III.E.2.b.v.c. State Action Plan Narrative by Domain

 

Adolescent Health Domain Application Year

Overview of Priority MCHBG Projects and Activities As the population of adolescents in Washington increases, our vision is to serve as a statewide leader in optimizing the health, well-being, and development of all adolescents and young adults (AYA), and our mission is to provide programs that promote the health and well-being of adolescents where they live, learn, work, and play.

 

Adolescent Health Programs

Our state action plan for adolescent health focuses on the following priorities:  supporting youth behavioral health care, improving access to and the quality of adolescent and young adult health care, supporting sexual and reproductive health and education and access to appropriate services, and providing improving youth access to and experience with sexual health care. We selected MCHBG performance measures, priorities, and strategies that reflect the activities and programs we plan to continue. These measures, priorities, and strategies were selected for their impact on improving health care services and access for young people and will also contribute to our efforts to health equity for all. Over the next reporting year, we will expand and strengthen several programs and ramp up two new ones. We will also explore ways to better support young people’s health care journey, and the providers that care for them.

 

School-Based Health Center (SBHC) Grant Program provides grants for planning, startup, operations, and behavioral health improvement for SBHCs in Washington, support and technical assistance to advance SBHC sustainability and operations, and training for SBHC health care providers. Among the many strengths of SBHCs is that the medical and behavioral health providers are embedded in the schools, allowing them to develop different kinds of relationships with their young patients compared with in traditional clinical settings. SBHC staff and providers collaborate with schools to coordinate care, services, and referrals, and emphasize health promotion. They also develop relationships with other community providers to ensure holistic care for their students. For more about our SBHC grant program, see our narrative in the report, or go to the webpage linked here.

 

The Youth Advisory Council (YAC) is a community engagement group of about 40 teens and young adults from around Washington state. YAC members meet with DOH staff regularly to discuss key topics in adolescent health care that overlap with Title V focuses, including youth mental and behavioral health, youth-friendly care, well-visits and primary care, teen dating, youth with special health care needs and disabilities, and sexual and reproductive health. Youth engagement is an integral part of mental and behavioral health program planning for Adolescent Health. Talking to young people about the issues they see in schools and their communities, and the solutions that they think will work to get young people the care they need is the only way for public health programming to truly be youth-friendly and responsive.

 

The YAC and other youth engagement opportunities at DOH are grounded in the theory of positive youth development. We are intentionally creating opportunities for teens and young adults to learn about and participate in public health planning and government activities as one more way we can make a positive change in our community. Creating a positive space for young people to develop and build positive relationships with caring and trusted adults is in itself a strategy to support youth and stave off negative outcomes from behavioral health conditions (see The Knowledge Institute 2019 and Positive Youth Development at CDC 2023). In addition, the CDC reports that positive youth development programming has the potential to prevent riskier behaviors, like substance use and riskier sexual behaviors that contribute to preventable pregnancy, as well as preventable illnesses and diseases, like STIs and HIV.

 

The Youth Voice Program is a volunteer/internship opportunity for teens and young adults to collaborate with DOH to develop youth-friendly communications materials that are geared to youth. Volunteers are recruited through DOH’s Workforce Development Team in Human Resources, and notices go out to high schools and colleges throughout the state. Previous projects include making websites more youth-friendly, creating social media campaigns, and collaborating on other communications materials.

 

The new  Adolescent Health Data Dashboard is a one-stop-shop for relevant and state-level adolescent health data. The Dashboard is housed on DOH’s Washington Tracking Network page and contains interactive dashboards on key data about Washington youth ages 10-19, including demographics, teen pregnancy, STIs, mental and behavioral health. The Dashboard also includes links to other relevant data resources, including other state and federal resources.

The Washington State Personal Responsibility Education Program (WA PREP) is a federally funded program awarded to states to prevent the spread of STIs and unintended pregnancy among youth. DOH, in partnership with the Office of Superintendent of Public Instruction (OSPI) and Cardea Services, does this through professional learning and capacity development. Intervention Partners (IPs) are selected based on readiness, and services can include needs assessments, curriculum selection and adoption assistance, and other support needed to deliver comprehensive sexual health education (CSHE). WA PREP prepares teachers and youth development professionals to implement CSHE. All services are provided at no cost for WA PREP partners.

