Priority: Strengthen the capacity of the health system to promote mental health and emotional well-being.
Objective 1. Increase the percent of high school students who report having a teacher or other adult in school they could talk to about a problem to 77% from baseline (75%, 2017 YRBS).
School-Based Health Centers
SBHC staff will continue to support resilience in students and the school community to respond to the collective trauma related to the COVID-19 pandemic. There will be continued emphasis on connecting with students and building a solid therapeutic alliance. Clinicians will continue to assess for protective factors, including the presence of a trusted adult and school connectedness. The SBHC program intends to support the creation of an online educational platform that provides robust asynchronous learning to educate on our quality standards and core values, such as the importance of the trusted adult, to the statewide SBHC network.
All SBHC staff (including nurse practitioners, behavioral health clinicians, and community health workers) will build upon the strategies and skills that were developed in the training offered in FY22 titled: Healing is in the Return. Programmatic changes will be implemented in response to feedback provided by SBHC clients and non-clients obtained in FY23 aimed at assessing sense of student belonging and validating students using a strengths-based approach.
Office of Sexual Health and Youth Development (OSHYD)
The OSHYD will continue to provide trainings to funded organizations on positive youth development using the Search Institute’s 40 Developmental Assets framework, with the goal to increase youth protective factors such as access to a trusted adult. In addition, OSHYD will provide trainings that address the Standards of Practice for Adolescent Sexuality Educators. The standards are professional disposition, racial equity and intersectional inclusion, trauma informed, positive youth development, content knowledge, program planning, implementation, and assessment. Other activities planned for FY24 intended to encourage youth to access trusted adults will include:
- OSHYD will conduct an annual Suicide Prevention Question, Persuade, Refer training to all programs as a strategy to increase protective factors among the adolescent population.
- OSHYD will continue to partner with Advocates for Youth to offer free virtual professional development opportunities for health educators/case managers. Advocates for Youth provides a virtual classroom space where educators can practice and refine a variety of skills needed to effectively teach sex education to teens. Educators will practice teaching student avatars using short scenarios and support from an instructional coach so they can quickly learn and master the skills they most need to be effective, such as: answering difficult questions when teaching sex education, tailoring lessons to meet different developmental levels, and providing trauma-informed sexuality education.
- Additionally, OSHYD will partner with the Planned Parenthood League of MA to offer the Sexuality Education Cornerstone Series Training (SECS). This training equips youth-serving professionals with a foundation of knowledge on sexual health information.
- OSHYD staff will continue to provide TA on family/parent engagement to OSHYD funded providers, with the goal to strengthen facilitators’ ability to communicate effectively with youths’ family/guardians about the importance of sexuality education and their role as trusted adults.
- OSHYD staff will provide the Valuing Our Impact for Civic Engagement (VOICES) curriculum training to new facilitators. VOICES is a civic engagement and leadership curriculum comprising six workshops to facilitates discussions with adolescents on topics such as identity, community, and their agency to make changes as leaders.
- Lastly, OSHYD will also continue to provide safe spaces for adolescents to explore topics such as sexuality and mental wellness as a part of its programming, including Adolescent Sexuality Education, Personal Responsibility Education Program, and Successful Teens: Relationship, Identity, and Values Education.
Objective 2. By 2025, return to the pre-pandemic baseline the percentage of middle and high school students who report feeling so sad or hopeless almost daily for 2+ weeks in a row that they stopped doing some usual activities (high school: 33.8%, 2019 YRBS; middle school: 24.3%, 2019 YHS).
School-Based Health Centers (SBHC)
The SBHC program reprocured services for a new 10-year funding cycle beginning in FY23. In this procurement, there is a greater focus on leveraging a comprehensive care team with a greater emphasis on providing integrated and enhanced behavioral health care, using universal strength-based approaches to build on the resilience of youth and families, identifying and mitigating health risks, and actively addressing the impacts of racism on all children’s ability to learn and thrive. In this expanded model, funded SBHCs must have a full-time behavioral health provider and medical provider onsite at the SBHC during all hours that school is in session. The new model is in response to increasing need for behavioral health services for youth, both prior to and especially as a result of the COVID-19 pandemic. SBHCs are encouraged to offer tele-behavioral health services in addition to having a provider onsite full-time. The expanded model also requires a full-time community health worker at each SBHC site. This role has proven crucial to strengthening connections with the school, building trusted relationships with students and families, improving outreach services, and facilitating meaningful feedback opportunities for students regarding SBHC services.
The SBHC Program will continue to offer professional development opportunities to SBHC staff to increase their capacity to respond to the behavioral health needs of students and continue to foster resiliency with the students and school communities. The SBHC program plans to continue to develop a robust educational platform that will allow for asynchronous learning and access to the SBHCs quality standards, a SBHC start-up toolkit to support community partners planning to initiate an SBHC, and continuous quality improvement initiatives to support funded agencies in implementing meaningful behavioral health screeners (in accordance with the national American Academy of Pediatrics and U.S. Preventive Services Task Force guidelines) with a focus on equity.
