Adolescent Health Domain

Application Year 2024

Priority Area 1: Reducing grief and trauma- related symptoms among children and adolescents.

Performance Measures:

• Continued: State Performance Measure (SPM) 3: Mental Health- Increase the percent of children and adolescents, ages 3-17 with mental health needs who received counseling.

Objective 1: Increase the percent of adolescents age 12 to 17 with mental health needs who received counseling from 59.1% to 65% by 2026.

Strategies:

• Provide training and consultation/crisis support on trauma and bereavement to key partner staff (i.e., teachers, administrators, social workers).
• Provide individual or group therapy to District residents, ages 6-21, who have been exposed to trauma and/or traumatic loss.
• Engage in service coordination with the DC Department of Behavioral Health and other clinical service providers in partner schools and community organizations.
• Refer participants to appropriate mental health and other community services as needed and follow up with parents/legal guardians to verify completion.
• Provide mental health screenings to adolescents in the District
• Provide accessible mental health programs in school-based health centers and community-based organizations.
• Provide training for behavioral health professionals.

Activities:

In FY24, the Wendt Center for Loss & Healing will continue the Resilient Scholars Project. This community-based mental health program creates pathways to healing and health for low-income, minority children and adolescents from underserved neighborhoods of the District who are impacted by trauma and grief. The project partners with schools and other child-serving organizations in the lowest-income Wards of DC to provide intensive, evidence-based trauma and grief therapy to students affected by violence, racism, abuse, deaths of loved ones, poverty, and other Adverse Childhood Experiences (ACEs). The project also provides specialized trauma and grief training to build the capacity of District public and public charter school systems to effectively support traumatized and grieving students.  

The priority area for this program is Mental Health, including Grief and Trauma-Informed Care. This project will focus on increasing access to effective mental health care through the provision of high-quality, evidence-based mental health services in school- and community-based or virtual settings to low-income children (ages 6-21) exposed to trauma and grief and through specialized training services informed by evidence-based practices that expand the capacity of the school workforce to effectively support trauma- and grief-impacted children. The Wendt Center anticipates partnering with school and community-based organizations in the District. 

In FY24, the Wendt Center for Loss & Healing will continue to focus on the following: 

• Increase access to effective mental health care by providing high-quality, evidence-based mental health services in community-based or virtual settings to low-income children (ages 6-21) exposed to trauma and grief. 
• Increase access to effective mental health care by providing specialized training services informed by evidence-based practices that expand the capacity of members of the school workforce to support trauma effectively- and grief-impacted children. 

In FY24, as part of the Pediatric Mental Health Care Access Grant (PMHCA), DC Health will continue to partner with the District of Columbia Department of Behavioral Health (DC DBH) to expand services offered within the DC Mental Health Access in Pediatrics (DC MAP) program, including the provision of pediatric mental health care telehealth access, continuous quality improvement, and extensive collaboration with regional and national partners. In FY24, a Memorandum of Understanding (MOU) will be signed to continue the partnership between DC Health and DC DBH. Paving the Way will also continue to serve as a subcontractor of DBH to implement DC MAP and the strategic planning of expanding services.  

In FY24, the PMHCA telehealth expansion will continue to address the following priority areas: the timely detection, assessment, treatment, and referral for behavioral health conditions; and the integration with School-Based Health Centers (SBHCs) and providers. The program's first goal is to implement and expand the regular use of DC MAP telehealth mental health services by enrolled Pediatric Primary Care Providers (PPCP). This ongoing goal will encourage PPCPs to consistently use DC MAP's services, including teleconsultation, training, technical assistance, and care coordination. The second goal is establishing a referral system and protocol to link patients to SBHC mental health support via telehealth. By the start of FY24, DC MAP should be fully integrated with all School-Based Health Centers, including the effective referral system between DC MAP and each SBHC when referring patients for mental health resources. This integration will continue to reduce grief and trauma-related symptoms among children and adolescents by improving access to and utilization of behavioral health services.   

The key activities for FY24 are as follows:  

• PPCPs will be contacted about their use and experience with telehealth services, including implementation challenges. The challenges will also be identified and addressed for those PPCPs using DC MAP services who are not formally enrolled.  
• There will be ongoing surveying (or phone calls if needed) to review the experiences of PPCP sites. The utilization and satisfaction with DC MAP telehealth, obstacles to use, and potential expansions (e.g., screening training, etc.) will be assessed. Modifications to enhance telehealth for their MH service provision will occur so that input from all providers/practices is collected. This evaluation will also include items to elicit and identify unmet needs, modifications needed to engage different patient populations, and cultural attunement to optimize mental health delivery for all PPCP practice patients. 
• There will be continued technical assistance in telehealth and mental health delivery. The partnership with Concert Health to provide professional development and individualized training will continue with the inclusion of cultural competency within the training curriculum.  
• DC MAP will also begin exploring the regional expansion of its services by partnering with Maryland Behavioral Health Integration in Pediatric Primary Care (MDBHIPP). 