 

We are excited to share that we will be rolling out 2-3 new programs in the next reporting period:

 

• The Adolescent and Young Adult Health Resource Hub and Information Center will be a new DOH website geared to adolescents and young adults in the state. The Hub will include a curated list of youth-friendly health resources, and how-to guides and other guidance on health topics requested by youth. During discussions with the Youth Advisory Council in 2022, we learned that young people want easy and online access to quality and accurate information on specific health topics, including sexual and reproductive health, and mental and behavioral health.  YAC members report that online tools like social media, websites, and apps can be a powerful tool to sharing health information with youth – and, because there is a lot of misinformation on the internet, having information that comes directly from a reputable source (like the government) is essential to support young people’s health literacy and agency. Research supports this recommendation. Studies show that the number of people using the internet for health information is increasing, and that people go to the internet for many of their health care needs, including disease information, how to find providers, and how to get health insurance (see Zhao and Zhang, 2017). Internet use for health information has jumped to social media over the last few years. The American Academy of Pediatrics reports that in 2016, 76% of teens were using at least one social media site, and social media use by youth impacts behaviors, including substance use and sexual activity (see Hill et al, 2016). The use of social media to spread health information (and misinformation) was never more apparent than during the COVID-19 pandemic, where social media both benefited and harmed the public with non-stop access to virus information (see Rosenburg et al, 2020). 

 

• Consumption of online content by teens and young adults provides DOH an opportunity to get important health information directly to young people, and in return, be responsive to young people by getting them the health information they want and need. In addition, the YAC reported that young people want to be able to access online health information in a youth-friendly, confidential way that is visually appealing and easy to navigate and understand. In response to this feedback and the YAC members’ recommendations to promote and provide quality and accurate health information, over the next reporting period, we hope to release a new adolescent health website. The website will cover four topic areas: primary care/well-visits, sexual and reproductive health, teen dating and healthy relationships, and mental and behavioral health. For each topic area, the website will provide two types of content: a curated health resources hub consisting of existing online resources and managed by trusted sources; the second type of content will consist of several how-to guides developed around topics and questions recommended by the YAC and made in youth-friendly and visual styles that resonate with young people.  We will collaborate with the Youth Advisory Council and internal partners to plan content, create a brand identity, and contract with local vendors to enhance tools and promote the resource.  Over the next reporting period, we hope to release the new adolescent health website in two phases. The first phase (January 2024) will include the release of the curated resources hub. The second phase (June 2024) will include the release of some of our how-to guides and other resources.

 

• The DOH Youth-Friendly Certification will benefit adolescents and young adults and the providers that care for them. During the last reporting period, the YAC identified a need for providers to demonstrate that they are youth-friendly, so teens and young adults know where to go to seek health care services from trustworthy providers. The YAC describes youth-friendly care as providing a welcoming and safe environment and creating positive interactions between providers and young patients that are compassionate, non-judgmental, inclusive, factual, truthful, and confidential. Over the next reporting period, DOH will collaborate with internal and external partners, including the YAC, the Children and Youth with Special Health Care Needs program, and the Washington State Health Care Authority, to outline criteria for youth-friendly health care clinics and practices, outline technical assistance and training to support health care provider and practice participation, and develop communications materials that include a logo that providers will be able to display to visually represent certification so they can be found by young people.  Youth-friendly self-assessments and certification projects are not new, and other organizations and agencies have been successful in implementing them. National Adolescent and Young Adult Health Center’s toolkit, National Health Mission Adolescent Friendly Health Clinics, and Minnesota’s Hennepin County MySelf,MyHealth.

 

The New WYSHIIN and TPP

In 2019, the Washington Youth Sexual Health Survey findings highlighted issues for AYA regarding 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 do not work with their schedule (37%), not understanding how insurance works (38%), feeling judged (39%), and being afraid that their parent or caregiver will find out (48%).

 

In 2020, the Adolescent Health team, in collaboration with the Surveillance and Evaluation unit, was awarded one new grant for the next round of Teen Pregnancy Prevention funding from the Office of Population Affairs (OPA). We are the only state agency awarded this funding, and one of only 13 grantees total. We will continue our partnership with the Office of Superintendent of Public Instruction and the Northwest Portland Area Indian Health Board to coordinate the Washington Youth Sexual Health Innovation and Impact Network (WYSHIIN) 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. The interventions range from the clinic setting to social media campaigns, and the partners are from all sectors who have bidirectional impact on youth sexual health care.  As described in the report, we are working with 11 implementation partners and to date have served over 3,500 youth, 372 caregivers, and 753 community members. More information can be found here: Washington Youth Sexual Health Innovation and Impact Network | WaPortal.org.

 

Pivots and program expansion into Year 3 of the project include the utilization of a youth advisory committee to provide feedback on program impact and youth-led presentation opportunities of their recommendations, culminating in a report of recommendations to share with implementation partners, lead agencies, OPA, and the communication of results to the youth.

 

Sustainability planning will be an integral part of year 3 activities among implementation partners.  In the second half of year 2, we reported on the development of collaborative alliances among cohort 1 and 2 implementation partners.  We will expand these opportunities in year 3 through:

• Promotion of the communications plan activities, providing additional activities and opportunities for cohort 1 and 2 to connect and collaborate.
• Key informant interviews with partners to ask about project goals, process measures for each organization, and evaluation themes.

 

MCHBG Plan for 2023-2024

Over the next reporting period, the Adolescent Health Team will continue ongoing programming and roll out new programs to advance efforts to strengthen adolescent and young adult health care and services, engage young people in adolescent public health, and support youth-serving health care providers in the state. This report provides a summary of ongoing and new programming, as well as discussions of specific projects and activities as they relate to specific priorities, performance measures and strategies, below. For more information, go to: Adolescent Health | WaPortal.org.

 

Topic areas of focus, priorities, performance measures, and strategies have been selected based on the data available at the time of this plan, feedback and recommendations from community engagement activities (including with the Youth Advisory Council), guidance from DOH leadership, and alignment with internal and external partners. The following is an outline of current and upcoming programming and its relevance to priorities, performance measures, and strategies for Adolescent Health’s MCHBG/Title V deliverables.

 

Priority:

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

 

Data:

Behavioral health is a priority issue for the Department of Health and the Adolescent Health Team. Like most of the nation, Washington data from 2019-2021 show us that behavioral health needs of young people in the state increased tremendously because of the COVID-19 pandemic. Teens and young adults continue to struggle with depression, anxiety, and for too many, thoughts of suicide. Substance use is still an issue impacting young people across the state. In addition, stigma, and lack of behavioral health providers throughout the state have compounded the issue, making youth behavioral health a statewide initiative.

 

The data below highlight key findings from several sources that helped us decide where to focus efforts and funding to best support young people in the state, within our scope in Adolescent Health.

 

Healthy Youth Survey

The 2021 Washington Healthy Youth Survey indicates that 38% of 8th, 10th, and 12th graders reported depressive feelings. Among female students, it was 50%. White students were more likely to report depressive feelings than their Asian classmates, but less likely than Hispanic, American Indian/Alaska Native, and classmates who identified as more than one race. All females, no matter which race/ethnicity they identified as, reported higher rates of depressive feelings than males of any race/ethnic group. Approximately twice as many respondents who identified as not heterosexual reported having depressive feelings as did those identifying as heterosexual, 62% and 30%, respectively. Sixty-five percent of students reported they did have an adult in the community they could talk to if they felt sad or depressed (HYS 2021).

 

Responses to the 2021 Washington Healthy Youth Survey showed that 20.5% of 10th grade students considered attempting suicide in the past year. 8% of 10th grade students reported making a suicide attempt in the 12 months prior to the survey.

 

The Healthy Youth Survey from 2021 shows that drinking within the past 30 days was related to grade level. It was also down considerably from 2018. In 2021, 20 percent 12th graders and 8% of 10th graders reported drinking. In comparison in 2018, 28% of 12 graders and 18% of 10th graders reported drinking. The most common source of alcohol was from friends, while the second most common source was from parents with their permission. The attitudes of parents and peers does seem to influence adolescent drinking, with those who report more disapproval by either group less likely to report drinking. As the degree of disapproval increases, the likelihood of drinking decreases in a “dose-response” model.

 

Cannabis use in the prior 30 days was, like alcohol, inversely related to grade level with 16% of 12th graders, 7% of 10th graders, 3% of 8th graders and 1% of 6th graders reporting use. There was a very strong inverse relationship between use and perception of acceptability of use from both peers and the general community in which students lived.  Fourteen percent of 10th graders and 27% of 12 graders reported that it would be very easy to obtain cannabis if the wanted to.

 

COVID Student Survey

In 2022, responses to the COVID Student Survey showed that 39.4% of high school students experienced extended periods of sadness and hopelessness and almost 20% reported having seriously considered suicide during the past year. LGBTQIA2S+ youth, disabled youth, and those reporting financial distress reported higher levels of prolonged sadness, suicidal ideation, and lower levels of hope.

 

Conversely, over two-thirds (67.9%) of all high school students reported having at least “moderate” hope. More than half (55.2%) of students reported that their stress was manageable.

 

Only 4.7% of high school students reported past year cigarette use compared to 13.6% who reported past year electronic cigarette use, 19.3% who reported past year alcohol use and 15.2% who reported past year marijuana use.  Overall, past year substance use was more common among students who identified as LGBTQIA2S+, those identifying as having a disability, and those identified as financially distressed.

 

MCHBG Needs Assessment

Respondents to the maternal and child health needs assessment reinforced findings of the youth behavioral health crisis impacting teens and young adults across the nation. Respondents consistently identified clear barriers and needs around youth mental and behavioral health care and support. For example, many shared how young people have difficulty finding medical and behavioral health providers because of the lack of providers (especially in rural areas), but also because the health care system is hard to navigate and needs better coordination, linkages, and referrals.  Respondents also demonstrated there is still a need for providers to provide more and improved screening for mental health and substance use risk when seeing young patients and clients. The MCH needs assessment, combined with data from a number of sources, clearly demonstrates the need for systems-level improvements so that adolescents can access and experience patient-centered medical and mental health care.

 

Other data

Unfortunately, many young people have experienced trauma in their lives. This was true before the pandemic and is even truer now, as we move into after the pandemic. Recent data from the Washington State Healthy Youth Adverse Childhood Experiences Score (2021) found that while youth tended to most frequently report 0-1 adverse childhood experiences (ACEs), many young people are reporting 4 or more: 14.6% of 12th graders, 11.4% of 10th graders, and 12.4% of 8th graders reported four or more ACEs. In addition, trauma-related events impact young people at different rates depending on their socioeconomic and racial/ethnic backgrounds. For example, the same survey shows that lesbian, gay, and bisexual 10th graders were three times more likely to report 4+ ACEs than heterosexual youth, and transgender 10th graders were seven times more likely to report 4+ ACEs than boys. The data varied across race and ethnicity, with Asian/Asian American and white youth reporting the lowest WAH-ACEs scores compared to their peers. Additionally, 10th graders who moved with their families for seasonal, temporary, or agricultural work were more likely (15.0%) than those who didn’t (10.7%) to have WAH-ACEs scores of 4+ or more.

 

State Performance Measure:

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.             

 

Strategies:

• Improve the knowledge and ability of health care professionals to deliver youth-friendly and responsive mental and behavioral health care, screenings, and interventions.
• Promote standardized depression, anxiety, and substance use screening that are youth-friendly and responsive.
• Take action to reduce stigma surrounding adolescent and young adult behavioral health conditions, treatment, and related challenges, and implement trauma-informed services specific to adolescents and young adults in community services and health care systems.
• Expand access to and the quality of behavioral health services in SBHCs. 
• Support efforts to address and mitigate individual and community effects of substance use among adolescents and young adults.  
• Build on efforts to identify the scope of impacts of substance use, including inequities among adolescents and young adults from priority populations. 
• Support interventions to address suicide ideation among youth, especially among those marginalized by mainstream society. 

 

Objectives:

• By September 30, 2025, provide accessible training for adolescent and family health care providers on trauma-informed care, adolescent-friendly services, and discussing sensitive topics.
• By September 30, 2023, conduct an Adolescent Health Provider needs assessment to learn more about provider experiences with behavioral health screenings and risk assessments; by September 30, 2024, follow up on the needs assessment with recommendations and actions for improvement.
• By September 30, 2023, conduct an Adolescent Health needs assessment among youth to learn more about adolescent experiences with medical and behavioral health care; by September 30, 2024, follow up on the needs assessment with recommendations and actions for improvement.
• By September 30, 2023, partner with youth volunteers to develop and implement an adolescent behavioral health awareness campaign using social media.
• Through September 2025, implement efforts to expand trainings to additional adolescent and young adult friendly providers.
• Through September 30, 2025, identify/develop behavioral health interventions for young people based on the ideas and recommendations of the Youth Advisory Council.
• By September 30, 2025, increase the number of school-based health centers with licensed mental health services by 5%.

 

Relevant Activities and Projects:

School-based health centers (SBHCs) will continue to be a key strategy we use to address mental and behavioral health needs of young people. SBHCs provide comprehensive and integrated medical and behavioral health care in settings where young people already spend their time, and where they already have developed relationships with trusted adults. They increase access for all students, including those from low-income backgrounds, as well as improve health outcomes, and as a result, lower health care costs (see McNall et al 2010). Most SBHCs have advanced practice medical providers and mental and behavioral health providers on staff and see students both in person and in telehealth settings.

 

Supporting mental and behavioral health in school settings is an important part of our SBHC Grant Program. Research has shown that SBHCs are an effective tool and strategy to address youth behavioral health needs with trusted providers (see Guo et al, 2010). It is also a consistent recommendation of the Youth Advisory Council. Young people want and need the support of school-based physical and behavioral health professionals who can spend more time to build relationships, answer their young patient’s questions, complete developmental, emotional, behavioral, and sexual health screenings, and provide culturally responsive and age-appropriate care and treatment.

 

Over the next reporting period, we will continue supporting our five behavioral health improvement SBHC grant sites to improve and expand behavioral health access in their school community. We anticipate that SBHC grants sites who are currently in the startup phase at the time of this plan will move into the operations phase, and along with other grant sites, will shift focus of their grant project towards long-term sustainability. 

 

The DOH SBHC team plans to collect information and gather resources, trainings, and support for SBHCs, particularly around behavioral health, reimbursement for services, long-term sustainability, and other school-based health service delivery models. The team also plans to continue convening a Community Advisory Board to inform program priorities and goals.

 

We will also continue to provide training, information, and support on trauma-informed/healing-centered care for SBHC providers and staff, as well as school staff. We will also continue to promote and provide support on behavioral health screening in SBHCs and school settings.

 

YAC: The next reporting period will be the second service year for the second-generation YAC.  During that year, we intend to dig into youth mental and behavioral health, including having topic-specific discussions around youth suicide prevention and youth substance use. Mental and behavioral health is one of the most important topics to YAC members. It’s also a topic shared by a large proportion of YAC applicants as a key issue impacting their community they want to address.  We intend to discuss issues, barriers, and challenges young people experience around behavioral health, as well as youth-friendly solutions. We will continue to collaborate with our partner programs at the agency, including Suicide and Substance Use Prevention in the Injury and Violence Prevention Unit, and Children and Youth with Special Health Care Needs, to plan and facilitate these important discussions with the YAC.

 

Like last year, the findings and recommendations of these discussions will be analyzed and summarized in a final report after the YAC service period has completed (2025). In addition, we will identify activities and actions that we can take in Adolescent Health or in other programs here at DOH. We will continue to expand the YAC’s exposure to the DOH, other state agencies, and youth-serving leaders, policymakers, and organizations in the state.

 

Youth Voice Volunteers: Over the next reporting period we will bring on two new youth voice volunteers to continue helping us with our social media campaigns, including creating a new youth mental and behavioral health campaign to increase awareness and reduce stigma. The goals of these campaigns will be to enhance the knowledge of mental and behavioral health signs and symptoms, resources, and knowledge among young people and their families, to help remove the more ephemeral barriers stigma can create. The Youth Advisory Council has shared that young people want to know specifics about behavioral health, including how to recognize when behaviors are normal and when they aren’t, how to help their friends, where to find support, and how to get support and buy in from parents and the community. In response to the YAC’s feedback, the Youth Volunteers will help us create communications content that addresses some of these topics and requests and provides information to young people and their families to connect them to the many behavioral health resources in the state.

 

New! Adolescent Health Website: The new Adolescent Health Info and Resource Hub website will include a section on youth mental and behavioral health resources and information, as well as how-to guides. This section of the website will be developed with members of the YAC as well as subject matter experts at DOH in Suicide Prevention and Substance Use Prevention, located in the Injury and Violence Prevention Unit. We expect this to be released in 2024.

 

Provider Training and Support: Over the next reporting period, we will plan provider training, support, and technical assistance based on what we learn during the previous reporting period’s engagement and needs assessment activities. We anticipate funding and coordinating training on topics to support adolescent health care providers’ knowledge and practice around behavioral health topics, including behavioral health screening, and trauma-informed and compassionate provider-patient interactions. We will leverage existing external and internal resources to identify and/or develop new training, and when needed, will contract with trusted vendors to develop new training as well. We will collaborate with partners, including providers, to learn more about how providers want training delivered and what they hope to get out of the training. We will also provide continuing education for training whenever possible.

 

Support of DOH Programs: We value the work of our internal colleagues and external partners that furthers collective efforts to create better health care and support systems for young people in the state. We will continue to learn about and align with programming at DOH and other agencies that impacts youth, so we can support the work that is successful, align our work with others, and find new and promising opportunities for relevant collaboration.

 

We will continue to learn from the Washington State Children and Youth Behavioral Health Workgroup. DOH contributed to the development of recommendations on this workgroup, and moved recommendations to action, at our own agency. Recommendations we’ve implemented included trauma-informed care training and education for health care providers (as described above), expanding the behavioral health workforce through the SBHC BH Grant, and supporting and promoting population-level screening for students and strengthening regional response teams.

 

We will continue to support and promote the suicide prevention work carried out by our partners in DOH’s Injury and Violence Prevention unit.  Their work includes contracting with middle schools throughout the state for Sources of Strength; launching the Native and Strong Campaign in partnership with the Health Care Authority; and working with tribal communities to launch the Washington State Indian Behavioral Health Hub. Future work will include reviewing suicide prevention data for adolescents to begin work to tease apart culturally relevant interventions.

 

Priority:

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

Identify and reduce barriers to quality health care.

 

Performance Measures:

• National Performance Measure: Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year.
• ESM 10.1: Increase the percentage of 10th graders in school districts with active DOH-supported interventions who have accessed health care in the past year.

 

Data:

The Washington State Health Care Authority (Medicaid agency) reports that rates of adolescent well-visits among Medicaid clients are down for 2021, and are especially low for people ages 18-20, at only 20%, while those for 12- to 17- year -olds were at 47%.  (HCA Medicaid Maternal and Child Health Data Dashboard).

 

 

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.
• 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.
• Promote school-based health strategies to serve adolescent populations where they are.
• Promote preventive care screening and wellness visits for adolescents and young adults.
• Promote the use of evidence-based practice guidelines, like Bright Futures, among adolescent health providers.
• Conduct needs assessment to identify existing strengths and gaps in data, as well as top barriers for adolescents and young adults in seeking health care services. 
• Identify and develop methods to monitor systems and data gaps and improvements needed in adolescent health.
• Through partnerships, understand and mitigate issues related to financial eligibility for health care and other support services for adolescents and young adults.

 

Objectives:

• By September 30, 2024, discuss key MCHBG topics with the Youth Advisory Council, including challenges, barriers, and youth-friendly solutions on health care access and utilization, youth-friendly services, patient-provider interactions, and well-visits.
• By September 30, 2024, have a sustainable comprehensive sexual health network focused on youth from historically underserved communities.
• By September 30, 2023, partner with youth volunteers to develop and implement social media campaigns on key adolescent health topics.
• By September 30, 2024, award grants to plan, start, and improve school-based health centers throughout Washington, primarily in communities that have been historically underserved.
• 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% of services delivered.  
• By September 30, 2024, create a mechanism to share promising sexual health innovations and begin dissemination. Plan and begin implementation of sustained efforts to improve access to holistic, youth-friendly sexual health care, particularly for youth from historically underserved communities.

 

Relevant Activities and Projects:

SBHCs: Ongoing support of SBHCs through grants, training, and technical assistance is a primary activity we use to address key objectives and strategies to improve equitable and inclusive access to and the quality of adolescent health care. The SBHC Grant Program works to expand and sustain SBHCs throughout the state with funding and activities prioritized in communities historically underserved. As outlined in the law, we continue to support and promote comprehensive and integrated medical and behavioral health care that is age-appropriate, youth-friendly, follows evidence-based recommendations, is community responsive, and is grounded in healing-centered care.

 

During the next reporting period, we expect to continue funding our current 12 SBHC grant sites. We hope planning grant sites will move into startup, resulting in up to five new SBHCs in Washington. We also hope to see startup grants move into more stable operations and shift grant projects to focus on long-term sustainability, community engagement, and the ever-present work of equitable health care. We hope to begin to analyze data collected from previous grant cycles to learn more about the impact of SBHCs and the DOH SBHC grant program.

