Better Together Hennepin Health Mentor Model

Hennepin County Public Health (HCPH) is the largest public health department in Minnesota. Its vision is for all people who live, work, and play in Hennepin County (HC) to experience optimal health grounded in health and racial equity. HCPH takes a comprehensive approach that strives to respond to the unique and important needs of all residents. Its dynamic programs promote physical and mental health, reduce chronic diseases, and prevent illnesses and injury associated with communicable diseases and environmental conditions. Better Together Hennepin (BTH) is HCPH's adolescent health team.

HC is Minnesota's largest county, with 1.27 million people, or about 23% of the state's population. HC is rich with diverse cultures, dynamic immigrant groups, arts, and civic engagement. HC also struggles with institutional and historic racism and classism, with the 2020 murder of George Floyd in Minneapolis bringing local inequities to the national lens. The county's population is 0.5% American Indian/Alaska Native, 3.9% two or more races, 6.9% Hispanic/Latino, 7.1% Asian, 13% Black/African American, and 67.9% White (Source: 2020 ACS 5-year estimate).  HC is home to over 75,000 adolescents, ages 15-19.

During adolescence young people experience significant physical, mental, and emotional changes including increased risk-taking behaviors. Sexual risk behaviors can lead to HIV, sexually transmitted infections, and unintended pregnancy. Adolescents experience stress, anxiety, and trauma that impacts their general health and specifically their sexual and reproductive health. Community and school leaders, parents, health professionals and youth have identified that there is a current mental well-being crisis among youth. Public data supports that concern.

In partnership with local clinics and schools, BTH created the Health Mentor Model to provide a public health response to the above identified issue. The Health Mentor Model embeds a full-time sexual health educator called a health mentor in a school site. Health mentors are employed by adolescent-friendly clinics.

BTH provides funding, guides vision and strategy, monitors and evaluates programming, supports aligned activities, mobilizes resources, creates shared measurements, and provides training and technical assistance to the Health Mentor Model. Clinic and site partners coordinate activities to meet specific community needs and maximize resources and impact.

Health mentors provide four tiers of support: one-to-one education; small groups; classroom education; and systems work. Additionally, Health mentors facilitate youth leadership councils that inform program approaches and mobilize young people at the site.

This tiered approach supports all students with evidence-based classroom sexual health education. The focus on systems work addresses the needs of all by striving to create safe and supportive environments, while being responsive to specific community needs. Small group and 1 to 1 interventions offer a directed approach for young people who have higher or more individualized needs, and support mental well-being. With any tier, adolescents may be referred to adolescent-friendly health care and other supportive services. Because the health mentor is employed by a local clinic, warm referrals are easy to make.

The goal of the Health Mentor Model is to improve adolescent health and well-being, reduce health disparities and advance health equity in HC communities with the greatest needs and disparities.

The Health Mentor Model promotes health equity by prioritizing sites in communities with the greatest inequities. Priority communities are identified by a range of data indicators. They may be geographical or specific populations of young people, i.e., groups experiencing racial inequities, LGBTQ+ youth, etc.

Partner clinics strive to hire health mentors that reflect the communities they serve and train them to provide trauma-informed, culturally, and linguistically responsive, age-appropriate, inclusive, and medically accurate programming.

Assessment data confirms that the Health Mentor Model addresses needs identified by young people, parents, community stakeholders, and adolescent health professionals. Evaluation activities identify that programming reflects strategies the community determined to be important, especially the inclusion of well-being with sexual health promotion.

The Health Mentor Model is successful due to strong partnerships. BTH contracts with seven clinic organizations that are trusted by youth. These organizations have MOUs with 17 sites to host the health mentor, facilitate implementation of all tiers the model, collect required data, and commit to improving the sexual health and well-being of young people. Each site has a youth leadership council that engages with the health mentor to guide and inform the work. Parent and community engagement are also key to the success of the model, and a community advisory group guides and informs all BTH's work. On the IAP2 Spectrum of Public Participation, the HMM falls under the collaborate” pillar.

The Health Mentor Model is unique because it: Meets young people where they're at, literally and figuratively; offers education, youth development and support services; Implements evidence-based practice informed by community wisdom; Partners schools, clinics, and local public health; Addresses adolescent sexual health holistically, understanding that it is not just about behaviors and decision making; Uses a systems thinking approach to identify leverage points to create systemic changs; Responds to the diverse needs of young people in the environment; Addresses the intersection between well-being and sexual health; and Prioritizes communities with the greatest needs.

