By Patty McGrew
Director - Office of Maternal, Child and Family Health’s Adolescent Health Initiative, West Virginia Department of Health and Human Resources
The West Virginia Adolescent Health Initiative (AHI) began in 1988 with a state project director and a team of eight teen pregnancy prevention specialists. Extensive research into the concept of positive youth development steered the program toward a more holistic approach in 1993. Today, the AHI still funds a dedicated network of eight regional adolescent health coordinators (AHCs) who engage individuals, organizations and the community to address negative health impacts and create a supportive environment in which adolescents can thrive.
The transformation of the Title V Maternal and Child Health Services Block Grant (aka MCH 3.0) in 2015 brought about more changes for the AHI program with the implementation of specific, strategic focal areas. Some, like improving the rate of adolescent well-visits, were new territory for AHI. Data about well-visits were limited. Program staff decided the best way to learn what barriers existed or what services were needed by West Virginia youth and their parents was to ask them.
Throughout the 2016 fiscal year, the AHI focused on obtaining statewide input from youth and parents to guide program efforts in order to increase adolescent well-visits and decrease bullying (particularly cyberbullying). Adolescent and parent survey tools were developed based on feedback from four youth test groups. Surveys were distributed during community-based focus groups across the state, where the regional AHCs discussed the surveys with participants, obtained feedback, provided information and answered participant questions. Focus groups were conducted at schools, churches, housing authorities, malls, various youth groups (Students Against Destructive Decisions (SADD), Gay-Straight Alliance Clubs, Boys and Girls Clubs, etc.) and even professional meetings – basically, anywhere there was a captive audience. The survey tools were also made available online via Survey Monkey and distributed via social media, newsletters and email.
The number of responses exceeded expectations. In total, 1,450 parents and 3,131 youth responded to the surveys. When asked what would help with the problem of bullying, 53 percent of youth responded, “If more teens knew how to stop a bullying situation without getting into a fight or becoming a target themselves.” Fifty-two percent responded, “If more teens had a trusted adult they could be open and honest with,” and 46 percent responded, “If [their] community or society in general realized true bullying is a problem and not just part of growing up.” Many youth expressed frustration with adults not listening to them or taking them seriously. Comments included:
“Adults seem to think that bullying is only as bad as it was when they were kids, but it is way worse.”
“It would be nice if parents, adults and teachers would take bullying seriously. It isn't a joke. We know the difference between friends kidding and actually being bullied. STOP treating us like we don’t!”
“I have been bullied a lot – face to face and on social media. I talked to a lot of adults [who] did not help me. I even wanted to die it was so bad.”
Not surprisingly, when asked what form of bullying was the biggest or most common problem, 54 percent of youth identified social (also called relational) as the biggest problem versus verbal (36 percent) or physical (10 percent). Parents differed slightly identifying verbal (46 percent) as the greatest, with social (42 percent) closely behind.
On the well-visit surveys, parents expressed confusion about adolescent well-visits versus an annual sports physical: “I thought my son had a well-visit, but I learned today that’s not what it was.” Both youth and parents also listed affordability as a barrier (16 percent for both groups). Also high among the parents’ concerns were convenience, namely office hours, missed time from work/school and travel time. Most youth (58 percent) stated they did not feel it was important to go to the doctor when they weren’t sick. Youth offered (sometimes humorous) suggestions for increasing awareness on the importance of well-visits:
“How about a health event [with] famous people there like dirt bike riders!”
Youth were very vocal about the “awkwardness” of visiting a “baby doctor” and how uncomfortable they felt:
“In the waiting room, do not let it just be quiet and awkward [with] everybody staring at each other.”
“I would like the doctor a lot better if the office had Wi-Fi and less little kids’ shows.”
“How about snacks and comfortable chairs – like bean bag chairs!”
“I’d go if I wasn’t afraid to see my weight.”
Parents spoke highly of School Based Health Centers and said more were needed. Parents and youth stated transportation was a barrier, particularly in rural areas. Both parents and youth expressed confidentiality concerns: Youth did not want parents in the exam room, and parents were concerned about staff (particularly in small communities) revealing health information to friends and neighbors.
The data has not only guided the program but also the work of our partners. The well-child data has been shared at state and regional meetings and presented at the West Virginia Department of Education’s annual Kid Strong Conference. These conversations have paved the way for many projects and opportunities in the coming year. Most notably, data from the bullying surveys will be used by SADD Chapters across West Virginia to develop a media campaign. The campaign will launch at the annual state conference in November and will continue throughout the year. However, finding a famous dirt bike rider has proven to be a bit more challenging.