School-Based Telebehavioral Health Pilot Program
School Health Services
Comprehensive School Health Services (CSHS) grant activities will focus on providing specific strategies to achieve increased student connection. The following CSHS grant performance objectives have been revised to more accurately reflect the scope of school health service practice:
- Increase in the percentage of students who are identified as experiencing symptoms of depression and/or anxiety, or suicidal ideation, and are not currently receiving behavioral health care, that are referred for mental health services by school health/counseling staff (Target – increase by 10% annually).
- Increase in the percentage of students who are identified as homeless or marginally housed assessed for unmet health care needs by nursing services (Target – increase assessments by 10% annually).
- Increase in the percentage of students who have special health needs (e.g. asthma, autism, ADHD, diabetes, life-threatening allergies, seizure disorders, diagnosed mental health disorder) that have an individualized healthcare plan (IHP) developed (target – 100% IHPs developed).
- Increase in the percentage of English Language Learners (ELL) students assessed for unmet health care needs by nursing services (Target – increase assessments by 10% annually).
The MDPH School Health Unit will also continue to support school health staff and schools facing many vacant school health positions. Schools will have an opportunity to continue to spend CDC workforce funding first awarded in FY22 to forty-two schools and school districts to retain and hire school health staff through a no-cost extension. The School Health Unit’s professional development vendor (BU SHIELD) will continue to offer an entire school mental health series, which is now an enduring offering on the BU SHIELD website. School health staff, in partnership with the Division of Children and Youth with Special Health Care Needs and BU SHIELD, will continue their collaboration on a project facilitated by CDC Workforce funds that will help to support nurses caring for youth with complex healthcare needs in schools.
In FY23, CSHS grantees were eligible for additional state funding under a behavioral health expansion opportunity, and 18 schools and districts were selected for funding. This activity will continue in FY24 if adequate funding is available in the state budget. The theme for professional development for school nursing staff will focus on the IEP/504 process and the role of the school nurse, as well as continuing our work with Wheelock College around exploring, understanding, and addressing racism in educational and healthcare institutions.
Office of Sexual Health and Youth Development (OSHYD)
The OSHYD’s Adolescent Health programs will revert to implementing programming based on its original design. While modifications have been critical tools for providers attempting to provide sexuality education during the worst of the COVID-19 pandemic, new agency staff are being onboarded with the understanding that modifications are the intended implementation plan and that is making it increasingly harder to evaluate the original program design. Funded agencies that continue to require accommodations to implement flexible program models on a case-by-case basis will be allowed to do so with permission from their contract manager. This will allow them to address the mental health needs of youth and will allow us to better monitor and track the types of mental health supports being implemented throughout the fiscal year. There are several internal and external factors contributing to poor mental health among adolescents such as housing instability, increased family responsibilities, the racial reckoning in the United States, and global conflicts. OSHYD programs serve as a consistent safe place for youth to process their feelings and access resources. Program strategies will include using funding to support the basic needs of young parents such as rental/utility assistance, dedicated spaces to de-compress and speak with peers about their feelings, and weekly staff wellness check-ins.
The Sexual and Reproductive Health Program’s core values include providing confidential youth-friendly and trauma-informed care. Through its training center, MDPH will continue to provide training and technical assistance on these critical values for the provision of services for adolescents. Completing an e-learning module on the program’s values will continue to be a required element of each contract. In addition to the curation of a collection of resources for providers on the topic, the training center will develop a tool kit to support providers to address the mental health needs of their adolescent clients. Oversight will occur during monthly meetings with contracted health centers.
Objective 3. By 2025, return to the pre-pandemic baseline the percentage of middle and high school students who seriously considered attempting suicide in the past 12 months (high school: 17.5%, 2019 YRBS; middle school: 11.3%, 2019 YHS)
School-Based Health Centers
SBHC care teams will continue to use the Multi-Tiered System of Supports (MTSS) framework to support students and school communities. Staff will demonstrate heightened awareness of behavioral red flags among students in the clinical high-risk category, including those at risk of suicidality. Staff will operationalize the learnings on preparing emergency plans in response to dynamic and shifting levels of acuity. Program managers will engage in ongoing clinical quality improvement work for their agency and sites to ensure they are moving toward alignment with the national clinical guidelines from the AAP and USPSTF on behavioral health screening, including suicide screening.
Suicide Prevention Program
It is anticipated that a needs assessment geared towards understanding the current landscape of suicide awareness among school personnel will be completed. An instructional designer will be engaged to develop a new training for suicide awareness and prevention for school personnel that will be available online at no cost. The current project timeline anticipates that the training and custom online platform will be built at the end of the fiscal year.