Having an accessible, safe, and supportive adult ready to address sensitive topics is a unique and valuable addition to local schools. The following quotes demonstrate the impact this has on young people and school staff:

She gave me time to think carefully and gave me important info I needed” -1 to 1 participant

She really didn't judge she just helped. she made me feel comfortable about my situation honestly.”  - 1 to 1 participant

I learned not be afraid to communicate to a trusted adult and don't be afraid to ask questions” classroom participant

I learned about my own body and others and how they work and how to protect myself.” classroom participant

The HM understands the barriers that our community faces day to day. They meet the students where they are and give them what they need.” school staff

Best program I've experienced in over a decade working in schools.” school staff

Information about HCPH and BTH can be found at the following links:

HCPH: https://www.hennepin.us/publichealth 

BTH: https://www.hennepin.us/bettertogether

Target population

Although Hennepin County (HC) is typically highly ranked in overall health, there are significant racial and geographic disparities in adolescent sexual health and well-being for the 75,000 adolescent residents of HC, aged 15-19. For some indices, disparities by race and geography in HC are among the worst in the US. (Racial Equity Alliance, 2020). African American/Black, American Indian and Hispanic/Latinx teens are inordinately impacted by teen pregnancy, STIs and related behavioral risk factors. The HC communities of Brooklyn Center, Brooklyn Park, North Minneapolis, Central Minneapolis, Richfield and Robbinsdale have clearly defined geographic boundaries and young people in these communities experience substantial disparities in teen birth and STIs compared to other teens in HC, the state of MN and the US.

To address health inequities, Health Mentor Model sites are intentionally located in or serve the 6 geographic communities of greatest need mentioned above. Seven clinic organizations hire and supervise health mentors, helping to provide strong clinic-site partnerships to support health referrals and linkages to clinics. The model reaches over 6,000 of HC's approximately 75,000 adolescents annually. The Health Mentor Model serves about 8% of HC adolescents overall but serves a much higher percentage of youth living or attending school in the 6 geographic communities in of greatest need in which the model operates. Evaluation has shown that site staff, young people and community organizations highly value the model and see the impact it has on students.

Problem and model overview

Adolescence is a time when young people experience significant physical, mental and emotional changes, and begin to experience their emerging sexual identity and face sexual choices. Sexual risk behaviors can lead to HIV, sexually transmitted infections (STIs), and unintended pregnancy. According to the US Office of Population Affairs (OPA), the percentage of adolescents who are having sexual intercourse at earlier ages has decreased since 1988 and contraceptive use has increased since the 1990s, contributing to the United States (US) reaching its lowest teen birth rates in years. Still, adolescents ages 15-24 account for nearly half of the 20 million new cases of STIs each year. (https://opa.hhs.gov/adolescent-health/reproductive-health-and-teen-pregnancy#ftn1)

Additionally, stress, anxiety and trauma all have an impact on adolescent health in general and specifically adolescent sexual and reproductive health. Mental well-being is the state of thriving in various areas of life, such as in relationships, at work, play, and more, despite ups and downs. There is a strong intersection between sexual health and well-being. Supporting well-being provides a base for young people to make sexually healthy decisions. And when young people experience sexual health, it improves their mental well-being.

To address this problem, BTH promotes adolescent sexual health and well-being through the Health Mentor Model by partnering with schools, and adolescent-friendly clinics to offer sexual health programming that is innovative, responsive, comprehensive, holistic, and focused on health equity. Historically, evidence-based teen pregnancy prevention and sexual health promotion interventions have focused on reaching youth through schools and health clinics with information and education to support positive decision-making and impact individual behavior. While they have successfully reduced teen pregnancy rates across the country, STI rates remain high, and they do not address systemic barriers to sexual health or address the intersection of sexual health and wellbeing. The Health Mentor Model aims to remedy those shortcomings by providing access to a safe and supportive expert who can provide a broader range of services informed by community input.

Through contracts with adolescent-friendly clinics, the HMM embeds full-time sexual health educators, called health mentors” in schools or youth-serving organizations. These clinics are highly trusted by young people in their communities and have a demonstrated ability to implement effective programs and provide supportive services.

