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#ScreenToInterveneForAYAs: Adolescent and Young Adult Behavioral Health Blog


Welcome to the #ScreenToInterveneForAYAs Adolescent and Young Adult Behavioral Health Blog!  Supported by the Adolescent and Young Adult Health National Resource Center,*  this is a space for state Title V maternal and child health professionals and their partners to learn about efforts to build better preventive care systems for optimal adolescent and young adult wellbeing across the country. As you navigate this site, you’ll see short posts that include food for thought, resources, reflections, and stories related to the work being done by Title V to support optimal emotional wellness among AYAs.  Please feel free to share your reactions, ideas, and feelings by tweeting us (@AMCHP_GrowingUp) and using the hashtag, #ScreenToInterveneForAYAs. 

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If you’d like to submit a post, please contact Anna Corona (acorona@amchp.org) to have your writing featured!

  
Picture Placeholder: Anna Corona
  • Anna Corona
08/25/2021 10:19 AM

Recently, several members of AMCHP's Youth Voice Amplified Committee as well as several state Title V Maternal and Child Health (MCH) program staff convened virtually to envision what it would look like for adolescents and young adults (AYAs) to have equitable access to high-quality mental health supports. Much of the dialogue centered around re-thinking the ways in which we provide mental health support for young people to ensure they are receiving care when and how they want it. Below are some of the key concepts and specific strategies that were elevated to help create more equitable systems of mental health supports, as well as the role that MCH programs can play in affecting change:

  • Prioritize and support community-centered mental health supports. For a helpful framework on how to conceptualize and implement community-centered mental health supports, check out Mental Health America's Strength in Communities Toolkit, which highlights alternative mental health supports created by Black, Indigenous, and People of Color (BIPOC) for BIPOC. This framework highlights three approaches: community care, self-directed care, and culturally-based practices. MCH programs can work to identify community-based organizations (CBOs) that are led by young people most impacted by inequities in access to high quality mental health supports. Once identified, MCH programs can strategize on how to respectfully build authentic partnerships that center the needs of CBOs in determining how MCH programs can support their efforts.

  • Move upstream. While screening is an important component of identifying mental health concerns early, it is critical that MCH programs integrate long-term strategies to prevent mental health concerns in the first place. Several meeting attendees cited the importance of schools as a setting that provides many of the supports that have been shown to promote optimal mental health among young people, such as: connection with peers, participation in athletics, connection with employment opportunities, and involvement in clubs and activities.[1] MCH programs might consider building meaningful partnerships with school systems to understand how best to support the creation and/or sustainability of spaces and opportunities for young people to participate in the activities listed. Similarly, supporting schools to create spaces free of bullying was elevated as key to promoting good mental health.

Equity in accessing mental health supports requires thinking through how we provide support outside of our traditional medical system. There are several strategies we currently have in place for supporting mental health to consider as we navigate the medical system:

  • Eliminate late and no-show fees for missed appointments. At the start of the meeting, a member of AMCHP's Youth Voice Amplified Committee shared their personal experience with the challenges they faced in accessing mental health care when they needed it. They described difficulties accessing transportation to get to appointments and finding ways to pay for expensive treatment. Charging late and missed appointment fees piles on to financial burdens, exacerbates inequities in access to mental health care, and prevents young people from accessing the care they need.

  • Cultivate a mental health workforce that is reflective of those accessing or needing support. Research has shown that patients experience higher quality care and improved outcomes when they receive care from providers that are culturally congruent (meaning that the provider reflects the patient's culture and applies evidence-based practices that are in alignment with the preferred cultural values, beliefs, worldview, and practices of the patient[2]). There are many resources available that assist providers in improving behavioral health care for identities that have been marginalized. One such resource is the Center of Excellence for LGBTQ+ Behavioral Health Equity which provides behavioral health practitioners with vital information on supporting the population of people identifying as lesbian, gay, bisexual, transgender, queer, questioning, intersex, two-spirit, and other diverse sexual orientations, gender identities and expressions.

  • Consider if traditional primary care clinics are the most inclusive spaces for AYAs who seek mental health support. Imagine being 12-18 years old and sitting in a pediatric waiting room surrounded by infants, toddlers, and young children that are 10-15 years younger than you are. Alternatively, imagine being a young adult in a primary care waiting room surrounded by much older and elderly adults. It doesn't take a stretch of the imagination to conclude that it might be hard to feel like you belong in these settings. Creating clinical spaces that are AYA-friendly can go a long way in creating a sense of belonging in these spaces. MCH programs can promote the Adolescent Health Initiative's Youth-Led Health Center Assessment Tool with their clinical partners to identify practical ways that clinics can create environments that are welcoming to AYAs. 

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[1] Youth.Gov. Risk and Protective Factors. Accessed August 20, 2021 from https://youth.gov/youth-topics/youth-mental-health/risk-and-protective-factors-youth

[2]Marion, L., Douglas, M., Lavin, M., Barr, N., Gazaway, S., Thomas, L., Bickford, C., (November 18, 2016) "Implementing the New ANA Standard 8: Culturally Congruent Practice" OJIN: The Online Journal of Issues in Nursing Vol. 22 No. 1.

8/25/2021 10:19 AMNo
  
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  • Anna Corona
07/29/2021 9:16 AM

​Earlier this month, the Adolescent & Young Adult Health National Resource Center hosted a virtual meeting to kick-off an 18-month learning collaborative which aims to improve access to depression screenings with linkage to high quality, culturally appropriate treatment if the screen is positive. The newest cohort is made up of five interdisciplinary teams in Arizona, California, Iowa, Ohio, and Pennsylvania, with each team led by the state's Title V maternal & child health (MCH) program. The kick-off meeting provided an expanded orientation to the overall project goal using a systems- and policy-level approach and provided foundational knowledge on strategies that can be implemented to achieve the project aim. There were two panels featuring youth and adult experts that discussed the importance of identity in mental health outcomes for AYAs and strategies for reaching AYAs in the changing landscape of mental health care during the time of COVID (click the links to access recordings of the panels). Check out the table below to learn more about how each of the five participating state team MCH action plans prioritize AYA mental health.

StateRelated Title V Priority Related State FY21 MCH Action Plan Objective 
ArizonaEnhance equitable and optimal initiatives that positively impact the emotional, physical, and social wellbeing of adolescentsDecrease the bullying rate (victimization) by 10%
CaliforniaEnhance strengths, skills and supports to promote positive development and ensure youth are healthy and thriveBy 2025, increase the percent of adolescents aged 12-17 who have an adult in their lives with whom they can talk to about serious problems from 77.2% to 79.7%
IowaImprove access to care for the Maternal, Child, and Adolescent Health PopulationBy 2025, decease the percent of adolescents who report that during the past 12 months they have felt so sad or hopeless almost every day for 2 weeks or more in a row that they stopped doing some usual activities to 23.5%
OhioIncrease protective factors and improve systems to reduce risk factors associated with the prevalence of adolescent substance useBy 2025, increase coordination and capacity of state and local partnership to support adolescent mental health and reduce adolescent substance use, including tobacco use
PennsylvaniaImprove mental health, behavioral health and developmental outcomes for child and youth with and without special health care needsAnnually increase the number of community-based organization staff trained in bullying awareness prevention program by 5% each year

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Honoring BIPOC Mental Health Month – Important Resources for Title V Programs and their Partners

A major theme throughout the learning collaborative kick-off meeting was the importance of honoring, centering, and acknowledging identity as an essential practice in the provision of high-quality mental health care for AYAs. To emphasize this importance, we recommend that our readers take a moment to learn more about Black, Indigenous, People of Color (BIPOC) Mental Health Month, which was created to increase awareness of the unique mental health challenges that BIPOC individuals living in the United States face (Mental Health America, 2021). The theme of this year's observance is "Strength in Communities" and aims to elevate alternative mental health supports created by BIPOC and queer and trans BIPOC (QTBIPOC), for BIPOC and QTBIPOC (Mental Health America, 2021). As such, Mental Health America released a toolkit titled, "Strength in Communities" that lifts up three approaches to alternative mental health supports: community care, self-directed care, and culturally-based practices. The toolkit offers definitions, background information, and practical examples of each approach (on the tables found on pages 11-12 and 14). The resource concludes with a call to action of "What Can You Do" (pg. 17) and includes a list of resources and tools (pgs. 18-20) that are thoughtfully curated to improve mental health systems so they can be more inclusive and supportive of various identities.

7/29/2021 9:16 AMNo
  
Picture Placeholder: Anna Corona
  • Anna Corona
05/6/2021 2:10 PM

​May 1st marked the start of the annual observance of Mental Health Month and celebration of Asian/Pacific American Heritage Month. We wanted to take this opportunity to elevate the unique mental health needs of young Asian American and Pacific Islander (AAPI) communities. We invited Jaclyn Dean, Policy and Government Affairs Director of the National Asian Pacific American Women's Forum, to discuss the prevalence of mental health conditions among AAPI adolescents and young adults (AYAs), the impact of the recent resurgence of violence against AAPI communities, and strategies that MCH professionals can implement to support the mental health of AAPI AYAs. We are grateful to Jaclyn for sharing her time and expertise with us.

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Jaclyn Dean, Policy and Government Affairs Director of the National Asian Pacific American Women’s Forum (left) and Maura Leahy, Program Analyst, Child & Adolescent Health at AMCHP (right)

Maura Leahy (AMCHP): Many of us may not be familiar with the prevalence of mental health conditions of AAPIs. Could you give our readers a little background to mental health in AAPI and the prevalence of mental health conditions or behaviors among AAPI AYAs?

