Program Spotlight: Promoting Adolescent Well-Being with NYC Health + Hospitals
A Q and A with Lily Ann Divino, LCSW, MPH, Director of the Adolescent Health Program
In this edition of NYC Opportunity’s “Program Spotlight” series, we explore the Adolescent Health Program at NYC Health + Hospitals with Director, Lily Ann Divino, LCSW, MPH.
The Adolescent Health Program (AHP) works to ensure the physical, emotional, social, and mental well-being of adolescents and young adults served by NYC Health + Hospitals (NYC H+H) as they make their transition from childhood to adulthood. Through education, quality improvement, and youth and community engagement, the program deploys evidence-based and adolescent-centered healthcare practices to eliminate barriers and advance health equity.
AHP is funded by the New York City Young Men’s Initiative (YMI) which develops and champions policies, programs, and partnerships that holistically support the success of young Black and Latino men throughout New York City, focusing on education, employment, health, and justice. AHP also receives administrative, evaluation, and learning support from NYC Opportunity.
The following questions were written by NYC Opportunity Summer Fellow David Baltazar. Many thanks to AHP Director, Lily Ann Divino and team for the great insights! Learn more about the program below.
Can you provide an overview of the goals of AHP? Who is served by the program and what is the intended impact?
NYC Health + Hospitals is the nation’s largest municipal healthcare delivery system. Within NYC H+H, the AHP is dedicated to making system-wide changes to improve the health and development of adolescents and young adults (AYA) across New York City. AHP aims to enhance the care provided to all our AYA patients, totaling 109,790 individuals aged 12–21 who received services from NYC H+H in Fiscal Year 2023 (July 2022 — June 2023) alone. Through education, quality improvement, youth engagement, and community outreach, we aim to improve the physical, emotional, social, and mental well-being of young people. Our program is committed to eliminating barriers that prevent this population from accessing the care they need and to promoting health equity for all AYAs who receive care at NYC H+H.
Could you share some key achievements or success stories from AHP that highlight its impact on the community, especially in promoting adolescent behavioral health, mental health, and safety?
I am proud to share that AHP is a dedicated team working on various initiatives within NYC H+H. Among our many projects, the Youth Leadership Council (YLC) has been a consistent highlight since its pilot year in 2020–2021. Comprised of 6–10 diverse high school students, the YLC brings youth perspectives to AHP’s various projects, to the annual NYC H+H Adolescent Health Conference at which they present, and to projects they select and complete with AHP staff support. It is amazing to see the range of YLC-led initiatives, from a Photovoice project in 2021 highlighting adolescent resilience during the height of the COVID-19 pandemic, to crucial input on patient surveys and adolescent health risk assessments for NYC H+H sites.
In the past few years, AHP has achieved many more key successes including: implementing tablet screeners at 19 of our hospital facilities to screen adolescent patients for depression and anxiety; piloting the Adolescent Community Health Worker (CHW) model at Elmhurst Hospital; and establishing standards to transition care for older adolescents to adult medicine at 12 NYC H+H facilities. All of these initiatives are ongoing and continue to expand as we strive to enhance care for even more AYA patients.
How does AHP engage with schools, educators, and young people to provide resources and support that contribute to their growth and success in areas like health education, mental health awareness, and overall well-being?
Since its inception in 2012, AHP has partnered with NYC H+H pediatric and adolescent clinics to provide contraception, educational materials, professional trainings, and marketing materials to promote adolescent health and mental health services. AHP also provides support to pediatric and adolescent staff focusing on quality improvement centered around the YouthHealth standards of care to ensure that adolescent patients ages 12–21 receive optimal care. The YouthHealth standards are focused on primary care, confidential sexual and reproductive health services, and mental health.
In addition to the YLC’s input, we also engage high school and college students through internship programs. In recent years, high school interns from the Department of Youth & Community Development (DYCD) Summer Youth Employment Program have provided key feedback on AHP’s YouthHealth website and social media, patient surveys for adolescent patients transitioning into adult care, adolescent educational materials focusing on mental health and substance use, and mystery shopper contact center calls to improve access to appointments for confidential reproductive health services.
What specific challenges has the Adolescent Health Program faced since its inception, and what strategies have you employed to overcome those challenges?
