PROGRAM TITLE: Youth Health and Wellness Clinic. Michigan. Name of Health Department: Grand Traverse County Health Department,

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1 PROGRAM TITLE: Youth Health and Wellness Clinic Name of Health Department: Grand Traverse County Health Department, Michigan Short Description: The Grand Traverse County Health Department s Youth Health and Wellness Clinic provides primary and acute medical care services at a technical high school in Traverse City. The clinic aims to improve access to care for adolescents through a wide range of services and health promotion activities with an emphasis on reducing obesity, sexually transmitted infections (STIs), tobacco use, and substance abuse. Although it targets low-income, uninsured youth, any resident between ages can access services on a sliding fee scale. Key words: Access to Care, Adolescents, Cancer, Chronic Disease, Health Promotion and Health Education, Obesity, Oral Health, Rural, Tobacco Jurisdiction: Rural

The clinic aims to improve access to care for adolescents through a wide range of services and health promotion activities with an emphasis on reducing obesity, sexually transmitted infections

2 Name of Program: Youth Health and Wellness Clinic Program Summary: The Youth Health and Wellness Clinic provides essential health and wellness services for adolescents. The clinic is located at a local high school largely attended by low-income and homeless youth at high risk for dropping out, teenage pregnancy, infectious disease including sexually transmitted infections, and suicide. The clinic was born out of data gathered through the Community Health Assessment and Improvement Project (CHAIP), a process of assessing community health indicators and identifying perceived needs in the health and medical care infrastructure, assembling and implementing corresponding action plans and evaluating the success of such efforts over time. Through this process, adolescent health was identified as an issue of concern due to increasing numbers of respondents reporting poor or fair health and incomes below $25,000 per year. Furthermore, most charity medical clinics in the county only see adults and various stakeholders cited child and adolescent primary care as a need. In addition to primary care provision, the Youth Health and Wellness Clinic targets four specific health concerns: substance abuse, smoking reduction, sexually transmitted infections (STIs), and obesity. Name of LHD: Grand Traverse Health Department - Michigan Funding source(s): Grant funding through the State of Michigan Departments of Education and Health and Human Services; Grand Traverse Regional Community Foundation; the local Rotary Club. Medicaid and private insurance companies through medical billing. School district provides space and utilities. Jurisdiction size: Rural. With over 86,000 residents, the Grand Traverse County Health Department serves the largest county in an 11 county area in northern Michigan. The county is primarily rural serving Traverse City and surrounding farmland. The area has low racial and ethnic diversity with 95% of the population identifying as non-latino white. LHD size: 50 full-time employees Category depicting level of evidence used*: Emerging Program Objectives:

3 To improve access to medical care, particularly primary care services, among low-income and uninsured adolescents in Traverse County To improve access to dental care for uninsured, low-income adolescents To prevent chronic diseases particularly diabetes, cancer, and cardiovascular disease To promote healthy lifestyle choices To reduce the number of adolescent suicides Health disparity addressed: Access to care, infectious disease (primarily sexually transmitted infections), oral health, chronic disease Population served: The clinic targets low-income, uninsured adolescents, but services are available to anyone age in the five county Traverse Bay Intermediate School district and their infants and young children. Participants need not be enrolled in school and parental permission is not required. Activities: The Youth Health and Wellness Clinic brings vital health services to adolescents including: Primary care and acute medical care service provision Dental hygiene service provision Personal hygiene education and one-on-one services Assistance and advocacy with health insurance Vaccinations STI testing and treatment Chronic disease management including asthma, allergies, and diabetes Crisis intervention and psychosocial support through a partnership with community mental health services and a community crisis clinic Pregnancy testing and referral to family planning services Parenting and prenatal education Smoking reduction services Referral to other social services and community resources Measure of success/evidence: The Youth and Wellness Clinic tracks the numbers of services provided and patients treated or counseled. They report increases in vaccination rates and STI testing and positive cases. They believe that there are many people accessing services at the clinic who were not receiving care previously. In addition, they administer pre- and post- treatment questionnaires to patients. They do not have data on public health outcomes such as birth rates and acknowledge that they should consider more broad, long-term health impacts.

addressed: Access to care, infectious disease (primarily sexually transmitted infections), oral health, chronic disease Population served: The clinic targets low-income, uninsured adolescents, but

4 The clinic has significant community support and is deemed so successful that a satellite clinic will soon open in Kingsley, a small town where there is no doctor or dentist. Outcomes: In 2008, the Youth Health and Wellness Center: Saw 1108 patients, most of whom did not have a medical home elsewhere Conducted a total of 3524 patient visits Provided 1278 services related to dental care Provided 1129 services related to STI testing, diagnosis, and treatment Provided health education for 655 participants Administered 615 vaccines Conducted 351 physical exams focused on preventive health In addition, the clinic anecdotally reports seeing a decrease in smoking rates among their patients. For more information: Youth and Wellness Center: Wellness_Center.htm Community Health Assessment and Improvement Project (CHAIP): Health_Assessment_Project.htm Fred Keeslar, MSPL Phone: fkeeslar@co.grand-traverse.mi.us * Criteria based on University of Washington School of Nursing survey responses, key informant interviews and the table below from Brownson et all. article: Brownson RC, Fielding JE, Maylahn CM. Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health Apr 29; 30: Review. Category Evidencebased Effective How established Peer review via systematic or narrative review Peer review Considerations for the level of scientific evidence Data source examples Based on study design and execution Community Guide External validity Cochrane reviews Potential side benefits or harms Narrative reviews based on Costs and cost-effectiveness published literature Based on study design and execution Articles in the scientific literature External validity Research-tested intervention Potential side benefits or harms programs (123) Costs and cost-effectiveness Technical reports with peer review Promising Written program Summative evidence of effectiveness State or federal government reports

to dental care Provided 1129 services related to STI testing, diagnosis, and treatment Provided health education for 655 participants Administered 615 vaccines Conducted 351 physical exams focused on

5 evaluation without formal peer review Formative evaluation data Theory-consistent, plausible, potentially (without peer review) Conference presentations high-reaching, low-cost, replicable Emerging Ongoing work, practicebased summaries, or evaluation works in progress Formative evaluation data Theory-consistent, plausible, potentially high-reaching, low-cost, replicable Face validity Evaluability assessments Pilot studies NIH CRISP database Projects funded by health foundations

evaluation works in progress Formative evaluation data Theory-consistent, plausible, potentially high-reaching,

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