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National Network of State Adolescent Health Coordinators

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The National Network of State Adolescent Health Coordinators (NNSAHC) unites those designated as state adolescent health coordinators (SAHCs), and other public health professionals responsible for coordinating adolescent health program/policy direction in state Title V/maternal and child health programs, and other programs in state public health agencies. This mission of NNSAHC is to provide leadership and advocacy for adolescent health and positive youth development in state and federal agencies. The membership of NNSAHC includes designated SAHCs in most states and some U.S. territories.

Key Facts

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  • The roots of the State Adolescent Health Coordinator (SAHC) role date back nearly a century to the work of the Children's Bureau and the passing of the Social Security Act of 1935.
  • The SAHC role originated within State Title V Maternal and Child Health (MCH) Block Grant programs in the early 1980’s spurred on by increased awareness of the unique health and developmental needs of adolescents.
  • Overtime, some Title V/MCH program funded SAHC positions have moved into in other state public health agency programs (e.g. Title_X family planning programs], EPSDT, chronic disease, school based health centers) as state and federal funding sources shift.
  • As of 2011, 42 states and 3 territories had a designated SAHC (or at least someone designated as a main adolescent health contact).
  • NNSAHC is a voluntary leadership structure representing designated SAHCs in states and territories. Funding and resources for NNSAHC functions are provided through extensive collaborations with federal agency and national organization partners. Leadership positions are elected from
among SAHCs, and serve in 2 or 3 year leadership roles.

Maternal and child health programs in the United States have played an instrumental role in demonstrating the unique health and development needs of adolescents in the context of the life course of an individual, and in the context of family health. National recognition for adolescence as a unique population and developmental period has roots dating back nearly a century to the work of the Children's Bureau, and the passing of the Social Security Act of 1935 which established Grants to the States for Maternal and Child Welfare (known today as the Title V Maternal and Child Health Block Grant).

Key Facts

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  • Federally funded maternal and child health (MCH) programs have played an integral role in elevating adolescence as a unique period of health and development within federal and state public health programs.
  • Throughout the 1960's and 1970's federally funded MCH programs were responsible for landmark adolescent health training programs for medical and public health professionals.[1]
  • In 1968, an MCH funded adolescent medicine seminar led directly to the development of a new professional association devoted to adolescents, The Society for Adolescent Medicine (later renamed the Society for Adolescent Health and Medicine, or SAHM), an organization that has provided a forum for the exchange of information on adolescent health issues, promoted research related to adolescents, and served as an advocacy group for adolescent health needs for over three decades. [2]
  • Federally funded MCH programs are responsible for establishing the role of State Adolescent Health Coordinators, public health professionals responsible for coordinating adolescent health program/policy direction in state MCH and other public health programs.

Roots in the Social Security Act of 1935

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Decades of Maternal and Child Health (MCH) program leadership for adolescence as a unique period of health and development dates back nearly a century to the work of the Children's Bureau and the passing of the Social Security Act of 1935. The Act resulted in the establishment of state departments of health or public welfare in some states, and facilitated the efforts of existing agencies in other states. Title V of the Social Security Act also established Grants to the States for Maternal and Child Welfare, originally assigned to the Children's Bureau within the U.S. Department of Commerce and Labor. Many changes have occurred to Title V over the years, including the transfer of administration of Title V state grants to the Public Health Service in 1969, the conversion of Title V to a Block Grant program as part of the Omnibus Budget Reconciliation Act of 1981, and the creation of the Maternal and Child Health Bureau (MCHB) in 1990 to administer the Title V Block Grant program.[3] Throughout its history, Title V has been responsible for landmark guidelines for child health supervision, influenced the nature of nutrition care during pregnancy and lactation, recommended standards for prenatal care, identified successful strategies for the prevention of childhood injuries. Title V has also been instrumental in promoting and supporting a national and state focus on adolescent health in this country.

