Wisconsin adolescents lack strong, positive, and consistent sources of social connection and support, impacting both their psychological and physical health. The negative health impacts of this lack of sufficient support especially affect those with minoritized identities including young people who are LGBTQ+, Black, Indigenous, and/or People of Color (BIPOC), or youth with special health care needs. The Covid-19 pandemic furthered these challenges for young people in Wisconsin and nationwide. Populations who experienced more inequity before the pandemic had greater risks during the Covid-19 pandemic related to mental health, suicide, substance use, abuse, and racism. According to the Center for Disease Control and Prevention’s Adolescent Behaviors and Experiences Survey, more than 1 in 3 high school students experienced poor mental health during the pandemic and nearly half of students felt persistently sad or hopeless.

Suicide remains a high-profile public health issue in Wisconsin. The release in late 2020 of the report, Suicide in Wisconsin: Impact and Response (a collaboration between the Title V Program, the Core Injury Prevention team, and multiple other state programs and partners) provided extensive analyses on burden of suicide across the life span and among youth as well as an extensive, multi-strategy and multi-sector statewide suicide prevention plan that will inform Title V and partners’ adolescent well-being efforts through 2023.

Wisconsin’s Title V Program addresses these needs through work to address National Performance Measure 07.2 Rate of hospitalization for non-fatal injury per 100,000 adolescents, ages 10 through 19 and State Performance Measure 05 Percent of adolescents reporting feeling so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities in the last 12 months. Additionally, findings from the 2020 MCH Needs Assessment led to a long-term plan to shift the Title V Program’s adolescent injury prevention work to a more upstream approach, grounded in the public health shared risk and protective factor framework. SPM 05 addresses the 2020 Priority Need to Foster Positive Mental Health and Associated Factors.

Public health can improve outcomes and reduce harm across multiple high-risk behaviors among adolescents that drive rates of injury-associated hospitalization among this age group, including bullying, suicide and self-harm, lack of social connectedness or belonging, substance misuse, and interpersonal violence or sexual assault. The Title V Program’s public health approach is directed to disrupting negative behavior patterns and fostering protective factors like peer and adult support. Evidence strongly supports the direction of limited public health resources and capacity building toward both promoting protective factors and reducing risk factors to effectively reduce adolescent injury. For example, an intervention that promotes an adolescent’s sense of connectedness or belonging can increase a protective factor and reduce that adolescent’s risk of engaging in behaviors such as suicide and self-harm, bullying, or substance misuse. Similarly, interventions that reduce rates of untreated depression, post-traumatic stress disorder and anxiety among adolescents are also focused on reduction of risk factors associated with adolescent injury, thus potentially reducing morbidity and mortality rates associated with these risk factors.

With that framework in mind, Wisconsin plans to be in close collaboration with partners throughout 2023, to promote strategies that support the enhancement of protective factors, and the reduction of risk factors associated with adolescent injury. The Wisconsin Violent Death Reporting System will continue to inform Title V Program prevention planning and guidance for partners, with analyses and reports of adolescent suicide death investigation, as well as other types of violent death among youth and adults. A robust Child Death Review structure will also be supported across the state in collaboration with local and tribal health agencies. Local and tribal health agencies in Wisconsin have built a strong foundation for adolescent well-being work through partnerships with local school districts and other partners. The significant mental health effects of the COVID-19 pandemic have amplified local interest in adolescent well-being work and highlighted the need for expanded capacity and broader collaboration across and within agencies.

National Performance Measure 07.2: Rate of hospitalization for non-fatal injury per 100,000 adolescents, ages 10 through 19

Work with local and tribal health agencies to support skills-based, risk-recognition suicide prevention trainings in multiple settings.

Local and tribal health agencies receiving Title V funds will continue to have the option of addressing suicide risk reduction and mental health promotion activities in 2023 in collaboration with local school districts, public safety and emergency medical systems, hospital systems, community-based coalitions, and other local partners. Specifically, local public health agencies will be supported to pursue coordinating and/or facilitating skills-based, gatekeeper, risk behavior recognition, and other evidence-based suicide prevention and mental health promotion trainings with local community coalitions and other partners and collaborating with local schools on the implementation of evidence-based suicide prevention programs or trainings directed to youth. Local and state-level results from the Youth Risk Behavior Survey will continue to inform program and training development and evaluation.

Support for this strategy will be provided by a content-expert technical assistance provider identified through a competitive process following state procurement standards. The technical assistance provider will lead quarterly learning community calls with local and tribal health departments and partners to share best practices, troubleshoot any potential challenges and identify alignment for collective impact.

The target population for this strategy is young people in communities who are identified as struggling with mental health challenges and/or suicidal ideation. Progress for this strategy will be measured via quarterly reports from local public health agencies via REDCap. Reporting will identify numbers of individuals trained who obtain skills needed to recognize suicide warning signs, ask about suicide, and persuade people to accept professional help.

The Title V Program also continues to address NPM 07.2 through much of the work outlined under SPM 05.

State Performance Measure 05: Percent of adolescents reporting feeling so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities in the last 12 months

Support local and tribal health agencies to share resources on anti-bullying policies and best practices with their local school districts, incorporating an equity lens.