Child Fatality Review
The Injury Prevention and Control Program (IPCP) anticipates that prior to FY24, coordination responsibilities for the Child Fatality Review program will be transferred to another agency. IPCP will continue to facilitate tailored technical assistance to local CFR teams, particularly around suicide prevention.
Priority: Promote equitable access to sexuality education and sexual and reproductive health services.
Objective 1 (SPM 2). By 2025, decrease the Latinx teen birth rate of 26.0 per 1,000 Latinx women aged 15-19 to 16.0 per 1,000 to reduce the inequity between Latinx and White youth.
Objective 2. By 2025, decrease the gap between the Black and White teen birth rates to less than 2 times higher.
Office of Sexual Health and Youth Development
The OSHYD’s FY23 programmatic plans were significantly delayed as a result of staffing turnover at funded agencies requiring agencies to delay programming and prioritize hiring and onboarding of staff. OSHYD staff supported agencies in onboarding new staff by funding professional development and onboarding strategies. The Adolescent Sexuality Education Program (ASE) will focus on reaching Black and Latinx youth, using the following strategies: leveraging peer leaders to recruit youth within their social networks to participate in ASE programming; hosting focus groups with Black and Latinx youth to identify organizational and cultural barriers to program participation; and offering staff professional development opportunities on topics such as how to recruit and retain youth, exploring the impact of racial identity development, and building authentic relationships with youth.
The Personal Responsibility Education Program (PREP) will also continue its effort to serve Black, Latinx, LGBTQ youth and other marginalized youth populations that traditionally have not had access to quality sexuality education. PREP will strengthen its partnerships with the Department of Elementary and Secondary Education (DESE) to fund seven school districts/collaboratives to deliver sexuality education services. These seven additional districts will receive sexuality education curricula training, data and evaluation training, and technical assistance in implementing PREP programming in the classroom. PREP-funded agencies will also receive professional development trainings on the standards of practice for adolescent sexuality educators that will strengthen their services and ensure young people are receiving accurate, comprehensive, and inclusive sexuality education services.
OSHYD remains committed to integrating and centering youth voice. OSHYD will launch a youth advisory board. Ten young people will be engaged to inform program designs and shape the youth internship program. Additional details about this initiative are described in the family, father, and youth engagement priority within the Crosscutting domain.
Objective 3. By 2025, provide training to 75% of Adolescent Sexuality Education and Sexual Reproductive Health program grantees on the integration of reproductive justice principles into delivery of sexuality education and/or sexual and reproductive health services.
Office of Sexual Health and Youth Development
OSHYD will continue to operationalize its core values of racial justice, health equity, reproductive justice, trauma-informed care, sustainability, youth development, and evidence-based/data-driven programming with a focus on centering racial justice and reproductive justice through its partnerships and services. Reproductive Justice framework trainings will be offered annually to MDPH-funded organizations. ASE and PREP program staff will be required to participate in these trainings and develop reproductive justice action plans to support the integration of reproductive justice principles into their service delivery.
Funded agencies will submit their action plans and receive technical assistance from OSHYD annually. OSHYD anticipates the following types of activities may be included in the agencies’ action plans in FY24: organizational training on racial bias, history of the birth control pill development, exploration of agency policies that may pose a barrier to accessing services, development of a community advisory board to support the reproductive justice initiative, and curricula adaptations supportive of reproductive justice. These curricula adaptations may include acknowledgement of the history of contraceptive development ensuring that youth are aware of the kernels of truth behind some “myths” about contraception, particularly those that are common in communities of color. The integration of reproductive justice principles into sexuality education will be an ongoing and iterative process.
Objective 4. By 2025, 85% of females under age 25 will be screened for chlamydia at SRHP-funded clinics.
Sexual and Reproductive Health Program (SRHP)
The SRHP will launch its second year of the new 10-year program cycle (FY23-FY32). In FY23, six new agencies were awarded SRHP contracts. This expanded the network and geographic coverage from sixteen agencies to twenty-two agencies who were selected from a competitive procurement process. Procurement is based on the new SRHP Core Values and Program Standards, which emphasize evidence-based guidelines, including the Quality Family Planning guidelines, the Quality STD Clinical Services guidelines, the STD Treatment guidelines, and federal Title X regulations. The updated Core Values also emphasize the delivery of adolescent-friendly services, including protecting the confidentiality of adolescents and others who are not the primary subscribers on their insurance plans.
