Insights from the LAC DPH Youth Advisory Council: A Model for Replicability

The Los Angeles Department of Public Health serves 10,441,080 people and strives to improve the lives of LA County residents through its 39 programs and 14 public health centers. Activities include direct medical services for immunizations, tuberculosis, and STDs; disease surveillance and communicable disease control; restaurant and other food facility inspections; emergency preparedness and response; and substance abuse prevention and control. One of the Positive Youth development Initiatives that began in 2019 is the Los Angeles County (LAC) Department of Public Health (DPH) Youth Advisory Council (YAC) which is a service-learning approach that utilizes the learned experience of adolescents to inform our youth-oriented programming and improve adolescent health. The youth advisors ages range from 16 to 21 years old and represent the demographic, geographic, cultural, socio-economic diversity of the LAC population. As a result of the program, we have fostered an ongoing partnership between youth and adults at DPH to collaborative on decision-making aimed at improving adolescent health outcomes. The YAC consists of a 3-layered systems approach: 1) each Service Planning Area Health Center is assigned 2-4 youth advisors where they work alongside a public health professional as their SPA Supervisor 2) we hold a monthly meeting to convene the council and professional and leadership training, technical training and assistance, health education, and community building and 3) the 2nd year Sr. Youth Advisors serve as the mentors for the each incoming cohort of youth advisors and as leaders for the monthly meetings.   

Traditionally, many public health programs targeting adolescents focus on solving single issues like drug abuse or teen pregnancy. However, the PYD framework in our program focuses on enhancing strengths of youth participants instead of addressing weaknesses. By engaging youth in this manner one can improve their competence, confidence, connection, character, and compassion (the 5 C's of PYD). This in turn ends up improving their overall health and well-being. 

Since its inception in 2019, the LAC DPH YAC has grown from 14 to 34 youth council members and has expanded to serve all eight service-planning areas within the county, representing a 14% expansion in service coverage in two years (2019-2021). The youth advisors have collectively served over 4,000 hours to address nearly every adolescent health topic and geographic location in the county and advocate for better health outcomes through improved access to quality information and intervention.  

Involving youth advisors as leaders in program planning has been instrumental to the success of the Youth Advisory Council and community. We include youth voice through electronic surveys, focus groups, listening sessions, and group collaboration. We partnered with an innovative consultant group called Community at Work to train the SPA Supervisors and Youth Advisors respectively in exploring team strengths and practicing group facilitation strategies. Through these trainings, the youth advisors apply their listening skills to facilitate groups effectively and provide well-thought-out responses to public health issues while simultaneously building their confidence as leaders. In addition, the Community at Work training program bolstered our team morale and creativity on running meetings in the new era of working remotely.  

More information about the LA DPH YAC can be found at: http://publichealth.lacounty.gov/mch/CAH/Youth%20Advisory%20Council-About.htm  

The introduction of PYDI in DPH has provided the opportunity to address various health inequities among by having youth representation within the department to inform on program planning and interventions thus helping public health not only to tailor programming to their needs but to understand adolescence through a developmental lens. The 5 C's of PYD principles support the youth advisors in their development through an ecological perspective that impacts their sense of belonging, academic and vocational competence, goal-setting, and social-emotional learning.  

In a historical sense, DPH has typically addressed adolescent health through various programs that mainly target parents, children, and adults. This year, the youth advisors participated in providing public comment for the state MCAH Title V report. The youth advisors used this platform to provide recommendations for better health access and interventions for adolescents therefore making the current health measures more relevant for adolescent well-being.  

Many of the Youth Advisors implement their passion projects using our Project-Based Learning Plans with support from their SPA supervisors; a tool that helps tap into their strengths and public health interests to develop a passion project within their communities. In addition, this tool empowers the youth advisors to explore or take on a public health issues of their choice which is often an issue that they are affected by or that have observed as a priority issue in their community. This approach also amplifies the voices of youth to address public health issues regardless of departmental objectives. Both youth advisors and public health staff benefit in various ways to meet goals and objectives set forth by the youth and the department through collaboration, shared resources, and most importantly shared leadership.   