1950s: Early Roots of Adolescent Health Within the Children's Bureau

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Reflecting the national issues of the early part of the 20th century, the Children’s Bureau’s initial concerns for the adolescent population grew out of other contexts such as children with special health care needs, children of working mothers, and children in unfair labor practices. In the 1950’s, a shift began to occur – a new understanding emerged of adolescents’ needs incorporating biological, psychological, social and environmental factors.[4]

This new understanding of adolescents gained traction at the December 1950 Midcentury White House Conference on Children and Youth. The purpose of the Midcentury Conference was to “consider how we can develop in children the mental, emotional and spiritual qualities essential to individual happiness and responsible citizenship and what physical, economic and social conditions are deemed necessary to this development."[5] [6] The Midcentury White House Conference was historic for several reasons, among them that for the first time, youth themselves were invited to participate, and over four hundred youth attended, representing every state in the Union. The Midcentury Conference was also historic for recommendations emerging from the conference. One such recommendation recognized the need for a workforce trained in the unique development needs of children and adolescents: "That all professions dealing with children have, as an integral part of their preparation, a core of common experiences on fundamental concepts of human behavior, including the need to consider the total person as well as any specific disorder; the inter-relationship of physical, mental, social, religious, and cultural forces; the importance of interpersonal relationships; and the role of self-understanding; and emphasis on the positive recognition and production of healthy personalities and the treatment of variations; and that lay people be oriented through formal or informal education to an understanding of the importance of the foregoing concepts." [7]

Urged on by growing national attention to adolescent health and development, the Children’s Bureau emphasized, in a statement issued in 1951, that special attention should be focused on the needs of certain groups of children, including “adolescents who are having trouble finding a significant place for themselves in life.” [8] Shortly after the Children’s Hospital of Boston opened the nation’s first adolescent unit in 1952, and the Children’s Bureau’s Title V/MCH program funded fellowship training for pediatricians to study adolescent health at five sites, including Boston.[9]

1960's - 1970's: MCH Programs Responsible for Establishing Long-Lasting Adolescent Health Initiatives

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Throughout the next two decades, the Title V/MCH program supported significant advances in training and education for adolescent health:

  • 1960: The Children’s Bureau MCH Program supported the first national forum on adolescent health ever to be held, entitled the “Joint Adolescent Clinic Conference.” A subsequent series of annual conferences referred to as Adolescent Seminars was organized by Dr. Felix Heald of Children’s Hospital in the District of Columbia, a graduate of the MCH Training Program in Boston.
  • 1963: In response to a growing concern about births to unmarried teen parents, the Children's Bureau funded the Webster School Project in Washington, D.C., a research demonstration program involving cooperative efforts between the public schools and the Departments of Public Health and Public Welfare. At the time, most public schools barred pregnancy girls from attending regular classes. The Webster School experiment assumed that pregnant teenagers needed comprehensive educational, health and counseling services in order to overcome the disadvantages associated with early child bearing.[10] The Webster School experiment’s comprehensive model became widely accepted as the preferred approach to teen pregnancy prevention, and ultimately was incorporated into the Adolescent Health, Services and Pregnancy Prevention Care Act of 1978, which provided for the establishment of the Office of Adolescent Pregnancy Programs in the Public Health Service.[11]
  • 1965: The Children's Bureau MCH Program established a new grant program to fund projects to State health departments, or, with their approval, to local health departments or various institutions of higher learning or teaching hospitals, to provide diagnostic services, preventive services, treatment services, correction of defects, and aftercare for children and youth who would not otherwise receive it because they are from low-income families or for other reasons beyond their control. These projects became known as Children and Youth (C&Y) Projects.[3]
  • 1967: The Children's Bureau MCH program provided funding to expand or develop new adolescent health programs at six sites. The grants paid for 14 physician fellowships in adolescent medicine, and these programs defined the adolescent fellowship experience. [12]
  • 1968: An Adolescent Medicine Seminar funded by the Children's Bureau MCH program led directly to the development of a new professional association devoted to adolescents, The Society for Adolescent Medicine (later renamed the Society for Adolescent Health and Medicine, or SAHM), an organization which has provided a forum for the exchange of information on adolescent health issues, promoted research related to adolescents, and served as an advocacy group for adolescent health needs for over three decades.[1]
  • 1975: Now under administration of the U.S. Public Health Service, Office of Maternal and Child Health, the Title V/MCH program published Approaches to Adolescent Health Care in the 1970s. The report recognized the unique characteristics of adolescents and their need for appropriately organized health services. The authors called attention to scattered, fragmented, and uncoordinated services, explaining that health problems were evident at increasingly early ages, and making clear that effective preventive measures and health education must be initiated early.[13]
  • 1976: The Office of Maternal and Child Health funds nine new interdisciplinary adolescent health training programs to train not only physicians, but also persons from the fields of nursing, nutrition, psychology, and social work. Known today as the Leadership and Education in Adolescent Health (LEAH) Program, the goal was to develop a cadre of leaders who would secure improved care and services for adolescents through policy, research, training, and clinical care. [14] [15] The LEAH training program has continued to the present, with relatively minor modifications. In 2013, seven funded LEAH programs still exist.[16] [17]