Jaclyn Dean (NAPAWF): I think the most important thing to realize is that there is just not a lot of data about us. When data is collected on our communities, it's not done very thoroughly and it's not disaggregated in the way that we would like.

We do know that among Asian Americans ages 15 to 24, suicide was the leading cause of death and Asian American females in grades 9-12 were 20% more likely to attempt suicide compared to their non-Hispanic white peers. Asian American adolescents and younger women also experience higher rates of major depressive disorder than their peers. There has also been a little bit of research that shows that Asians are the least likely of any racial group to seek mental health resources. Only 43.9% of Asian American adults who experienced a major depressive episode received treatment, far less than the about 69% of white adults.

All of these statistics overlap and coincide with each other and I think for many people, that can be really surprising. When you think of Asian Americans or Pacific Islanders, or what the media tells us and a lot of the stereotypes and norms we've grown up with, you think of this high achieving, more economically and socially successful group of people, this "model minority" myth that has kind of culturally become acceptable even though it really masks a lot of the issues and struggles that we face, especially when it comes to mental health. So mental health issues are very prevalent, but mental health is just not really talked about and it's not very visible to people outside of our community and sometimes even within our own community itself.

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Maura: Thanks for sharing these statistics, Jaclyn. I agree that some of our readers might be surprised by these numbers especially given the prevalence of the model minority myth. Could you talk a little more about some unique challenges and barriers AAPI AYAs may face around their mental health?

Jaclyn: I think the thing that stands out to me the most, one common experience that lots of us have – and this is speaking from my personal experience so note that AAPIs have many very different experiences across the U.S. – is that most of us are either immigrants or children of immigrants. What comes with that is you are straddling two different cultures and you know that what you're taught at home might be very different from what you're taught in schools, and the themes that you see on TV or in the media may be very different from whatever cultures or ethics you're taught at home. Themes like the acceptance of LGBTQ identity, sexuality, or even a lot of social norms can be really difficult for AAPI youth to have to navigate.

I think that has a lot of implications for mental health that people may not realize. I can imagine that it is something that has become more normal for people to recognize as something that's different among AAPI youth, but it definitely shows up in a lot of different ways. All of this is compounded by what I talked about earlier: lack of visibility in our communities and lack of data.

There is a lot to say about just growing up in an immigrant household, but I think immigration itself has an effect on mental health. Actually being separated by your parents at the border is not as prevalent among AAPI youth but many have to deal with a lot of immigration issues, especially if your parents are undocumented and you have to act a certain way or hide certain things about your family – that has a huge toll on mental health. Many Asian American families, specifically Southeast Asians, have had family members deported in the last administration and could potentially be deported in this administration as well and that is just another form of family separation that can take a huge toll on mental health – growing up without a parent or family member and having to navigate immigration enforcement.

Another thing is that mental health is not something that is really talked about in our communities. It is not something that is seen as an issue that really needs to be addressed. A lot of times it could be things like "Oh, you're sad but pick up the work," this immigrant mentality of just putting your head down and working hard. Many of our parents and grandparents had to cross oceans just to make ends meet. Maybe they had depression, but they didn't label it as such--for them it was just survival. Growing up, a lot of our family, friends, and my community thought depression and mental health disorders aren't conditions that are treated like physical health. I think that is true outside of the AAPI community as well, but I think especially for our community. Mental health is not something that is in the lexicon of Asian cultures – I personally do not even know what that translates into in Mandarin Chinese.

I think all of that combined means that there is a lot of repression and lots of unlearning that needs to be done about what health is and how mental health plays into that and giving it attention and acknowledgement from a young age, especially within immigrant or AAPI families.

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Maura: 2020 was an extremely challenging year for everyone with the COVID pandemic, but we also witnessed (and are still witnessing) violence and discrimination against AAPIs in the United States. Can you speak to some additional challenges of what it's been like for AAPIs during these already trying times and how this might impact AAPI AYA mental health? How might these manifest or persist for AAPI AYAs after the pandemic is over?

Jaclyn: We actually released some new polling a few weeks ago that had a lot of specific questions about how AAPI women experienced racism and violence, especially in the last year during open but also generally. This poll found that in the past two years, even before the onset of the pandemic, 78% of AAPI women had been affected by anti-Asian racism and nearly one third said that the COVID-19 pandemic had an impact on their mental health.

Many of us AAPI women can talk about this compounded racial and sexist violence, this effect of racial misogyny on our ability to just be out in public and feel safe in public that has a toll on our mental health. This is something that a lot of Asian women grow up with and experience from adolescence, from being asked in school "what are you?" and then having a lot of sexual harassment also be about our race. Being an Asian women, I think this is something that we've all experienced at some point in our lives and it's only become a lot more clear to others in the two last months especially since the Atlanta shootings. But this hasn't been new for a lot of us.

Queer, young people of color have also experienced this kind of harassment that is not just based on their gender but also their race. One study showed that 45% of black, 49% of AAPI, 54% of Latinx, and 65% of indigenous LGBTQ youth reported feeling unsafe at school based on their sexual orientation. Those are really large and concerning numbers for queer people of color feeling safe in school. A lot of times they're discouraged from reporting that. A lot of our schools also don't have the resources or the kind of support for addressing racial violence or sexual violence, and racialized sexual violence together can be difficult in some settings. I think especially in the Asian community, there is a belief that if you report something, nothing is really going to happen anyway. And again, it goes back to that mentality where it's just easier to put your head down and continue on.

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Maura: What suggestions would you have for Title V and youth-serving professionals working with AAPI AYAs and what MCH can do to prioritize AAPI AYA mental health? What organizations or resources would you recommend to someone wanting to educate themselves?

Jaclyn: I think the most important thing is to increase access to culturally and linguistically appropriate care. This means not just improving language and interpretation services, but also the ability for staff and people who are serving AAPI youth and AAPI people to be able to have a better understanding of the culture in which they come from and to be able to talk to them in a way that looks at their health within the context of their entire lives and to think about the cultural background that may make their experience different from somebody else's. A lot of times this might include trainings; it's also about hiring and building a pipeline for more AAPIs or people of color in these types of professions. There is a huge difference in walking into a clinic and being seen by somebody who looks like you. Culturally appropriate care is especially important for immigrant communities and for those who are facing violence or harassment in their homes. That extra layer of understanding and support can go a really long way.

Another thing is to do away with the model minority myth. A lot of AAPIs are low wage workers and AAPI women are actually overrepresented in the low wage workforce and the frontline workforce. It's important to keep that in mind when serving patients and addressing a lot of these psychological outcomes of racism.

We also really need a lot more data on AAPIs, and especially on queer youth and on AAPI youth from different backgrounds and low incomes. Disaggregating this data means that it has to be disaggregated by ethnicity, so I as a Taiwanese American woman may have a very different experience from a Cambodian woman who may have a very different experience from a Fijian woman. We have to disaggregate this data in order to see the full picture of AAPIs and not just take whatever aggregate or average term for at face value. That data also needs to be cross tabulated and further broken down by sexual orientation and immigration status, a lot of these other factors that are really important factors in health outcomes that we might overlook.

There aren't really any AAPI organizations that are focusing solely on mental health since there aren't that many AAPI organizations to begin with and then we're all stretched across these various different issues. I would definitely recommend looking at the Association of Asian Pacific Community Health Organizations. They represent many community health organizations that primarily serve the AAPI community and are a great resource into learning more about what culturally competent and linguistically appropriate care looks like, what that means in certain contexts, and follow the lead of these community health centers who are working on the ground directly in these communities that serve AAPI youth, especially when it comes to mental health. The National Federation of Filipino American Associations promotes the welfare and well-being of Filipino Americans through leadership development, civic engagement, advocacy, and providing resources to facilitate their empowerment. The Asian Pacific Islander American Health Forum does health care advocacy broadly and are a great resource in learning about the health of AAPIs.  I would also recommend Empowering Pacific Islander Communities. They are specifically focused on the Pacific Islander community in general and the various host of issues that they face, such as the long lasting impacts U.S. militarism has had on Pacific Islanders and their livelihoods generally.

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If you or someone you know is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit their webpage to chat with someone online.

5/6/2021 2:10 PMNo
  
Picture Placeholder: Anna Corona
  • Anna Corona
04/28/2021 9:54 AM

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We're excited to present this blog entry as we approach Mental Health Awareness Month in May. Here at the Adolescent & Young Adult Health National Resource Center (AYAH-NRC), we have a lot to learn from this community of adolescent health champions. We also have a lot to offer partners like you, such as:

  • Outreach to the state Maternal and Child Health (MCH) workforce and their colleagues based on adolescent and young adult (AYA) priorities identified in Title V Needs Assessments.
  • Responsive training and technical assistance to states ranging from topical learning communities and webinars to mentor "matchmaking" to long-term project consulting.
  • Support with continuous quality improvement measurement.
  • Translation of new research into best practice recommendations and other communications (including this blog!)

Recent resources, for example, include:

  • A report highlighting mental health interventions for college-aged young adults, from our partners at Young Invincibles.
  • Information and resources available on our behavioral health quality improvement project (using the Collaborative Improvement and Innovation Network or "CoIIN" model) including several webinars.

