Julie Neitzel Carr
National Network of State Adolescent Health Coordinators
Minnesota State Adolescent Health Coordinator
State Adolescent Health Resource Center
The state adolescent health coordinator (AHC) position has formally been part of the maternal and child health (MCH) system since the early-1970s. The position is not well understood and often vaguely defined. Yet, most state and territorial public health departments have supported an AHC over the past 20 to 30 years.
The foundation for this critical position started when the U.S. Bureau of Community Health Services first recognized adolescents' unique characteristics, and need for organized health services in the 1975 publication, Approaches to Adolescent Health Care in the 1970s. It highlighted scattered, fragmented, and uncoordinated services, health problems evident at increasingly early ages, and the need for effective preventive measures and health education. In 1986, the national Health Futures of Adolescents conference established a 15-year blueprint for U.S. adolescent services, research, and training. One of the 10 recommendations was to engage an AHC within each state/territorial MCH program and create an interagency adolescent health task force.
Title V programs responded! In the early 1980s, AHCs emerged in the Colorado, Arizona, and New Mexico MCH programs. The U.S. Maternal and Child Health Bureau (MCHB) conducted the first AHC meeting in 1988 and 33 Title V programs had AHC positions by 1989. These positions were funded almost exclusively through the MCH Title V Block Grant. To support this trend, MCHB awarded SPRANS to eight MCH programs grants in 1992-1997 to start AHC positions. Finally, AHCs banded together in the early 1990s to create the National Network of State Adolescent Health Coordinators (NNSAHC). NNSAHC provided networking and professional growth opportunities in addition to advocating nationally for state adolescent health needs.
Today, 86 percent of Title V programs have an AHC who address the needs of young people ages 10 to 24. Yet these positions have changed over time. Many have moved away from a full time focus on adolescents and have other job responsibilities. Based on ongoing AHC surveys, it's estimated that one-third of AHCs address adolescent health full time and another 25 percent are able to attend to youth issues minimally (for 10 to 20 percent of their time). A majority (89 percent) are located in Title V programs but only 41 percent are funded entirely by Title V Block Grant, while 26 percent are funded exclusively with other funding sources. These sources include Personal Responsibility Education Program (PREP), State Sexual Risk Avoidance Education Program (SRAE), Title X family planning, and state general funds. Finally, while 30 percent have been on the job for six years or more, 25 percent of these positions turn over annually.
AHCs have unique positions and differing roles based on the needs and resources of their state or territory. Some focus full time on coordinating/aligning adolescent health efforts and building workforce capacity (e.g., training!), while others address specific youth health issues. The most common issues are teen pregnancy prevention, sexual/reproductive health and sexual violence; suicide, bullying, and injury prevention; supporting school-based health centers; and improving health care quality and access for young people. AHCs use a strengths-based positive youth development framework to guide their work and 85 percent engage young people as leaders in some way. Youth engagement includes supervising adolescent or young adult staff, managing youth advisory councils, and/or supporting grantees to partner with young people.
AHCs bring real value to Title V programs. For example, the following accomplishments were highlighted in the 2019 AHC Survey:
- Supporting a network of regional AHCs working within local communities.
- Expanding and enhancing school-based health centers.
- Guiding clinics to conduct youth-led clinic assessments and certifying clinics as youth friendly.
- Adapting a health care literacy curriculum to help young people learn how to manage their health.
- Piloting a young adult survey.
- Creating an Adolescent Health Snapshot (a data-sharing tool that uses survey data and ties outcomes to policy).
- Engaging young people to tell their stories and make a difference through youth advisory councils across the state/territory.
- Partnering to conduct youth-driven social media campaigns.
- Creating conversation starter cards that engage parents, adults and young people in discussions about life issues.
- Implementing mentoring programs.
- Weaving trauma-informed-strategies into youth health initiatives.
- Bridging and aligning youth-focused efforts across state health departments.
- Raising awareness of young adult health needs.
The greatest value AHCs bring is to ensure that youth-focused programs in the MCH field do the right things (evidence-based strategies) the right way (designed for adolescents and young adults). They do this by building the capacity and skills of MCH colleagues and partners to effectively address the needs of young people. They support young people's parents and caregivers, and help young people get involved and make a difference.
Now is the time to take stock of your AHC position and its integration within the MCH program. If you're interested in finding ways to start, build, refine, expand, and/or refocus this critical role, contact Kristin Teipel at the State Adolescent Health Resource Center (part of the National Adolescent & Young Adult Health Resource Center) at email@example.com, and explore the state-created resources on the NNSAHC website.