1980s: Adolescent Health Takes Root in State Public Health Agencies

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Two events sponsored by the Office of Maternal and Child Health in the 80's helped carve out a niche for adolescent health in MCH programs:

  • A 1984 conference, Youth with Disability: The Transition Years, held in Minnesota identified major issues and barriers faced by adolescents with disabilities in each of four areas: social maturation, developing independence, education and career preparation, and community services.[18]
  • A 1986 conference, Health Futures of Adolescents, sponsored by the Society for Adolescent Medicine, the Office of Maternal and Child Health, and the University of Minnesota sought to establish a blueprint for the next 15 years for services, research and training that would better meet the needs of youth in the year 2000 and beyond. Study groups explored twenty-two areas in depth to identify salient issues and appropriate program development and research approaches.[19] Recommendations from the 1986 conference included the need for having one person responsible for assembling national-, state- and community-based data on adolescent health services and health problems.

In response to the 1986 conference recommendations from these conferences, several grants resulted through the Office of Maternal and Child Health’s Special Projects of Regional and National Significance (SPRANS), including a demonstration grant to the University of Minnesota’s National Resource Center for Youth with Disabilities.[20]

This decade saw the most significant change to the Title V/MCH program since its creation - the conversion of the program to a state Block Grant program as part of the Omnibus Budget Reconciliation Act of 1981. This conversion consolidated seven former Title V categorical child health programs into a single program of formula grants to states supported by a Federal special projects authority. The 1981 legislation gave states more leeway in determining how to use federal funds, allowing them to self-direct money to identified, state-specific maternal and child health needs.[21]

As states assumed more control over their Title V/MCH Block Grant funds, a focus on adolescent health began to take root in state public health agencies in a way it had not before as some state Title V/MCH programs took the opportunity to establish staff positions with specific responsibility for adolescent health within their newly awarded state Title V/MCH Block Grants. These positions became some of the first known as “State Adolescent Health Coordinators" (SAHC). Although these early positions were unlikely to have adolescent health as their sole responsibility, it was a major turning point in the evolution adolescent health in state and federal public health arenas, recognizing that when public health infrastructure includes an individual unit or focal point for a specific population group, policies, programs, services and supports for the designated group are greatly enhanced.[22]

Throughout the 80's, the appearance of SAHCs in state Title V MCH Programs gained momentum. By 1988, nearly twenty state Title V/MCH programs had created or designated existing staff as the state adolescent health coordinator. Seeing the promise and opportunity of providing a forum for strengthening MCH programs knowledge and skills to better serve adolescents within their programs, the Office of Maternal and Child Health (later to become the Maternal and Child Health Bureau) provided funding and coordination for what became the first annual meeting of state adolescent health coordinators in 1988, in Washington DC. The meeting was attended by representatives of twenty state Title V/ MCH programs. A second annual meeting of state adolescent health coordinators took place in 1989, in Denver, CO, attended by representatives of twenty one state Title V/MCH programs. It should be noted that at that time, few of the state agency representatives who participated had adolescent health as their sole responsibility, but wanted to embrace their role in their state to increase a focus on adolescent health. These early meetings were reported as great successes and participants expressed their enthusiasm and appreciation for the opportunity to meet and network with their peers from other states.[23]

