Title V Transformation Tools
Recommendations to Support NPM 10 – Adolescent Well Visit
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Significance. The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this NPM as follows:
Adolescence is a period of major physical, psychological, and social development. As adolescents move from childhood to adulthood, they assume individual responsibility for health habits, and those who have chronic health problems take on a greater role in managing those conditions. Initiation of risky behaviors is a critical health issue during adolescence, as adolescents try on adult roles and behaviors. Risky behaviors often initiated in adolescence include unsafe sexual activity, unsafe driving, and use of substances, including tobacco, alcohol, and illegal drugs.
Receiving health care services, including annual adolescent preventive well visits, helps adolescents adopt or maintain healthy habits and behaviors, avoid health?damaging behaviors, manage chronic conditions, and prevent disease. Receipt of services can help prepare adolescents to manage their health and health care as adults.
The Bright Futures guidelines recommend that adolescents have an annual checkup starting at age 11. The visit should cover a comprehensive set of preventive services, such as a physical examination, discussion of health?related behaviors, and immunizations. It recommends that the annual checkup include discussion of several health?related topics, including healthy eating, physical activity, substance use, sexual behavior, violence, and motor vehicle safety.
Background. The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures (NPMs) for the 2015-2017 grant cycle. In order to effectively address the NPMs, MCH professionals need to think about not only the evidence and strategies to make change, but also the capacity of the workforce to carry out these activities. These lists identify online learning materials, resources, and evidence-based strategies and programs to support the knowledge sets and skills needed to advance each NPM.
Introduction. Six skill sets have been identified by the National MCH Workforce Development Center to support implementation of the Title V National Performance Measure (NPM) 5: Safe Sleep: (1) population health; (2) strategic planning and program design; (3) strategic alliances and effective partnerships; (4) consumer engagement and cultural and linguistic brokering; (5) policy and program implementation; and (6) communication.
In addition, three knowledge areas specific to the NPM topic area have been highlighted that are keyed to the evidence base and promising practices: (1) adolescence, (2) adolescent backgrond, recommendations, and guideline, and (3) adolescent well visit policies and strategies.
The MCH Navigator, in collaboration with the Center, has developed this crosswalk to guide MCH professionals to online learning opportunities and implementation resources to support these skill sets.
Please click on the Read More buttons below for additional information, learning materials, and implementation resources. You can also email us with suggestions for additions.
Six skill sets have been identified to support implementation of this NPM:
1. Population Health
A renewed focus on MCH population health is key to achieving the NPMs in the era of health transformation. These skills enable Title V professionals to analyze how program interventions and their related health outcomes are distributed among a state’s MCH population. Population health skills complement all of Title V’s work, including program design and implementation, strategic partnerships and communication.
- Ability to conduct surveillance of adolescent well-visit utilization that allows public health practitioners to understand and respond to disparities in utilization of visits
- Ability to use population health surveillance to inform proposed delivery system changes
- Skills in analyzing how health care delivery systems identify and refer adolescents for appropriate treatment following a well-visit
2. Strategic Planning & Program Design
Effective strategic planning and program design require the ability to base programs on defined goals and desired outcomes. Strategic planning should include a monitoring and evaluation system to track and monitor progress and inform program alterations as needed. Program design skills must ultimately be coupled with implementation, where program design is carried out.
- Ability to employ qualitative methods in needs assessments with families and communities to identify attitudes about root causes of low use of preventive services
- Skills in quality improvement to support providers and health systems in making data-informed decisions
3. Strategic Alliances & Effective Partnerships
The wide array of stakeholders and partners in the field of MCH, from providers and insurers to women and children, require a set of skills in strategically aligning Title V goals with those of their partners. In the Title V world, there is an increasing interest in engaging unlikely or nontraditional partners to achieve the NPMs. The skills in this category take that into account and include unique partner groups linked to this measure.
- Skills to create and manage external alliances that engage public health, private health plans, federally qualified health centers, school-based health centers, and Medicaid/Children’s Health Insurance (CHIP) to increase awareness of adolescent well visit coverage among providers and patients
- Skills to manage public health and inter-governmental partnerships that work to advance the health, safety, and well-being of adolescents and the receipt of preventive services
- Ability to foster collaboration between public and private health care providers to increase the utilization and quality of adolescent well-visits
- Skills in working with other state agencies and relevant organizations from the private sector to improve access to high quality clinical preventive services by vulnerable groups of adolescents, including youth in foster care, homeless youth, and immigrant youth
4. Consumer Engagement/Cultural & Linguistic Brokering
Consumers are arguably the most important stakeholders in MCH work, thus skills in consumer engagement and cultural and linguistic brokering are essential to moving the needle for each NPM. In some cases, consumer engagement includes negotiating with other stakeholders on behalf of MCH populations. Closely linked with this skills category are skills in communication and strategic alliances.