The HMM offers four tiers of support to the staff and young people at the site:

1. one-to-one health education and support using Motivational Interviewing which includes making referrals to adolescent friendly services, including reproductive and mental health care, and other needed services
2. small group sessions, using positive youth development practices and evidence-based programs
3. classroom education, using evidence-based sexual health curricula
4. systems work focused on building safe and supportive environments for adolescents

Health equity

The Health Mentor Model promotes health equity by prioritizing program sites in communities with the greatest inequities. Priority communities are identified by a range of data indicators including racial disparities, poverty, mental well-being, social vulnerability index, and STI and teen birth rates. High priority communities may be geographical or specific populations of young people (i.e., LGBTQ+ youth, students with lived experience of homelessness, youth involved in corrections, etc.).

Partner clinics strive to hire health mentors who reflect the communities they serve. They train them to provide trauma-informed, culturally, and linguistically responsive, age-appropriate, inclusive, and medically accurate programming.

All health mentor work is guided by community and youth engagement, draws on community strengths and assets, and uses a human-centered systems thinking approach. This ensures that programming is relevant to the young people served and when possible, systemic barriers to adolescent sexual health and well-being are addressed.

Innovative Practice

The Health Mentor Model is innovative and new to the field of public health, as it expands on evidence-based interventions focused narrowly on teen pregnancy prevention. By adding practices to promote healthy youth development, well-being and systems work, the model addresses not only the individual youth, but the environment that surrounds them as well.

The Health Mentor Model is unique because it:

• Meets young people where they're at, literally and figuratively
• Offers education, youth development and support services
• Implements evidence-based practice informed by community wisdom
• Partners schools, clinics, and local public health
• Addresses adolescent sexual health holistically, understanding that it is not just about behaviors and decision making
• Uses a systems thinking approach to identify leverage points to create systemic change
• Responds to the diverse needs of young people in the environment
• Addresses the intersection between well-being and sexual health
• Prioritizes communities with the greatest needs

BTH is unaware of any similar model in the county that addresses adolescent sexual health and well-being in this way. The practice utilizes education frameworks, employs evidence-based sexual health curricula, addresses specific community needs, provides young people a connection to a safe and supportive adult, and is guided by community wisdom through ongoing engagement activities. By partnering with youth serving agencies, schools and clinics, the Health Mentor Model affects levers that can lead to systems change. The model's multi-tiered strategy is innovative and responsive to the diverse needs of young people in HC and is uniquely designed to support adolescent optimal health.

Application of existing tools and frameworks

Multi-tiered Systems of Support (MTSS) is an education framework recognizing that all young people need different supports to be successful. This responsive framework utilizes evidence-based practices at increasing levels of intensity as young people need more support. The Health Mentor Model applies the same tiered theoretical framework to sexual health and wellbeing interventions. (Citations: What is MTSS? | A Multi-Tiered System of Supports (pbisrewards.com) and Multi-Tiered System of Supports (MTSS) | OSPI (www.k12.wa.us))

The Health Mentor Model requires the implementation of evidence-based interventions with fidelity and following best practices, based on research, when providing programming to young people. Specifically, health mentors offer one of two evidence-based classroom sexual health education programs (FLASH and Positive Prevention PLUS) and provides 1 to 1 support to youth using Motivational Interviewing. FLASH and Positive Prevention PLUS were selected as they are medically accurate and have demonstrated behavioral outcomes related to teen pregnancy prevention based on rigorous evaluation. Both programs are approved by the HHS Office of Population Affairs which funds many health mentor model sites.  School administrators determine which of the two programs is the best fit for their communities in partnership with the health mentor, and often with community input. Motivational Interviewing is a recognized evidence-based practice shown to have a positive impact on promoting health behavior change, allows the young person to guide the conversation and demonstrates respect for their autonomy. Motivational Interviewing is often used in interventions that focus on alcohol and drug use, but has also successfully been used in evidence-based teen pregnancy prevention interventions as well.

