Find State ESMs

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: To increase the number of counties with an HRC available to youth ages 12-17 either in a school or community based setting

Numerator: Number of HRCs available to youth ages 12-17

Denominator: Not applicable.

Significance: Adolescence is a period of major physical, psychological, and social development. As adolescents move from childhood to adulthood, they assume individual responsibility for health habits, and those who have chronic health problems take on a greater role in managing those conditions. Initiation of risky behaviors is a critical health issue during adolescence, as adolescents try on adult roles and behaviors. Risky behaviors often initiated in adolescence include unsafe sexual activity, unsafe driving, and use of substances, including tobacco, alcohol, and illegal drugs. Receiving health care services, including annual adolescent preventive well visits, helps adolescents adopt or maintain healthy habits and behaviors, avoid health‐damaging behaviors, manage chronic conditions, and prevent disease. Receipt of services can help prepare adolescents to manage their health and health care as adults. Adolescents face many concerns when deciding where to seek sexual-health services. Access to care is important to youth, and when trying to seek care at a primary care physician or clinic, issues may include: “lack of transportation; difficulties making appointments; not knowing where to go; hours and days when services are available; and requirements to return for follow-up.” The HRCs fill this primary care gap by being available and accessible in the schools youth attend and in the communities where they reside. Expanding the number of HRCs in the state will expand availability of vital health services for youth. Lesbian, Gay, Bi-sexual, Transgender and Questioning (LGBTQ) youth face unique barriers to care, including confidentiality around their sexual identity and the fear of being “outed”, as well as judgment from health care workers once their sexual orientation is disclosed.

Data Sources and Data Issues: Data collection and analysis will be performed by the Grantee that subcontracts with schools and community organizations for the HRCs that are established. It will be a grant deliverable as required by the work statement and reported to DOH via quarterly reports.

Year: 2017/2019

Unit Type: Count, Unit Number: 20

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to families/children/youth

Goal: To empower adolescents to make responsible, healthy decisions to enable them to better transition into adulthood

Numerator: The number of adolescents trained on Teen Pregnancy Prevention/Positive Youth Development curriculum

Denominator: NA

Significance: Research has shown that youth who possess a greater number of health assets/protective factors are less likely to engage in high-risk behaviors such as sexual activity, illicit drug use, and alcohol use. Evaluations from the trainings capture each participant’s opinion of the training as it pertains to how well they feel the training prepared them for resisting or saying no to peer pressure, knowing how to manage stress, forming friendships that keep them out of trouble, making health decisions about drugs and alcohol, etc. Goesling B, Colman S, Trenholm C. Programs to Reduce Teen Pregnancy, Sexually Transmitted Infections, and Associated Sexual Risk Behaviors: A Systematic Review, Mathematica Policy Research. ASPE Working Paper. Department of Health and Human Services.

Data Sources and Data Issues: MCH sessions data recording tool completed by PREP staff, Adolescent Health Specialists, Health Educators, and School Health Nurses

Year: 2017/2019

Unit Type: Count, Unit Number: 10,000

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: To gauge the percentag of SBHCs which are able to bill Medicaid and other insurance for the full suite of services they provide their patients

Numerator: Number of SBHCs trained on how to bill Medicaid for services

Denominator: Number of eligible SBHCs to be trained on how to bill Medicaid for services

Significance: Many adolescents, especially high risk youth in vulnerable populations, may have a harder time accessing the medical care system due to many issues (lack of transportation, social isolation, complex life-situations) and might find accessing health care more convenient at school or other settings in which they are more comfortable. Increasing the number of places where such individuals can access care, not just to family planning/STI services, but also mental/behavioral and more general physical health would benefit all. This would be greatly facilitated by reimbursement to the clinics for these services. An increase in the numbers/percent of clinics trained and aided in getting reimbursed would make such a system of care more available.

