Adolescent Health Services Missing Opportunities (2009) / Chapter Skim
Currently Skimming:
1 Setting the Stage
1 Setting the Stage
Pages 17-51
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From page 17... ...
The correlations among minority racial and ethnic status, poverty, and lack of access to quality health services for adolescents are strong. Without specific attention to disparities in access to quality health services among adolescent members of minority racial and ethnic groups and actions to re duce them, such disparities may increase.
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From page 18... ...
. There is some disagreement as to whether health status is dependent more on health services or on other factors, such as genetics, income, or behavior (Association of Maternal and Child Health Programs and the National Network of State Adolescent Health Coordinators, 2005; Fuchs, 1974, 1991; Garfinkel, Hochschild, and McLanahan, 1996)
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. Much of that research, however, is focused on specific health domains, injuries or illnesses, special interests, or problem behavior -- such as mental health, teen pregnancy, sexually transmitted infections, substance abuse, tobacco use, violence, diet and exercise, or oral health.
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From page 20... ...
What lessons have been learned in efforts to promote linkages and integration among ado lescent health care, health promotion, and adolescent development services? What service approaches show significant promise in offering primary care as well as prevention, treatment, and health promotion services for adolescents with special health care needs and for selected adolescent populations?
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From page 21... ...
Are there important differences in the use and outcomes of different service models among selected adolescent populations on the basis of such characteristics as social class, urbanicity, ethnicity, gender, sexual orientation, age, special health care needs, and risk status? • Adolescent health system supports.
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From page 22... ...
Sinai Adolescent Health Center, New York City, New York. Each visit encompassed a tour of the program site or sites; meetings with leaders of the sponsoring institution to discuss institutional objectives and program operations, as well as reflections on successes, challenges, lessons learned, and research related to their efforts; and meetings with the institution's various health practitioners to discuss the nature of the adolescents who receive services in their setting, the primary health issues being addressed, obstacles to service delivery, and clinical and program management issues.
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From page 23... ...
that would provide longitudinal trends and enable comparison of the health behaviors of selected adolescent populations as they grow. Health services for adolescents are delivered in myriad settings and through varied institutional structures, and data on and evaluation of services are limited, thus making comprehensive assessment of the quality of service delivery, as well as comparison of different settings and services, a further challenge.
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. Research on behavior and development during the adolescent period also emerged in the twentieth century, further highlighting the unique aspects of adolescence and the importance of health services and systems that would support the healthy development of adolescents into adulthood.
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(position statement) – Adolescent medicine (ages 10–25)
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The committee also found that most evidence was limited regarding the health status, health services, and health service needs of those at the upper end of this age range. The committee therefore focused this report on adolescents aged 10–19.
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When possible, the committee considered a variety of population variables and their relationship to adolescent health status and health services. In addition, the committee considered the specific issues and needs of adolescents in various circumstances, such as those who are in the foster care system, are homeless, are in families that have recently immigrated to the United States, identify themselves as LGBT, or are in the juvenile justice system.
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The committee considered health services broadly, encompassing those services provided by doctors, nurses, mental health professional, dentists, or other health care providers. These services include health maintenance visits, school physicals, sports physicals, dental Defined as clinical preventive services that incorporate screening, immunizations, and counseling about potential health problems and address prevention of future illness and injury; may also be called a well-care visit, a physical examination, a well-child examination, or ambulatory care.
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More recently, the Health Resources and Services Administration's Maternal and Child Health Bureau and the Centers for Disease Control and Prevention (CDC) within the U.S.
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The initiative takes a broad view of adolescent health, recognizing that healthful outcomes for adolescents involve more than access to health services. A number of other components -- including behavioral strategies; counseling, support, and referral services; and safe, nurturing environments -- are important to healthy adolescent development and also help adolescents make healthful decisions.
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, considers the specific impact of food and beverage marketing on the dietary patterns and health status of American children and adolescents and offers recommendations for how government agencies, educators and schools, health professionals, industry companies, industry trade groups, the media, and those involved in community and consumer advocacy can promote healthful food and beverage messages to children and adolescents. Preventing Teen Motor Crashes: Contributions from the Behavioral and Social Sciences (National Research Council, Institute of Medicine, and Transportation Research Board, 2007)
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Of the total adolescent population, 51.2 percent are male and 48.8 percent female. The majority of adolescents aged 10–19 are white (76 per 70 Adolescent Population (Millions)
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Without specific attention and actions to reduce them, disparities in access to quality health services among mi nority racial and ethnic groups may increase. There is a correlation between poverty and the lack of access to quality health services for adolescents (Agency for Healthcare Research and Quality
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. Where adolescents live and with whom may also directly affect health status, health-related behavior, health needs, and health services because of the potential impact of these variables on financial stability and stress level.
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. While this factor is important, it is notable that, according to the National Survey of Child Health, family income and mother's own health status are more likely to be correlated with adolescent health status than is place of residence (Maternal and Child Health Bureau, 2005a,b)
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From page 36... ...
Roswell Gallagher, often credited as the founder of adolescent medicine, began the first inpatient adolescent health unit at Boston Children's Hospital. Early in his career he worked as a school physician, studying adolescent growth and development, and ultimately helping to highlight the need for health services that included comprehensive preventive services, as well as diagnosis and treatment of physical health and "mental hygiene" or emotional health issues (Prescott, 1998)
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From page 37... ...
There has also been a movement toward promoting healthy adolescent development rather than simply preventing adolescent problems. In addition to adolescent medical specialists, a broad range of medical practitioners continue to provide health services to adolescents.
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Nearly 1,200 adolescents responded to questions about their access to medical services, barriers to receiving care, communication about health services, the extent to which their parents or other adults or peers are involved in helping them obtain health services, their interest in using technology for health information and health reminders, and their perspective on how health services could be more helpful to them. Respondents reported that their parents are quite often involved in their health care and that they view this involvement positively.
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. Parents Parents' perspectives on adolescent health status and behavior frequently differ from those of adolescents.
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. At the same time, some providers believe adolescents are best served at medical clinics focused on specific health needs, such as mental health, substance abuse treatment,
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From page 41... ...
Policy Environment Whether adolescents receive quality health services, preventive health services, and supportive counseling is affected by the policy environment in which the need for and cost of these services are debated. There is disagreement among policy makers on whether there should be universal access to health services in the United States.
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From page 42... ...
As a result, a variety of proposals for the reform of state health insurance have surfaced that are currently being considered to increase health insurance coverage for children and adolescents. Privacy and Confidentiality Beyond attitudes and perceptions about adolescent health and health services, legal considerations of confidentiality and informed consent are central to any discussion of the interests and rights of adolescents with respect to their health.
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From page 43... ...
The second, which is described in Chapter 3, focuses on the objectives of adolescent health services. Neither framework alone is sufficient to explain significant variations in adolescent health outcomes; rather, they complement each other and, in tandem, provide a more complete picture of the features of the health system that should be improved in order to provide adolescents high-quality care and thus help to improve their health status.
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From page 44... ...
Prevention, early intervention, and timely treatment improve health status for adolescents and prepare them for healthy adulthood; such services also decrease the incidence of many chronic diseases in adulthood (Chapter 2)
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From page 45... ...
Chapter 2 reviews the health status of adolescents, while Chapter 3 describes the health services, settings, and providers currently available for adolescents. Chapter 4 identifies strategies for improving current health services to achieve a system that would reflect the needs and concerns of the adolescent population more accurately.
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From page 46... ...
Association of Maternal and Child Health Programs and the National Network of State Ado lescent Health Coordinators.
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From page 47... ...
Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy.
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. What gets measured gets done: Assessing data availability for adolescent populations.
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Maternal and Child Health Journal, 5, 265–272. Prescott, H
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National Admissions to Substance Abuse Treatment Services, DASIS Series: S-31, DHHS Publication No.
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From page 51... ...
. The transformation of child health in the United States.
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