Theoretical and evidence base

Health mentor activities are designed to promote protective factors and reduce risk factors that affect young people's knowledge, attitudes and behaviors related to sexual health. These Sexual Psychosocial Risk and Protective Factors are important because they have a demonstrated impact on sexual decision making and behavior and are feasible to change through education programs including 1 to 1, small group or classroom environments. Protective factors are promoted through Health Mentor Model activities and are aligned with behavior change theories including theory of planned behavior, social cognitive theory, theory of reasoned action and health belief model (citation: Reducing Adolescent Sexual Risk (etr.org))

The multi-tiered nature of the model addresses the varied supports needed to impact individual as well as community risk and protective factors. To this end, the Health Mentor Model is grounded in understanding the influence of the social determinants of health and positive youth development practices that address youth health and well-being holistically and is not solely focused on an individual's behavior. The following theoretical and public health principles ground the development and implementation of the model.

Social determinants of health have a major impact on people's health, well-being, and quality of life. The social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.” (WHO, https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 retrieved 12.15.22)

Karen Pittman's theory of Positive Youth Development grounds the Health Mentor Model. Pittman said, Being fully prepared doesn't require being problem-free, just resilient — ready to assess, handle or get support for life's challenges.

Positive Youth Development generally refers to prosocial programs and practices focused on utilizing young people's strengths and building their assets. Karen Pittman's theory of positive youth development includes promotion of six C's”:

• Competence
• Confidence
• Character
• Caring
• Connection
• Contribution

Funding

BTH provides funding, guides vision and strategy, monitors and evaluates programming, supports aligned activities, mobilizes resources, creates shared measurements, and provides training and technical assistance. Clinic and site partners coordinate activities to meet specific community needs and maximize resources and impact.

Since 2021, the Office of Population Affairs has been the largest contributor of financial support to the program. In 2021, BTH received a 2-year grant from OPA to support and expand the Health Mentor Model, creating an opportunity to scale up. This expansion required BTH to better define and operationalize the model. With the addition of this funding, the Health Mentor Model currently serves 14 high schools, 3 middle schools and one community agency that works with youth in the juvenile justice system.

The Health Mentor Model is also supported by HC tax dollars, Youthprise a local nonprofit advocacy and funding organization, and the Minnesota Department of Health. With this network of funding BTH can support health mentors in large public schools, as well as small alternative and charter schools, and has piloted the model in an organization supporting youth in the juvenile justice system.

Goals and objectives

The goal of the Health Mentor Model is to improve adolescent health, reduce health disparities and advance health equity as evidenced by young peoples':

-knowledge of sexual health

-awareness of and access to health and support services

-sexual decisions aligning with healthy practices and personal values

-confidence making health decisions

-leadership skills

-access to safe space and trusted adults

Health mentors influence systems at their sites by:

- increasing site staff knowledge related to sexual health and health equity

- promoting equitable policies and procedures that support positive sexual health and well-being

-  providing a bridge between the site and an adolescent-friendly clinic

Timeframe and stakeholders

Hennepin County Public Health's adolescent health team, Better Together Hennepin (BTH), started in 2006 as a County Commissioner effort to address disparate and high teen birth rates in HC. A small amount of funding was included to provide opportunities for programming.

From the beginning, BTH focused on grounding practice in evidence-based interventions, while using community engagement to understand the specific local needs of young people in communities with the highest needs.

In 2007 a very early prototype of the Health Mentor Model was initiated in two priority communities – Richfield and Brooklyn Center. It did embed a sexual health educator in a school building to address the sexual health needs of students and to provide healthy youth development opportunities.

In 2010 and 2015, BTH received federal OPA funding for teen pregnancy prevention programs in schools and clinics. These programs utilized a more traditional model to address teen pregnancy prevention, with a clinic-employed sexual health educator acting as a guest speaker in health classes to provide evidence-based sexual health curriculum across county middle and high schools. BTH also funded clinics to provide an in-clinic sexual health program that provided 1 to 1 sessions for patients that combined motivational interviewing and sexual health education. For these first 10 years, the Health Mentor Model was a valued but not well-defined or structured pilot project.

BTH coordinates and manages the Health Mentor Model with a team of five staff, three of whom are permanent employees, and two of whom are grant funded. BTH supports other initiatives but, the Health Mentor Model is the largest portion of BTH programming. The BTH staff – who are highly regarded local subject matter experts on adolescent health and sexual health education - are a part of Family Health service area Hennepin County Public Health department.

Ensuring equity in representation and fostering collaboration

Between 2015 and 2020, BTH developed a collective impact approach to the problem of teen birth rates and began to intensively engage community and youth in directing the focus of programming. The collective impact approach helped BTH identify and address gaps and provide equitable programming.

The Community Advisory Group (CAG) was established, and youth leadership councils became a key component of programming. BTH undertook strong community and youth engagement. What BTH heard from all involved – youth, sexual health educators, clinic leadership, and school leadership – was that a more holistic approach was desired.

Young people appreciated the classroom education they received but wanted more in-depth education about relationships, consent, healthy sexuality, sexual orientation, and gender identity. They wanted curricula that was more inclusive and more culturally responsive. They identified the strong link between sexual health and mental well-being. Even prior to the COVID-19 pandemic, young people articulated that they needed emotional and social support to help them manage the stressors and anxiety produced by the complexities they faced in their personal lives and the pressures they faced at school. They understood that their physical health was intimately intertwined with their mental well-being.

At that time sexual health educators implemented classroom-based teen pregnancy prevention programming. One educator would provide sexual health education series using evidence-based curricula at multiple school sites across the community. The sexual health educators liked their jobs but found them overwhelming. They wanted to be more effective by being more connected to the young people they served. They wanted to the opportunity to address questions, concerns, and other challenges young people were facing. 

Schools loved the idea of having a sexual health expert in their building who could go beyond just providing sex ed in health classes. School leadership also expressed alarm about the rising mental health stress that they saw young people experiencing.

BTH saw this as a call-to-action to broaden the focus of programming to include upstream mental well-being supports and to focus on and fully define the systems work component of the Health Mentor Model.

The CAG and the collective impact approach employed ensured collaboration with stakeholders and equitable, meaningful, and representative collaboration with highest needs populations.

Planning and implementation

In the Spring of 2021, BTH was successful in securing two years of funding from the HHS Office of Population Affairs, to expand the Health Mentor Model program. This was critical timing because the COVID-19 pandemic and the murder of George Floyd plunged HC communities into crisis, and there was an even stronger call to address adolescent mental well-being in addition to sexual health and teen pregnancy prevention.

With a six-month planning period, BTH, community partner organizations and schools worked to get the Health Mentor Model up and running in 11 school sites, while also reconfiguring additional funding to support the model in an additional six sites, including a middle school model pilot at three sites.

Lessons learned

Many lessons were learned during the process of scaling up, the biggest lesson being that BTH needed to find new ways to formalize, operationalize, and communicate expectations to partners about the model. Through ongoing engagement with health mentor managers at partner clinics, BTH created a Health Mentor Model manual. The Health Mentor Model manual includes defined key components, clear performance indicators, and clear policies and procedures. The Health Mentor Model was designed to provide structure to the implementation of evidenced-based programming, but also have room to respond to local community and youth needs. Clarity on policies and procedures provided by the manual was imperative to ensure continuity across sites while still providing room for innovation and responsiveness.

Costs

There are up-front costs to establishing a Health Mentor Model program at any given site. In addition to health mentor's salary and supervision time, those include:

-Private office space and furnishings at the school where the health mentor can provide confidential 1 to1 education

- Safer sex supplies such as condoms, dental dams, lube, and pregnancy tests

- Training for the new health mentors, who must be trained in the evidence-based classroom sexual health education program they implement and are also required to have both beginning and intermediate motivational interviewing training in their first six months. Additionally, new health mentors must be trained in Youth Mental Health First Aid, mandated reporting, and medically accurate contraception and STI information.

Each health mentor site requires an annual budget of between $85,000 and $100,000. The annual budget includes health mentor salary and benefits, 2-4 hours a week of supervisory time, travel and transportation costs, support for youth leadership councils (stipends and activity costs), program and office supplies, costs for both required training and general professional development, and when possible, a stipend for the site to offset the cost of collaboration and space.

This work has required a different-than-standard engagement with all stakeholders involved in the process, which does require more HC staff time dedicated to the project. BTH has regular engagement opportunities which allow for bi-directional communication and have truly made the Health Mentor Model a co-created program with HC, local clinics, schools, community agencies and youth designing and guiding the work together.

Touchpoints include monthly health mentor office hours, monthly health mentor manager meetings, reflective monthly Progress Indicator” reports, ongoing training and technical assistance, engagement with youth leadership councils and annual celebrations.

Throughout the development of the HMM, community needs assessment, performance measure monitoring and evaluation activities have informed the model's guiding principles, logic model, implementation activities, and HM practices.

