Action Plan: Adolescent:

Vermont continues to support a Vermont youth advisory council, VT Raise Awareness for Youth Services (VT RAYS).  We will continue to look for opportunities to collaborate with VT RAYS to inform activities related to services or resources for the adolescent and young adult population. Additionally, we plan to work with VCHIP, VT RAYS, and Vermont Afterschool to:

• Support youth lead activities including the development of resources or materials that address youth focused COVID response and recovery topics [i.e., COVID-19 vaccine promotion, improving utilization of adolescent health preventive services; informing school based guidance/policy]
• Create opportunities with youth and medical community, public health officials and other stakeholders to share and promote youth voice and experience on COVID response and recovery efforts
• Access and utilize data to inform new initiatives, based on youth identified areas of concern
• Provide opportunities for trainings to build skills around youth leadership and/or specific public health priority areas [i.e., youth social emotional wellness].

Health Department School Liaisons and Maternal and Child Health Coordinators promote Bright Futures 4th edition with school and primary care providers. Liaisons will continue to look for opportunities to promote the concept of annual preventive care for all school-aged students with an emphasis on the adolescent population as measured by our annual School Nurse Report. Additionally, Liaisons will continue to promote strategies with school nurses for increasing awareness and promoting annual well care visits (in partnership with VCHIP).

The Health Department will be working closely with schools this fall as they begin to reopen while Vermont continues to deal with the COVID-19 pandemic response and recovery. There will be a strong emphasis on the importance of schools and provider offices strengthening relationships and communication to ensure the best outcomes for students and families. We hope that through these emphasized or renewed partnerships, schools and provider offices will develop, maintain, or improve the way they communicate to ensure students and families are accessing preventive care, addressing chronic illness care, and coordinating on acute needs (like when students present with COVID-19 symptoms, or to promote COVID-19 vaccinations). We are also hoping providers will be able to support local level health related information needs for their communities (e.g. be available to present information or answer questions locally) in alignment with public health messaging. As part of school reopening processes in the fall and ongoing pandemic response and recovery efforts, the Health Department will continue to coordinate and collaborate with the Agency of education for the 21-22 school year over the summer 2021.

Over the past two years, the VT Dept of Health has engaged in a robust body or work with the Agency of Education and a variety of community partners. As a result of some work with our state legislature, the Agency of Education (AOE) and the Health Department have been working collaboratively for the last two years to improve sexual health education in Vermont, especially in Vermont schools, and to frame sexual health education within the broader context of comprehensive health and wellness education for sustainability.

During the most recent legislative session a condom availability in schools’ law was passed and goes into effect on July 1, 2021. The law requires that all secondary schools in the state (grades 7-12) must make condoms available. The Health Dept and AOE are working in conjunction with several community partners to create supportive materials and guidance for schools to help support this implementation.

Before COVID, the Health Department and Agency of Education staff conducted stakeholder meetings and developed state guidance in response to the legislature’s request to focus on improving sex ed in schools. This group meets regularly to review community and PreK-12 sexual health education activities across the state. This workgroup collaborated to develop the following publications:

Implementing Comprehensive Health Education: Laws and Regulation (1/30/20) Agency of Education Memo, Secretary Daniel French

Comprehensive Sexual Health Education and Condom Availability Programs (1/30/20) Joint Memo, Agency of Education, Secretary Daniel French and Dr. Mark Levine, Vermont Department of Health

Sexual Health Education Resource Guide 1/30/20
Joint guidance developed by the Agency of Education and the Vermont Department of Health

The Sexual Health Education Advisory Group includes representation from several organizations that directly provide, or support organizations that provide, sexual health education to their constituents. Members represent AOE, the Health Department, Planned Parenthood of Northern New England (PPNNE), Outright VT, VT Cares, VT Network, PreK – 12 health educators, and a pediatrician who specializes in Adolescent Medicine and sexual and reproductive health. The group is dedicated to identifying priority topics in sexual health education and delivering professional learning and resources that support high-quality sexual health education. Many of these partners have supported PREP programs in a variety of ways over the years via training and TA.

In 2021-2022 MCH’s Adolescent Health Unit will continue to inform the work outlined above. This work will be further supported and enhanced by VT’s participation in the Leadership Exchange for Adolescent Health Promotion (LEAHP). This is a learning collaborative aimed at building state education and health policymakers’ capacity to improve sexual health education, sexual health services, and safe and supportive environments in schools. The Vermont LEAHP team will include representation from the Health Department, the Agency of Education, and community partner organizations, such as Planned Parenthood of Northern New England and Outright VT. School- based health educators will also be invited to serve on the team. Vermont will be part of the third LEAHP cohort and will participate in training and TA opportunities for a 2-year period which began in the spring of 2021.

