Illinois’ priorities for the Adolescent Health Domain are:

• Empower adolescents to adopt healthy behaviors (Priority # 5)
• Assure appropriate transition planning and services for adolescents and young adults including youth with special health care needs. (Priority # 6)

The Illinois Title V Program took the opportunity presented by staff attrition to change the duties of the Adolescent Health Coordinator to become the Adolescent and Child Health Coordinator to strengthen synergy between child and adolescent health activities and promote a life course approach to programming. 

During FY20, the Illinois Title V Program will utilize the following strategies to address the Adolescent Health Domain priorities:

A. Certify and financially support school-based and school-linked health centers to expand access to primary health care, mental health, and oral health services for Illinois children and adolescents.

The School Health Program will continue to provide funding to School- Based Health Centers in FY20. A School-Based Health Center improves the overall physical and emotional health of students, including underserved racial and ethnic populations, by promoting healthy lifestyles and by providing available and accessible preventative health care when it is needed.  Health centers will continue to provide routine medical care to students enrolled in designated schools who have obtained written parental consent or who are otherwise allowed by law to give their own consent.  Each regular clinic user undergoes an age-appropriate health risk assessment and receive related age-appropriate anticipatory guidance, treatment, or referral in response to findings.  Each local advisory board decides whether other services (dental, mental health, drug and substance abuse counseling, and contraceptive services) will be provided on site or by referral.  Students in need of care beyond the scope of that offered at the health center are referred to specialists as needed.

The School Health Program and Title V leadership will join other states in participating in the School Health Services National Quality Initiative Collaborative Improvement and Innovation Network (NQI CoIIN) for School-Based Health Centers. Work will be completed over the 2019-20 School Year to implement School-Based Health Center quality and sustainability improvement strategies and innovatively conquer challenges in a peer sharing environment. It is hopeful that the technical assistance received as a part of this workgroup will provide insight to inform decisions around updating the funding allocation for school-based health centers statewide.

The School Health Program has added a new goal to the work plan for grant-funded centers: Increase awareness, knowledge, competency and alignment in suicide prevention, assessment, and treatment for school and school health center personnel.

Title V will continue to provide funded for a Graduate Student Intern to assist with updating and maintain the database and creating state-level reports

B. Provide training, support, and technical assistance to school nurses in Illinois.

School Health Days Training for fall 2019 is in the planning stages and will be facilitated in five locations statewide.  The Illinois Medical Emergency Response Team will provide training to school nurses on STOP the Bleed, a national initiative to address bleeding control in emergency situations.  Recently, the Illinois Terrorism Task Force designated some funding to provide each public school with Basic STOP the Bleed kits, which requires training on hemorrhage control. A survey was sent to school nurses and over 400 responded with over 90% indicating an interest in receiving STOP the Bleed training. 

C. Facilitate collaboration of School-based Health Centers (SBHCs) and the state Family Planning (Title X) program to directly provide family planning services in SBHCs.

The Adolescent and Child Health Coordinator will set up quarterly meetings between programs to identify opportunities to collaborate and determine feasibility of providing Title X funds to school health centers already provide family planning services on site and cross reference entities currently receiving each type of funding.

D. Work with the Illinois Chapter of the American Academy of Pediatrics to encourage providers to adopt “adolescent-friendly” principles in their practice (started in FY18).

E. Implement an Adolescent Health Initiative to support communities’ efforts to increase adolescents’ access to preventive and primary healthcare, and to become adolescent-friendly clinics (started in FY18).

The Adolescent Health Initiative was first funded in FY19 and provided grants to 11 entities, including ten local organizations to support the local implementation of strategies and support to increase the percentage of adolescents who received preventive and primary health care. We also fund the Illinois Chapter of the American Academy of Pediatrics to continue to develop and provide training and support for healthcare providers to expand adolescent‐friendly healthcare services. Methods used by local organizations span from providing more youth friendly waiting areas, social media campaigns, conducting youth focus groups, to various modes of outreach and education.

In an effort to collect more robust data and be able to evaluate the impact of the Adolescent Health Initiative, the reporting forms were edited in January 2019, halfway through the grant year. Preliminary information collected suggested continuing this work through FY20.  For FY20, IDPH is asking the same funded entities to:

• Demonstrate the need for the continuation of this program within the community(ies) the organization serves.
• Describe what the organization requires to continue the current work as well as build in additional activities that will enhance the work initiated during the FY 19 grant project. 
• Develop a plan that outlines sustainability and the leveraging of missed opportunities in order to increase well-care visits.
• Demonstrate the development or continuing of partnerships with key stakeholders such as other Title V agencies, Local Health Departments, Federally Qualified Health Centers, community-based organizations, and faith-based organizations to improve adolescent health and well-being.

Continuing this funding opportunity into FY20 will allow the OWHFS to better assess if the approaches taken have increased adolescent well care visits statewide and evaluate its success.

The Chicago Department of Public Health (CDPH) will continue to receive funding to implement the CHAT Program (Chicago Healthy Adolescents & Teens) to improve access and coordination of school health services and linkage to medical homes and access to adolescent sexual and reproductive health. A challenge for them has been maintaining consistent funding for evaluation of CHAT and the Illinois Title V Program intends to consult with CDPH to see what support our epidemiology/data staff can provide.

F. Serve on statewide Adolescent Suicide Adhoc Committee to develop strategic plan to reduce suicide ideation and behavior among youth in Illinois (started in FY19). 

During FY20, Title V funds will support a graduate intern position within IDPH Injury and Violence Prevention (IVPP) Program to facilitate adolescent suicide prevention activities.  Activities are guided by Title V and IVPP staff, in collaboration with the Illinois Suicide Prevention Alliance Adolescent Suicide Prevention Ad Hoc Committee.  Activities will include:

• Collect and disseminate child and adolescent suicide-related data, including fatality, hospitalization, emergency department, Illinois Violent Death Reporting System, and Youth Risk Behavior Surveillance Survey data.
• Collaborate with Illinois State Board of Education to provide resources to schools.
• Provide resources to school health centers.
• Collaborate with the Illinois Suicide Prevention Alliance to align activities with the Illinois Suicide Prevention Strategic Plan.
• Update and maintain an environmental scan of activities and organizations addressing child and adolescent suicide prevention.

Starting in FY20, School-Based Health Centers will be required to increase alignment in suicide prevention and response between school and school health center through collaboration on suicide protocol development. Centers will report the status of affiliated school’s suicide protocol (adopted protocol, draft, none); engage with school administration and staff to develop new protocol or adapt an existing protocol to specifically mention school health staff and resources and the involvement of the school health center within protocol; identify appropriate professionals who should be trained in identifying and responding to persons at risk of suicide; identify evidence-based training and tools and develop training plan and schedule; provide training to appropriate professionals in identifying and responding to persons at risk of suicide; and, adapt training plan and schedule as needed to incorporate additional staff or activities.

G. Partner with School-Based Health Centers and other interested providers to educate and encourage pediatric providers to incorporate transition into routine adolescent well visits, and to use a standardized transition tool (e.g. Physician Resource Tools housed on ICAAP’s website, including the transition checklist [readiness assessment], the Portable Medical Summary, and the informational skill sheets, along with the Six Core Elements of Health Care Transition).

This will be completed for funded school-based health centers during FY20. Using information from the transition care needs assessment developed in FY19, centers will establish criteria and processes for identifying and tracking transitioning youth and young adult SBHC clients ≥14 years of age and conduct regular transition readiness assessments, beginning at age 14, to identify and discuss with youth their needs and goals in self-care. Work continues in this area to address tracking and monitoring transition progress in the many electronic health records utilized by the School-Based Health Centers.

Challenges and Emerging Issues

Below are some emerging issues identified by the Illinois Title V program. This information has been collected anecdotally by School Health Program staff while in the field well as preliminary data from focus groups being conducted in school advisory boards for the FY2020 Needs Assessment:

• Youth suicide/mental health
• Measles/vaccinations
• Adequacy of school health screening requirements and subsequent treatment
• Bullying
• Oral health
• Cannabis/substance misuse
• Vaping/e-cigarettes
• Gun violence