Evaluation Activities, Measures and Analysis

Annually, the BTH team monitors available public health data sets to identify inequities and trends over time to focus HMM programming and supports in communities with greatest need (priority communities). The following HC secondary data sets are included in this annual needs assessment surveillance:

- Birth rates by age, city, neighborhood, and race/ethnicity (Minnesota Department of Health Health Statistics)

- Sexually transmitted infection rates by age, gender, city, and race/ethnicity (Minnesota Department of Health Health Statistics)

- Sexual activity by school district, grade, gender, and race/ethnicity (source: Minnesota Student Survey)

- Contraception use by school district, grade, gender, and race/ethnicity (source: Minnesota Student Survey)

- Well-being indices by school district, grade, gender, and race/ethnicity (source: Minnesota Student Survey)

- School enrollment records by age, gender, race/ethnicity, and free and reduced-price lunch (source: Minnesota Department of Education)

- Population demographics by city, age, race/ethnicity, family income below 100% poverty, and % adults less than HS education (source: Census)

- Population mental well-being and health care utilization (source: HC SHAPE Survey)

In addition to reviewing available public health data, the BTH team reviews available qualitative data gathered by partners and engages community stakeholders (youth, clinic partners, school staff and stakeholders) in assessment activities to interpret available data and provide recommendations for programming, supports and resource allocation.

BTH also collects and monitors the following performance measures to inform program implementation:

- HMM activities completed by program type

- HMM reach by program activity and participant demographics

- Referrals to supportive services including health care

- Saturation of evidence-based interventions at OPA funded HMM sites

- Quality of implementation through program observations and fidelity monitoring at OPA funded HMM sites

- Youth, parent, and community engagement

In addition to ongoing secondary data surveillance and performance measure monitoring, in 2021 BTH worked with external evaluators to develop and implement an evaluation plan for primary data collection. This work deeply engaged BTH stakeholders including young people, utilized an equity framework, and focused on feasibility and sustainability in any products developed and recommendations identified. This work resulted in:

- 21 stakeholder interviews and 2 listening sessions with HMs, clinic partners and school staff to inform the evaluation plan and identify HMM impacts

- Revised and annotated HMM logic model 

- Five online instruments for classroom education participants, 1 to 1 session participants, school/site staff, health mentors, and clinic partners to measure impacts, satisfaction, and improvement areas

- Data analysis and interpretation plan with HMM site specific results and feedback loop process for continuous quality improvement

- Identified how the HMM utilizes a racial equity framework to address disparities in adolescent sexual health in HC

With support from HCPH's assessment team, BTH team manages the collection and analysis of all primary data sources including the above-mentioned performance measures and evaluation instruments. BTH utilizes the following tools for data analysis:

- Health Mentor Model database reports of quantitative reach data

-Qualtrics quantitative and qualitative analysis on performance measures and evaluation instruments

- Stakeholder Engagement focused reflection with BTH Community Advisory Group, HMs and other stakeholders to interpret evaluation results and consider strategic directions

Evaluation Results

The following results demonstrate how the HMM met program goals and objectives outlined previously in this application over the past year.

Surveillance of community needs assessment data demonstrated that the following geographic communities in HC experience the greatest disparities in sexual health and well-being indices compared to other HC communities, HC in general, and MN: Brooklyn Center; Brooklyn Park; Minneapolis Central; Minneapolis North; Richfield; Robbinsdale.

Additionally, needs assessment activities confirmed that BTH and the HMM needs to continue to support building health equity among communities of color in HC as they experience disproportionate rates of STIs, teen births, and well-being challenges as compared to their peers.

Monitoring of performance measures demonstrated the following:

- 7 community clinic partners

- 18 HMM sites in priority communities

- 5000+ young people reached by HMs (15 & 16-year-old is largest proportion)

- 700+ referrals to sexual health services by HMs

- 250+ referrals to mental health and well-being services by HMs

- 94 program observations with mean quality rating of 4.35 out of 5.0

- 24% saturation of evidence-based interventions across Office of Population Affairs funded sites

Evaluation activities over the past year demonstrated the following results. Young people (N=666) from 16 schools agreed that the classroom sex education provided by the HM:

- Made them feel better prepared to make decisions about their health (93% agreed)

- Created a comfortable environment to talk about sexual health (95% agreed)

- Information shared was clear and understandable (95% agreed)

- Presentation kept them interested (79% agreed)

