Priority:

Promote mental wellness and resilience through increased access to behavioral health and other support services.

 

State Performance Measures:

Percentage of 10th grade students who have an adult to talk to when they feel sad or hopeless.

Percentage of 10th grade students who report having used alcohol in the past 30 days.

 

Objective:

By September 30, 2025, increase the number of school-based health centers with licensed mental health services by 5 percent.

 

General Status on this Objective to Date:

Respondents to last year’s maternal and child health needs assessment noted that young people have difficulty finding providers (including behavioral health providers), and the health care system needs to be easier to navigate – including enhanced coordination, linkages, and referrals. Respondents also consistently identified concerns related to suicide and youth mental health, including the need for providers to screen for risk when seeing adolescent patients and clients. The MCH needs assessment highlights the need for systems-level improvements so that adolescents can access and experience user-centered medical and mental health care.

 

Increasing the number of places where individuals can access care, not just to family planning and sexual health services, but also behavioral and more general physical health, benefits all. In fact, there is strong evidence that access to a school-based health center and regular well-adolescent visits reduces absenteeism, dropout rates, chronic illness, substance use, sexually transmitted infection, and pregnancy rates; increases graduation rates; and improves management of diabetes, asthma, and mental illness. An increase in the number of clinics trained in providing mental health care will make such a system of care more available.

 

The Adolescent Health team will begin work in July 2021 with partners, including the Office of Superintendent of Public Instruction and Health Care Authority, to implement Substitute House Bill (SHB) 1225: Concerning School Based Health Centers. Accessing behavioral health services can be challenging for adolescents for many reasons, such as lack of transportation, social isolation, or complex life situations. Some students might find accessing health care more convenient at school or other settings in which they are more comfortable. SHB 1225 provides expanded options for students.

 

Strategy:

Improve the knowledge and ability of health care professionals to deliver comprehensive evidence-based/informed services, including integrated mental health and chemical dependency screening and interventions for adolescents and young adults.

 

In addition to our ongoing and upcoming work with SBHCs mentioned above, we have identified additional strategies to strengthen our SBHC providers’ ability to care for students with behavioral health needs and integrate behavioral health services into SBHCs throughout the state. Some of this work will include:

 

• Continue our partnership with the Health Care Authority to help SBHCs bill effectively for behavioral services rendered. School-based health centers face numerous barriers to receiving adequate reimbursement for services provided. Because no student is denied services because of inability to pay, this has a detrimental effect on the funding and sustainability of these centers.

 

• Deliver technical assistance to health care providers around behavioral health services to ensure they are adolescent and young adult (AYA) friendly.

 

• Seek additional funds to complement SHB 1225 funds to ensure behavioral health services are also accessible through current and new school-based health centers, and that there is capacity at DOH to monitor and manage that access. Schools and SBHCs are well-positioned to identify behavioral health needs of students and connect them with needed resources, however, they lack adequate resources to do this. We are seeking additional funding so DOH can provide key resources and tools for schools and community providers/SBHCs to identify and address gaps in school and SBHC staff knowledge about addressing the behavioral health needs of adolescent students.

 

Strategy:

Take action to reduce stigma surrounding adolescents’ and young adults’ behavioral health conditions, treatment and related challenges.

 

As the need for mental health care among AYA rises – especially over the course of the COVID-19 pandemic – mental illness stigma can impede access to needed care and can make it less likely youth will seek services. According to the U.S. Department of Health and Human Services, National Institute of Mental Health, 32 percent of 13- to 18-year-olds experience anxiety disorders. Depression occurs in approximately 13 percent of 12- to 17-year-olds; attention deficit-hyperactivity disorder (ADHD) occurs in approximately 9 percent of 13- to 18-year-olds.

 

However, stigma and misperceptions about youth with mental health diagnoses are an ongoing problem, and have a profound impact on whether youth will get the care they need. This includes internalized stigma, or “self-stigma,” among individual youth; and external stigma and misperceptions of diagnoses among family, friends, and providers. Research has shown that youth often experience feelings of shame and secrecy related to a mental health diagnosis and treatment, and that they fear being “ostracized” from peer groups and not fitting in because of mental health diagnosis. This comes at a time when “fitting in” is an essential developmental need among adolescents and can have a strong influence on youth willingness to participate in any kind of activity, including mental health care and treatment. This is compounded by the fact that people with mental health conditions report experiencing discrimination and prejudice, which is one of the primary reasons people do not seek the care they need when they need it.