The Youth Advisory Council aims to address health inequities by involving the youth advisors in every stage of the recruitment phase that we hold during the Spring. The Sr. Youth Advisors collaborate and guide the recruitment phases by reviewing, interviewing, and selecting the new cohort of youth advisors along with SPA Supervisors and PYD staff to ensure that we represent a diverse an inclusive body of youth. They are also the designers of the recruitment flyer and target messaging and have held informational meetings where they used skits to encourage youth audiences to apply.  

Some highlights of their work include advocating to the Board of Supervisors in 2019 for the ban of flavored tobacco where the ordinance was passed into effect in May 2020. Though the pandemic has halted the ability to meet in person, the engagement and participation among the youth advisors significantly increased in a virtual space. Other examples of passion projects that the youth advisors have worked on throughout the pandemic is the development of an ongoing documentary on persons experiencing homelessness, a photo-voice video testimonial showcasing health disparities across the county, wellness center lectures on food swamps and diabetes, community forums on racism and violence, awareness campaigns on vaping and substance abuse, support groups on mental health for LGBTQ+ youth, panel participation on mental health coping strategies during COVID quarantine, social media posts on vaccination trust and workgroup collaboration to improve Black infant and maternal outcomes within several communities across LA County. 

Because the PYD Initiative places youth at the center of identifying solutions to their issues, collaboration with local internal health department programs and external youth-serving community-based organizations is critical to its effectiveness. By partnering with national youth empowerment organizations like the Truth Initiative, local youth coalitions like Knowledge Empowers Youth, and sister PYD programs like the Public Health Ambassador Program, youth participants develop public health knowledge and skills. Public health topic areas include adolescent mental health, substance abuse, climate change, COVID-19/infectious disease control, anti-tobacco/vaping advocacy, distracted driving, anti-violence, and health equity, to name a few. Skills include collaborative problem-solving, public speaking, networking, time management, and meeting facilitation. According to expanding research on PYD, improving youth competence, confidence, and community connectedness improves overall health outcomes while decreasing high-risk "problem" behaviors. Additionally, many national agencies and initiatives are promoting PYD as an effective public health strategy to improve outcomes for youth, including the Centers for Disease Control and Prevention, the Association of Maternal and Child Health Programs, and the American Academy of Pediatrics.   

As the lead on the PYD Initiative, the Maternal, Child and Adolescent Health (MCAH) division provides overall project support and oversight, serving as the administrative hub for planning, implementing, and monitoring initiative goals and objectives. This includes administrative responsibilities, coordination of collaborative efforts across DPH, and coordination of technical assistance, capacity-building training, and workshops for the Youth Advisors and adults. MCAH works closely with Community Field Services (CFS). CFS is broken into eight service planning areas (SPA). Each SPA has designated a point-person/liaison who works directly with MCAH staff and their respective Youth Advisors. Functioning as a mentor/manager to the Youth Advisors, the SPA PYD Liaison encourages youth engagement and leadership opportunities. They help prepare office space for youth, including tools and supplies and work with internal SPA program staff to ensure a positive, safe, and supportive environment for the Youth Advisors. They also participate in all relevant training, including capacity-building strategies for creating successful youth-adult partnerships for DPH staff and skill-building such as leadership, effective communication, and project-based learning for the Youth Advisors.  

Finally, aside from programmatic collaboration, the Youth Advisory Council works with other programs, including the Tobacco Control and Substance Abuse Prevention programs to reimburse youth advisors for their service. Also, PYD staff consulted PYD principles and youth programming to the Los Angeles County (LAC) Board of Supervisors Youth Commission, LAC Department of Mental Health, San Diego County Department of Public Health, Monterrey County Department of Public Health, Helpline Youth Counseling, Maricopa County Department of Public Health (Arizona), Los Angeles Metro Youth Advisory Board, LAC Department of Parks and Recreations, and several community-based organizations. We aim to support the development of youth programs and youth engagement locally and nationally.  

The YAC program is evaluated using the guidance from the state mandated MCAH annual report and using the Strength, Opportunities, Aspirations, and Results (SOAR) analysis internally. Throughout the year, we also use surveys, questionnaires, and conduct listening sessions to continuously receive input from youth advisors and SPA Supervisors on public health issues.  