In FY24, through the Resources and Education for Adolescents in Community Health (REACH) program, Children’s National Medical Center will continue addressing the widening medical and psychosocial disparities due to COVID-19. Project-REACH will continue implementing a multipronged teen-friendly program facilitated through the primary care medical home. The priority focus area is Mental Health, Including Grief and Trauma-Informed Care. Children’s National anticipates partnering with community-based organizations.  

In FY24, through Project REACH, Children’s National Medical Center will continue to focus on the following:    

• Service patients ages 13 – 21 through the mobile medical program (and when indicated CHC-THEARC) who reside in the District of Columbia. 
• Implement evidence-based/evidence-informed virtual group education for adolescents (13 – 19 years) annually to include the following: (a) 15-week longitudinal educational series; (b) weekly reproductive health education sessions; (c) bimonthly mental health education sessions. 
• Facilitate continued access to adolescent-friendly services within the primary care medical home for non-parenting and parenting adolescents ages 13 – 19 years annually by providing care coordination and closed-loop referral processes. 

Priority Area 2: Enhancing positive youth development for adolescents to decrease high-risk behaviors.

Performance Measures:

• Continued: State Performance Measure (SPM) 4: Teen Pregnancy Prevention – Decrease the percentage of live births to teenagers ages 15 to 19. 
• Revised: State Performance Measure (SPM) 7: Positive Youth Development - Retain 80% of youth engaged in curriculum-based learning within youth-serving programs.
  • Rationale: To enhance the data collection of the performance measure.

Objective 2: Reduce births to teens ages 15 to 19 from 15.6% to 10.4% by 2026.

Objective 3:  Retain at least 85% of youths (aged 14-21) engaged in tailored adolescent health programming, including the Youth Advisory Council and positive youth development (PYD) curriculum.

Strategies:

• Provide accessible pregnancy prevention programs within schools.
• Provide the youth with opportunities to become leaders and advocates within their community.
• Increase participation in YAC across all DC public, private, and charter schools.
• Promote peer health education and survey implementation within a youth-focused curriculum.
• Facilitate in-person engagement within the partner schools to promote youth-serving programs, increase participation, and maintain retention.
• Provide oversight for DC Health’s Teen Pregnancy Prevention (TPP) Program to increase enhanced knowledge regarding access to and increasing the use of contraception methods, including long-acting reversible contraceptives (LARCs) among adolescents.
• Implement One Key Question (OKQ) and develop reproductive health plans for students who visit in SBHCs or participate in the TPP program.
•  Increase the availability of adolescent-friendly health services.
• Create sustainable community-clinical linkages for adolescent health services.

Activities:

In FY24, Crittenton Services of Greater Washington will continue to provide oversight for DC Health’s Teen Pregnancy Prevention Program. DC Health’s Teen Pregnancy Prevention (TPP) Program will continue expanding its focus to incorporate a more inclusive approach to Adolescent Health. The program will address two of the state’s top priority needs: Mental Health, including Grief and Trauma-Informed Care and Positive Youth Development. Program participants will continue to receive enhanced knowledge regarding existing contraception methods, how to access them, and how to appropriately use them. The TPP grantee will also expand the implementation of One Key Question® at the grantee sites. Crittenton Services of Greater Washington anticipates partnering with school and community-based organizations. 

In FY24, Crittenton Services of Greater Washington will continue to focus on the following:   

• Teen Pregnancy Prevention Program participants will have enhanced knowledge regarding existing contraception methods and how to access them and will increase their use. 
• SNEAKERS and PEARLS participants will have positive attitudes toward healthy relationships, have post-secondary educational plans, and avoid pregnancy. 
• SNEAKERS and PEARLS participants will develop essential life and leadership skills. 
• Teen Pregnancy Prevention Program participants will develop a reproductive life plan based on their awareness and/or intent to become pregnant. 
• Crittenton will continuously learn from and improve program curricula and delivery. 
• SNEAKERS and PEARLS participants who receive mental health and other services will report improvements to Crittenton staff. 

In FY24, the Youth Advisory Council (YAC) will continue to implement activities in alignment with DC Health’s mission, the YAC Framework, and the tenants of Positive Youth Development (Relationships and Inclusion, Education, Health and Wellness, Leadership and Advocacy, and Employment and Entrepreneurship). The YAC will continue to recruit and engage youth 14-21 years of age that reside in the District of Columbia and attend DC Public, Public Charter, Private and Parochial high schools and target this population with health education and outreach activities. This work will continue contributing to Title V’s state performance measure 5.  