 

Research has shown that social media campaigns focused on stigma reduction around mental health and treatment have been an effective tool to increase the use of mental health services among adults. We plan to apply this strategy and implement social medial campaigns – like the Substance Abuse and Mental Health Services Administration’s (SAMHSA) “What a Difference a Friend Makes” – to reduce stigma related to behavioral health conditions among youth to increase access to behavioral health care. Over the next project period, we will work with partners to plan a communication/social media campaign geared toward youth, their family, and youth-serving providers, which addresses key concepts related to “self-stigma” among youth, and public and institutionalized stigma. The communications campaign will focus on disseminating evidence-based information related to stigma reduction among youth-serving providers, agencies and community organizations.  We hope to couple this with the coordination of behavioral health stigma-reduction trainings for youth-serving providers throughout the state.

 

Strategy:

Implement trauma-informed services specific to adolescents and young adults into community services, health care systems, and the public sector.

 

The goal of DOH and key partners like HCA and DCYF is to move Washington toward a statewide culture of trauma-informed approaches. According to a study by Darnell, Flaster, Hendricks, Kerbrat, & Comtois (2019), among adolescents between the ages of 13 and 17, 62 percent have been exposed to one or more traumatic events throughout their lifetimes. These numbers make it critical for those serving AYA to incorporate trauma-informed approaches in their programs, and to ensure behavioral health services are accessible. Understanding the impact of trauma on youth development, and how to engage youth to be resilient, is an essential part of care for adolescents and young adults.

 

To continue toward this goal, we will work with community organizations and other state agencies to promote, support, and facilitate education and training for health providers and youth-serving organizations around trauma-informed services for AYA. This will include:

 

• One or more media campaigns to promote existing and available resources like these trauma-informed approaches for adolescent and young adult behavioral health care, including in SBHCs.
• Work with internal experts and partners to facilitate access to provider and school staff trainings on trauma-informed approaches to adolescent health care, including among SBHC providers. Some examples include SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach and Cardea Services’ Promoting Adolescent Sexual Health.
• Given severe provider shortages, support DOH COVID-19 Behavioral Health Group pilot effort to increase the school and community-based workforce qualified to provide adolescent behavioral health screening, assessment, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) treatment.
• Work with partners within DOH and with other state agencies to promote policies and programs related to youth behavioral health care that include a trauma-informed approach.

 

The “roadmap” work being done by the Essentials for Childhood ACEs and Resilience Community of Practice, described in the Child Health Application Year Plan section, will inform our AYA work as well.

 

Strategy:

Support interventions to address suicide ideation among youth, especially among those marginalized by mainstream society.

 

Suicide is the second leading cause of death for Washington youth between the ages of 15 and 19. On average, in 2017, each week in Washington, nearly four youths killed themselves, and two youths ages 10 to 24 were hospitalized because of intentional self-injuries, which included suicide attempts. Responses to the 2018 Washington Healthy Youth Survey showed that 23 percent of 10th grade students considered attempting suicide in the past year. Ten percent of 10th grade students reported making a suicide attempt in the 12 months prior to the survey. In addition, preliminary data and anecdotal evidence suggests that COVID-19 related stressors are having a significant impact on rates of youth depression and suicide during 2020 and beyond.

 

Responses by eighth grade students on the 2018 Washington Healthy Youth Survey showed that 20 percent had considered killing themselves, and that 10 percent had attempted suicide in the past year.

 

To strengthen our work to address suicide risk among youth, we will partner with our Injury and Violence Prevention program to expand existing interventions that are proven effective and collaborate on new goals and strategies. This will include implementing strategies identified by the Washington State Children’s Behavioral Health Workgroup. Over the last year, the workgroup identified six strategies that agencies and partners can implement now to address the youth behavioral health crisis exacerbated by COVID-19. Recommendations include expanding the behavioral health workforce (strategy described above in the third bullet point), conducting population-level screening for students, training providers in trauma-focused interventions, and strengthening regional response teams.