SRHP will be supported through an updated data system that collects and reports demographic and service information, extracted from contracted providers’ electronic medical records. This data system will support the collection and reporting of data necessary to respond to this Objective. In addition, the SRH training center will provide training and technical assistance to both MDPH-funded vendors and other SRH providers throughout the Commonwealth that do not receive direct funding from MDPH. The training center will share best practices, clinical updates, and emerging trends with a wide SRH safety net service audience. These activities will ensure that clinical best practices, including chlamydia screening, will be disseminated to many SRH providers throughout the state.
All SRHP activities, including training and technical assistance provided by MDPH staff and the new SRH training center, are expected to be supported by both state funds and Title X funds. After two years out of the Title X program, MDPH was awarded funding and returned to the federal program as of April 1, 2022, under a newly revised program regulation.
SRHP will continue to incorporate into contract management the collection and reporting of chlamydia testing data and monitor progress towards meeting this objective. SRHP will provide technical assistance regarding chlamydia testing during monthly meetings with contracted agencies, and additional training during semi-annual statewide provider meetings.
Objective 5 (NPM 10). By 2025, increase by 2% from baseline (92.3%, NSCH 2017) the percent of adolescents who have a preventive medical visit in the last year.
School-Based Health Centers
The SBHC program will continue to work with Apex, the selected data vendor, to accurately measure preventive medical visits in SBHCs. Professional development for SBHC clinicians will focus on developing care practices that are sensitive and welcoming to priority populations, including youth of color, immigrant/refugee youth, low-income youth, youth in rural communities, and LGBTQ+ youth. The SBHC program is explicitly communicating the expectation that preventive care visits be tailored to these populations and that specific strategies need to be implemented to intentionally recruit these students to enroll in SBHC care.
MA SBHC Quality Standards require SBHCs to conduct and document student satisfaction surveys and deliver services in response to feedback. All SBHC clients must be given the opportunity to provide student satisfaction feedback. MDPH will require SBHCs to launch and report on a satisfaction initiative that provides a meaningful opportunity for both existing clients of the SBHC and students who are not yet clients of the SBHC to provide feedback. The SBHCs will need to report on how these initiatives were designed to be culturally, linguistically, and age-appropriate for the student body and in accordance with CLAS national standards. SBHCs will report the findings from these initiatives to DPH, as well as their plans for making modifications to their SBHCs in response to this feedback.
Sexual and Reproductive Health Program
The SRHP will continue to ensure that contracted agencies are a source of primary care and referrals for adolescents through provision of technical assistance during monthly oversight meetings and during comprehensive on-site program reviews. In addition to providing education and training related to CDC’s Quality Family Planning Guidelines, SRHP will continue to make available an e-learning module through its training center that shares best practices and guidance on program-specific guidelines that detail the expectation of specialized care for adolescents.
The SRHP will launch its second year of a 10-year programming cycle, which includes a comprehensive Training and Technical Assistance center that will provide ongoing guidance and support to contracted agencies on the recently updated program standards. During monthly FY24 grant oversight meetings, the SRHP will also provide direct technical assistance to the contracted agencies regarding adolescent preventive and reproductive health care.
Priority: Prevent the use of substances, including alcohol, tobacco, marijuana, and opioids, among youth and pregnant people.
School Health Services
The School Health Unit, in partnership with BSAS, will continue to implement SBIRT screening in schools. Particular attention will be paid to increasing the number of non-public schools and approved special education programs that implement SBIRT. School Health Services continues to work closely with MASBIRT TTA, our SBIRT training vendor, to review and revise SBIRT training as needed, and to add additional training sessions to accommodate the marked increase in school staff turnover.
School-Based Health Centers
The SBHC program will continue to work closely with the Leadership Education in Adolescent Health (LEAH) program at Boston Children’s Hospital to deliver professional development to SBHC staff on topics of interest related to screening for behavioral health needs. Additionally, the SBHC program plans to initiate a continuous quality improvement framework that is designed to support SBHC sites and their host agencies at building internal capacity to assess and improve their behavioral health screening practices to be in alignment with the national guidelines from the AAP and USPSTF. SBHC sites will be required to continue to use the CRAFFT+N to facilitate screening and brief intervention for students 12 years old and above.
The SBHC Program will require funded sites to report on the substance use treatment and prevention services that are offered at the SBHC in addition to the classroom based/school wide services and outreach/collaborative activities completed within the year.
Additional activities to prevent the use of substances among youth
MassCALL3
As described in the FY22 report, MassCALL3 grantees developed strategic plans based on an assessment of needs and resources in their catchment areas. Each comprehensive strategic prevention plan is being reviewed by a Prevention Contact Manager within BSAS, a representative from the state’s prevention technical assistance center (the BSAS Center for Strategic Prevention Support), and the cross-site evaluation team for the MassCALL3 initiative. We anticipate final plan approvals for the majority of grantees early in FY24 and expect that these grantees will then progress to providing direct and indirect prevention services with the population(s) identified in their approved plan.
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