Health services failing many adolescents

Health services for adolescents are often highly fragmented, poorly coordinated, and ill-suited for the needs of many young people, according to a new report.

Adolescents who are poor, recent immigrants to the U.S., from racial or ethnic minorities, or who are gay, bisexual or transgender are particularly at risk, the report says.

The report, “Adolescent Health Services: Missing Opportunities”, was prepared by an expert panel convened by the National Research Council and the Institute of Medicine.

Panel focused on the health needs of the roughly 45 million Americans aged 10 to 19 years of age.

Dr. Frederick Rivara, who served on the panel and who is a professor of pediatrics at University of Washington School of Medicine, said that while most adolescents are healthy and “do quite well”, there are many young people who have physical or mental health problems or who are engaging in risky behavior and developing unhealthy lifestyles who are not getting needed care and counseling.

Often services are available, but they are “uncoordinated and discombobulated,” Dr. Rivara said,

In Seattle, for instance, a student can get some care at a school-based health center, but might have to go a public health clinic to get treatment for a sexually transmitted infection, and another clinice to get mental health or substance abuse counseling, he said.

Another problem is that the health-care system is designed to treat acute medical problems and, thus, is poorly equipped to provide health promotion and disease prevention education or to provide help with the mental health and behavioral problems that trouble many adolescents, Dr. Rivara said.

Primary care physicians are not paid to spend time needed to listen to these young patients and to provide counseling and health education, he said. 

Dr. Leslie Walker, chief of the Adolescent Medicine Division at Seattle Children’s and also a member of the panel, said Seattle is “a little bit ahead of the curve” compared to many other cities because it has set up a system of school-based health centers but fragmentation of services is still a problem. 

A teen might get care at a school clinic, for example, but the teen’s primary care doctor might never learn about it, she said.

Another concern is the lack of providers who are trained in adolescent medicine, Dr. Walker said. Many specialists in the field are retiring, and there are too few replacements in the training pipeline, she said. “We don’t have the same number coming in who are leaving.”

The panel’s recommendations include:

• Federal and state agencies, private foundations, and private insurers should support and promote the development and use of a coordinated primary health care system that strives to improve health services for all adolescents.
   
• 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.
   
• 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.

Tags: Adolescents, Pre-teens, Teens, Youth

Category: Child & Youth Health, Education, Health-care Policy