Data Sources and Data Issues: The source of the data would be program staff at OHC tracking the numbers of trainings and outreach they did with eligible clinics. Definitions of which clinics would be eligible and what a “successful” training/TA session will have to be developed.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Top level: direct services

Service Recipient: Activities directed to families/children/youth

Goal: To increase the percent of adolescents ages 12-21 at the MCH-contracted health centers who have at least one comprehensive well-care visit with a PCP or OB/GYN practitioner each year

Numerator: number of adolescents 12-21 years of age at the MCH-contracted health centers who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year

Denominator: total number of adolescent patients ages 12-21 years of age at the MCH-contracted health centers by the end of the measurement year

Significance: Recognizing that the health of adolescents is largely impacted by behavioral patterns developed during this developmental period, NH MCH collaborates with state and local partners to increase access to health care and promotes annual well-care visits for families and adolescents. The well-care visit is a prime opportunity for health care providers to screen and counsel adolescent/family about key areas including: mental and behavioral health, tobacco and substance use, violence and injury prevention, sexual behavior and nutritional health.

Data Sources and Data Issues: DHHS will collect adolescent well-care visit data from MCH-contracted Community Health Centers per Primary Care contracts exhibit A. The MCH Performance Measure was changed from 12-17 years of age to 12-21 years of age as of July 1, 2015. During the January 2016 reporting DHHS determined that this change caused some issues with data collection and reporting. DHHS has provided technical support to reduce reporting issues.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percent of youth who enroll in AFLP without access to preventive services who receive a referral from an AFLP provider for those services.

Numerator: Number of youth who received a referral for primary, reproductive and / or prenatal care.

Denominator: Number of youth with a service matrix collected within 90 days of program enrollment who need preventive health care services, including primary, reproductive and prenatal care.

Significance: Receiving health care services, including annual preventive well visits, helps adolescents adopt or maintain healthy habits and behaviors, avoid health damaging behaviors, manage chronic conditions, and prevent disease. Adolescence is a crucial periods of the life course — not only do major developmental changes occur, but unique opportunities exist for preventing risky behaviors and onset of common chronic conditions of adulthood. During these years (ages 10-17), habits and behaviors related to lifelong health are established, and for some youth, mental health disorders, adolescent pregnancy, and other chronic conditions may emerge. High-quality preventive services can play an important role in providing the support youth need to enter adulthood on a healthy footing. (Need to reword – this comes from the Adolescent and Young Adult Health (AYAH) Collaborative Improvement and Innovation Network)

Data Sources and Data Issues: Data Source: CA AFLP MIS Lodestar Data Issues: Because agencies are currently able to report on initial referrals up to 90 days after program enrollment, approx. 10% of youth who enroll in the program each year do not have complete referral information.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: To increase the number of adolescents who have a preventive medical services.

Numerator: Number of middle and high schools covered by Immunization School Outreach Program.

Denominator: Total number of middle and high schools.

Significance: Adolescence is a period of major physical, psychological, and social development. As adolescents move from childhood to adulthood, they assume individual responsibility for health habits, and those who have chronic health problems take on a greater role in managing those conditions. Initiation of risky behaviors is a critical health issue during adolescence, as adolescents try on adult roles and behaviors. Risky behaviors often initiated in adolescence include unsafe sexual activity, unsafe driving, and use of substances, including tobacco, alcohol, and illegal drugs. Receiving health care services, including annual adolescent preventive well visits, helps adolescents adopt or maintain healthy habits and behaviors, avoid health‐damaging behaviors, manage chronic conditions, and prevent disease. Receipt of services can help prepare adolescents to manage their health and health care as adults. The Bright Futures guidelines recommends that adolescents have an annual checkup starting at age 11. The visit should cover a comprehensive set of preventive services, such as a physical examination, discussion of health‐related behaviors, and immunizations. It recommends that the annual checkup include discussion of several health‐related topics, including healthy eating, physical activity, substance use, sexual behavior, violence, and motor vehicle safety.

Data Sources and Data Issues: Immunization Program

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to families/children/youth

Goal: To increase preventive health visits to adolescents at SBHCs

Numerator: Number of annual completed visits at all SBHCs

Denominator: Number of annual projected visits at all SBHCs

Significance: SBHCs offer both comprehensive primary care and behavioral health services within schools where children and adolescents spend most of their time. SBHC clinicians are skilled in motivational interviewing with children and adolescents. They have extensive knowledge of critical issues impacting the students they serve. Each visit to a SBHC, regardless of the reason, serves as an opportunity for clinicians to build a therapeutic relationship with students, aimed at fostering their strengths. At each visit, students are regularly assessed for risk and protective factors to intervene as early as possible. SBHC clinicians are well integrated within their schools and are knowledgeable about appropriate services/resources within their communities ensuring that students are well-connected, including with a medical home. It is an explicit goal of the SBHC Program that all children/adolescents attain health insurance and be connected with a Primary Care Provider. In addition, every effort is made by SBHC staff to help students develop the skills they will need to navigate the health care system upon graduation from high school.