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"What is AYAH-NRC in the vast national landscape of adolescent health funders and practitioners?"

We thought you'd never ask. The AYAH-NRC ("The Center") is basically a national-level adolescent health collaborative in the U.S. Each of our four partners that make up The Center bring complementary expertise and relationships. The Center is a partnership of the National Adolescent Health Information Center (University of California San Francisco), the Association for Maternal and Child Health Programs, the National Improvement Partnership Network (University of Vermont), and the State Adolescent Health Resource Center (University of Minnesota).

We joined forces in 2014 to improve the health of adolescents and young adults (AYAs) by strengthening the capacity of State Title V MCH Programs and partners to address the needs of AYAs (ages 10-25), specifically increasing receipt of a quality annual well visit (or "preventive visit" or "check-up").

Our 2018-2023 programmatic priorities – based on what the research is telling us about the best ways to improve AYA health – are ongoing focus on well visits and increasing our nation's focus on young adult health in state-level initiatives.

One of the few upsides to the COVID-19 pandemic is that it's reminding us all that better access to and uptake of mental and behavioral health services is a great way to both increase and enrich AYA Well Visits.  We also see mental and behavioral health screenings as a crucial lens through which to prioritize AYAs for age-specific interventions. Indeed, our "CoIIN" has focused on depression screening and follow up since 2018.

Over the past year, the Center has responded to the challenges brought on by the pandemic by adapting our technical assistance (e.g., focusing on telehealth), and creating resources to advance AYA health in our priority areas. We'd love it if you checked out some of our COVID-related materials:

  • A COVID-19 resource page, featuring sections on clinical resources, telemedicine, vaccinations, mental health, and broader programs and policies.
  • A series of webinars focused on the distinct needs of young adults.
  • And strategies learned from the pandemic highlighting the challenges and opportunities for adolescents and young adults moving forward. 

 

Reach out to see if we can help you reach your goals! Contact us at ayah@ucsf.edu.

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4/28/2021 9:54 AMNo
  
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  • Anna Corona
03/24/2021 3:27 PM

As we surpass one year of responding to challenges of adolescent and young adults that have been exacerbated by the COVID-19 pandemic, we wanted to take a moment to pause and reflect on why we commit to this work. At the AYAH National Resource Center, we are appreciative of the magnitude that Title V Adolescent Health programs and their partners put forth to continue to strengthen, improve, and build equitable systems that support the well-being of young people. In an effort to pause and re-ground ourselves in the reasons why we show up to work day-in and day-out, we wanted to amplify a youth voice, as shared in the American Academy of Pediatric's Council on School Health's Winter 2021 newsletter . This writing is being re-shared with permission from the author, Katherine Lewton.

 

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Still Kids
 
By: Katherine Lewton - High School Student, Vermont
Member, Vermont RAYS (Raise Awareness of Youth Services), a Youth Health Advisory Council
 
---
 
We have zoom, google meet, facetime, and every other form of video service at our fingertips,
But we don’t have a true connection.
 
 
There is no replacement for the smiles in the hallway, the feeling of winning playoff games, and the satisfaction of knowing the correct answer.
 
 
We want to be kids, but the pandemic has forced us to grow. We are still young, but we feel so aged by all we have been dealt.
 
 
We want to cry about all we’re missing, as we’re still just kids trying to cope, but we also know that we are grateful for our health and safety. We feel guilty, relieved, and completely terrified.
 
 
We’re big kids, we can handle the truth, but we also want our loved ones to hold us tight, and tell us it will all be alright.
 
 
Because we’re just kids in crazy times.
 
 
We are trying to be mature, but please remember we’re just naive kids.
 
 
We miss the embrace of our friends, small talk with teachers, and those early school mornings we once dreaded. We miss our lives. We miss just being kids.
 
 
We are really trying our best to be strong, so please just be patient and tell us if we do something wrong. Remember that we are still young and living through strange times.
 
 
Because we are just kids.
 
 
We’re missing silly school crushes and awkward proms. These things that we always thought were going to be part of our life, well, now they’re gone.
 
 
But it’s okay, we will be alright. We are still just kids with a whole lot of time.
 
 
In the age of social media, love can occur online, and we’re learning to adapt.
 
 
But please, just remember that we are just kids. We try our best, and we learn as we go. We’re bound to make mistakes, it’s only normal.
 
 
When you’re a teen everything feels so serious, but now it really is.
 
 
So help us learn how to grow up during these unprecedented times, but also help us remember that we’re just kids.
 
 
We haven’t gotten to be kids in a while, and we’re not ready to be completely grown up just yet.
 
 
 
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3/24/2021 3:27 PMNo
  
Picture Placeholder: Anna Corona
  • Anna Corona
02/25/2021 2:46 PM

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By: Maura Leahy, MPH, CHES, Program Analyst, Child & Adolescent Health at the Association of Maternal & Child Health Programs

As February comes to an end, so does the annual observance of Teen Dating Violence Awareness Month (TDVAM). We wanted to bring additional attention to this important issue by highlighting teen dating violence (TDV) strategies and resources that Title V Maternal and Child Health (MCH) programs use that can elevate TDV prevention year-round.

Adolescence is a unique period of opportunity and growth when young people are making deeper connections with their peers, developing interests and passions, and testing the waters of romantic relationships. This range of relationships are natural parts of a young person's brain and identify development, but it is vital that these relationships are safe and healthy. Adults have a role to play by creating and supporting safe environments in which adolescents can thrive and grow. Title V can also play a role in supporting programming and capacity geared towards preventing TDV so that adolescents and young adults can experience this stage of development in a safe and healthy manner.

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What is TDV and why is it an issue? TDV is a type of intimate partner violence (IPV) that can include four types of behavior: physical violence, sexual violence, emotional or verbal abuse, and stalking. These behaviors can happen in-person or electronically. Since emotional abuse is most common among youth, it is important to recognize the warning signsso that red flags of potential TDV are not overlooked. TDV is much more common than adolescents and adults may realize: 1 in 3 three teens in the U.S. will experience some form of dating violence. Victims of TDV are more likely to experience symptoms of depression and anxiety and to have suicidal thoughts, and these consequences can be long-lasting. Additionally, most adult survivors of IPV first experienced violence when they were adolescents (National Intimate Partner and Sexual Violence Survey, 2015). 

What is Title V doing to prevent TDV? According to their recent MCH action plans, many states incorporate healthy relationship programming through a variety of federal funding streams (such as the Personal Responsibility Education Program, Sexual Risk Avoidance Education Program, Rape Prevention and Education Program), and through broader Positive Youth Development programs. Two main strategies emerged in these efforts: implementing evidence-based curricula and outreach/media campaigns. Here's a snapshot of what some states are doing:

 

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Resources for Title V programs to promote throughout the year:

 Broader Violence Prevention/IPV Resources:

 

If you or someone you know is victim of domestic violence, please call the National Domestic Violence Hotline: 1-800-799-SAFE (7233)

2/25/2021 2:46 PMNo
  
Picture Placeholder: Anna Corona
  • Anna Corona
01/26/2021 3:27 PM

question.pngResults from many Title V 2020 Needs Assessments confirmed that access to mental health care providers is a challenge for improving mental health status among the adolescent population. In fact, several state Title V programs cited mental health workforce provider shortage as a significant barrier to linking adolescents to appropriate treatment when screening positive for depression or other conditions. Given the prevalence of this shortage nationally, a recent Journal of Pediatrics[1] article discussed the promise of Child Psychiatry Access Programs (CPAP) as a tool for primary care providers to feel more comfortable providing mental health care to their patients. CPAPs provide primary care physicians with access to child psychiatrists via same-day telephone consultations that cover questions related to diagnosis, management, and care coordination for their patients. CPAPs are viewed as a promising strategy for gap-filling services while experts continue to explore ways to grow the mental health provider workforce.

The article emphasizes that the greatest challenge to the sustainability of CPAPs is a consistent funding source.  Title V programs, with their flexible block grant funds, are in a unique position to directly support CPAP programs as a strategy for addressing adolescent mental health. Montana's Title V program has done this by contracting with the state's Billings Clinic to establish a toll-free access line for primary care providers to call and consult with the clinic's Child and Adolescent Psychiatrists during daytime hours. Other Title V Programs also support federally-funded programs to implement their state's CPAP, including:

  • Colorado, which contracted with the Pediatric Mental Health Institute and Department of Psychiatry at the University of Colorado to implement the Colorado Pediatric Psychiatric Consultation and Access Program; and
  • Kansas, which established a provider consultation line that supports primary care physicians and clinicians in treating behavioral health conditions within their practices.

Additionally, Title V Programs have been working to amplify and disseminate the message of available CPAPs to provider networks in their states, including:

  • Iowa, which educates and markets their state's 24/7 Psychiatry Consultation line to primary care providers utilizing resources enabled through the Health Resources and Services Administration's Pediatric Mental Health Care Access Program; and
  • New York, which partners with their state's Office of Mental Health to increase awareness of the expansion of Project TEACH (NY's model for pediatric psychiatric consultations).

Finally, Title V programs can support CPAPs by providing evaluation services to serve as an important data source for communicating the importance of this resource for improved access to mental health care. For example, the Wisconsin Title V program supports implementation and evaluation of their state's Child Psychiatry Consultation Program in collaboration with the Medical College of Wisconsin.

