This Change Package provides a range of tools and guidance for state-led efforts to improve receipt of preventive services for adolescents and young adults.
- It reflects the experiences of the twelve states that took part in a quality improvement project to support state efforts to increase receipt of well visits, (National Performance Measure #10 of the Title V Block Grant: percent of adolescents, ages 12 -17, with a preventive medical visit in the past year).
- The project, based on the Collaborative Improvement and Innovation Network model (CoIIN), involved partnerships between state Maternal and Child Health/Title V programs working with clinical and other partners.
This training module guides viewers through the CoIIN’s approach to improving well visit and links to multiple resources. Selected links for some resources are provide below. The module is organized around the CoIIN’s three national strategies that guided all efforts:
- 1: Increase Access & Utilization of AYA Preventive Services
- 2: Improve Quality of AYA Preventive Services (Clinic-Level)
- 3: Improve State- and Systems-Level Policies and Practice for AYA Preventive Services
See an overview of selected state approaches.
- The AYAH-National Resource Center conducted several policy and practice-relevant studies and reports on the well visit, including a guide to well visit data sources, updated in August 2023.
- Partners from the MCHB-funded Adolescent and Young Adult Health Research Network, housed at the University of California, San Francisco, have conducted multiple studies on preventive services, including a comprehensive literature review.
- Mechanisms of change: The CoIIN guided states in identifying critical factors that shape receipt of well visits in their state and mapping activities to affect those chapters. CoIIN states used a Key Driver Diagram model to provide this “map” of activities and intended change. See an example here.
- Aims statement: States also created an Aim statement. See sample guidance is available here.
National Strategy 1 – TO THE DOOR: Increasing Uptake of the Well Visit
Public Education/ Health Literacy
The Center created these adaptable tools for promoting the well visit to parents.
The CDC offers general guidance and several tools about engaging parents in school health.
Tools from the States
Iowa’s CoIIN team conducted parent and youth focus groups (see interview protocol and focus group report). These informed a statewide “Every Age, Even Teenage” education campaign, including publicity at places where teens and families gather, such as sporting events.
Vermont’s CoIIN Team led youth in in developing youth-friendly flyer about the well visit.
Clinic-based efforts to promote the well visit
The Center created an overview of clinical-based strategies to to increase AYA well-visits
Several states aimed to expand the “sports physical” to a well visit. Oregon’s Title V program developed a report comparing this visit to a well visit.
National Strategy 2 – IN THE CLINIC: Improving the Quality of the Well Visit
Several guidelines include recommendations for the well visit. The Center has synthesized major well visit guidelines into brief clinical toolkits for to guide delivery of preventive services to Adolescents and Young Adults.
Sources of well visit guidelines include:
- Bright Futures, including provider tools
- US Preventive Services Task Force
- CDC Guidelines for Immunizations
The American Academy of Pediatrics provides guidance on coding for Preventive Care. The 2022 update is available here.
This compendium of adolescent and young health care measures, intended to guide quality improvement projects, was developed by core Center Collaborator, National Improvement Partnership Network (NIPN) at the University of Vermont.
Several states focused on improving provision of youth friendly care and engaged youth in these efforts. See the Center’s Toolkit on Youth-friendly care.
- The State Adolescent Health Resource Center at the University of Minnesota, a core Center partners, created a Guide on Youth Center Care, with multiple state examples.
- The Vermont CoIIN Team engaged the Vermont Raise Awareness for Youth Services (RAYS), who work included development of a clinical assessment tool.
- Several states used materials from Wisconsin’s PATCH program (Providers and Teens Communicating for Health)
- The Mississippi CoIIN Team developed a guide to help providers navigate state and federal laws on confidentiality.
- The New Mexico CoIIN Team engaged young people to create this toolkit to guide clinicians and clinic staff in delivering quality well visits. It includes links to resources such as motivational interviewing, patient satisfaction and provides sample waiting room posters, developed by youth, that promote the well visit.
National Strategy 3 – ACROSS THE STATE: Changing Systems
Several resources offer guidance, with examples, on state, community and clinical systems-level initiatives to improve delivery of the well visit. Most focus on adolescents.
- Practical state-level initiatives are presented in this report from the federal Center for Medicaid and Medicare Services. Strategies Case studies
- This brief from the Oregon Improvement Partnership Network summarizes strategies for states to consider.
- Visit the AAP for case studies and stories about implementing Bright Futures.
Confidentiality: Several tools can guide efforts to assure confidential care, including many focused on challenges with electronic health records
Position statements from clinician organizations:
- Policy Statement: Standards for Health Information Technology to Ensure Adolescent Privacy, 2012, AAP
- Position Paper: Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process, 2016, Society of Adolescent Health and Medicine & AAP
- The Federal Title X Family Planning Program: Privacy and Access Rules for Adolescents
- Protecting Confidentiality for Individuals Insured as Dependents
- Title X-funded Health Center Staff Members’ Perspectives on Barriers to Insurance Use for Confidential Family Planning Services
- Protecting adolescent confidentiality under health care reform: the special case regarding EOBs, 2014, UCSF
- Meaningful Use of a Confidential Adolescent Patient Portal, 2016, Journal of Adolescent Health
Creating partnerships: Tools to guide collaborative work
From the National Improvement Partnership Network
- Establishing a Child Health Improvement Partnership: A How-to Guide
- Improvement Partnerships to Advance Child Health Care Quality Brief
- The National Improvement Partnership Network: State-Based Partnerships That Improve Primary Care Quality
From the Robert Woods Johnson Foundation:
From the National Alliance to Advance Adolescent Health: