Coulee Region, Wisconsin
Caitlyn is a 16-year-old girl who goes to a clinic with her mother for an annual school physical. In preparation for her appointment, she brings a list of questions to discuss with the doctor in private. She understands her rights to confidentiality and knows her mother will be asked to leave the room at some point during the visit. During the one-on-one time with the doctor, Caitlyn opens up about her recent struggles with anxiety and concerns about the relationship with her new boyfriend.

The doctor recommends different options for treatment and resources, and Caitlyn remembers to take notes and ask for clarification when she has questions. She is relieved to have finally talked to someone, knowing she can open up to her mom on her own time. Before she leaves, Caitlyn takes initiative to learn about the clinic’s online system for setting up appointments and messaging her doctor for non-emergency questions.

Managing her health care seemed like a daunting task until Caitlyn attended a PATCH-for-Teens workshop at her high school. It was there that she learned about her legal rights to confidentiality and the importance of having honest conversations with her doctor. She credits PATCH (Providers and Teens Communicating for Health) for preparing her to manage her health care, including knowing where to ask for help, before moving away to college.

In a Nutshell
PATCH is an evidence-based promising practice that addresses maternal and child health (MCH) priorities and has been a key component of state-based MCH efforts in Wisconsin. This youth-driven program works to improve adolescent health by educating, engaging, and empowering young people to take control of their own health. Young people are trained to deliver workshops, addressing the three R’s: relationships, rights, and responsibility. PATCH operates in seven sites across four states: Wisconsin, New York, Indiana, and Oklahoma.

PATCH in Action
With an aim to improve the communication and overall relationship between adolescents and health care professionals, PATCH offers communities three evidence-based intervention components: the PATCH Teen Educator Model, the PATCH for Providers workshop, and the PATCH for Teens: Peer-to-Peer workshop.

The PATCH Teen Educator Model employs and empowers youth to facilitate PATCH workshops and advocate for change within the community and health care system. They gain the appropriate knowledge and skills through rigorous training to deliver peer education workshops and professional development workshops for health care professionals, as well as to advocate for better adolescent programs and policies in schools, communities, and health care systems.

The PATCH for Providers workshop has been developed as a continuing education opportunity for a wide range of health care professionals, including nurses, doctors, clinicians, medical students or residents, therapists, counselors, pharmacists, social workers, and any other front-end or support staff. In this 90-minute workshop, PATCH Teen Educators share their authentic insights into the health care concerns, preferences, and realities of today’s young people, offering better ways to connect with young patients and ensure high-quality, youth-friendly services.

The 60-minute PATCH for Teens: Peer-to-Peer workshop is led predominately by PATCH teen educators with the assistance and direction of a PATCH site coordinator, and is intended to be delivered outside of a typical school classroom setting (e.g., conferences, youth group meetings, student organizations/clubs, and other places young people gather to learn from one another). The workshop aims to empower young people to learn to manage their own health care and equip them with the knowledge and skills needed to navigate and advocate for youth-friendly services.

Outcomes
A study of participant data from the Dane County PATCH site, published in the Wisconsin Medical Journal in 2015, showed that Caitlyn’s story is not outside the norm. The study reported significant improvement in the areas of knowledge, self-efficacy, and reported behavioral intentions to seek and provide quality health care for teens and clinicians. Teens exhibited the greatest growth in learning confidentiality policies and the importance of patient/clinician communication.

The PATCH program demonstrated evidence of early efficacy, feasibility, and statewide demand. The Coulee Region, centering in La Crosse County, launched the new PATCH site, and since January 2019 has conducted seven workshops, reaching nearly 80 participants. Becoming a PATCH site encourages communities to engage and connect with various stakeholders; encourages them to align resources, policies, initiatives, and strategies within and across systems and sectors; and builds skills for convening, planning, and implementing shared/collective impact efforts.

Data collected by the new Coulee Region PATCH site in March and April 2019 resulted in the following findings:

• 91 percent of provider participants were “likely” or “very likely” to use the knowledge and resources gained from PATCH workshop in their practice; and 88 percent said they were “likely” or “very likely” to change the way they interact and care for teens because of the PATCH workshop.
• 87 percent of teen participants learned something from the PATCH workshops; 95 percent found it useful and easy to understand; and 100 percent said they liked learning from other teens.

Changes and Challenges Ahead
PATCH-Coulee Region is operating as a satellite of the Dane County PATCH site but is seeking a local organization to adopt the program and become fiscal agent. Establishing this partnership would allow the greatest opportunity for growth and development in the region.

Moving forward, PATCH-Coulee Region is focused on expanding collaborative efforts with community-based organizations that have similar health-driven goals. In addition, we intend to diversify the team of Teen Educators, expanding outreach to neighboring counties to La Crosse.

PATCH sites often run into implementation challenges related to youth management, engagement, transportation barriers for youth to and from PATCH activities, and more. Being able to troubleshoot with a PATCH coach in Dane County has proven to be instrumental in overcoming these challenges in a timely manner. Furthermore, utilizing the expertise and guidance from the Community Advisory Team provides the site coordinator an opportunity to gain insight and work though concerns, successes, challenges, best practices, and lessons learned.