For those states where a CPAP does not currently exist, the article recommends building a coalition of stakeholders who are interested in developing this for their state. Since Title V programs are well positioned to serve as conveners, this could present as an opportune starting point in such states.  Once coalitions are formed, suggested next steps include contacting nearby states who have active CPAPs to learn more about how they were successfully started and implemented.

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[1] Sulivan, K., George, P., and Horowitz, K. Addressing National Workforce Shortages by Funding Child Psychiatry Access Program. Pediatrics 2021;147; DOI: 10.1542/peds.2019-4012

1/26/2021 3:27 PMNo
  
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  • Anna Corona
012/17/2020 11:24 AM
 

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Happy holidays #ScreenToInterveneForAYAs blog readers! First and foremost, thank you for your readership this year—we hope you've found the posts to be informative and helpful for your work. While thinking about how we wanted to wrap up our blog in 2020, we realized the importance of pausing to promote the value of self-care for our readers. Understanding that we can't take care of others if we are not well ourselves, the AMCHP team wanted to learn what you do to take care of yourselves in the midst of a global pandemic, to bring your best self to this important work. Tina Palmer, Adolescent Health Coordinator for the state of Iowa, has graciously shared her reflections (below) on the importance of self-care and how she practiced it this year. A million thanks to Tina for sharing her story—we hope you all find some inspiration for yourselves. For additional ideas, check out the Association of State and Territorial Health Official's self-care strategies and tools for public health professionals.

The year 2020 began as any other. Life was chugging along as usual and I was in the midst of planning graduation for my step-daughter. The typical Iowa graduation open house…food, guests, and pictures galore. The date was set and the invitations were ordered. Spring Break hit and suddenly the first cases of COVID-19 began popping up a little too close to home. And then, March 17th. Restaurants were suddenly closed down, school was put on hold, and gatherings were limited. My work pivoted to temporary telework from home. This will be short-lived, right? We have senior trip in April, and then Prom, Graduation, and then her senior season of softball (we play summer ball in Iowa). And anyone that knows me knows how much I LOVE SOFTBALL! We cannot miss our softball season! There were other family plans happening as well, as my oldest daughter was in the early stages of planning her November wedding. November is forever away, we will be fine then. Certain of it!

I sat in my "home office" every day and tuned in to the Governor's press conferences for updates. Every. Single. Day. March came and went. Schools remained closed. Senior trip was postponed. Track season cancelled. April came and went. Graduation is virtual with a town parade to celebrate the graduates. A much smaller graduation open house was held. It's now May. Softball practice should be starting. We will make a repeat appearance at the state tournament this year, so the season has to happen. There is talk that Iowa could be the first state to allow high school sports. There will be new protocols and mitigation strategies, but they will get to play. And that our girls did! In fact, they took every advantage of being able to play their last season together and not only made that repeat appearance to state, but WON! Well, there's some good news amongst all this chaos.

Chaos. That's what I call it. Yes, we won the state championship. But what about the rest of my life? I continued to work from home. Loving my commute, but missing the day-to-day interactions with people. I NEED people. Conversations with the dog just don't quite fill the gap. Those daily press conferences continue, maybe not daily, but I'm still watching. Every. Single. Time. I'm still watching the news. Every. Single. Day. It's taking a toll.

Here we are in December. The pandemic continues. The wedding happened. Not the way it was originally planned, but still absolutely PERFECT and the bride was absolutely stunning. I might be a bit biased. Work from home continues, but you know what? I don't have to worry about traffic and winter driving. I am listening to music…without earbuds. I couldn't do that in my cubicle! Video calls give me the people interaction that I need. I can take a quick break and do some yoga poses to stretch and re-center in the privacy of my living room. I can look out my front window right next to my desk and see the beauty of the bright white snow that fell over the weekend.

I have always been a very optimistic person, but that can be very difficult in the uncertain times that we are living. Seeking the positivity every day has helped. Oh, and so has turning off the news. I don't watch the press conferences anymore. I don't watch the news every day. I seek the information I need to know and let the rest go. I breathe, I laugh…loudly, I find refuge in music and sing along…loudly, I craft, I seek inspiration, I give a lot of grace to others and myself, and I focus on the positives that exist. There are a lot of them when you look. Nothing has become more important and there has been much to learn. My eternal optimism persists like never before. Take care of yourself first. Always. 

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12/17/2020 11:24 AMNo
  
Picture Placeholder: Anna Corona
  • Anna Corona
011/13/2020 10:24 AM

friends.pngAdolescents are in a phase of their social, emotional, and identity development where they are seeking more opportunities to be independent as well as spend time with their peers, however due to the pandemic, they are less able to access those opportunities in an environment where social distancing is necessary. The New York Times (NYT) published an article[1] emphasizing that the pandemic presents these unique challenges for adolescents. Different survey data highlight that the effects of the pandemic vary among groups of adolescents and depend greatly on context. Below is a summary of the results of two different surveys featured in the article:

  • The Institute for Family Studies and the Wheatley Institution surveyed 1500 adolescents between May and June and found that overall, the proportion of teens who reported feeling depressed and lonely had decreased since 2018. The survey's authors postulate that these improvements may be attributable to increased amounts of sleep during the pandemic and also observed that a majority of respondents indicated feeling closer to their families. Notably, this survey found that adolescents facing food insecurity reported higher rates of depression.
  • Wellbeing.org surveyed 1000 adolescents in early October and found less optimistic results. Nearly half of respondents indicated that their mental health had worsened since the start of the pandemic and more than half reported that their social lives had been negatively impacted due to the pandemic. Additionally, this survey found that outside of the pandemic, climate change and the struggle for racial justice were major sources of stress for respondents.

What does this mean for Title V MCH programs? To start, the effects of the pandemic on young people cannot be generalized at the national level. It's important to assess adolescents' experiences in their specific contexts to drill down to the root causes of behavioral health challenges during COVID and beyond. There is a critical need to address food insecurity among adolescents and their families as well as climate change, racial injustice, and other societal stressors that impact their lives and development. Approaching these issues with a social justice lens will be an important strategy for preventing adverse health outcomes for the remainder of this pandemic and beyond. 

survey.pngAs public health practitioners consider replicating and/or adapting the surveys linked above, they can also think about convening youth-centered focus groups, working with youth advisory councils, or hosting virtual listening sessions or town halls (with youth as facilitators) to understand the root causes of stress and behavioral health challenges among adolescents in your specific jurisdiction. It's essential to identify and connect those adolescents to quality care who are living with behavioral health challenges, but also equally important to implement a long-term plan for addressing the complex root causes driving behavioral health challenges among adolescents in your setting.

In September's blog post, we emphasized the importance of elevating and amplifying suicide prevention resources year-round. To live up to that call to action, we are sharing this list of resources here again. Be sure to check out the list as it offers tailored resources and diverse messaging for adolescents and young adults: Closing out Suicide Prevention Awareness Month: Resources to Promote and Utilize Year-Round.

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[1] Malo, A. The Hardest Fight to Have With Your Teen (October 2020). Accessed via: https://www.nytimes.com/2020/10/28/parenting/teens-stress-lonely-coronavirus.html on October 30, 2020.

11/13/2020 10:24 AMNo
  
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  • Anna Corona
09/28/2020 2:34 PM

According to the National Alliance on Mental Illness (NAMI), Suicide Prevention Awareness Month (September) serves as an opportunity to highlight resources for suicide prevention and share the stories of those affected by suicide. As such, in observance of Suicide Prevention Awareness Month, this post is dedicated to sharing:

  • The story of the South Carolina maternal and child health (MCH) program's effort to support their NAMI state chapter's Ending the Silence Campaign
  • Resources that MCH Programs can help promote and disseminate in their efforts to reach adolescents & young adults (AYAs) directly 
  • Professional development opportunities as well as tools for implementing suicide prevention strategies for the AYA population  

The South Carolina MCH Story:

As participants in the Adolescent & Young Adult National Resource Center's AYA Behavioral Health learning collaborative, the South Carolina team has strategically focused their resources on building partnerships with organizations around the state that are already addressing AYA emotional well-being, including the state's local NAMI chapter. They are supporting SC NAMI in implementing their "Ending the Silence" campaign in high schools across the state. This campaign educates students, school staff, and the larger community on the signs and symptoms of common mental health conditions and offers clear steps to take if an individual or loved one is in need of support. With the pandemic forcing students to spend less time physically inside their schools, the SC team has been proactive in promoting the NotOK app as a tool for youth that are experiencing mental health issues such as depression and axiety but can't reach their typical resources in person. The app is designed and maintained by two young adults and their trusted furry companion (check out their "about us" page!).

Check out NAMI's local chapter search page to identify the one closest to you and reach out to learn how your MCH program might be able to help spread their messaging, particularly during the pandemic. 

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Resources to Share & Amplify Year-Round:
  • National Suicide Prevention Lifeline: 800-273-8255 (English) 888-628-9454 (Spanish)
  • The Trevor Project: TrevorLifeline (1-866-488-7386), TrevorChat, and TrevorText (Text START to 678-678)
  • We R Native: a resource developed by Native youth for Native youth for achieving balance physically, spiritually, and mentally
  • NotOK app: developed for youth by youth, this app provides young people with a way to connect with a trusted adult during times when emotional support is needed

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Professional Development & Implementation Resources to Explore:

General Suicide Prevention Resources
Resources for Preventing Suicide among LGBTQ+ Youth
Resources for Preventing Suicide among Black Youth
Resources for Preventing Suicide among Native American Youth
Resources for Preventing Suicide among Latinx Youth
Resources for Preventing Suicide among Asian American Youth:


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This graphic was accessed via NAMI's Awareness Resources page. NAMI has a library of graphics, free of charge, that your organization can use across social media sites to help raise awareness. Remember-these graphics and messages can and should be promoted year-round!


9/28/2020 2:34 PMNo
  
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  • Anna Corona
08/26/2020 9:57 AM

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Reflection shared by:

Iliana White, MPH, CHES, CPH

Senior Program Manager, Adolescent Health

Association of Maternal & Child Health Programs


In the era of COVID-19, there is an increased spotlight on the emotional and mental tolls that this unprecedented pandemic has fueled. When it comes to adolescents and young adults (AYA), their experience in navigating back to school, college campus, or their return to the workforce can be met with stress, anxiety, and a lot of uncertainty. In a recent learning session for the AYA Behavioral Health CoIIN,  Dr. Sharon Hoover of the National Center for School Mental Health discussed strategies to address students’ and school employees’ needs as they return to some form of instruction, whether remote, in-person, or a hybrid approach. As part of her presentation, she touched on the concept of “Always and Now”. With coronavirus, many of our planned public health strategies and activities, including those related to AYA mental health, may have become suspended or shifted to accommodate more pressing emergency responses. When able to focus on the mental health needs of AYAs, strategies are changing to accommodate the current environment we are living in. With schools resorting to spring instruction completely online, stay at home orders, and sometimes the need to quarantine, the massive isolation of young people from their friends, classmates, and other supportive factors can have its toll. There may be an increased spotlight on the implications of being isolated and not being able to access the care or support needed to adjust and live through this modified state of society. Unusual, unprecedented circumstances—that is the Now. But what about the Always

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The concept of Always is a grouping of those ideal, core principles that we as providers, public health practitioners, and adult champions should be embedding in our work and systems that serve young people. Pre-COVID, adolescents were experiencing a variety of mental health conditions, with the top four most prevalent being ADHD, anxiety, diagnosed behavioral problem, and depression (Danielson et al., 2018, Ghandour et al., 2019). The rates of Major Depressive Episode (MDE) have been steadily increasing since 2008 among 12-17 year olds (NSDUH, SAMSHA, 2018); increased suicide rates, especially among females, Black and Latinx, and LGBTQ youth, has been cited as a growing concern for state Title V and MCH programs over the past several years. The bottom line is that youth have been dealing with increasing challenges of navigating their development while trying to understand and maintain their status of mental health since before the pandemic. We can’t simply STOP the work we Always do to improve AYA mental health...how do we ensure young people don’t become further disenfranchised? The prioritization and intention around strategies to address mental health and emotional well-being can’t be put on hold because COVID-19 came along. If anything, the pandemic may exacerbate some of the adverse experiences or lack of social support networks that youth experience. In a recent plenary discussion at the 2020 AMCHP virtual conference, several peer and young adult leaders shared their perspectives regarding mental health, resilience, and how we can support young people. A key theme that kept surfacing is the notion of investment—investing in their support now, so that they can thrive in the present, not just in the future. 

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We should Always have the calling to ensure that AYA mental health needs and concerns are met with empathy and action. Often, we see their mental health challenges be dismissed as a phase, a temporary episode “that will go away on its own.” The unmet needs of adolescents amplify into unmet needs as young adults. Stress and trauma can continue to be multigenerational. It is easy for young people to feel isolated, disconnected, frustrated, and anxious, especially with how drastically COVID-19 has changed our ways of interacting. In a recent MMWR Report from CDC, a survey found that 25% of young adult respondents ages 18-24 have seriously considered suicide in the past 30 days. Think about that—1 in 4 young adults, the highest out of all the age groups surveyed. 

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Prior to Coronavirus, and after, a significant amount of youth’s emotional well-being or mental health concerns were not addressed nor treated and thus left to exacerbate. We need to Always make sure we acknowledge their challenges and experiences; support their development in healthy spaces; and encourage them to seek care and act Now to protect and enhance their present and future development. There has been the optimistic mindset regarding the pandemic that “this too shall pass.” Let’s hope the heightened awareness, empathy, and acknowledgement of AYA mental health does not pass also, but rather remains a key priority to monitor and support, Always, and especially starting Now

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8/26/2020 9:57 AMNo
  
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  • Anna Corona
07/23/2020 2:20 PM

online school.pngIn preparation for the start of another potentially virtual school year, The Adolescent and Young Adult Behavioral Health CoIIN state teams convened online earlier this month to hear from experts on strategies for supporting student well-being, including mental health,  in the distance learning setting. Included in the group of experts were two student leaders representing the Moving In New DirectionS (M.I.N.D.S.) group of Rice County Minnesota, a school-based student group working to support the mental health of their peers. Recently, the M.I.N.D.S. team administered a survey to fellow students in four high schools and two middle schools to understand the state of mental health among their peers, how COVID-19 had affected their mental health, and how they were coping given the switch to a fully virtual school setting. A major takeaway from this survey was that students were missing their connections to their classmates, teachers, and school counselors. Because of this, the CoIIN state teams posed several questions to the M.I.N.D.S. leaders on how to best reestablish these connections in an online setting. The students suggested the following strategies:

  1. Prioritize building trust between new teachers and/or counselors and their students, especially at the start of a new school year. Suggestions for how to facilitate trust-building online included:
    • One-on-one meetings between teacher and/or counselor and each student to get to know each other with sufficient time to dive into deeper issues
    • Encourage teachers to organize study groups for their students where they make themselves available to pop in and assist with assignments
    • Create a "Wellness Wednesday" class that is mandatory where health teachers speak on the topic of wellness or facilitate a conversation with the students regarding their emotional well-being
    • Create space at the beginning of regular class and/or study group interactions to ask students how they're doing or feeling 
  2. Utilize innovations, such as the free CloseGap software, to regularly check-in on student well-being. It's important that these check ins come from a trusted teacher or school counselor rather than from administration, which may not have achieved the same level of rapport as a teacher. 
  3. Consider that not all students are comfortable turning on their webcams because they may not want teachers/peers to see the space where they live and be open to audio-only check ins. Training on how to pick up on cues without being able to read body language or gauge appearance is important for teachers and/or counselors that are operating in a virtual environment where their students may not feel comfortable using their webcams.
  4. Connect students directly to relevant mental health/wellness resources and don't assume that students—or even the staff at the schools they attend—are aware of the available virtual resources for supporting their mental health and wellbeing. 

In summary, intentionality around scheduling time for teachers and school counselors to engage with their students is crucial in building the trust required for students to ask for help when they need it. As MCH professionals, one step we can take to assist these efforts is to ensure that our partners in the local school systems are aware of relevant mental health resources and services so that our partners in education can share them with students during their trust-building events. As the technical assistance and training center with a focus on advancing research, training, policy, and practice in school mental health, The National Center for School Mental Health (NCSMH) has a treasure trove of resources, including:  

7/23/2020 2:20 PMNo
  
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  • Anna Corona
06/24/2020 8:26 AM

pride.pngIn honor of Pride Month (learn the history of Pride Month), we asked State Maternal & Child Health (MCH) programs to share what they are doing to improve and support emotional well-being among lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth in their states. We know that LGBTQ youth experience life differently than their cisgender, heterosexual counterparts, including increased likelihood of experiencing negative mental health outcomes as evidenced by the results of the Trevor Project’s National Survey on LGBTQ Youth Mental Health. Two key points from the survey: LGBTQ youth are more likely to consider attempting suicide and they report feeling sad or hopeless for at least two weeks in the past year.

State MCH Programs are working on supporting and improving LGBTQ youth mental health in their settings. Here’s a snapshot of what they are doing: 

Assessing for LGBTQ-Friendliness: The Tennessee MCH program partners with their state's Title X Family Planning Program to implement an annual teen, male, LGBTQ friendliness assessment in family planning clinics across the state. The survey allows clinics to assess themselves and illuminate areas where they can improve male, teen, and LGBTQ-friendliness within their practice. To address the assessed areas of improvement, the TN MCH program will partner with local, youth-led reproductive justice and LGBTQ organization to advise on innovative solutions. If you are interested in viewing the assessment, click here

Partnering to Provide Trainings:

  • The Florida Maternal, Child & Adolescent Health (MCAH) Program partners with Equality Florida, an organization dedicated to securing full equality for Florida’s LGBTQ community, to offer trainings to school district staff and health education. The trainings include sexual minority competency and creation of safe spaces. In addition to partnering for trainings, the Florida MCAH Program distributes Equality Florida’s resource to all their youth-serving organizations.
  • The New Jersey Child and Adolescent Health (CAH) Program partners with the Transgender Training Institute to provide trainings for staff of youth-serving programs and services to assist them with ensuring that their spaces are inclusive for transgender and non-binary youth. Policies and practices that are encouraged during the training include providing gender neutral restrooms, using gender affirming pronouns on signatures and name badges, sensitivity training for all program staff, and building inclusivity into all lesson plans, if applicable. Additionally, the NJ CAH Program has partnered with the Department of Children and Families Safe Space Program in their state to provide training and support to foster parents across the state so that they are able to provide a more supportive environment for their foster children who are LGBTQ identified.   