 

One example of implementation of these recommendations is our work with partnering agencies to request additional legislative funding to support schools and community health providers/SBHCs to conduct population-level behavioral health screening for all students, and refer students to additional community supports when screenings indicate a need. Provided the legislation is put forward and passed, funding will cover access to screening and referral tools, technical assistance, and support at the state level; and cover additional training costs to enhance the workforce of school and community health provider/SBHC staff and increase their capacity to conduct screenings and referrals appropriately.

 

Strategy:

Promote standardized depression, anxiety, and substance use screening for adolescents and young adults.

 

The effectiveness of risk screening is dependent on ensuring confidentiality. Research shows that adolescents are more likely to share risk behaviors and answer screenings honestly if they believe their care is confidential. The Washington Youth Sexual Health Survey demonstrated that teens in Washington have significant concerns about their privacy and confidentiality when accessing services, and more work is needed in Washington to implement best practices using innovative interventions to incorporate these tools into clinical workflows. And although screening and counseling adolescents on risk behaviors is universally recommended by the Society for Adolescent Health and Medicine, American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, and American College of Preventive Medicine; it is not universally followed, and rates of use range from only 15 to 50 percent.

 

To work toward ensuring youth can participate in youth friendly and confidential screening for risk behaviors, we will promote the use of a youth-friendly standardized risk behavior screening tool among providers who serve youth and young adults. The Adolescent Health Initiative (AHI) at the University of Michigan has created toolkits and resources for providers and clinics that can be adapted to the local setting to encourage risk screening of adolescents. We will utilize internal communications resources – like social media, listservs, and adolescent-focused webpages – to disseminate information on this toolkit, and we will work with partners to spread awareness about the toolkit and how it is used through communications and webinars. We will also work specifically with SBHCs to promote use of the toolkit in SBHC settings.

 

This strategy also appears in our Child Health Application Year Plan – see that section for additional information about our activities.

 

Strategy:

Support efforts to address and mitigate individual and community effects of substance use among adolescents and young adults.

 

While the rates of tobacco use and exposure have significantly declined in our state, we are particularly concerned with the youth vaping epidemic because tobacco use is a risk factor for teen pregnancy. Additionally, the high smoking prevalence among pregnant women in our state presents serious health risks for both expectant mothers and their babies.

 

Over the next five years, the DOH Adolescent Health program will continue to collaborate with the Tobacco and Vapor Product Prevention and Control Program (TVPPCP) on the following efforts to help address these issues:

 

• Connecting with adolescent health providers, understanding that school-based health centers may better serve youth than the traditional framework of primary care providers or behavioral health providers.
• Partnering on prevention and cessation outreach to American Indian/Alaska Native tribes and communities.
• Promoting the Washington State Tobacco Quitline and tobacco cessation smartphone app, with emphasis on each program’s tailored pregnancy programs.
• Disseminating TVPPCP training and education opportunities to youth and young adult providers throughout the state.
• Providing letters of support to TVPPCP for activities that promote and support youth smoking cessation.

 

As mentioned above, we will also encourage the use of AYA-friendly screenings for risk behaviors, including substance use, during primary care visits.

 

Strategy:

Build on efforts to identify scope of impacts of substance use, including inequities among adolescents and young adults from priority populations.

 

Health disparities continue to be evident in rates of youth and young adult substance use. To better understand how youth are impacted by substance use, and the inequities that exist, we will assess existing data to identify gaps in services and underlying socioeconomic factors playing into substance use. We also will examine structural issues through a lens that acknowledges systemic racism, sexism, and homophobia, and their effects on health inequities.

 

In addition, we will form a cross-agency workgroup to align substance use reduction and prevention strategies and efforts among internal programs. This will help inform current and future substance use reduction and prevention programming, and policy recommendations. Potential partners include Injury and Violence Prevention; TVPPCP; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Immunizations; Heart Disease, Stroke, and Diabetes Prevention unit; and Healthy Eating and Active Living (HEAL).  

 

Priority:

Identify and reduce barriers to quality health care.

 

Objective:

By September 30, 2025, develop and provide technical assistance for school-based health centers and adolescent health providers so they report the ability to appropriately bill insurance for 50 percent of services delivered.

 

General Status on this Objective to Date:

As mentioned in the Adolescent Health Annual Report, we will continue to collaborate with the HCA to identify and address billing issues and cost sharing. Many SBHCs have an “in-person assister” to help with Medicaid enrollment for youth who are eligible but not yet enrolled. Additional training will expand this service, and training development is currently underway. This work will be prioritized with the hiring of the new school-based health center position created as a result of SHB 1225.

 

Strategy:

Conduct needs assessment to identify top barriers for adolescents and young adults in seeking health care services.

 

In 2019, the Washington Youth Sexual Health Survey findings highlight issues for AYA with access to and experience with health care visits. Seventy-five percent of respondents reported they have a health care provider that they have seen more than once, yet only 18 percent reported having had a sexual health wellness exam. Respondents also reported barriers associated with going to see a health care provider, such as the hours of the clinic don’t work with their schedule (37 percent), not understanding how insurance works (38 percent), feeling judged (39 percent), and being afraid that their parent or caregiver will find out (48 percent).

 

Over the next reporting period, we will work to update and redistribute the survey. We will continue our partnership with the Office of Superintendent of Public Instruction and the Northwest Portland Area Indian Health Board to coordinate a new Washington Youth Sexual Health (WYSH) innovation network to understand and improve youth access to and experience with sexual health services holistically, and to learn about what works, how, for whom, and why. Most of the efforts will be focused on interventions within the clinic setting, but the network will also include partners from all sectors who have bidirectional impact on youth sexual health care. We are currently in the process of developing the survey and hope to release it soon.

 

Our MCHBG epidemiologist completed a project, in collaboration with the Adolescent Health Program Manager, on well-adolescent visits. One of our goals was to identify major barriers to seeking care for AYA. We utilized the results of this project, along with earlier survey data on AYA well visits, to identify and address gaps in health care services. These results were used to inform many other projects in the Adolescent Health unit. Moving forward, we plan to conduct complementary qualitative data collection and analyses to learn more about individual experiences on AYA, and recommendations for improvement.

 

Strategy:

Through partnerships, understand and mitigate issues related to financial eligibility for health care and other support services for adolescents and young adults.

 

A number of adolescents eligible for Medicaid coverage are yet to be enrolled. We will continue to work with Health Care Authority / Washington Apple Health (Medicaid), to discuss strategies to ensure that adolescents have appropriate health insurance and better understand issues around billing for care. We will also work with the Family Planning program to ensure that clinics provide appropriate preventive services with no cost sharing.

 

Strategies:

Ensure all adolescents and young adults, regardless of race, ethnicity, sexual orientation, and gender identity, have a full range of education, access, and ability to utilize health services that meet their individual needs.

 

Support and enhance efforts to increase health literacy among adolescents and young adults.

 

We will continue to partner with tribal organizations to identify and help address specific needs of American Indian/Alaska Native youth. We will also work with community partners to evaluate the unique needs of other priority populations, including LGBTQ+ youth, Latinx youth, Asian American, Black or African American, and homeless youth. Youth can also inform this information gathering so we can be best informed of their individual needs in health services.

 

According to the Health Resources and Services Administration (HRSA), low health literacy can cause individuals difficulty in locating providers and services, sharing their medical history with providers, seeking preventive health care, managing chronic health conditions, and understanding directions on medicine. Evidence demonstrates that addressing health literacy at an early age can help develop one’s ability to understand health information and improve interactions with the health care system, leading to positive health outcomes later in life.

 

We will continue to promote health literacy among AYA by partnering with OSPI to promote the inclusion of health literacy education in school curriculum using strategies like those proposed in this Youth Health Literacy Toolkit, and with entities like HCA and managed care organizations, to make sure that health statements and documents are user-friendly and available in multiple languages to increase accessibility. Prior to promotion, steps in this process include learning how OSPI and the regional Educational Service Districts have assessed needs and identified gaps in this area of student learning. Since OSPI recommendations are based on accommodation of all public school boards and communities, health literacy curriculum needs to be broad in scope.

 

Priority:

Improve the safety, health, and supportiveness of communities.

 

State Performance Measure:

Adolescents reporting at least one adult mentor.