For a fifth year we are contracting with a pediatrician and adolescent medicine specialist, Dr. Erica Gibson, who has been providing training and TA to our PREP program staff. This year, Dr. Gibson will also continue to provide TA to VT Afterschool Inc. In the plan year efforts will also be expanded to help support the professional development of sexual health educators across the state. These include health educators in Vermont’s middle and high schools, school nurses, community based sexual health educators, and afterschool professionals. This will include offering professional development opportunities both in person (where possible) and remotely.

MCH will continue to have leadership engaged in various partner initiatives, including co-chairing the Youth Services Advisory Council (YSAC), which promotes shared responsibility across state and community stakeholders for achieving positive outcomes for youth and young adults in Vermont; and collaborating with the Agency of Education to conduct an assessment of the current landscape related to sexual health education, and following up on activities that were recommended to the state legislature in January of 2020 for improved standardization of sexual health education. The YSAC will be completing a data analysis and developing policy recommendations on the seven youth wellness outcomes this year.

MCH will continue to fund Vermont Afterschool’s work around preventing risky behavior and promoting strengths for youth. Vermont Afterschool will be entering its fourth year of funding from MCH, which continues to support the work of the Youth Voice Coordinator and the Youth and Community Health Coordinator, as well as many elements of the Vermont Youth Project and Youth Councils. VT Afterschool has become a recognized leader in our state for their collaborative work across many priority topics and with many partners, but especially for their commitment to youth voice and the establishment of youth councils. 

MCH Adolescent Health Program Manager will continue to participate in the Vermont 9to26 Coalition in the year ahead. The focus of this coalition is to ensure that all young people ages 9-26 are safe, healthy, supported, educated, and engaged. MCH staff are able to provide guidance on best practice approaches to out of school programming, performance measurement and stakeholder engagement.

We hope to explore leverage points with Vermont’s health reform system given that adolescent well care visits are an ACO measure. Health Department leadership sit on several ACO subcommittees. Vermont MCH has developed supporting materials on Clinical & Community Strategies to Improve Adolescent Well Care Rates that have been and will continue to be distributed widely to ACOs and Unified Community Collaboratives.

VDH School Liaisons and the Vermont Child Health Improvement Program (VCHIP) will provide ongoing TA to school nurses to facilitate connections between schools and medical homes. Work will be ongoing to maintain and strengthen partnerships between schools and medical providers locally.  These partnerships will address the planning for school response and recovery efforts during the current COVID-19 pandemic, be a local resource for schools for COVID-19 related questions by using the most current public health information, and address acute needs related to chronic health conditions care plans, promote COVID-19 vaccination for eligible youth, or illness that may reflect COVID-19 symptoms.

 MCH previously worked with VCHIP through the youth health improvement initiative on finishing an updated sports clearance form that highlights the importance of annual well care. This form had been reviewed by the Vermont chapter of the American Academy of Pediatrics and Vermont Academy of Family Physicians. It was shared with the Vermont Principals Association’s Sports Medicine Advisory Council. We planned to roll it out during the previous two school years, but there were some delays, and this activity was later put on hold due to the early closure of schools due to the COVID-19 pandemic. COVID-19 response also took priority during the previous school year. We plan to review the current iteration of this document to update it using this plain language lens to ensure a product that is easily understandable and continues to highlight the importance of an annual well care visit (especially for the adolescent population). We hope to do this in partnership with VCHIP and the Primary Care Public Health Integration work group.

Vermont MCH will continue to participate on the Vermont Suicide Prevention Coalition and on the suicide data subcommittee. We have increased data capacity from the NVDRS (violent death analysis) and the ED-SNSRO (suicide surveillance in emergency departments) grants that is informing our programs. In partnership with the Vermont Child Health Improvement Program (VCHIP), MCH will collect and report on quality improvement data from pediatric practices on depression screening and will promote suicide screening in primary care using the nationally recognized Zero Suicide approach. MCH will build upon its partnership with DMH by ensuring that leadership from both departments meets bimonthly to support enhanced coordination and collaboration around shared priorities. We are exploring how QI projects can be used to support youth under stress from the significant disruptions of the COVID-19 pandemic. MCH holds a lead role in the VT Child Fatality Review Team and will assist with review of deaths by suicide and formation of relevant recommendations. MCH funds Umatter Youth and Young Adults, a leadership and training program that trains youth on personal skills, coping, and stress management as part of upstream suicide prevention.  While this work was somewhat interrupted due to COVID-19, there have also been important developments related to adapting materials for online learning and offering more options which increases the reach of this program.

MCH plans to identify and work with key community partners that serve Vermont’s New American population to identify outreach and engagement strategies to promote messaging around adolescent health issues, such as injury, suicide, well-visits, and other preventive health measures. More specifically as part of the state’s COVID-19 response, the MCH Adolescent Health Program Manager was assigned to serve as the Equity Technical Advisor based on her leadership as a member of the Health Department’s Health Equity Action Team (HEAT). This role in the Health Operations Center has been critical to identifying needs and gaps related to health equity, and planning activities to respond to and address barriers facing specific populations in our state. The primary role of this position has been to work with a Health Equity and Community Engagement Team to engage partners across the state in targeted educational outreach, prevention and outbreak response plans unique to each setting and population. This work has included, and will continue to focus on New American communities, BIPOC communities and other vulnerable populations.