Funding Direct Services for LGBTQ Youth: The Pennsylvania MCH Program has recently released a request for applications to provide LGBTQ youth behavioral health services. From the RFA, “applicants will achieve these changes in targeted behavior through the implementation of evidence-based or evidence-informed behavioral health programming focused on improving the mental health, reducing substance use, or providing suicide prevention education for LGBTQ youth ages 12-21 in Pennsylvania.” Stay tuned for an update on the selected grantees via this blog, coming in the Fall!

Here are additional resources for State MCH Programs and their partners from The Trevor Project, the leading national organization providing crisis intervention and suicide prevention services to LGBTQ people under 25:  


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If you or someone you know is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit their webpage to chat with someone online.

6/24/2020 8:26 AMNo
  
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  • Anna Corona
06/3/2020 8:57 AM

It was never a question of if COVID-19 would impact the emotional well-being of adolescents and young adults (AYAs), but rather, what will be the extent of the impact? The United States Census Bureau has been collecting data since April 23, 2020 to shed light on the answer to that question. The  Household Pulse Survey is distributed weekly with responses analyzed and reported at the same frequency. The U.S. Census Bureau plans to continue distributing the weekly survey for a total of 90 days. It includes questions related to employment, education, food security, health, and housing. The section assessing health impacts includes four questions asking specifically about symptoms of anxiety and depression. The questions are derived from depression (PHQ-2) and anxiety (GAD-2) screening tools and are as follows:

·        Over the last 7 days, how often have you been bothered by the following problems…

o   Feeling nervous, anxious, or on edge?

o   Not being able to stop or control worrying?

o   Having little interest or pleasure in doing things?

o   Feeling down, depressed, or hopeless?

The results of the latest weekly survey (distributed May 21-26) found that young adults aged 18-29 are experiencing the greatest impacts on their emotional well-being based on reported symptoms of anxiety and depression.  Data summaries prepared by the Centers for Disease Control and Prevention (CDC) revealed that 29.4% of all respondents reported symptoms of anxiety and 24.9% of respondents reported symptoms of depression.  However, when the data is broken down by age, those rates are highest among young adults with 39.1% of 18-29 year olds reporting symptoms of anxiety and 36.7% reporting symptoms of depression. 

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Data for reported frequency of symptoms of anxiety and depression during the last 7 days are also broken down by state and are available for viewing on the Center for Disease Control’s Household Pulse Survey website. According to the data, all adult respondents (ages 18+) in Louisiana (41.4%), Nevada (40.7%), and Florida (39.1%) are faring the worst while Minnesota (26.1%), Iowa (25.9%), and Idaho (24.8%) have the lowest rates of reported symptoms of anxiety and depression.

After asking “what is the impact?” the next logical question is, “what can we do about it?” To answer this question, we can look to localized, youth-led initiatives that are working hard to create community and connection during a time of physical distancing and social isolation. Groups like WE RISE and Active Minds are leaning on young adults to reach out to their peers and share messaging that is supportive to mental health and points to available resources. 

·        WE RISE is a project of the Los Angeles County Department of Mental Health that organizes “events [that] are calls to action to break through barriers and defy old assumptions about mental health and the many related social conditions that compound problems and hurt our communities.” Most recently, this group hosted a Virtual May that emphasized well-being through art and opportunities for online connection.

 

·        Active Minds self describes as “the nation’s premier nonprofit organization supporting mental health awareness and education for young adults.” Headquartered in Washington, D.C., this organization has a presence at more than 800 colleges, which includes 550 student-led chapters with “programs and services to empower student to reduce stigma surrounding mental health, create communities of support, and ultimately save lives.” Check out Active Mind’s list of chapters to find one you can connect with in your efforts to disseminate mental health messaging in your state.


While we’ve highlighted only two organizations, there are many more organizations just like them across the country—consider finding and connecting with these types of youth-led organizations in your state to learn how you can help amplify their messages and support their efforts. The Adolescent and Young Adult Health National Resource Center recently released a resource, “Improving Young Adult Health: State & Local Strategies for Success” that provides concrete strategies that Title V agencies and others can use to advance young adult health.  

For additional support, check out these resources for taking action to improve the emotional well-being of young adults:

·        Love is Louder is a campaign out of the Jed Foundation that is focused on COVID-specific emotional well-being resources and messaging for Young Adults.

 

·        From the Adolescent and Young Adult National Resource Center:

o   Advancing Young Adult Health in the States—scroll down to view resources under the second banner, labeled accordingly.

o   COVID-19 Resources About Adolescents and Young Adults

6/3/2020 8:57 AMNo
  
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  • Anna Corona
05/13/2020 1:06 PM

Many thanks to our guest writer, Sharon Koller, who coordinates the UP for Learning's Getting to 'Y' program, which she highlights below.   Although we are experiencing a moment in time that has challenged us to be innovative in the ways we continue engaging youth in our work, we know our readers are pushing forth in their efforts.  Please feel free to reach out to the Adolescent and Young Adult National Resource Center (via my email, acorona@amchp.org) or directly to Sharon (email below) for assistance with thinking through how the "Getting to 'Y'" youth engagement approach, outlined below, might be adapted for a virtual setting.  Happy reading!  

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 " [T]his generation is, and has to be, so concerned with exactly what is happening with our future."  

- Alex Smart, high school junior

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By: Sharon Koller, Coordinator, Getting to 'Y' 

Young people care deeply about the world around them and crave meaningful opportunities to share their insights, wisdom and passion and to improve things now and for the future.  Through over a decade of involvement with Getting to 'Y': Youth Bring Meaning to their Youth Risk Behavior Survey (GTY), I have seen such opportunities flourish as adolescents use validated local data to set priorities, engage peers and adults in dialogue about what matters to them, and take action to improve youth health and well-being. 

Getting to 'Y' began in 2008 as a partnership between the non-profit organization UP for Learning and the Vermont Agency of Education.  The Vermont Department of Health (VDH) became a primary GTY partner in 2013 and continues to see GTY as an important tool in elevating youth voice and connection as part of Maternal and Child Health Title V and Alcohol and Drug Abuse Division prevention work.  Dr. Breena Holmes, MCH Director for Vermont, says, "GTY is the strength-based approach to youth voice and agency that public health needs.  It is the foundation of our prevention efforts and changes the conversation in communities in meaningful ways."   To date, 147 teams from 80 Vermont schools (45%) have participated in GTY, as have 8 teams in 4 public schools in New Mexico.  

GTY uses a positive youth development and action-research model where students utilize existing data (local Youth Risk Behavior Survey surveillance data) to take the lead in making sense of their own health information.  The process is simple, but effective:  (1) a core youth team and their adult advisor attend a youth-led training to learn and practice tools and skills to implement GTY, (2) the core team recruits a larger representative group of peers and leads them through asset-mapping, data analysis, root cause review and initial solution brainstorming, (3) the core team shares their work and leads community dialogue about their findings and ideas, (4) the core team plans and implements actions based on all they have learned throughout the process. 

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Before becoming the GTY Coordinator at UP for Learning, I advised GTY teams for 9 years at the high school where I worked as a Student Assistance Program counselor.  Over and over, I saw the profound impact of GTY on individual and systemic levels.  As expected, there were concrete changes that came about as a direct result of the students' work: more accessible condom distribution, a peer-mentoring program, student-led consent training in health classes, and distracted driving education campaigns.  Other changes were spurred by school staff and community members hearing the passionate voices of youth at community dialogues.   Our school implemented suicide prevention programs in all health classes after the GTY group repeatedly focused on the data around suicide as a top concern.  

Even more powerful for me to witness was the impact on individuals.   Because GTY addresses issues personally relevant to all youth, and because all youth are experts in their own lived experience, our group drew in students who had leadership roles in the school as well as many students who had never joined a club or led a group of peers and adults.  Because the initiative utilizes a strengths-based and structured approach which builds on scaffolded skills and experiences, the diverse groups worked well together and individuals discovered or grew their sense of themselves as capable agents of change.  I never tired of hearing the confident voice of a previously "invisible" student leading a group of peers, administrators, parents, community members, and even legislators through a discussion of a sensitive and important health topic.  

My anecdotal observations have been upheld by data as well.  During the 2018-2019 GTY year, UP for Learning worked with the University of New Mexico Prevention Research Center, with support from VDH, to complete a mixed-methods evaluation of GTY's impact on participants.  Pre- and post-survey data of core team and data analysis participants showed significant positive changes in Health Literacy, Self-Efficacy, Community Engagement, Resilience and Protective Factors, and Knowledge, and focus groups. Written feedback pointed to increases in a Sense of Connection, Knowledge and Self-Confidence.   Youth noted things like:

"I gained knowledge that I can use to help others around me if they are having a hard time."

"I gained information about the problems and strengths about my community and state."

"I gained a more confident voice and I learned to speak up about my opinion."

"I had more of an opportunity to lead others in the right direction when solving youth risk  problems."

"I gotta stay involved 'cause this is the way to help the community."

"I gained friendship and I've learned that I can trust people, and I don't really trust people much.  Before this I only trusted 3 people. Now I trust like 10 people." 

Getting to 'Y' is well-poised for replication by other states interested in engaging youth in meaningful work around their own health and well-being.  UP for Learning is excited to envision a time when youth across the nation are seen as integral partners in utilizing the YRBS as a springboard for change.  Who better than youth to bring meaning to their own health data and then experience the satisfaction of making the world a better place? 