Data Sources and Data Issues: The visit numbers are collected from each SBHC at the end of the fiscal year. Limitations include possible delays in reporting and variations in the quality of the documentation provided by clinicians.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Top level: direct services

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percent of adolescents 12-17 who have a BMI measured at the time of a medical visit.

Numerator: Number of adolescents 12-17 with at least one completed BMI at the time of a well visit at all School Based Health Centers (Physical)

Denominator: Number of students 12-17 who had at least one well visit at all School Based Health Centers (Physical)

Significance: The U.S. Preventive Services Task Force recommends that clinicians screen children ages 6 to 18 years for obesity and refer them to programs to improve their weight status. The recommendations are explained in the special article, “Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement,” in the February 2010 issue of Pediatrics. The American Academy of Pediatrics (AAP) recommends that periodic measurement of BMI be performed as part of a comprehensive approach to prevention of pediatric overweight, and recommends that BMI be calculated and documented once a year for all children and adolescents. BMI screening and well child visits have been included as clinical outcome measures for the School Based National Quality Initiative - with School Based Health Center sites in Connecticut participating in the national pilot to establish national quality standards for School Based Health Centers. The AAP Bright Futures guidelines recommend that adolescents have an annual checkup starting at age 11. The visit should cover a comprehensive set of preventive services, such as a physical examination, health history, and developmental assessment, discussion of health and related behaviors, and immunizations. It recommends that the annual checkup include anticipatory guidance and discussion of several health related topics, including healthy eating, physical activity, substance use, sexual behavior, violence, and motor vehicle safety.

Data Sources and Data Issues: Funded School Based Health Centers database and annual contractual program reports. Annual School Based Health Centers Medical Results Based Accountability Report Cards. National NQI data portal.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to families/children/youth

Goal: To ensure supportive programming for well adolescent visits/preventive health care.

Numerator: Number of adolescent program participants (12-21 years) who have received education on the importance of a well adolescent/preventative visit in the reporting year

Denominator: Number of adolescent program participants (12-21 years)

Significance: Adolescence is an important period of development physically,psychologically, and socially. As adolescents move from childhood to adulthood, they are responsible for their health including annual preventive well visits which help to maintain a healthy lifestyle, avoid damaging behaviors,manage chronic conditions, and prevent disease.

Data Sources and Data Issues: Data Application and Integration Solution for the Early Years (DAISEY): Web-based comprehensive data collection and reporting system/shared measurement system used by all MCH grantees to capture client and visit/service data

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Partner with school-based health centers to promote and incentivize adolescent health services.

Numerator: Number of schools with school-based health centers that participate in programs to increase the rate of adolescent well-visits.

Denominator: Number of schools with school-based health centers.

Significance: Adolescence is a period of major physical, psychological, and social development. As adolescents move from childhood to adulthood, they assume individual responsibility for health habits, and those who have chronic health problems take on a greater role in managing those conditions. Initiation of risky behaviors is a critical health issue during adolescence, as adolescents try on adult roles and behaviors. Risky behaviors often initiated in adolescence include unsafe sexual activity, unsafe driving, and use of substances, including tobacco, alcohol, and illegal drugs. Receiving health care services, including annual adolescent preventive well visits, helps adolescents adopt or maintain healthy habits and behaviors, avoid health‐damaging behaviors, manage chronic conditions, and prevent disease. Receipt of services can help prepare adolescents to manage their health and health care as adults. The Bright Futures guidelines recommends that adolescents have an annual checkup starting at age 11. The visit should cover a comprehensive set of preventive services, such as a physical examination, discussion of health‐related behaviors, and immunizations. It recommends that the annual checkup include discussion of several health‐related topics, including healthy eating, physical activity, substance use, sexual behavior, violence, and motor vehicle safety.