 

Objective:

By September 30, 2025, reduce the percentage of 10th grade students receiving our interventions who reported that someone they were dating limited their activities, threatened them, or made them feel unsafe by 10 percent (from 9.5 to 8.5 percent).

 

General Status on this Objective to Date:

Through four successful cycles of the Pregnancy Assistance Fund project through the federal Office of Population Affairs, we expanded and coordinated a diverse network of partners. The group of intervention partners through the PAF grant included: state agencies (OSPI and Office of the Attorney General), the Northwest Portland Area Indian Health Board and tribal health centers, local health jurisdictions, a nonprofit domestic violence coalition, a federally qualified health center, and other community-based organizations. We plan to continue relationships with these partners to increase access to community resources for AYA throughout the state. We finished this project over the last reporting period and will be working on strategies to maintain key partnerships we created through this work.

 

Strategy:

Support violence prevention efforts and promote healthy relationships among adolescents and young adults.

 

We will continue working with key partners to support efforts to promote healthy relationships among youth in our state, including:

 

• Continue to collaborate with tribal partners and other community entities, such as the Washington State Coalition Against Domestic Violence (WSCADV), working with priority populations to address community-specific issues around intimate partner violence and other related concerns.

 

• Collaborate with internal and external partners to identify initiatives and efforts geared to youth and provider education about health relationships, disseminate information about these resources to key partners and communities, and identify areas where we can address any gaps in information.

 

• Partner with OSPI to review and support materials in the education sphere that promote and teach healthy relationships.

 

• Provide or support trainings to health care providers (including emergency medical technicians) to recognize signs of dating abuse, partner violence, and trafficking through screenings.

 

Our Personal Responsibility Education Program will continue to provide education on adult preparation topics such as healthy relationships, including positive self-esteem, relationship dynamics, friendships, dating, romantic involvement, marriage, and family interactions; parent-child communication; and healthy life skills, such as goal-setting, decision making, negotiation, communication, and interpersonal skills and stress management.

 

Strategy:

Implement and promote fatherhood inclusion opportunities and support resources.

 

Over the last reporting period, we completed our PAF project. We worked with stakeholders and partners around the state on several programs specifically focused on teen fathers, including specific strategies to implement fatherhood programs for teens, conduct outreach focused on teen fathers, increase father engagement and linkage to resources, and address fathers’ unemployment rates. Now that this projected has finished, we will identify strategies to continue and expand partnerships with organizations that support and provide fatherhood initiatives.

 

Priority:

Optimize the health and well-being of children and adolescents, using holistic approaches.

 

National Performance Measure:

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

 

Objective:

By September 30, 2022, form youth advisory council and hold at least one initial meeting.

 

General Status on this Objective to Date:

Access to appropriate health care services is a continuing issue for adolescents in Washington and is a priority need to be addressed among the Adolescent Health team. Adolescents are often reluctant to seek health care services, and it is important to find ways to offer care in a manner that adolescents perceive as welcoming, comfortable, and responsive. This is particularly true in rural areas where providers knowledgeable about AYA-specific health concerns can be scarce.

 

We want to ensure adolescents have access to health care services that meet their needs in the communities they are in. The Health and Human Services Office of Adolescent Health defines this as “youth-friendly health care services,” which includes “those that attract young people, respond to their needs, and retain young clients for continuing care.” These services are based on a comprehensive understanding of what young people want and need (rather than being based only on what providers believe youth need).

 

We have multiple strategies planned to help us meet this objective:

 

• As mentioned before, we will partner with OSPI and others to implement a new Washington Youth Sexual Health Survey to understand and improve youth access to and experience with sexual health services holistically, and to learn about what works, how, for whom, and why.

 

• We will continue our partnership with OSPI and the Northwest Portland Area Indian Health Board to create and convene a youth advisory council. The council will help provide insight and feedback on a number of current and upcoming projects.

 

• The Family Planning program will continue to provide teen-friendly services in communities across the state. They will also continue to partner with state and local programs on community-based intervention and education programs to prevent teen pregnancy, such as the PREP program.

 

• Adolescent Health staff will continue to participate on OSPI’s Exemplary Sexual Health Education steering committee to ensure that Healthy Youth Act criteria are met for all adolescent health programs. Staff will continue to provide technical assistance for the review of sexual health education curricula.

