Pa. with anticipated implementation beginning in 2024. The new grantee will use the Coaching Boys into Men (CBIM) curriculum and tools to teach young male athletes skills to build respectful and nonviolent relationships with dating partners, and ultimately, prevent sexual assault and adolescent relationship abuse. Data suggests that coach-delivered dating violence prevention programs reduce violence perpetration and negative bystander behaviors condoning dating violence. Young male athletes engaged in the CBIM program learn about personal responsibility, modeling respect, and promoting equality among other important life lessons. Through implementation of CBIM it is anticipated that there will be a reduction in adolescent mortality and injury resulting from interpersonal violence. The Grantee will service a minimum of seven schools or organizations with two to three separate sports teams in each school or organization per year.

 

Priority: Support and effect change at the organizational level and system level by supporting and promoting policies, programs and actions that advance health equity, address the social, environmental, and economic determinants of health, and deconstruct institutionalized systems of oppression

 

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

 

Strategy: Increase the number of youth who are receiving sexual health services and education, including effective contraception methods 

 

Objective: Increase the percentage of clients who are provided a most effective or moderately effective contraceptive method by three percent each year

 

ESM: The percentage of adolescents aged 21 years of age or younger at risk of unintended pregnancy who are provided a most effective or moderately effective contraceptive method

 

ESM: The percentage of adolescents aged 21 years of age or younger at risk of unintended pregnancy who are provided a LARC method

 

The BFH will continue to partner with the four Title X family planning councils in the state to provide adolescents aged 21 years and younger with health education and counseling services during a reproductive health visit. The BFH recognizes that adolescents who face prejudice and discrimination because of their life experience or family circumstances may experience a disproportionate rate of teen pregnancy and sexually transmitted infections. By working with the Title X family planning councils per the Quality Family Planning Guidelines (Guidelines) issued jointly by the CDC and the Office of Population Affairs, the BFH will provide opportunities for adolescents to receive additional counseling on how to prevent a pregnancy and communicate with parents/guardians. Recognizing that work with adolescents is most effective when providers fully understand the impact of prejudice and discrimination on vulnerable adolescents, the BFH will continue to fund, through Title V, office visit and counseling codes to allow providers to spend additional time with adolescents during a reproductive health care visit to assess and address their needs and build on their assets. Counseling should be presented in a teen-friendly environment. The Guidelines also acknowledge, in many cases, a reproductive health visit is the only usual health care adolescents and women are receiving; therefore, it is critical that providers have additional time to spend with adolescents to make sure all their healthcare needs are being addressed.

 

The BFH will track the percentage of adolescents aged 21 years of age or younger at risk of unintended pregnancy who are provided a most effective or moderately effective contraceptive method, as well as the percentage of adolescents aged 21 years of age or younger at risk of unintended pregnancy who are provided a long-acting reversible contraception (LARC) method. These measures are in line with the Office of Population Affairs’ Title X performance measures and aim to increase access to contraception by encouraging providers to ask about clients’ pregnancy intentions and inform them of the wide range of contraceptive methods available.