For this issue's CoIIN Corner, we asked our state teams to share how they have implemented training-related activities as a part of their strategies for improving access to and quality of the Adolescent well visit. Read on to see how Maryland, Minnesota, and New Jersey responded:
The purpose of the Maryland AYAH CoIIN Quality Improvement (QI) project is to improve preventive services delivered at the selected clinical demonstration site by implementation of an evidence-based practice model. Substance use is a leading cause of adolescent morbidity and mortality, and within pediatrics there is an unmet need for increased recognition and treatment of substance use disorders. The QI project is thus focused on "Screening, Brief Intervention, and Referral to Treatment" (SBIRT), an evidence-based model of screening and early intervention for adolescent substance use, with a goal of filling this unmet need. This comprehensive model is recommended by the Substance Abuse and Mental Health Services Administration and the American Academy of Pediatrics, with a goal of increased substance use screening and intervention in the adolescent population.
The QI project was designed and is being implemented by a team of faculty and fellows from the Johns Hopkins Leadership Education in Adolescent Health (LEAH) program: Dr. Maria Trent, Dr. Hoover Adger, Dr. Rachel Alinsky, and Kayla Percy NP, in collaboration with Dr. Diana Fertsch of Dundalk Pediatric Associates and immediate past-president of the Maryland Chapter of the American Academy of Pediatrics. Dundalk Pediatric Associates was chosen as the clinical demonstration site as it is a large pediatric practice located in Baltimore County that serves a diverse patient population and has a high Medicaid payer mix. It is operated by pediatric clinical providers across disciplines: physicians, physician assistants, and nurse practitioners.
Utilizing the "Plan/Do/Study/Act" approach, the QI project began with a baseline needs assessment and provider survey which is being used to guide the educational content and provide support to the pediatric providers over a six-month window. The Hopkins staff conducted a training session for the Dundalk providers regarding an overview of adolescent substance use and substance use disorders, as well as guidance on how to perform motivational interviewing. Utilization of the screening tool was explored in depth during this training session, with case examples of how to respond to and provide "brief intervention" or "referral to treatment" to those adolescents in need. The providers have since integrated this screening tool into their clinical workflow. Following the completion of this first phase, chart review data and provider input will again be collected and studied in order to inform the phase two training session; this training will delve deeper into motivational interviewing and brief intervention. Technical support will be provided to the office-based staff throughout, and the project will conclude with a final analysis and discussion of best practices for continuation of SBIRT.
This project will ideally serve as a model of best practices for integration of SBIRT into pediatric primary care practices throughout Maryland.
In March, we hosted a retreat for our AYA consultants where we introduced the Sparks trainings created by the University of Michigan Adolescent Health Initiative. These youth-friendliness trainings for clinicians and clinic staff take only 20 minutes to present. Each training is followed up with Spark materials to keep the topic and conversation going within the clinic supporting what was learned during the training. The AYA consultants will continue presenting trainings to the staff of our clinic partners in pairs over the next month. The topics include: Nonverbal Communication Bias, Being Youth-Friendly, Strengths-Based Approaches to Adolescent Sexual Health, and Being an Askable Adult. We will be evaluating the trainings with a brief survey of staff to determine the effectiveness of this training modules and to decide if we should continue to provide Sparks trainings moving forward.
In August of 2017 NJDOH partnered with Wyman Center to provide a two-day summer institute for adult providers and youth to focus on youth adult partnerships and collaboration. This training was a joint project between the NJ PREP, Title V, and AYAH-CoIIN projects and included a full day of training for adult providers followed by a full day of training for youth and adults. The rationale for the training was to highlight the importance of meaningful youth engagement and youth adult partnerships.
Through discussion with grantees, we determined there was varying degrees of youth engagement and skill to engage youth among providers. This training was designed to provide an overview and an opportunity to actively engage with youth and practice engagement skills. During day one, providers were given an overview of youth development with components of social and emotional learning, adolescent brain development, and effective youth adult partnerships. The training was interactive and informative and provided a foundation for which providers could begin to build or enhance their skills to actively engage youth. On day two, youth from our programs joined the training and participated in a variety of engagement activities with adults. The youth were in groups consisting of peers and adults. Activities focused on communication, partnering, and problem solving. The day concluded with an activity in which teams of adults and youth discussed an issue in their community and completed a web analysis of root causes and possible solutions. This was the first day of New Jersey's statewide youth engagement initiative and the start of what is now 12 youth advisory boards across the state. Each board is comprised of 5-10 youth who will convene again with their adult advisors on July 2 for a Youth Leadership Summit at Brookdale College and the first official meeting of the New Jersey State Youth Advisory Board. The topic of this first meeting is "A Discussion of Teen Health and Wellness in New Jersey: Nothing About Us Without Us."