 

• We will continue work with partners to maximize care coordination and emphasize provider awareness of common mental health occurrences for children and adolescents.

 

• We will continue to disseminate information and education about youth-friendly services through existing networks and projects, including PREP, both TPP grants, and others.

 

Strategy:

Promote the use of evidence-based practice guidelines, like Bright Futures, among adolescent health providers.

 

We continue to encourage adoption of the Bright Futures Guidelines for clinical services, and will include evidence-based practices for providing a culturally appropriate environment of care.

 

Bright Futures was officially recognized in the Patient Protection and Affordable Care Act (ACA) as the blueprint for all visits to the health care provider for health supervision (often referred to as well-child visits). Bright Futures Guidelines for provider visits include priority issues that should be addressed. These issues for adolescents include:

 

• Physical growth and development (physical and oral health, body image, healthy eating, physical activity).
• Social and academic competence (connectedness with family, peers and community; interpersonal relationships; school performance).
• Emotional well-being (coping, mood regulation and mental health, sexuality).
• Risk reduction (tobacco, alcohol, or other drugs; pregnancy; sexually transmitted infections).
• Violence and injury prevention (safety belt and helmet use, substance use disorder and riding in a vehicle, guns, interpersonal violence [fights], bullying).

 

In addition to continuing to promote the use of Bright Futures Guidelines, we will conduct evaluation activities (including surveys and key informant interviews) to assess the number of providers using the guidelines, whether they are experiencing barriers to using the guidelines and what those are, and what other guidelines are being used. This information will be used to target quality improvement activities around the promotion and use of best practices like these.

 

Strategy:

Increase the proportion of Washington adolescents who receive age-appropriate, evidence-based clinical preventive services.

 

The Adolescent Health program conducted a survey of youth in 2017 on AYA-friendly care, and developed a list of best practices for clinicians based on the results. The MCHBG Epidemiologist and the Adolescent Health Program Manager used this survey data to identify why youth may not be seeking care, and gaps in youth-friendly services. Over the next reporting period, we will use results of this project to work with providers to develop technical assistance and training, and develop ways to help youth navigate the health care system and advocate for themselves as end users and consumers of services, including promoting health literacy. We also hope to follow up with qualitative data collection and analyses to understand individual experiences and factors around accessing health care services.

 

We explored the use of Spark Trainings for health centers and other organizations serving youth. The Spark training model was developed by AHI to meet the needs of busy clinical staff. The mini-trainings, called “Sparks,” are made to be delivered in about 15 minutes so that this meaningful professional development can occur within the context of a regular staff meeting. During our exploration process, we learned the trainings were comprehensive and effective; however, the cost of the trainings exceeded our current budget. Over the next reporting period, we will explore options to fund these trainings or identify more cost-effective options.

 

As mentioned before, we will continue our partnership with OSPI and the Northwest Portland Area Indian Health Board to create and convene a youth advisory council. The council will help provide insight and feedback on a number of current and upcoming projects. We hope to work with the council to explore ideas around a Youth-Friendly Services Centers of Excellence certification program.

 

Strategy:

Promote preventive care screening and wellness visits for adolescents and young adults.

 

We will support improved communications strategies to youth and parents about the importance of well visits, including social media posts such as the “Well Child Wednesdays” post below. We also will continue our partnership with the Immunization program to promote and improve access to human papillomavirus (HPV) vaccine. We will continue to explore how best to provide information and training to providers about ways to discuss the HPV vaccine with youth and parents.

 

 

Strategy:

Foster measurable quality improvements in preventive care across the health system to increase adolescent and young adult-friendly care.

 

We will conduct needs assessment activities such as surveys and key informant interviews to assess what quality improvement (QI) practices are already in place, and then develop measures for QI based on our findings to ensure optimal AYA-friendly care.

 

One method of doing this will be creating an AYA-friendly provider certification program similar to Breastfeeding Friendly Washington. With partners and the newly formed Youth Advisory Council, the goal of this work will be to encourage organizations to promote and support AYA-friendly care through changes in their policies and procedures. We will develop a checklist of AYA-friendly services based on research and evidence, including criteria for making appointments, the waiting area, patient communications, provider visits, and follow-up procedures. There will be an application process in which the program will evaluate an organization and provide feedback if the organization is not yet considered ready for certification. Successful applicants will receive a certificate and promotion by DOH on our website and on social media.

 

Strategy:

Promote school-based health strategies to serve adolescent populations where they are.

 

Through previous and current initiatives, we developed strong partnerships with many SBHCs throughout the state that will allow us to continue to implement this strategy.

 

• In 2017, we convened a workgroup, led by Title V staff, for the Adolescent and Young Adult Health (AYAH) Collaborative Improvement and Innovation Network (CoIIN) Cohort #2 through the Association of Maternal and Child Health Programs (AMCHP). This SBHC workgroup included representatives from DOH, HCA, Medicaid managed care organizations (MCOs), OSPI, the Leadership Education in Adolescent Health (LEAH) project at the University of Washington, and the Washington School-Based Health Alliance. The project examined ways to increase youth engagement in SBHCs and increase well-visits at SBHCs. We will continue to keep these partnerships, and engage new partnerships through a new state community of practice.

 

• As mentioned before, we will work with partners to implement SHB 1225 and create an internal office to serve existing and create new SBHCs around the state.

 

• We will work to secure complementary funding to SHB 1225 to support a behavioral health component for SHB 1225 and SBHC.

 

• We recently began participating in a learning collaborative to develop health and education information-sharing resources related to legality of Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) rules as they relate to SBHCs. That work will result in examples, toolkits, and resources about the laws that can be disseminated to SBHC providers and sites.

 

• Additionally, we have been participating on the Healthy Students, Promising Futures Learning Collaborative. This national collaborative is co-convened by the Healthy Schools Campaign and Trust for America’s Health. The purpose of this collaborative is to increase access to school health services through Medicaid reimbursement. The HSPF focuses on federal and state polices that impact school-based health services for children in Medicaid, models for delivering school-based health services, and cross-state collaboration.

 

• We will continue to partner with the Health Care Authority to: assist SBHCs to bill for services rendered to promote sustainability of centers; support efforts to increase youth engagement with SBHCs to improve and enhance services; and support legislative work around expanding SBHCs, including statewide committees in which DOH staff already participate.

 

Strategy:

Identify and develop methods to monitor systems and data gaps and improvements needed in adolescent health.

 

Our first activity will be to assess data already collected through the PREP and GRADS programs, which serve adolescents and young adults through existing projects in the Adolescent Health unit. For example, PREP program surveys evaluate adult preparation subjects, including healthy relationships, parent-child communication, and healthy life skills. We will also work with our evaluation partners to identify communities that are disproportionately impacted and find possible solutions to data gaps.

 

As mentioned before, another useful source of data will be the new Washington Youth Sexual Health survey from OSPI; we will continue to support development, distribution and evaluation of this survey. In 2019, OSPI conducted a statewide youth survey to update the Washington Youth Sexual Health Plan. This effort was done collaboratively with stakeholders, including those from our Adolescent Health program, and was inclusive of youth in Washington state. The process honored the voices of youth, and their input was received through the survey as well as through engagement on the written goals in the Washington Youth Sexual Health plan. We have partnered with OSPI and others to update and redistribute the survey.

 

We will review and assess data from surveys related to COVID-19 completed in 2020. Some details from the COVID-19 Student Survey, conducted instead of the 2020 Healthy Youth Survey, are included in the Needs Assessment Update section under the heading, “Impacts of COVID-19 Pandemic.”

 

Strategy:

Include adolescents in this work through strategies such as building and supporting a youth advisory council, and identify other meaningful ways to engage the population to be served.

 

We recognize the importance of getting input from a variety of youth voices on our programs and programmatic needs. As we’ve mentioned before, one of the ways we will obtain this perspective is to partner with OSPI and others to create and convene a youth advisory council. Having a youth advisory council will enable us to better represent the individuals we serve, and to expand our reach to more of the community. By forming a stronger connection to AYA, we can gain insight into their needs, and, as a result, our programs can have a greater impact. We will work with our partners at OSPI, who currently have a youth advisory council, to identify best practices for recruitment and retention, communication about how youth recommendations are being used, and evaluation. Our goal is to have four quarterly meetings by the end of this five-year cycle.