Midwest Adolescent Health Project

Overview

The Midwest Adolescent Health Project (MAHP), a project of the Adolescent Health Initiative, aims to improve the healthcare landscape for the health and well-being of youth and young adults by building capacity for adolescent-centered health care. The MAHP serves rural and under-resourced communities in the Health and Human Services (HHS) Region V (Illinois, Indiana, Ohio, Michigan, Minnesota, Wisconsin). The MAHP strives to achieve their goal through provision of adolescent-friendly healthcare through the evidence-based Adolescent-Centered Environment Assessment Process (ACE-AP).

Recommendations

Recommendations for entities interested in implementing a similar project to improve the systems of care through the medical home lens:

• Center the youth-perspective when developing programming directly impacting youth health.
  • Meaningfully engage youth and young adults from the beginning of an initiative through the end.
    • Example: the MAHP has an advisory council of youth and young adults providing oversight, guidance, and partnership on all the resources developed and implemented through the initiative.
• Trust the community to be the experts.
  • • Example: the healthcare centers and youth-facing organizations in which the ACE-AP is being implemented decide how many and which indicators to prioritize based on the needs and wants of the community they serve.

Data/Outcomes

• The MAHP is in the final year of funding from the Healthy Tomorrows Partnership for Children Program (HTPCP) and is focusing on analyzing the data collected across the 16 sites who have completed the process and the 11 sites currently in the process.
  • While there are no formal outcomes to report at this time, when outcomes are available they will be reported to the funder at the completion of the 5-year funding cycle.
  • Projects funded through the HTPCP report full or partial sustainment at 89% five or more years after the end of the HTPCP funding.
• Evaluation is a crucial component of the ACE-AP. The total process takes 18 months for full implementation.
  • In months 1-3, sites collect baseline data through surveys.
    • Sites aim to collect 50 surveys from youth and young adults receiving services from the clinic; these surveys focus on patient satisfaction and best practices in adolescent-centered case such as, “Did the provider talk privately with you (without your parent/guardian/caregiver in the room)?”.
  • Sites additionally survey staff to assess baseline knowledge on areas such as staff perceptions on how youth friendly the site is, attitudes and knowledge on minor consent and confidentiality laws in their state.
  • The site also participates in the assessment at both the beginning of the process and at mid-point.
  • In the last 3 months of the process (months 15-18), youth and staff are once again surveyed, and data are analyzed to determine shifts in baseline knowledge and perceptions.

Project Background

• The ACE-AP is an 18-month quality improvement initiative for health care centers and youth serving organizations to make improvements in adolescent-centered care.
• Recruited sites (primarily from rural and under-resourced communities) complete a facilitated self-assessment on nearly 80 indicators based on best practices in adolescent-centered care. These indicators span 12 sections including topics such as Reproductive & Sexual Health, Confidentiality, and Adolescent Engagement and Involvement. Sites rate themselves on a scale of 0-2 (zero is not at all implemented, 1 is partially implementing the indicator or implementing inconsistently, 2 is fully and consistently implementing the indicator).
  • Indicators focus on 3 components of care: policy, practices, and physical space. Sites review the assessment and choose which indicators they would like to improve in their practice.
  • There is no required number of indicators sites must choose; sites are recommended to work on as many indicators for which they have the capacity and aligns with goals of the community.
• Sites work directly with coaches who have been trained in the implementation of the ACE-AP.
  • The coaches are all public health professionals with varying backgrounds including health education, teen pregnancy prevention, maternal and child health, program evaluation, and youth engagement. At the onset of the project, potential coaches apply to be part of the project and AHI trains them through a series of interactive training summits and regular check ins.
  • At the time of publication of this Promising Practice, 5 coaches had been recruited, trained, and actively working with sites on implementation.

Funding Mechanism

• This project is funded through the Healthy Tomorrow’s Partnership for Children Program and the University of Michigan.

Sustainability

• Sites participating in the process and who have “graduated” from the program have access to resources to support continued implementation of adolescent-centered care.
  • The MAHP has a database of enduring resources, trainings, education, etc. to support continued efforts on all 80 indicators.
• Sites are offered the opportunity to be certified through the MAHP as an adolescent-centered environment after completing the process.
  • Sites are certified by meeting 11 key indicators and are provided 2 years of technical assistance, training, and other resources after reaching certification.
  • Sites can apply for re-certification after 2 years.
  • Of the 16 sites who have completed the process, 14 sites are currently certified.

Youth and Young Adult Engagement

• Youth and young adult engagement is key to effectively implementing adolescent-centered care.
• The project recruited a youth advisory council of 16 young adults for provision of guidance and oversight on the project.
  • Advisory council members were recruited through local high schools, colleges, and universities.
  • MAHP team seeks to move towards a more inclusive recruitment process by connecting and engaging with youth and young adults in places outside of educational institutions.
  • The advisory council provided input on the original program assessment and continues to provide input on assessment revisions and youth survey.
  • The advisory council developed a video that is used to recruit health centers to participate in the initiative.
• Sites are highly encouraged to engage with the youth and young adults in their community through the implementation of assessment indicators and are evaluated on how visible youth and young adults are at the site.
  • Are there visual representations that support diversity within youth and young adults?
  • Do youth and young adults “see” themselves at the clinic and know they belong?

Related American Academy of Pediatrics (AAP) Policy

• The work of this promising practice aligns with recommendations and evidence outlined in the AAP policies, “Unique Needs of Adolescents” and “Achieving Quality Health Services for Adolescents.”