In FY 2019-20, our 1st objective was to collaborate and/or partner with DPH programs and/or other youth-serving LA County Departments to inform standardized youth development principles and practices.   

-Convene at least 2 DPH Youth Advisory Council meetings to provide programmatic and policy input to DPH programs and leadership. 

-Provide one capacity-building training on youth development principles and youth engagement strategies for youth-serving LA County staff. 

-Identify two partnerships outside of DPH to strengthen protocols and/or procedures for youth engagement.  

-Inform other youth-focused LA County Departments, Initiatives, Programs on Positive Youth Development principles and strategies. 

-Identify opportunities for the Youth Advisory Council to participate and/or partner with external stakeholders on youth-focused events, activities, strategies, etc. 

Outcomes:  

Youth Advisors completed 3 departmental requests to provide programmatic and policy input.  

10% increased knowledge of Positive Youth Development principles and strategies amongst participating DPH programs and youth-serving LA County Departments assessed through training evaluation forms.  

Established 2 Interagency collaborative partnerships were established to strengthen protocols and/or procedures for youth engagement.  

100% of Youth Advisors reported participation in civic and community engagement activities with DPH and external stakeholders. 

Our 2nd objective for FY 2019-20 was to build leadership capacity of the DPH Youth Advisory Council through trainings, career exploration, and/or project-based learning opportunities.  

-Provide two leadership and soft skills trainings to the DPH Youth Advisory Council.  Topics include communication and marketing, group collaboration, public speaking, group facilitation, using research for advocacy, in addition to training on various public health programs and topics 

-Develop project-based learning workplans for each youth advisor placement site, outlining projects and activities. 

Outcomes: 

2 youth leadership trainings completed. 

10% increase in confidence and self-efficacy for youth and staff. 

10% increase in knowledge on public health topics and application of public health approaches. 

Through the SOAR Analysis, we have learned qualitative insights from the youth advisors on their experiences and critiques for areas of opportunity. This approach includes their voices as key drivers for the program. Below are comments from the Strengths section:   

-I believe what has been the most helpful for me is the hands-on public health work that I have taken part of in my community. All the outreaches, meetings, conferences, projects, and speeches I have worked on have truly exposed me to what public health is. My supervisors, youth advisors, and the ones in charge of the program have been a great foundation of support as well." 

-One project that I participated in that I will always remember is when I spoke in front of the Los Angeles County Board of Supervisors. I spoke on an ordinance that I was in favor of. That day sparked a political interest in me. Then at a YAC meeting, I met [the DPH Board liaison], she has a JD and MPH. It turns out that she wrote the ordinance. Meeting her taught me that I can merge my interests together which are medicine, public health, and politics. I will always remember this task I did because it was the first time I was booed upon my advocacy work by people who were against the favor.” 

-What I like best about the program is that it is a well-organized program that helps youth learn skills that they can apply in the future. This program also helps youth work hands-on in public health clinics to get a real-life experience of public health works. I like that it helps creates great networking connections and exposes youth to so much of public health. I truly love the County of Los Angeles Department of Public Health Youth Advisory Council because it has helped me assure my passion for public health. I have enjoyed everything about the program.”  

We have involved the youth advisors in providing feedback for the MCAH Title V report to comment on the state objectives and strategies to ensure that they meet the needs of their overall community. We have conducted meeting evaluations, via Microsoft Forms electronic surveys called Reflection Forms,” collected after every YAC meeting where the youth advisors describe the meeting content. They have shared that seeing their fellow Sr. Youth Advisors co-leading the monthly meetings resonates well with them as they find relatability and a sense of belonging within the program. This tool inversely supports the youth advisor's development in writing and analytical skills which provides them a safe and anonymous platform to speak their truths. Their feedback has been analyzed by the Sr. Youth Advisors and PYD staff in debriefing calls to discuss improvements for future monthly meetings.  