MCH continues to partner with VCHIP’s, Youth Health Improvement Initiative and the Wisconsin-based, PATCH (Providers and Teens Communicating for Health) program to promote the use of, PATCH for Teens: Classroom Edition. This program provides school health educators, health-related professionals, youth workers, and other adults the materials and resources needed to teach young people about their rights and responsibilities in health care settings. Our hope is that this curriculum that can be delivered in a health class will help to empower youth to access their primary care provider and develop skills that will help them to access recommended preventive care and care as needed. Recruitment for this activity was delayed the last two school years. We reconnected with the program in Wisconsin and planned to recruit in the winter/spring of 2019/20. Due to the closure of schools in 2020, this was not accomplished. Additionally, COVID-19 pandemic response efforts continued to take priority over implementation of this program during the previous school year.  The PATCH program has confirmed we are still able to access the kits, so we plan to revisit recruitment in the fall/winter after reconnecting with the PATCH Program. We hope to identify schools willing to try this curriculum and report back on reactions. We also plan to share information about PATCH through other electronic communications with schools, and through the Health Department School Liaisons.

MCH will continue to promote healthy behaviors among youth through an empowerment model through promoting of UP for Learning’s Getting to ‘Y’ program. Getting to 'Y' is an opportunity for students to take a lead in bringing meaning to their own Youth Risk Behavior Survey data and taking steps to strengthen their school and community based on their findings by addressing risks and promoting strengths. MCH is also continuing to support, M3: Mindset, Metacognition and Motivation described elsewhere in the report. UP for Learning is planning to adjust program delivery strategies as needed relative to public and school health needs during the next school year. M3 has been continuously improved and adapted to have a deep and more sustained impact by consistently refining it to be more relevant, engaging, and responsive. For the coming year, the M3 concepts will move out of a siloed M3 program to be integrated into all of UP’s youth empowerment programs to fully align with the Whole School/Whole Community/Whole Child national initiative, which takes a holistic approach to the well-being of children and their community. All GTY and M3 resources and materials are adapted for remote, hybrid, or in-person educational settings. 

MCH plans to continue its work to engage providers and school partners regarding school-based health centers (SBHC). MCH will continue to identify its roll regarding providing infrastructure and convening support to school-based health centers. We will continue to build upon our assessment of SBHC across the state, examine opportunities to establish connections to primary care medical homes, and opportunities for common indicators and measures across centers. MCH has reached out to existing SBHCs to form what we’re calling, Vermont’s SBHC Peer Collaborative. We plan to build upon information gathered during collaborative calls to help direct the future of our MCH support related to this work. We will use these opportunities to highlight MCH Title V and EPSDT priorities and explore opportunities to encourage participants to consider objectives and measures that align with MCH priorities (such as adolescent well care). Additionally, we will continue to explore opportunities to engage the School Based Health Alliance, and continue to use this national resource to learn more about SBHCs and begin to network with national partners and build relationships for possible technical assistance and resource sharing. One of Vermont’s adolescent health leaders was invited to participate in the School Based Health Alliance State Leader’s monthly call, an opportunity to hear about issues happening nationally, and opportunities to learn from this leadership community and share resources. Thanks to steps taken over the last several months to implement telemedicine opportunities in primary care, we are interested in exploring what types of school linkages could be continued, made, or sustained to continue to increase access and connection to primary care in the school setting. MCH will be partnering with the Youth Health Improvement Initiative at VCHIP to develop an assessment tool for our existing SBHCs, identify common assessment measures of SBHC implementation and desired outcomes, consider training and development opportunities with SBHCs, and gather youth perspectives on SBHCs.  YHII will be conducting interviews of our SBHC peer collaborative members, developing a survey tool that includes both nationally validated assessment and performance indicators of SBHCs and locally derived process and outcome measures. They will then be sharing findings with MCH and other stakeholders.

MCH will continue to fund travel and work stipends for school nurse’s participating in Vermont’s School Nurse Advisory Committee. The primary role of the School Nurse Advisory Committee is to review and update the Standard of Practice: School Health Services Manual, maintain and update the new school nurse orientation, and to strengthen the school nurse workforce development. In the upcoming year, the State School Nurse Consultant and the School Nurse Advisory Committee plan to revise the format of the Stands of Practice: School Health Services Manual and create documents that support student, family, and school community physical and mental health and resilience during and after the COVID-19 pandemic.  The SSNC and the School Nurse Advisory Committee will also evaluate and revise the current new school nurse orientation content, and potentially create continued training and support opportunities for school nurses statewide.

Please note: Only those strategies that link with national and state performance measures are identified in the Action Plan Table for this section.