This strategy will involve building local and tribal health agency capacity and readiness to provide consultation to school districts on promoting student mental and social well-being and the compilation of existing resources, including equity tools.

Support for this strategy will be provided by a content-expert technical assistance provider identified through a competitive funding process. The technical assistance provider will lead quarterly learning community calls with local and tribal health departments and partners to share best practices, troubleshoot any potential challenges and identify alignment for collective impact. Additionally, Title V and the technical assistance provider will promote the extensive resources developed by the Wisconsin Department of Public Instruction to support the implementation of school-based anti-bullying and protective environment policies and interventions that are utilized by local school districts around the state.

Title V Program will work closely with the Wisconsin Department of Public Instruction, the technical assistance provider, and local partners to disseminate these resources and provide technical assistance for creating public health approaches to bullying prevention. The Title V Program will specifically build capacity among local partners for the development of policies or programs that aim to establish inclusive, safe spaces for BIPOC, LGBTQ+, and youth with special health care needs, as well as the degree of social connection or sense of belonging among students.

This collaboration will focus on expanding attention and developing policies to shift social norms against the acceptance of bullying. LGBTQ+ youth, youth with special health care needs, and youth of color face a disproportionate impact of bullying and violence and are a priority population for this strategy, though anti-bullying policies benefit all school age youth. Protective environments and anti-bullying policies are associated with reduced levels of bullying and self-harm, hopelessness, depression, and other negative mental health outcomes. Schools that have these policies are considered safe spaces for students and increase protective factors for students such as having a trusted adult, sense of belonging, and a sense of connectedness to the school environment. Implementation of these policies also decreases risk factors for adolescent injury.

Progress for this strategy will be measured via quarterly reports from local agencies via REDCap. Reporting will identify numbers of area school districts partnering to implement these policies and create supportive environments for young people.

Support mental health of underrepresented populations through tools such as support groups or warm lines.

Support for this strategy will be provided by a content-expert partner identified through a competitive process in line with state procurement standards. This strategy will emphasize supporting peer support programs and hot/warm lines for underrepresented youth, such as LGBTQ+ individuals, who are more likely than their straight cis peers to experience suicidal ideation. Programs will not diagnose or prescribe treatment, but rather listen, validate, and help youth set and reach their own goals and provide help with things like coming out, finding gender affirming care, relationship issues, and more. The selected partner will monitor progress for this strategy utilizing a robust evaluation plan developed based on the specific intended outcomes of their programs, including data on individuals served.

Empower youth and equip providers to provide appropriate, responsive, and high-quality health care.

Support for this strategy will be provided by a content-expert partner identified through a competitive funding process. This strategy will emphasize youth-driven programs that empower young people to take charge of their own health care as well as educating medical providers about best practices for delivering responsive, inclusive health care services to adolescents. Target populations for this strategy include young people and their caregivers as well as health care providers who receive training.

The selected partner will monitor progress for this strategy utilizing a robust evaluation plan developed to include numbers of participating youth, caregivers, and providers, as well as the percent of providers trained who implement a practice change after attending training. Additionally, the content-expert partner will engage and educate families about key components and recommendations for young people receiving an adolescent well-visit, and how to empower them to take an active role in their own healthcare.

Further, the content-expert partner will encourage youth leadership opportunities allowing young people to serve on a youth advisory board to adolescent health programs and provide guidance on building a system of adolescent health best practices throughout the state.

Collaborate with Department of Public Instruction to support the implementation and update of the Youth Risk Behavior Survey to support school-based mental health quality improvement efforts.

The Title V Program will continue to support implementation of the bi-annual Youth Risk Behavior Surveillance Survey administered by the Wisconsin Department of Public Instruction. This survey captures many data points that are key to informing suicide and self-harm prevention work, including questions about suicidality that can be broken down by demographic variables (such as race, sex, or sexual orientation). It is a valuable data source for local communities to learn about their youth, particularly for smaller communities where a youth suicide is a rare event and mortality data is not very useful to them. Title V supports the Department of Public Instruction as well as local and tribal health departments to work intentionally with local school districts to recruit and support their participation in the Youth Risk Behavior Survey. There have been challenges in reaching a representative sample in the state in prior years, which have been mitigated by Title V investments in this area. The data from the Youth Risk Behavior Survey in turn both inform and motivate school districts’ efforts to provide supportive environments for enrolled youth.

Participate in the statewide Office of Children’s Mental Health Collective Impact Council and the Children’s Committee of the Governor’s Council on Mental Health.

Title V Program staff will continue to collaborate with the Wisconsin Office of Children’s Mental Health in 2023, with five collective impact partner teams contributing to enhancement of protective factors and reduction of risk factors in promotion and protection of mental health and wellbeing for all children. These teams reflect the voice of youth and families with lived experience and work to support timely access to high quality, trauma-informed, and culturally appropriate mental health services that promote children's social and emotional development. Additionally, actively participating in these teams promotes inter-agency collaboration and identifies areas for collective impact in supporting the well-being of Wisconsin’s young people.