Information available on the  GTY website or from Sharon Koller: sharon@upforlearning.org 

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5/13/2020 1:06 PMNo
  
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  • Anna Corona
04/22/2020 11:10 AM

By: Lyndsey Reece, DHA
Child and Teen Checkups Coordinator, Rice County Public Health (Minnesota)

shining light.pngThe Minnesota Adolescent and Young Adult Behavioral Health (AYA BH) CoIIN Team has prioritized youth engagement as a part of their work to improve the rates of depression screenings among AYAs ages 12-24 in their state. One of the team’s most recent youth engagement endeavors centers around partnership with a youth-led group called “Moving In New DirectionS (M.I.N.D.S.)”.  M.I.N.D.S. is a team of 12 high-school aged youth from four schools in Rice County, MN that were recruited through a partnership between public health and a school counselor. M.I.N.D.S. aims to partner with the MN CoIIN team on tackling the following goals:  1) educating adolescent and young adults that they have a voice and how to use it, 2) shining a light on mental health to break stigma, and 3) communicate with the community on how to support adolescents and young adults

The first order of business for the group was to brand themselves and hammer out an action plan for how they wanted to achieve their goals. The M.I.N.D.S. team came up with their group name, a logo, and a work plan to shine the light on AYA mental health in Rice County. For the group, “shining a light on mental health” means to reducing stigma and showing that it is normal to face mental health concerns. The youth believe that raising awareness of mental health will help knock down barriers to accessing mental health supports that they see throughout the community. 

Next on their agenda, M.I.N.D.S. plans to survey adolescent and young adult students from their four high schools  on several questions regarding their perceptions of and personal experience with mental health as well as their personal experiences with mental health screenings in community clinic setting. The M.I.N.D.S. team is also are looking to receive training on advocacy skills for taking charge of their health during primary care visits. The M.I.N.D.S. youth are also planning a mental wellness event within the community for their peers in all schools as a way to support their goal to break the stigma associated with mental health challenges. 

videoconference.pngTo keep momentum up during the current social distancing brought on by COVID-19, Rice County public health and the M.I.N.D.S team are planning to continue their work by utilizing Google Classroom as an online platform for organizing and storing their team documents and communications.  In lieu of in-person meetings, the group is meeting online using Google Hangouts as regularly as they did pre-social distancing. During each virtual convening, the public health team kicks of each meeting by checking in with each of the M.I.N.D.S. team members to ensure they are receiving the resources they need to maintain their overall well-being during the pandemic. After the initial check-in, M.I.N.D.S. members take the reigns of the conversation and strategize on how best to keep this important work moving forward. During their last meeting, the M.I.N.D.S. team decided their immediate next step will be to invite relevant community organizations to join their virtual meetings as a way to begin partnership building in preparation for a time when it will be possible to gather again in-person. The M.I.N.D.S. youth also expressed interest in connecting with their school and clinical leadership to provide expertise on how adults can be supportive to youth during this time. Although the pandemic has created unprecedented barriers for community organizing, the Minnesota AYA-BH CoIIN team and their M.I.N.D.S. partners are finding ways to make progress despite the challenges. 

4/22/2020 11:10 AMNo
  
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  • Anna Corona
04/8/2020 1:55 PM

Combatting Stigma in Schools

school.pngIn South Carolina, the Adolescent and Young Adult Behavioral Health (AYA BH) CoIIN team has been focused on leveraging existing initiatives to increase depression screenings with appropriate follow up care for AYAs.  To achieve this, the SC team has strategically infused the  MCH perspective within existing  initiatives  to share their work and expertise,  including the Ending the Silence campaign being implemented by the National Alliance on Mental Illness (NAMI) in South Carolina.  At a recent SC CoIIN team meeting, Paige Selking with NAMI SC joined us to share the work their team is doing to implement the Ending the Silence program in schools and communities across the state.   

According to NAMI’s website, the Ending the Silence program “teaches the next generation about mental illness through an educational package designed to teach students on three grade levels: upper elementary, middle school, and high school about serious mental illness. This easy to use package uses stories to humanize serious mental illness and teach that these illnesses are no-fault brain disorders. Students also examine the role the media plays in perpetuating stigma.” 

In addition to direct education to youth, there are trainings  for their supportive adults, such as parents and school staff, to address the same topics addressed in the student trainings.  Perhaps most important is that someone with a lived experience related to mental illness is always part of the training.  In an effort to bring more youth into the planning and connecting being done by the SC CoIIN, it became important to the group that we support the NAMI efforts to include the lived experiences of youth in their presentations and have made those connections wherever possible.  For example, the CoIIN team has connected NAMI with the Statewide Child Well Being Coalition, and they will be bringing the Ending the Silence training to this body once large gatherings can be held again.  Additionally, NAMI will be presenting to the State Alliance for Adolescent Sexual Health and the training will include insight from a young person living with mental/behavioral health issues. Both of these bodies include professionals and community leaders who work directly with adolescents and young adults.

Check out NAMI’s national webpage to find your state’s local NAMI chapter.

Continuing on Amidst a Global Pandemic

stay-home (1).pngConsidering the limitations that have been placed on many organizations as a result of the CoVID-19 pandemic, the needs of organizations that reach out to youth have changed.  To adapt to our changing environment, the CoIIN team is working is shifting the ways in which we support these organizations, including publicizing and featuring NAMI’s online trainings that have been organized since the start of quarantines across the state. Work to identify and include organizations that represent youth through youth voices has also been an increased focus during this time.  Gender Benders, an organization working to ensure that the LGBTQ community, especially transgender individuals, has access to safe spaces, resources, and support, is one organization that has not yet been represented in the SC CoIIN  work, but has accepted an invitation to join the efforts at our April meeting.  Gender Benders has a strong youth leadership component that will center important voices into the conversation related to supporting the emotional well-being of AYAs across SC.

As the work in SC continues to progress in ways we had not originally planned due to COVID-19, we are taking this opportunity to think and collaborate outside the box to determine where the needs of AYAs in SC are the most immediate.  Our hope is that the voices of youth will guide our collaborations and outreach more and more as we are pushed further into areas where we have not historically thought to go.

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By: Rebecca Williams-Agee, MSW, MPA

PREP/Adolescent Health Coordinator, South Carolina Dept. of Health and Environmental Control

4/8/2020 1:55 PMNo
  
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  • Anna Corona
03/24/2020 2:30 PM

Hello, and welcome to the fifth and final installment in our "Approaches to Measuring Quality Improvement in Public Health" series! While quality improvement principles have traditionally been implemented in clinical settings, this series is focused on unpacking a measurement framework to apply a Q.I model/lens to public health, systems-level work. In our most recent post, we focused on the Assessment, Measurement, and Monitoring piece of the framework.  The post highlighted the Vermont Adolescent and Young Adult Behavioral Health (AYA BH) CoIIN team's efforts to take inventory of current related efforts across the states and to prioritize AYA BH needs by incorporating several relevant measures within their state Title V action plan.

For today's entry, we'll be zooming in on the Partnership piece of the QI framework.  This domain emphasizes the importance of developing new and/or enhancing existing relationships within state government and external entities as well as the value of coordinating efforts between partners.  Read on to learn how Indiana's AYA BH CoIIN has operationalized this tenant of the framework.

Centering around Provider Capacity-Building: An Example of State-Level Partnerships in Indiana

By: Steven Holland, Bureau Chief, Youth Services, Division of Mental Health and Addiction

handshake.pngIn practice, many systems struggle with meaningful connections to other relevant partners. Often, the situation occurs where the right hand is not aware of what the left hand is doing. The Indiana AYA BH CoIIN team has a history of forming and maintaining key partnerships that goes back to their participation in the first iteration of this CoIIN project, which focused more generally on the uptake and quality of the Adolescent Well-Visit.  For the current iteration of the CoIIN project, which has a more specific focus on depression screenings within the well-visit, the team includes members from the State Department of Health, Division of Mental Health and Addiction, Medicaid/Anthem insurance, Indiana University, and Foster Success (a local agency that provides services to foster youth). In addition to the public health team partnerships, the Indiana team successfully recruited clinical partners around the state hungry for information about how to improve rates of depression screening with a follow up care plan for adolescents and young adults, ages 12 to 25. In all, 21 practices, primarily of Family Medicine, were recruited with 29 health care professionals participating to learn more about depression screening, evaluation, and treatment.

webinar.pngIn an effort to support provider capacity to provide depression screenings for AYAs in their care, the Indiana CoIIN team has centered their current partnership around the development of a state mental health system webinar, which will educate clinical partners on the state resources that are available for behavioral health referrals and consultations. In planning for the content of this webinar, it has become increasingly apparent how valuable the various perspectives of the team members are. While each member has a piece of understanding on how the mental healthcare larger system works, they have only been able to fully address gaps and articulate a more comprehensive picture of the mental health care system in Indiana through incorporation of every team member's knowledge. With the work being done on this webinar, each member of the team will walk away with a more comprehensive understanding of the state mental health system. This will not only create a more cohesive story and understanding of the mental health system among all CoIIN team members and participating clinicians, but it will also facilitate the sharing of information with team member's respective agencies to inform future partnerships and decision-making.

Looking beyond the current project, continued development of the partnerships that make up the Indiana CoIIN has the ability to leave a lasting impact on Indiana's youth and young adults as a whole. As our team works collectively to build support for the medical providers in the field, it is the Indiana CoIIN team's hope that adolescents and young adults will be able to access behavioral health care more efficiently and effectively.