Data Sources and Data Issues: Title V Program; FQHCs

Year: 2017/2019

Unit Type: Count, Unit Number: 2

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: Increase the capacity for training and quality improvement efforts on adolescent-centered care to clinicians and other clinic staff, using the Bright Futures model, through a partnership established with the HRSA-funded UAB LEAH project.

Numerator: Number of Healthcare Providers Trained

Denominator: Number of Healthcare Providers in Alabama

Significance: Today's adolescents struggle with a wide range of health care needs related to a variety of social, economic, and environmental factors. Adolescents in the southeastern U.S., of which Alabama is a part, are particularly plagued by these health concerns. Over 21 percent of Alabama's adolescents aged 12-17 had no preventive medical care visits in 2011-12 compared to 18.3 percent nationally. Adolescence provides a unique opportunity to invest in the health and well-being of youth. Good health (physical, emotional, social, and spiritual) enables young people to make the most of their teenage years, while laying a strong foundation for adult life. Lifestyle behaviors developed during adolescence often continue into adulthood and influence long-term prospects for health and risk for chronic disease. Yet, improving the health and well-being of adolescents is a challenging endeavor. UAB LEAH is committed to improving the health status of adolescents, particularly those in the southeastern region of the U.S. To improve adolescent health and build capacity among healthcare providers statewide, collaboration between ADPH and the UAB LEAH is necessary.

Data Sources and Data Issues: Data Sources: UAB Leadership and Education in Adolescent Health (LEAH) Program Evaluation Tools NSCH (National Survey of Children's Health) data for Alabama Data will be collected through the aforementioned partnership using the UAB LEAH program evaluation tools. This data will measure the number of healthcare providers trained through this partnership. Additionally, NSCH Alabama data will be used to establish a baseline of the percentage of adolescents who received at least 1 well visit in the last year. Once the strategic plan is in the implementation phase, the baseline percentage will be the measure against which improvement in NPM 10 is tracked. Data Issues: Issues may include: difficulty integrating with the database maintained by the UAB LEAH Project in order to keep an accurate account of the number of healthcare providers who are trained through this partnership, difficulty identifying and reaching all healthcare providers who need to receive the training; and difficulty getting providers to agree to be trained via this partnership.

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 4: measuring quality of effect (% of "is anyone better off")

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: The completion of both trainings will lead to skills in counseling adolescents on behavior change and in communicating with adolescents overall; thereby promoting a better provider-patient relationship and increased access of preventive services.

Numerator: Number of providers who complete both the Motivational Interviewing web course and professional development training that report skills to effectively counsel youth on changing risky behavior.

Denominator: Number of providers who complete both the Motivational Interviewing web course and professional development training

Significance: Quality adolescent care is delivered in a developmentally-appropriate, adolescent-friendly and confidential manner. Positively impacting adolescent care requires significant system changes aimed at addressing known barriers to quality care: health professional lack of training, lack of effective communication skills, and low self-efficacy in providing adolescent preventive services. The combined impact of completion of both the Motivational Interviewing web course and professional development training will lead to higher quality care for adolescents. Increased skills in not only counseling adolescents on behavior change, but in communicating with adolescents overall, promotes a better provider-patient relationship and increases the likelihood that adolescents will access care (including preventive services) with that provider.

Data Sources and Data Issues: MDHHS (participant assessment tool)

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: To promote preconception wellness.

Numerator: Number of Title V partners that conduct activities to promote preventive well visits for youth

Denominator: All Title V partners that conduct activities to promote preventive well visits for youth

Significance: Adolescents face a variety of health risks and health problems including unintended pregnancies, sexually transmitted diseases, substance use disorders, and depression, among others. Getting an annual well-visit provides an opportunity for adolescents to discuss and address any of these issues in a timely fashion.

Data Sources and Data Issues: Data Source: Nevada Title V/MCH Program

Year: 2017/2019

Unit Type: Count, Unit Number: 17

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase the knowledge of school districts and other adolescent serving organizations on the topic of strategies to increase preventive medical visits among adolescents ages 12 through 17.

Numerator: Number of school districts and other adolescent serving organizations educated and/or partnered with to increase preventive medical visits among adolescents ages 12-17.

