Adolescent Health Services Missing Opportunities (2009) / Chapter Skim
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7 Overall Conclusions and Recommendations
7 Overall Conclusions and Recommendations
Pages 293-310
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From page 293... ...
The National Academies' Board on Children, Youth, and Families formed the Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development, with funding from The Atlantic Philanthropies, in May 2006 to study adolescent health and the adolescent health system. This committee was asked to explore the following issues: • Features of Quality Adolescent Health Services.
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From page 294... ...
health services for adolescents comprise a series of individual services delivered in myriad settings and through varied institutional structures, with limited common goals and no coherent, organizing system; (5) evaluation of health services for adolescents has been limited, and there is no agreed-upon set of standards within the field of adolescent health with which to evaluate the success of individual programs or compare services and service models; and (6)
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From page 295... ...
The committee also reviewed the training needs and current requirements for providers of adolescent health services and identified deficits in these areas. In addition, it examined health insurance alternatives for adolescents and assessed the extent to which public and private financing options meet adolescents' health service needs.
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From page 296... ...
. A more complex and complete picture of adolescent health status, however, also encompasses the prevalence of various leading adolescent behaviors and health outcomes, as well as health indicators that may adversely affect health status in adulthood.
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From page 297... ...
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. Framework 1: Behavioral and Contextual Characteristics Certain sets of behavioral and contextual characteristics, listed below, matter for adolescents in the ways they approach and interact with health care services, providers, and settings.
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From page 298... ...
Framework 2: Objectives of Health Services for Adolescents Research from various sources and the experiences of adolescents and health care providers, health organizations, and research centers suggest the importance of designing health services that can attract and engage adolescents, create opportunities to discuss sensitive health and behavioral issues, and offer high-quality care as well as guidance for health promotion and disease prevention. Consistent with these findings and views, a variety of national and international organizations have defined critical elements of health systems that would improve adolescents' access to appropriate services, highlighted design elements that would improve the quality of those services, and identified ways to foster patient–provider relationships that can lead to better health for adolescents.
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From page 299... ...
Adolescents receive both primary care and specialty care services. They receive these services in various settings, including private physician and dentist offices, community outpatient departments, school-based health centers, emergency departments, and even mobile vans, and from various providers, including doctors, nurse practitioners, dentists, psychologists, and social workers.
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From page 300... ...
Although an extensive literature on the quality of school-based health services for adolescents is available, few studies have examined the quality of other safety-net primary care services, such as those that are hospital- or community-based, on which so many adolescents depend. Evidence also shows that existing specialty services in the areas of mental health, sexual and reproductive health, oral health, and substance abuse treatment are not accessible to most adolescents, nor do they always meet the needs of many adolescents who receive care in safety-net settings.
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From page 301... ...
Overall Conclusion 4: Health services for adolescents are poorly equipped to meet the disease prevention, health promotion, and behav ioral health needs of all adolescents. Instead, adolescent health services are focused mainly on the delivery of care for acute conditions, such as infections and injuries, or special care addressing specific issues, such as contraception or substance abuse.
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From page 302... ...
Having health insurance, however, does not ensure adolescents' access to affordable, high-quality services given current shortages of health care providers and problems associated with high out-of-pocket cost-sharing requirements, limitations in benefit packages, and low provider reimbursement levels, especially in areas that involve counseling or case management of multiple health conditions. For example, the current system of health insurance coverage is often limited or nonexistent for treatment and prevention in areas that are particularly problematic for adolescents, such as obesity, intentional and unintentional injury, mental health, dental care, and substance abuse.
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From page 303... ...
Research Needs Developing a clear definition of adolescent health status is a critical step in delivering health services and forming health systems that can respond appropriately to the specific needs of adolescents. Moreover, the ability to understand and characterize health status within this definition is dependent on available data, particularly that related to adolescent behavior.
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From page 304... ...
The report also provides a framework for identifying key objectives of a high-quality system of health services for all adolescents in the United States, with particular attention to those who engage more heavily in risky behavior or who face major barriers in gaining access to health services. Based on the overall conclusions presented above and reflecting the need for a multifaceted approach to fostering successful interactions between adolescents and health service settings and systems, the committee makes eleven recommendations, directed to both public and private entities, for investing in, strengthening, and improving health services for adolescents.
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From page 305... ...
Recommendation 3: Providers of adolescent primary care services and the payment systems that support them should make disease prevention, health promotion, and behavioral health -- including early identification, management, and monitoring of current or emerging health conditions and risky behavior -- a major component of routine health services. For this recommendation to be realized, providers of adolescent primary care services would need to give attention to the coordination and management of the specialty services young people often need.
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From page 306... ...
Adolescent Health Care Providers Recommendation 6: Regulatory bodies for health professions in which an appreciable number of providers offer care to adolescents should incorporate a minimal set of competencies in adolescent health care and development into their licensing, certification, and accreditation requirements.
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From page 307... ...
Important as well is to increase the number of Leadership Education in Adolescent Health programs that train health professionals in adolescent medicine, psychology, nursing, social work, and nutrition, and to enhance the program by adding dentistry. Health Insurance Recommendation 8: Federal and state policy makers should develop strategies to ensure that all adolescents have comprehensive, continu ous health insurance coverage.
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From page 308... ...
First, they could see that benefit packages cover at a minimum the following key services for adolescents: preventive screening and counseling, at least on an annual basis; case management; reproductive health care that includes screening, education, counseling, and treatment; assessment and treatment of mental health conditions, such as anxiety disorders and eating disorders, and of substance abuse disorders, including those comorbid with mental health conditions; and dental services that include prevention, restoration, and treatment. Second, they could ensure coverage for mental health and substance abuse services at primary or specialty care sites that provide integrated physical and mental health care, and require Medicaid to cover mental health rehabilitation services.
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From page 309... ...
and health outcomes of young people who receive care through different service models and in different health settings, as well as of those who are difficult to reach and serve. Fourth, they could identify effective ways to reach more underserved and vulnerable adolescents with appropriate and accessible health services.
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From page 310... ...
CLOSING THOUGHTS While the gaps and problems in the health services used by young people discussed in this report are not unique to this age group, a compelling case can be made for improving health services and systems both to support the healthy development of adolescents and to enhance their transitions from childhood to adolescence and from adolescence to adulthood. Current interest in restructuring the way health care is delivered and financed in the United States -- and defining the content of care itself more broadly -- is based on a growing awareness that existing health services and systems for virtually all Americans have important and costly shortcomings.
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