 

We will support SBHC providers by funding/coordinating training on relevant topics, like youth-friendly care, behavioral health screening, and other topics identified as a need, facilitating Communities of Practice with SBHC Grant sites, and promoting educational webinars and training provided by WASBHA and the National SBHA.

 

In addition, we will participate in workgroups and partnerships to learn more about how to support SBHCs and adolescent and young adult health providers.  We will partner with WASBHA to leverage partnerships with the HCA, the Office of the Insurance Commissioner, and the Medicaid Managed Care Organizations to identify barriers and solutions to long-term sustainability for SBHCs. We will continue to support WASBHA and Public Health – Seattle & King County (PHSKC) to bring a data platform vendor for the SBHCs to access and use to collect and report data. We will determine funding needs for the platform to allow all DOH SBHC grantees to also access the system and to report data to DOH.

 

YAC: We will continue work with the new Youth Advisory Council to learn about the challenges and barriers young people face when trying to access and use health care services, including adolescent well-visits, youth-friendly services, teen dating/violence support, and health care for youth with special health care needs and disabilities. We will organize the information we learn and share with relevant internal and external partners. In addition, we will integrate their ideas and recommendations into our MCHBG strategies to reduce barriers to care for young people. We also hope to finish writing a white paper outlining our YAC process and activities so we can contribute to building the evidence base for youth engagement in public health.

 

Youth Voice Volunteers: During the next reporting period, we will recruit two new volunteers to support our social media and communications work in Adolescent Health. We hope to continue work to expand social media campaigns we’ve already started (including our Well Visit campaign and our Health Literacy Campaign) and help us create new campaigns. In addition, we hope to collaborate with our youth voice volunteers on other communications projects, including the upcoming website and new visual communications materials.

 

New! Adolescent Health Website: We expect to collaborate with both the YAC members and our youth volunteers to steer the website, the resources we include, and the how-to guides we create, as well as devise the name of the website and the overall design and visual style. We will leverage internal partnerships with DOH’s communications and design team, and existing contracts for graphic design and branding based on guidance from our youth partners.

 

Youth-Friendly Certification: Over the next reporting period, we hope to develop and finalize criteria for youth-friendly certification in collaboration with internal and external partners and young people. We also hope to open the certification up to practices and clinics that serve teens and young adults and begin support of providers who want to be more youth-friendly and better serve their young clients. Following the successful kickoff, we will begin looking at impactful incentives to make participation in the program by youth-serving providers easier and more cost-effective. Ultimately the goal of this work is to support adolescent health providers so they can support teens and young adults in the state.

 

As recommended by the YAC, we will continue other efforts to ensure health care is youth-friendly for teens and young adults. This will include collaborating with the Sexual and Reproductive Health Team at DOH and the Health Care Authority and the Office of the Insurance Commissioner to create better mechanisms to protect confidential services and ensure teens and young adults understand their rights related to consent and confidentiality. We will also collaborate with the HCA and identify innovative ways to address ongoing barriers around transportation to and from health care visits for teens and young adults.

 

Adolescent Health Data: Over the next reporting period, we will evaluate the effectiveness and reach of the new Adolescent Health Data Dashboard housed on our Washington Tracking Network (scheduled for release in spring 2023). We hope to learn more about who is accessing the data, identifying new data sources to add and expand the dashboard, and increasing knowledge and awareness of the dashboard as a resource for people in the state. In addition, we hope to continue to learn from data collected through other programs.

 

Teen Pregnancy Prevention (aka WYSHIIN): The WYSHIIN implementation partners will continue refining, evaluating, and disseminating their innovations through December 2023. Partners are participating in four national conferences and will continue strategic dissemination initiatives throughout the final project year. We will continue to collect monthly quantitative performance measures and qualitative process data, in addition to conducting another round of key informant interviews with partners and a sample of youth they have served. These interviews will encourage partners to reflect on their progress toward the key priority area of improving youth experience with and access to sexual health care and collect testimony from youth who can speak to program impact and distal outcomes. By October 2023, we will begin work on our Innovation Network Promotion Package, a final report showcasing all WYSHIIN-developed innovations, to be completed by March 2024. We will create this Promotion Package using StoryMaps, a web-based application that allows users to share maps in the context of narrative text and other multimedia content. This platform will enable our team to use digital storytelling and present WYSHIIN products in a way that feels most relevant to our partners while meeting all grant requirements. The Promotion Package will be disseminated publicly via WAPortal and to all key partners to promote promising WYSHIIN innovations.