Denominator: Not Applicable

Significance: Increasing the knowledge of school officials, adolescent serving community agencies, and adolescents on the importance of preventive medical visits will likely increase the participation rate.

Data Sources and Data Issues: Year End Reports from local Title V Child Health agencies. A foreseeable issue for the first year is that this is a new measure and activity for the agencies to be collecting on and coordinating.

Year: 2017/2019

Unit Type: Count, Unit Number: 200

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to families/children/youth

Goal: Promote access to a medical home by increasing the number of pediatric patients served in practices participating in the Medical Home Technical Assistance Program in the last year.

Numerator: Number of pediatric patients served in practices participating in the Medical Home Technical Assistance Program in the last year.

Denominator: 1

Significance: Receiving health care services, including annual adolescent preventive well visits, helps adolescents adopt or maintain healthy habits and behaviors, avoid health‐damaging behaviors, manage chronic conditions, and prevent disease. The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to improve patients’ and providers’ experience of care and the quality of care for all children.

Data Sources and Data Issues: The Medical Home Technical Assistance Program

Year: 2017/2019

Unit Type: Count, Unit Number: 500,000

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: To promote policies and practices to make health care more youth friendly through provider and health professional training.

Numerator: Number of health professionals who attend trainings and informational presentations on the promotion of youth friendly services and the adolescent well visit (through trainings and presentations on positive youth development, confidentiality and priv

Denominator: N/A

Significance: The degree to which providers and clinical settings are youth-friendly can influence youth acceptance and attitudes toward preventive care visits, both in adolescence and beyond. The Oregon Health Authority, Adolescent and School Health Section will be conducting training and informational presentations on the promotion of adolescent well visits for providers and health professionals, including Coordinated Care Organizations, providers, and youth service organizations. The measure will allow the Oregon Health Authority to see the scope of the providers trained.

Data Sources and Data Issues: Attendance sheets of all professionals attending training.

Year: 2017/2019

Unit Type: Count, Unit Number: 400

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: Improved uptake of preventative visits and quality of care during adolescent preventative medical visits. Track characteristics of trained providers (e.g., geographic distribution, characteristics of patients served race, etc.).

Numerator: Number of physician or registered nurse clinicians (including pediatric, adolescent medicine, family practice) who are trained in Bright Futures clinical recommendations.

Denominator: The state hopes to train at least 100 clinicians/providers per year on the Bright Futures Clinical Recommendations and on strategies for creating adolescent-centered environments. This training is evidence informed.

Significance: This measure is significant because it will inform the state on progress towards having a workforce trained in adequate provision of preventative medical visits to adolescents. A trained clinician will be a clinician who has registered for and completed a training (provided by a contractor to the state) on the Bright Futures Clinical Recommendations and adolescent-centered environments.

Data Sources and Data Issues: The data source will be training registration data maintained by the training contractor and shared with ODH.

Year: 2017/2019

Unit Type: Count, Unit Number: 100

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Improve the quality of preventive services to adolescents and young adults.

Numerator: Number of clinics actively engaged in youth-centered care quality improvement initiatives.

Denominator: N/A

Significance: Need Info

Data Sources and Data Issues: MSDH Adolescent Health Program documents (CoIIN reports).

Year: 2017/2019

Unit Type: Count, Unit Number: 100

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase by 10% percent the number of awareness campaigns on the importance and positive impact of annual school health screening provided to 90% Parents and Teachers Association (PTA) meetings annually

Numerator: Number awareness campaigns provided during parents and teachers association (PTA) meetings in the given year

Denominator: Number of Parents and Teachers Association (PTA) meetings in the given year

Significance: Improve Child and adolescent health outcome through preventive medical visits

Data Sources and Data Issues: Meeting sign-up sheets

Year: 2017/2019

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Top level: direct services

Service Recipient: Activities directed to families/children/youth

Goal: To increase the percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year

Numerator: Number of adolescents receiving a preventive medical visit in the past year at a local health department

Denominator: N/A

Significance: While adolescents are generally healthy, preventive medical visits are important in order to address unique health care needs as early as possible and to promote behaviors that will improve long term health.

Data Sources and Data Issues: North Carolina Health Information System (data pulled through the Client Services Data Warehouse)

Year: 2017/2019

Unit Type: Count, Unit Number: 10,000