By 1989, as many as thirty three states had designated SAHCs whose major function was to improve the comprehensiveness of services delivered to all adolescents - not only those who were poor, resided in underserved areas, or had special health care needs. However, little had been written about the size and characteristics of the adolescent populations served by state Title V MCH Blockgrant and children with special health care needs programs (CSHCN), a mandated component of Title V MCH Blockgrant Programs. Surveys of Title V agencies at the time, prepared by the Association of State and Territorial Health Officials and others, typically reported on the total number of children and pregnant women served, without reference to age. Even less was known about the types of health services offered to adolescents by Title V agencies. To more fully understand the role of state Title V MCH programs and CSHCN programs in serving adolescents, the Maternal and Child Health Bureau funded a 1989 survey of state Title V/MCH Programs and Programs for Children with Special Health Needs (CSHN) on their respective roles in serving adolescents.[24]

The 1989 survey provided the first published analysis of its kind on Title V's role in serving adolescents, and revealed important information regarding the characteristics of adolescent recipients, services provided, access barriers, and financing needs. The Maternal and Child Health Bureau had taken a critical, and historical step in examining how Title V MCH programs might be better coordinated and strengthened to serve adolescents. In addition to characterizing adolescents served by Title V program for the first time, the 1989 survey also further established the need for continued networking and peer learning between state adolescent health coordinators.

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1990's: MCH Programs Strengthen State and National Visibility for Adolescent Health ==

Annual meetings of SAHCSs from state Title V MCH Programs continued throughout the 1990’s (and up until 2007), funded first by the U.S. Maternal and Child Health Bureau (established in 1990 to administer the Title V/MCH Block Grant program), then later by the Centers for Disease Control and Prevention Division of Adolescent and School Health (through cooperative Agreements with the Association of Maternal and Child Health Programs). These annual meetings of SAHCs were instrumental in the creation of formal communication structure between state Title V/MCH program staff focused on adolescent health and others at the state and national level. Out of these annual meetings, a formal network of state adolescent health coordinators was established in 1990, known as the State Adolescent Health Coordinators Network (later renamed as the National Network of State Adolescent Health Coordinators or NNSAHC). With technical assistance and other support from partners and resource centers funded primarily through the Maternal and Child Health Bureau, NNSAHC evolved into a volunteer elected leadership structure dedicated to providing professional growth and consultation for those responsible for all aspects of adolescent health programs in state Title V/MCH programs, and other programs in state public health agencies.

Today: Continued MCH Leadership for Adolescent Health

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References

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  1. ^ a b Athey, J., Kavanagh, L., Bagley, K., Hutchins, V. (2000). Leadership Education in Adolescent Health, A Case study, in Building the Future: The Maternal and Child Health Training Program. Arlington, VA: National Center for Education in Maternal and Child Health. Retrieved 9/3/2013
  2. ^ Athey et al, 2000
  3. ^ a b U.S. Maternal and Child Health Bureau. (2001). Celebrating 65 years of Title V: The Maternal and Child Health program 1935-2000—A review of federal appropriations and allocations to states for maternal and child health programs under Title V of the Social Security Act. Rockville, MD: U.S. Maternal and Child Health Bureau, 143 pp. Available free from HRSA.
  4. ^ Athey, J., Kavanagh, L., Bagley, K., Hutchins, V. (2000). Leadership Education in Adolescent Health, A Case study, in Building the Future: The Maternal and Child Health Training Program. Arlington, VA: National Center for Education in Maternal and Child Health. Retrieved 9/3/2013
  5. ^ Roberts, Dean W. (1951). Highlights of the Mid-Century Conference on Children and Youth. American Journal of Public Health and the Nations Health: January 1951, Vol. 41, No. 1, pp. 96-99. Retrieved 9/3/2013.
  6. ^ Child Welfare League of America. (nd). The History of White House Conferences on Children and Youth. Retrieved 9/3/2013.
  7. ^ Social Security Administration. (1951). Recommendations of the White House Conference on Children and Youth. Social Security Bulletin, Vol. 14 No. 2. Retrieved 9/3/2013
  8. ^ Bradbury, D. (1962). Five Decades of Action for Children, A History of the Children’s Bureau. Written by Dorothy Bradbury, Director Division of Reports, Children’s Bureau to the future Children’s Bureau Chief, Katherine B. Oettinger. Chapter VI, page 73. Retrieved 9/3/2013
  9. ^ Athey et al, 2000
  10. ^ Goodman, E.M., and Gill, Fobola, M.L.. (1966). A Multi-Disciplinary Approach to a School-Centered Rehabilitation Program for Pregnant School-Age Girls in Washington, D.C. Washington, DC: District of Columbia Department of Human Resources, and District of Columbia Public Schools.
  11. ^ Finkel, M.L., and Finkel, D.J. (1983). Public policy and adolescent sexual behavior in the United States. Social Biology, 1983 Summer;30(2):140-50.
  12. ^ Athey et al, 2000
  13. ^ Milar, H. (1975) Approaches to Adolescent Health Care in the 1970s. Health Services Administration, Rockville, MD. Bureau of Community Health Services. Report number DHEW-HAS-76-5014.
  14. ^ Gephart, J. (1990). Introduction to published proceedings of 1989 Annual Conference of State Adolescent Health Coordinators. National Center for Education in Maternal and Child Health: Washington, DC
  15. ^ U.S. Maternal and Child Health Bureau (2010) Division of Research, Training and Education; MCH Training Program: Leadership Education in Adolescent Health Factsheet (2010), http://mchb.hrsa.gov/training/documents/fs/adolescenthealth_final.pdf
  16. ^ Athey J, Kavanagh L, Bagley K, Hutchins V. (2000). Leadership Education in Adolescent Health, A Case study, in Building the Future: The Maternal and Child Health Training Program. Arlington, VA: National Center for Education in Maternal and Child Health. Archived at: http://www.mchlibrary.info/pubs/PDFs/spr/Training.pdf
  17. ^ LEAH Training Website, http://leah.mchtraining.net/
  18. ^ Blum, R. W., and Leonard, B. (Eds.) (1985) An integration of the working papers developed for the conference published in: Youth with disability: The transition years. Journal of Adolescent Health Care. 6(2): 77-184. March 1985, 108 pp.
  19. ^ Blum, R. W. and Smith, M. A. (Eds.) (1987) A summary of the papers and proceedings published as Youth 2000: Regional Adolescent Futures Conference. Minneapolis, MN: Institute for Continuing Education in Adolescent Health Care, University of Minnesota, 80 pp.
  20. ^ Confiming Citation
  21. ^ U.S. Maternal and Child Health Bureau (Accessed January 2012) Understanding Title V of the Social Security Act, http://mchb.hrsa.gov/about/understandingtitlev.pdf.
  22. ^ Association of Maternal and Child Health Programs and the National Network of State Adolescent Health Coordinators (2005) Conceptual Framework for Adolescent Health. Funded by the Annie E. Casey Foundation, available at: http://www.aecf.org/upload/publicationfiles/ar3622h421.pdf
  23. ^ Confirming adequate citation? Birkhimer, N. (2012) Annual conference summaries and rosters of adolescent health coordinators dating back to the early 80’s compiled over time by Executive Committee members of the of the National Network of State Adolescent Health Coordinators, and maintained and forwarded to Rena Large, State Adolescent Health Resource Center by Nancy Birkhimer, former Maine adolescent health coordinator.
  24. ^ McManus, M., Kelly, R., Newacheck, P., Gephart, J. (1989). The Role of Title V Maternal and Child Health Programs in Assuring Access to Health Services for Adolescents. Published by McManus Health Policy, Inc., Institute for Health Policy Studies, University of California, San Francisco, with support from Maternal and Child Health Bureau, Department of Health and Human Services, Rockville, MD.
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