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3/24/2020 2:30 PMNo
  
Picture Placeholder: Anna Corona
  • Anna Corona
02/26/2020 9:56 AM

Hello, and welcome to the fourth installment in our "Approaches to Measuring Quality Improvement in Public Health" series! While quality improvement principles have traditionally been implemented in clinical settings, this series is focused on unpacking a measurement framework to apply a  Q.I model/ lens to public health, systems-level work. In our most recent post, we focused on the Augmenting MCH Capacity piece of the framework.  The post highlighted the Wisconsin Adolescent and Young Adult Behavioral Health (AYA BH) CoIIN team's efforts to support improved primary care provider's capacity for caring for their patient's emotional well-being through promotion the state's child psychiatry consultation program.

For today's entry, we'll be honing in on the Assessment, Measurement, and Monitoring piece of the QI framework.  This domain emphasizes the importance of assessing the current landscape of efforts across the state focused on AYA emotional well-being as well as creating a defined measurement plan to inform intervention and monitor outcomes.  Read on to learn how Vermont's AYA BH CoIIN has operationalized this tenant of the framework.

Assessment, Measurement, and Monitoring of Adolescent and Young Adult Emotional Well-Being in Vermont

By: Sally Kerschner, RN, MSN--Coordinator of MCH Injury Prevention, Vermont Department of Health

Assessment

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Vermont has spent much of its initial CoIIN efforts in the assessing the current landscape of existing mental health integration efforts across the state. In creating this inventory, the team realized that several projects and programs have been intentionally developed over recent years by many partners, all with a goal of achieving comprehensive and best practice screening processes in a variety of practice settings.

Below is a partial list of key projects or initiatives in Vermont:

This assessment of existing efforts and the resulting inventory has illuminated the need to partner with, or at the very least, coordinate with these varying programs in order to avoid duplication of efforts.  It is important to be intentional in avoiding duplication to avoid creating skepticism among front-line practitioners and inefficiencies in implementation. Moving forward, a key strategy is to assist our Department of Health and Department of Mental Health state agency leaders in coordinating these various efforts by developing better routine communications channels to be aware of the progress of each initiative.

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Vermont's CoIIN is working to augment and complement several other programs and initiatives to address upstream youth mental health and wellness, including suicide prevention. Vermont does not have dedicated injury or suicide prevention funds, however, we work to integrate public health interventions into our existing capacity. In order to anchor the key public health issue of youth suicide prevention in our work, we incorporated key measures into our MCH Title V Grant planning. The following priority needs are reflected in Vermont's current state action plan and will be revised after the Title V 2020 Needs Assessment process: 

Priority: Youth choose healthy behaviors and thrive

State Performance Measure: Percent of adolescents that feel they matter to people in their community

Supporting Objectives:

  • By 2020, increase awareness among health care providers of the importance of annual preventive health visits for adolescents to 75%.
  • By 2020, increase awareness among parents/ caregivers and patients (adolescents) on the importance of preventive health visits for adolescents to 75%
  • By 2020, increase access to preventive health visits in medical homes and school-based health centers by 20%

Strategies to Meet Objectives:

  • Partner with pediatric primary care practices to increase both access to and quality of well care visits for the adolescent and young adult. 
  • Provide TA and strategies to school nurses to facilitate connections between schools and medical homes.
  • Strengthen partnerships with Vermont's ACOs to leverage opportunities to focus on improving adolescent well-care visits. 

Priority: Children live in safe and supported communities 

State Performance Measure: Percent of high school students who made a plan to attempt suicide in the past 12 months (measured using the Vermont's Youth Risk Behavior Survey)

Supporting Objective: By 2023, increase the percentage of youth and adults screened for suicidality in the primary care setting by 25%.  

Strategies to Meet Objectives:

  • In partnership with the Vermont Child Health Improvement Program, collect and report on quality improvement data from pediatric practices on depression screening. MCH Leadership supports the AYA CoIIN for systems improvement in screening youth for depression and other factors that may lead to suicidality. 
  • Support presence of Umatter Youth and Young Adults Mental Health Wellness Promotion and Community Action in 10 schools statewide. 
2/26/2020 9:56 AMNo
  
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  • Anna Corona
02/5/2020 3:31 PM

Hello, and welcome to the third installment in our "Approaches to Measuring Quality Improvement in Public Health" series! While quality improvement principles have traditionally been implemented in clinical settings, this series is focused on unpacking a measurement framework to apply a  Q.I model/ lens to public health, systems-level work. In our most recent post, we focused on the leveraging existing initiatives part of the framework, which featured how the South Carolina Adolescent and Young Adult Behavioral (AYA BH) CoIIN team prioritized this domain as a part of their work to align efforts and enhance synergy for improving AYA emotional well-being in their state.

The Augmenting MCH Capacity and Strategies of this QI framework emphasizes increasing and enhancing the capabilities and skillsets of the workforce and sectors that are essential to addressing the emerging issues related to AYA emotional well-being.   This can include training MCH staff on understanding the mental health needs and conditions that arise during adolescent years, utilizing strategies to identify and prioritize AYA populations and communities that may experience inequalities that contribute to mental health disparities, or efforts to assist providers in their ability to screen and refer their AYA patients for depression, anxiety, and other conditions accordingly. Read on to learn about the systems in place in Wisconsin to support primary care providers on addressing mental health needs of patients through a statewide psychiatry consultation program.  

Supporting Wisconsin Primary Care Providers in Caring for Children, Adolescents and Young Adults with Mental Health Problems: Wisconsin Child Psychiatry Consultation Program 

By: Arianna Keil, MD, Quality Improvement Director, Children's Health Alliance of Wisconsin & Wisconsin Department of Health Services' Family Health Section

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Wisconsin is pleased to be participating in the public health and primary care arms of the adolescent and young adult (AYA) behavioral health Collaborative Improvement and Innovation Network (CoIIN). Over two thirds of Wisconsin counties do not have a child psychiatrist, so AYAs commonly receive mental health care from primary care providers (PCPs).  Many of these PCPs, however, say they did not get enough training to provide the scope of mental health services asked of them. One part of the solution to this complex problem is the Wisconsin Child Psychiatry Consultation Program (CPCP).

The CPCP offers real-time telephone and email support to Wisconsin PCPs who have questions about how to best care for children and AYA with mental health problems. Available in 65 of 72 counties, the CPCP is staffed during normal office hours by child psychiatrists and a pediatric psychologist, as well as mental health professionals knowledgeable about services available in specific communities. The program is administered through Children's Wisconsin and the Medical College of Wisconsin, and funded in part through a grant from the Wisconsin Department of Health Services' Maternal Child Health Program. Wisconsin is part of a national network offering this type of support.

Since launching in 2015, the CPCP has offered over 3,000 consultations and enrolled over 750 providers. Over half of the contacts are by email, and nearly all questions are answered within one day. Depression is the fourth most common presenting issue, behind anxiety, attention deficit hyperactivity disorder (ADHD) and disruptive behavior. Medication questions are by far the most common reason why PCPs contact the program. PCPs are very satisfied with the support they receive: nearly all (97%) indicate that CPCP consultations have helped them more effectively manage patient care, and that information learned will be used in future care of patients.

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"The CPCP has been a wonderful resource for me as a primary care provider. The ability to have direct access to psychiatrists has helped me to treat and give resources to children I normally wouldn't have been able to help. The program helps reassure me that my treatment decisions are appropriate and it guides me when complex patients walk in the door that I normally would be uncomfortable treating on my own. Without the program, I would have many patients who would not have access to proper mental health treatment. It truly is a great program!" 

-Wisconsin PCP

WI CPCP also offers educational opportunities to enrolled providers. Topics include:

  • Psychopharmacology - includes pharmacologic management of ADHD, depression and anxiety, and atypical antipsychotic agents
  • Rating scales and suicidality - includes general screening tools, specific rating scales, and assessment and triage suicidality
  • Trauma informed care - includes awareness of the impact of traumatic events, and safe, compassionate and respectful partnering
  • Behavioral interventions - includes behavioral dysregulation
  • Parents often appreciate and see the benefit of clinician-to-clinician support.

"My son's pediatrician told me of the CPCP services that she was enrolled in and how it worked. She said my son's treatment was outside the scope of her practice but that she could consult with child psychiatrists through this program. I agreed and trusted her. It was a quick turn-around in which my son's pediatrician called me to discuss medication and treatment options. He is currently stable and doing great in school, and he is even excelling in math! I have more respect for my pediatrician for seeking out assistance and using CPCP because we all don't know everything and need help. As the saying goes: It takes a village to raise a child."                                                          

 -Wisconsin parent  

Wisconsin providers enrolled in the AYA behavioral health CoIIN will learn about the CPCP on a webinar in March on state-specific resources.

To learn more, visit www.chw.org/CPCP or watch https://www.youtube.com/watch?v=ZTp94VPG2VU&feature=youtu.be

2/5/2020 3:31 PMNo
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*The AYAH-NRC is funded by a cooperative agreement with the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration. The center's work focuses on improving the health of adolescent and young adults (ages 10-25) by strengthening the capacity of state maternal and child health programs and their clinical partners to address the needs of those populations. The AYAH-NRC collaboration is led by the National Adolescent and Young Adult Health Information Center at the University of California, San Francisco, in partnership with AMCHP, the University of Minnesota's State Adolescent Health Resource Center, and the University of Vermont National Improvement Partnership Network.