In FY24, DC Health will continue to partner with The Young Women’s Project as a grantee to implement the YAC program and pursue activities outlined in the FY23 grantee work plan to increase the community reach and scale up of the work.  

In FY24, the YAC will maintain the following goals: 

• Recruit, engage, and retain 30 YAC members aged 14-21 from all eight Wards, who are racially and ethnically diverse, identify with all gender types, and bring diverse life experiences to the cohort. 
• Build the work readiness and performance of the YAC members so they can perform required duties and be ready to successfully enter the workforce.   
• Improve YAC members’ capacity to solve problems in their own lives; communicate assertively; set and achieve goals; resolve conflicts; build cooperative, supportive relationships; and make healthy decisions. 
• Improve YAC members’ sexual health knowledge and healthy sexual behaviors, including postponing pregnancy, using all forms of contraception correctly, using barrier methods to prevent STIs, accessing sexual health clinic services, and utilizing risk-analysis techniques in sexual decision-making. 
• Improve YAC members’ mental health-wellness knowledge, skills, and attitudes so that they can understand and navigate toxic stress, anxiety, and trauma, build resilience through emotional, physical, and social health, build positive coping skills, avoid, and understand substance abuse, and get connected to adult providers. 
• Train YAC members and have them work to improve peer health outcomes through individual and group projects that may include condom distribution and classroom presentations for agency and council level. 
• Increase YAC member leadership and advocacy skills through engagement with DC Health initiatives and awareness activities (e.g., condom distribution in schools, school-based STI testing in schools, immunization, COVID-19, access to school-based clinics and health services, health literacy, etc.). 
• Leverage social media accounts to improve peer health knowledge and awareness. 

In FY24, YAC will continue to sustain current partnerships with other District agencies and community-based organizations to support Adolescent Health programs within DC Health and youth programs and services in the District of Columbia. The YAC will also provide support in providing guidance on system-level strategies that will support adolescent health services and initiatives in the District. 

In FY24, the Healthy Babies’ Life Empowerment Program will continue to equip vulnerable, low-income District adolescents, ages 12-17, with evidence-based health education and life skills training to help them build stable lives. The priority area for this program is Positive Youth Development. The annual estimated reach is 150 low-income adolescents in the District in Wards 5, 7, and 8. Healthy Babies’ Life Empowerment Program anticipates partnering with school and community-based organizations. 

In FY24, Healthy Babies’ Life Empowerment Program will continue to focus on the following:  

• Utilizing the Sisters Informing Healing Leading Empowering (SIHLE), Making Proud Choices, and Real Essentials as evidence-based curricula to reduce teen pregnancy/STIs among District adolescents (ages 12-18). 
• Increase high school graduation / higher education attainment with retained program participants within six months post-program completion. 

In FY24, the Men Can Stop Rape (MCSR) will continue the implementation of Women Inspiring Strength and Empowerment (WISE) and Men of Strength (MOST) Clubs in support of the Title V Program priority area for Positive Youth Development. The Clubs utilize effective strategies for achieving the DC Department of Health’s goal to increase the percentage of adolescents aged 12-17 that engage in tailored programming on health and life skills topics. In addition, MCSR anticipates partnering with school and community-based organizations.  

In FY24, through the WISE and MOST clubs, MCSR will continue to focus on the following: 

• Implement WISE and MOST Club programming that engages adolescents ages 12-17 at 14 school locations in weekly programming about health, life, and career skills topics. 
• Engage WISE + MOST Club members in developing and implementing Community Strength Projects that demonstrate their increased understanding of health, life, and career skills topics and share this learning with the broader community. 
• Train professionals to implement WISE and MOST Club programming; become trainers in their communities on the role of engaging men and boys in gender-based violence prevention; and develop bystander intervention and consent skills among youth-serving professionals and key stakeholders. 
• Deepen the effectiveness and sustainability of programming that produces statistically significant changes in attitudes, behaviors, and relevant outcomes for adolescent health based on key indicators. 

Priority Area 3: Improving access to healthcare among adolescents.

Performance Measures:

• Continued: NPM11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home. 
• Continued: ESM11.1: Number of children and adolescents with and without special health care needs referred to a medical home.
• Continued: NPM12: Percent of adolescents with and without special health care needs, ages 12 through 17, who received services to prepare for the transition to adult health care.

Objective 4: Increase the proportion of adolescents 0 to 17 who have a medical home from 46.8% to 47.9% by 2026.

Objective 5: Increase the percentage of adolescents ages 12 to 17 who use transition planning services from 19.4% to 25% by 2026.