AHP faced its own set of challenges during the onset of the COVID-19 pandemic, much like other programs. One of the biggest hurdles at that time was having to shift the pilot year of the YLC from an in-person to a virtual format. Despite this, the program had a robust and successful pilot year, in which our YLC members’ passion for adolescent healthcare access only strengthened. They were deeply engaged with the program and presented powerfully at the 2021 NYC H+H Adolescent Health Conference on “A Zoom with a View: Growing Up in NYC During COVID-19.” As the YLC program has continued to grow, the skills and strategies learned in that first remote year allow us to improve access for our YLC members. Since its pilot year, the YLC has become a welcome voice of adolescents and a valuable partner in developing strategies to improve adolescent care with NYC H+H.
On a broader level, managing quality improvement projects across NYC H+H can be challenging due to its sheer size and scope. To tackle this challenge, we intentionally manage relationships with different H+H sites with support from executive leadership bodies such as the Pediatric Ambulatory Care Leadership Council and the Adolescent Advisory Panel. These groups are comprised of adolescent health champions from pediatric and adolescent departments across NYC H+H, who help AHP to better understand the nuances of their respective facilities and to advocate for the needs of adolescent patients. With their support, we pilot new initiatives on a small scale and expand our work strategically site by site. We also harness NYC H+H’s size and scope wherever possible in order to amplify internal experts’ voices and AHP’s work.
Can you provide insights into the training and professional development opportunities that AHP offers to its staff and partners to ensure they are well-equipped to support the needs of adolescents effectively?
Over the years, AHP has provided extensive training for NYC H+H on various aspects of adolescent care delivery, medical coding, minors’ rights, sexually transmitted infections (STI) screening and treatment, Nexplanon insertion [birth control implant], and mental health care in primary care. As part of our ongoing quality improvement work, we continue to conduct trainings for colleagues and partners on facilitating the transition from adolescent to adult care, effective implementation of Welcome Tablet Screeners, and best practices for adolescent community health workers. Additionally, the annual Adolescent Health Conference brings together a diverse group of adolescent health professionals, including physicians, nurses, social workers, health center managers, and other youth-serving community professionals. It is a platform to ensure adolescent health is at the forefront of care delivery and to recognize achievements across NYC H+H. The conference builds capacity to improve adolescent health services and provides networking opportunities for NYC H+H staff.
Collaboration plays a vital role in the success of government initiatives. How does AHP collaborate with other stakeholders in government, local healthcare providers, the nonprofit sector, and/or community groups to maximize its impact on adolescent health and well-being across New York City?
AHP maintains many partnerships, including through the Mayor’s Office to End Domestic and Gender-Based Violence Healthcare Working Group, the Interagency Coordinating Council, Society for Adolescent Health and Medicine (SAHM), the DYCD Summer Youth Employment Program as discussed above, and various other collaborative bodies. One of our major efforts toward collaboration is AHP’s annual Adolescent Health Conference, which had 245 attendees last year.
Last year’s conference featured keynote speaker Dr. Chinwe Efuribe, Associate Director of Programs for the SAHM, who spoke on empowering adolescents to take charge of their health and well-being. We also heard opening remarks from Nathifa Forde, Deputy Executive Director of the YMI within the Mayor’s office. YMI has been a great supporter of the conference since the beginning. The 2022 conference also featured speakers from Montefiore Medical Center, Bronx Health Collective, Boston Children’s Hospital, and NYU Grossman School of Medicine. Our partners and colleagues learned together about current issues impacting adolescents, including the experiences of immigrant and unaccompanied minors, gun violence, plant-based diets, and social media.
Since 2020, it has become the standard for the YLC to develop and present their own session at the conference. Last year they spoke about, and led a rich audience discussion on, creating comfortable environments for adolescents to participate in their healthcare. This year’s conference was held on November 13th and focused on the theme “Breaking Barriers: Ensuring Equitable Access to Adolescent Care in a Changing World.”
The NYC H+H Adolescent Health Program was created to help ensure that all adolescent and young adult patients feel safe, respected, and supported when seeking care. For program information, contact YouthHealth@nychhc.org. You can also visit their website or follow them on Instagram at @nycyouthhealth.
If you are an adolescent or young adult between the ages of 12 to 21 and need to talk to someone about your health or mental health, call 1–844-NYC-4NYC or visit AHP’s website to book an appointment at an NYC YouthHealth Center.