The PYD Initiative achieves sustainability by employing the following strategies:  

-Establishing a recognized DPH Youth Advisory Council to address regional health disparities and ensure youth perspective in the development, implementation, and evaluation of programs and policies affecting youth;   

-Creating an informal interdisciplinary Adult/Youth PYD Committee that works to align PYD definitions, data collection, and surveillance, funding opportunities, coordination of programs and services, and sharing of information; 

-Promoting and incorporating PYD principles into DPH infrastructure, prioritizes youth preparation, participation, and leadership experiences. This includes youth-centered policies, regulations, grants/contracts/Requests for Proposals (RFPs), strategic plans, evaluation indicators, and capacity-building training opportunities; 

-Collaborating with youth-serving organizations, parents/caregivers, and families in the development and implementation of youth programs and policies; and 

-Identifying and developing sustainable funding streams to support PYD activities and the DPH Youth Advisory Council. 

Central to the Initiative is the establishment of a DPH Youth Advisory Council. As a countywide initiative, MCAH has partnered with the Department's eight Service Planning Areas (SPAs) to deploy Youth Advisors regionally at one of the Public Health Centers throughout the County. With a minimum of two Youth Advisors per SPA, ranging from ages 16-21, each Advisor serves a minimum of one year or a maximum of a three-year term. Youth Advisors work closely with their respective SPA to address regional health issues, serving as local DPH youth ambassadors and gaining hands-on community-level experience alongside SPA PYD liaisons. These liaisons are existing SPA staff willingly devoting their time to this Initiative and serving as on-site mentors to their Youth Advisors. Through this real-world experience, Youth Advisors also have an opportunity to work on meaningful projects and activities based on their interests and strengths, a chance to reflect on their experiences and goals, and hands-on career exploration.   

Monthly, Youth Advisors from each SPA convene with MCAH staff to form the DPH Youth Advisory Council monthly meetings. As a recognized governing body, the DPH Youth Advisory Council works with MCAH and DPH leadership (i.e., planning, designing, and negotiation) to construct programs, practices, and policies impacting youth in a developmentally appropriate approach. In doing so, the Council is a core partner in developing a PYD blueprint to equip the Department better to understand and support the healthy development of all youth in the County. DPH Youth Advisory Council monthly meetings will incorporate capacity-building trainings and workshops to increase personal skills and knowledge about the public health field and tangible group and decision-making skills to prepare them for this role.   

Making this a paid opportunity is critical to respectful and equitable youth engagement, especially for youth from historically marginalized and underrepresented communities. The Tobacco Control and Prevention Program has allocated funding for participation reimbursement from Proposition 56, Tobacco Tax Increase state allocation. Through a Fee-For-Service schedule, youth advisors are reimbursed for various activities that provide an assortment of learning opportunities and experiences. These include activities for training and support, outreach and education, communication and media, research and evaluation, and youth advisory council activities.  

The PYD Initiative has evolved into an enduring adult-youth partnership where youth and adults work alongside one another in a professional setting as equals. The youth gain valuable advice, wisdom, and practical work experience from the adults. The adults gain valuable youth perspectives on adolescent health concerns and priority areas, novel modes of communicating information, and more effective means of reaching LAC residents to address social issues. The Youth Advisory Council represents the LAC population's demographic, geographic, cultural, and socio-economic diversity.  

The factors that enhance the Youth Advisory Council's sustainability are that it 

-Is predominantly youth-led  

-Has a geographically and demographically diverse membership that mirrors the youth communities represented   

-It has a three-tier system involving peer-to-peer mentorship, professional development, and community engagement  

-Maintains a direct line to public health leadership at the county and state levels  

The transition to working from home and using virtual platforms such as MS Teams and Zoom allowed for more flexibility to attend and engage in meetings, resulting in higher attendance across every SPA than in person. Electronic surveys and activities supported participation and convenience without compromising quality and value. Tools that served to be effective were Poll Everywhere, Jamboard, Kahoot!, Scribbl, Zoom Polls, and MS Forms. In addition, training on facilitating virtual meetings in a meaningful way bolstered our team morale and creativity in running sessions in the new virtual space. Youth programs should consider more peer-to-peer-led activities, which have increased overall participation and engagement in our program.