Strategies:

• Encourage and empower students to utilize school-based health centers as their medical home.
• Empower and encourage adolescents to utilize school-based health centers as their gateway and guide into adult care.
• Introduce early connections to a medical home through care coordination and collaboration (e.g., home visiting, CBOs
• Provide practice-based navigation services to families of children in accessing and coordinating medical care and community resources.
• Work with SBHCs to implement adolescent-friendly approaches, including confidential services;, a safe, non-judgmental clinic environment; and the availability of services that address adolescents’ most prevalent needs (sexual and mental health services) in the school.
• Assist students with finding an adult therapist and checking eligibility to enroll in Medicaid (transition).
• Collaborate with universities to assist with connecting students to adult medical homes. Train pediatric/adult providers around transition.
• Work with school health services (school nurses and SBHCs) to provide transition planning to seniors.
• Build communications/media to promote transition.

Activities:

In FY24, Title V will continue supporting DC Health staff overseeing the locally funded School-Based Health Center Program (SBHC). DC Health will continue to manage seven (7) SBHCs operated by four DC Health grantees – Children’s National Hospital, MedStar Health Research Institute, Mary’s Center, and Unity Health Care, Inc. –in seven DC Public high schools. SBHCs will be open year-round and promote an adolescent-friendly approach due to evidence supporting the need for care to be accessible, equitable, acceptable, appropriate, comprehensive, effective, and efficient. All providers will continue to offer the following services: primary care, acute care, reproductive health services, oral health services, behavioral health services, and linkages and referrals, including for transition planning. Students will also continue to be able to elect an SBHC site as their medical home. 

In FY24, DC Health will continue to evaluate the needs of the students and the services provided to ensure that the SBHCs provide a variety of high-quality health services to enrolled students. This includes but is not limited to improving access to behavioral health, dental and reproductive health services. Students with and without special healthcare needs who are enrolled in SBHCs will continue to have an opportunity to elect the SBHC as their medical home.  

During FY24, the SBHCs plan to strengthen their behavioral services through behavioral health providers and the partnership with the PMHCA grant to ensure that students receive adequate and timely behavioral health services. The SBHCs will expand access to the PMHCA grant to students at all seven sites. SBHCs plan to address gaps in dental services, especially for schools who do not have dental offices in the SBHC. The SBHCs will continue to provide behavioral health services by having providers (therapists, psychiatrists, social workers, and case workers) in the SBHCs. Additionally, students will be able to continue to receive referrals to community health providers through DC MAP and the PMHCA grant.  

The SBHCs will also improve the dental services offered to students. Each of the primary care providers offer oral health assessments during well-child visits. Sites with a full-service dental Operatory refer students to the dental suites within the SBHCs, and sites without full-service dental operatory refer students to community-based dental offices (within and outside of their organizational networks). Additional sites were able to open dental suites during FY23, those sites and sites that had previously established dental suites will continue to provide dental care. DC Health also plans to partner schools without dental services with the School-Based Oral Health program. The School-Based Oral Health Program providers will deliver dental services to students at some schools without dental providers, especially schools in high-priority wards. 

Historically, the SBHCs have assisted with transitioning seniors from Pediatric to Adult care. The SBHCs will provide transition readiness assessments to students 18 and older. The assessments will determine what type of assistance each student will receive. The types of assistance have varied from providing referrals to adult PCPs and scheduling annual physical exams for students to provide literature and guidance on how to navigate healthcare as an adult. During FY24, the SBHCs plan to continue providing transitional care services to graduating seniors. Additionally, the SBHCs and DC Health will begin to evaluate this process to measure the impact and provide guidance for improving the health care transition education, as needed.

In FY24, the telehealth program for the School Health Services Program (SHSP) will be expanded to include all schools currently enrolled in the SHSP and expand to schools added later. The school health services telehealth program is not meant to replace the student's medical home but meant to be an added resource in support of care coordination for that student. This program will greatly increase consistent access to medical care while simultaneously limiting a student’s time away from class and parental time away from work. The student can be seen by a licensed medical provider who will be able to assess the student's current medical needs and provide treatment plans/medication as deemed necessary.

In FY24, a data-sharing agreement between DC Health, the Department of Health Care Finance (DHCF), and D.C.  Public Schools (DCPS) will be utilized to assist in identifying students who are Medicaid beneficiaries who have/ have not had a well-child examination. A quality improvement and outreach plan in coordination with DHCF will be implemented to identify coordinated outreach to DCPS students who have yet to receive a well-child examination to ensure all students are properly navigated to a medical home. This data-sharing agreement will put a systematic data-sharing process in place, fill gaps in current DC Health data on well-child visits based on DCHF data and illustrate documented outreach to families from MCOs and school health program.