- Information was relevant based on their personal identity (gender, sexual orientation, race/ethnicity) (89% agreed)

- Information shared was helpful to them (93% agreed)

Young people (N=85) from 13 schools agreed that the 1 to 1 sessions provided by the HM:

- Made them feel better prepared to make decisions about their health after visiting the HM (77% agreed)

- Would recommend the HM to a friend (81% agreed)

- Would go back to the HM if needed future support (80% agreed)

- Felt heard by the HM (82% agreed)

- Created a safe and comfortable environment to talk (86% agreed)

School staff (N=289) from 10 schools reported:

- 92% were aware of the HM services at their school

- 84% agreed the HM meets the needs of a diverse array of students (16% did not know)

- 81% agreed the HM effectively engages with students (18% did not know)

- 83% agreed the HM is knowledgeable about adolescent sexual health (16% did not know)

- 39% had made a referral to the HM

- 13% reported that they co-facilitated education with the HM

Staff reported overwhelming support for the HMM at their school including:

The health mentor understands the barriers that our community faces day to day. They can meet the students where there are and give them what they need.”

Best program I've experienced in over a decade working in schools.”

Results from the HM and HM manager surveys were merged with the stakeholder interviews and listening sessions and the following themes were identified:

- The HMM works and participants are highly satisfied

- Schools are supportive of the HMM

- Clinic and school partnerships need to be strong for HMM success

- HMs need ongoing support, training, and guidance

- HMM needs to be operationalized and consistent across sites

- Data collection is strenuous but valuable

Based on these themes and other findings from evaluation activities and reflection with BTH stakeholders, BTH is developing a HMM Manual. This manual identifies the theoretical and evidence base underpinning the model, operationalizes model components and expectation, and identifies policies and procedures relevant to HMM activities. This manual will allow uniform practices for onboarding and supporting HMs, articulate shared expectations for all partners, maintain consistency in the model activities across sites, and build in sustainability for future replication.

In summary, assessment data confirmed that the HMM addresses the current needs identified by young people, parents, community stakeholders, and adolescent health professionals and that the communities in which the HMM is being offered, remain the priority communities. It was also clear from evaluation activities that the programming implemented by the HMM reflect strategies the community identified as important to meeting the identified needs, especially the inclusion of well-being within the framework of adolescent sexual health promotion.

BTH will sustain the focus on continued assessment, monitoring, evaluation, and continuous quality improvement when implementing the HMM. Specifically, BTH will continue to engage the community and stakeholders in assessment, evaluation and planning related to the implementation of the model to maintain relevant, high quality, community-driven, equity-focused programming in HC communities.

While the Health Mentor Model scaled up and became more clearly defined over the past two years, BTH has a long-term agreement to support the model on a small scale, with Youthprise, a local nonprofit funding and advocacy organization. Youthprise is interested in funding innovative new initiatives such as the Health Mentor Model middle school pilot.

Additionally, the Health Mentor Model enjoys broad support from the Hennepin County Board of Commissioners and administration. The model has been identified by other county departments as a model that supports their work as well (education, safe communities).

In 2023, BTH intends to apply for continued federal funding from OPA to support the model and was recently invited to apply in early 2023 to the Wallace Foundation to support further exploration of the middle school Health Mentor Model.

As mentioned in above sections, the Health Mentor Model manual is a sustainability activity, as it makes the model easier to replicate, and provides potential funders with reassurance that it is a thoughtful model, which utilizes evidence-based practice and innovation, and is responsive to community needs.

Stakeholders strongly support the Health Mentor Model. The schools and local clinics that partner with BTH on the model have enjoyed the financial support that BTH has been able to provide but have also expressed interest in finding new ways to support the model if HC is not re-funded by OPA.

The Minneapolis Health Department has health mentors at some school-based clinics that are not funded by BTH's Health Mentor Model program. Because BTH supports health mentors in some Minneapolis school-based clinics based on priority community status, these non-BTH funded mentor are supported by BTH with training and technical assistance. This is a model that we may expand in the future – providing coordination, training and technical assistance while programming is supported by other funding secured by providers.

BTH coordinates and manages the Health Mentor Model with a team of five staff, three of whom are permanent employees, and two of whom are grant funded. There are current efforts to find resources to sustain the grant-funded positions beyond the current Office of Population Affairs funding cycle.