- Ability to effectively engage adolescents and young adults in policy and program efforts that attempt to increase utilization and quality of preventive health care services for adolescents
- Skills to educate and monitor providers about their responsibilities for accessible interactions with adolescents related to confidentiality of care, youth-centered care, translation services, linguistic access, and American Disabilities Act (ADA) compliance
- Ability to assist public health and clinical health programs to provide evidence-based health education to youth and families on topics important to adolescent health including, for example, reproductive and sexual health, navigating the health care system, and inter-generational communications, to adolescents and their families in a variety of settings, including schools, and youth organizations
5. Policy & Program Implementation
These skills ensure that MCH priorities are integrated into all aspects of policy and program implementation, as well as ensuring that policies and programs selected are well-aligned with NPMs and other MCH program goals. Implementing policies and programs with fidelity also requires skills in the implementation science drivers: technical and adaptive leadership; selection; training; coaching; systems intervention; facilitative administration; and decision support data systems.
- Ability to create evidence-based practices systems that support the planning and implementation of transition from adolescent to adult services by others e.g. providers, health care systems, local public health, schools
- Skills to support robust and effective referral systems to preventive services in community settings
- Skills to promote health care providers’ effective use of youth-oriented community programs as resources to promote healthy development
- Ability to include measurements of family perspectives in program evaluation plans
- Ability to analyze workforce shortage data that impact capacity of communities to provide adolescent well visits
- Ability to analyze and make recommendations to strengthen “adolescent-friendly” payment systems that protect patient confidentiality
- Ability to determine legal authority behind existing memoranda of understanding with governmental agencies in regard to adolescent care
- Skills to develop memoranda of understanding with Medicaid and other payers to develop policies that promote sharing of data and ensure effective services and reimbursement for adolescent care
- Ability to analyze and refine state and health plan policies relevant to confidentiality, minor consent, and explanation of benefits statements
Communication skills support the creation and delivery of effective messages between MCH professionals, professional and community partners, and populations served by Title V. Effective communication ensures the delivery of appropriate messages to audiences in the way that they were intended and is key to all aspects of MCH work. These skills are linked closely with skills in strategic partnerships and cultural and linguistic brokering.
- Skills to effectively communicate the importance of preventive services with selected adolescent and family audiences
- Skills to effectively communicate with health care providers regarding adolescent use of preventive service visits and enhancing the quality and comprehensiveness of the visit
- Ability to effectively market adolescent health services offered by public health departments in states/territories where Title V provides or supports clinical services for adolescents
- Ability to communicate with adolescents, families, and health care providers information about legal rights related to access and quality of preventive care, especially confidentiality issues related to adolescents
- Ability to select and use traditional and/or social media to communicate the importance of adolescent visits and shift conversation to a culture of health
In addition to skills, each NPM requires a knowledge base that will help Title V progress effectively in the measure. Knowledge should be considered at the foundation of achieving all measures.
- Knowledge of developmental processes of adolescence and the application of this information to shape and refine health care services and systems to best engage young people in health care
2. Adolescent Background, Recommendations & Guidelines
- Knowledge of the health care system functions and processes (private, public, payment systems, provider and clinic systems, etc.).
- Knowledge about critical determinants of health for adolescents, including social, environmental, genetic, and health system
- Knowledge of health (physical, emotional, etc.) benefits of recommended preventive services for adolescents
- Knowledge of economic benefits, including return on investment of preventive health services, for adolescents
- Knowledge of clinical guidelines (especially Bright Futures) for preventive care for adolescents and components of adolescent well visits
- Knowledge of utilization rates for adolescent well visits in private and public practice settings, including national and state data for Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) visits and adolescent preventive service visits
- Knowledge of barriers to adolescent well visits
- Knowledge of confidentiality laws related to adolescent health services
- Knowledge of best practices for youth-centered clinic services
3. Adolescent Well Visit Policies & Strategies
- Knowledge of both general and state-specific preventive services coverage for adolescents
- Knowledge of Medicaid, Children’s Health Insurance Program (CHIP), Marketplace and employer-sponsored coverage for adolescent health services and associated cost sharing
- Knowledge of resources to regularly follow and/or research state and federal policies and guidance regarding preventive medical visits for adolescents
- Knowledge of evidence-based and evidence-informed strategies, practices, and interventions that increase adolescent utilization of preventive health services
- Knowledge of evidence-based and evidence-informed strategies, practices, and interventions that improve the comprehensiveness and quality of the adolescent well visit
See other online learning resources related to health transformation, collected in the Health Transformation Learning Laboratory.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 83.