 

The 2022 Washington Youth Sexual Health (WYSH) Survey remains open to obtain as large a sample size as possible. WYSH Survey findings, partners’ monthly and semi-annual reports, key informant interview data, and recommendations from our Youth Advisory Council will all be synthesized to inform next steps for sustainability of the Network, as well as the Adolescent Health Unit’s overall strategy to improve sexual and reproductive health among WA youth, and especially historically marginalized youth.

 

WA PREP works with schools, juvenile rehabilitation facilities, and youth-serving agencies statewide to implement sexual health education effective in reducing adolescent pregnancy, sexually transmitted diseases, and HIV. Programs teach abstinence, contraception, and condom use, as well as adult preparation topics, including parent/child communication, healthy relationships, and healthy life skills. WA PREP teaches youth ages 10 - 21 with age-appropriate and culturally relevant curricula for the groups and communities where they are implemented.  WA PREP 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.  For more information on the state's comprehensive sexual health education law, see RCW 28A.300.475: Comprehensive sexual health education (wa.gov). 

 

Family Planning/Sexual and Reproductive Health: Over the next reporting period, we will strengthen our partnership with the Sexual and Reproductive Health Team through collaboration and partnership on several projects. This includes collaborating on sexual and reproductive health discussions with the YAC, partnering with other state agencies to strengthen confidentiality for minors’ health care services, and developing content for the sexual and reproductive health section of the new adolescent health website.

 

Priority:

Improve the safety, health, and supportiveness of communities.

SPM:

Adolescents reporting at least one adult mentor.

Data:

HYS data on bullying, violence, sexual assault.  

HYS data show interpersonal violence, including bullying, is an issue for young people in Washington. In 2021, occurrences of bullying in the previous 30 days were reported by 21% of students in the Healthy Youth Survey across all surveyed grades. Among 10th graders, individuals who identified as either gay or lesbian or as bisexual were much more likely to have reported as having been bullied, 24% and 23% vs. 10% respectively.   

 

Interpersonal violence in the past 12 months among dating couples was reported at about 7% across 8th, 10th, and 12th grades. Individuals not identifying as heterosexual were twice as likely to have experienced partner violence in the preceding year, 10% vs. 5%.  

 

Strategies:

• Support violence prevention efforts and promote healthy relationships among adolescents and young adults.  
• Build networks and resources in communities to enable and enhance community and peer support.
• Align violence prevention efforts with partners, including DOH Injury and Violence Prevention and the Office of the Superintendent of Public Instruction (OSPI)

 

Objectives:

• 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% (from 9.5% to 8.5%).
• By September 30, 2025, discuss teen dating and violence with the Youth Advisory Council to learn more about their thoughts on how to improve support for young people to engage in healthy relationships.
• By September 30, 2025, continue to promote resources and information about, and support projects that promote healthy relationships for young people.
• By September 30, 2025, continue to work to align and support violence prevention efforts with partners, including DOH Injury and Violence Prevention and the Office of the Superintendent of Public Instruction (OSPI). 
• By September 30, 2025, continue to participate in and contribute to relevant internal and external workgroups that support the safety of young people to align efforts with agency partners.

 

Relevant Activities and Projects:

We will continue working with partners to support efforts to promote healthy relationships among youth in our state, especially those led by our partners in Injury and Violence Prevention.

 

Support of providers: We will continue to support providers to support their young patients to engage in healthy and appropriate sexual relationships. This includes providing access to training to SBHCs like “In Their Shoes”, a teen dating violence experience training developed by the Washington Coalition Against Domestic Violence, and to develop new trainings to better support providers in identifying and intervening in teen dating violence.

 

Support and promotion of partner programs: We will continue to support our colleagues in Injury and Violence Prevention to support young people’s access to information, programming, and support to engage in healthy and appropriate sexual relationships. This includes supporting projects like the Rape Prevention Education (RPE) collaboration between OSPI and DOH. This project is a peer-based education that focuses on consent. We will also continue to partner with the Sexual Health Education Team at OSPI to ensure medically accurate and age-appropriate Comprehensive Sexual Health Education is delivered to teens in public schools and contribute to other violence prevention activities.