Health for Youth Ages 10 18: Health Care Working with Community and Family to Impact Health Behavior

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Health for Youth Ages 10 18 Health Care
Working with Community and Family to Impact
Health Behaviors and Indicators
Paula M. Duncan, MD Paula.Duncan_at_uvm.edu Youth
Health Director Vermont Child Health Improvement
Project and the National Initiative for
Children's Healthcare Quality
Vermont Child Health Improvement Program
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CommunityParentsSchool SuccessEmployment
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Big 6 Indicators
Not Vigorously physical active 35 Overweight
(gt95th) 10 (20) Heavy drinking 32 Sexually
active (past 3 mos) 25 Rode with Drinking
driver 24 Attempted suicide 8
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Big 6 Indicators
Vigorously physical active 65 Not overweight
(lt95th) 90(80) Not drinking 50 Not sexually
active (past 3 mos) 75 Not riding with Drinking
driver 73 Not attempt suicide 92
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Whats new?

• Provider office led QI
• Referrals Can Happen
• Whats Right with You.
• Motivational Interviewing
• Parents Really Do Matter

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Vermont Child Health Improvement Program
VERMONT CHILD HEALTH IMPROVEMENT PROGRAM
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Mission to optimize the health of Vermont
children by initiating and supporting
measurement-based efforts to enhance private and
public child health practice.
VERMONT CHILD HEALTH IMPROVEMENT PROGRAM
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Youth Development Justification
Complex array of risk and protective factors
influence youth decision-making about health
behaviors
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Search Inst. Assets
Support Empowerment Expectation/boundaries/time Ed
ucational competencies Values Social
Competencies Positive Identity
Benson
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Search Institute 700 South Third Street, Suite
210 Minneapolis, MN 55415 1-800-888-7828 www.searc
h-institute.org
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Generosity Demonstrate honesty and caring
Contribute to family and/or community
Independence Be able to get things done
independently -- (self-efficacy)
G I M B
Mastery Have completed high school Have work,
learning or other activity they can pursue with
enthusiasm
Belonging Have connections to friends and family
Brendtro
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The Vermont Youth Health Improvement
Initiative 6 4 more than 10
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6 4

• Generosity
• Independence
• Mastery
• Belonging

• Nutrition
• Physical Activity
• Substance Abuse
• Sexuality related behaviors
• Unintentional Injuries
• Emotional Health - Suicide

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Vermont Youth Health Improvement Initiative
Goals 1) VT youth, ages 8-18, will receive a
health supervision visit according to the VT
Periodicity Schedule and will be screened for
risk- and protective-factors in their medical
home 2) Youth who have an identified behavioral
health problem, including substance abuse, will
be further assessed and will receive an
office-based intervention or will be referred to
an appropriate service provider 3) All efforts
to improve health service delivery to VTs youth
will include input from youth and parents
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Vermont Youth Health Improvement Initiative
Partners

• Vermont Child Health Improvement Program
  Department of Peds
• Youth
• Parents
• Primary care offices Physicians, NPs, office
  nurses, administrative staff, other staff

• AHS VDH,PATH,SRS
• BCBSVT, MVP, TVHP
• BISHCA
• AAP, AAFP
• AHEC
• Regional Partnerships
• School Nurses
• Student Assistance Counselors

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Vermont Youth Health Improvement Initiative

• 1-year planning phase
• Expert Meeting
• Focus Groups
• Data Analysis
• Needs and Resources Assessment
• 1-year pilot project
• 13 primary care offices (6 pediatric, 7
• family practice)
• Focused on improving
• strength assessment and
• substance abuse screening, treatment, and referral

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2002
LS 1
Vermont Youth Health Improvement Initiative
Practice Recruitment
Engaging SA/Mental Health Treatment
Focus on substance abuse and protective factors
2001
Data analysis
Statewide needs and resources assessment
Focus groups with Vermont youth and parents
National Expert Meeting on Youth Health Services
VCHIP hires a youth advisor
2000
VDH, BISHCA, Health Plans, OVHA, and VCHIP began
working together to improve health care delivered
to Vermont youth
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VCHIP Pediatric Family Practices in attendance
at Fall 2002 Vermont Youth Health Improvement
Initiative LS1
St. Albans
Milton
Burlington
Williston
Plainfield
Middlebury
Randolph
South Royalton
Castleton
Bellows Falls
Manchester
Bennington
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Youth

• In one year
• A higher of youth will have had a health
  supervision visit
• Youth in need of substance abuse assessment and
  treatment will have received it
• gt 75 will have improved
• Youth with health supervision visits
• will have gotten help with problems
• will have been linked with community resources
• will have been made more aware of their
  strengths
• 100 who wanted a mentor will have gotten one

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Primary Care Providers In these practices

• In one year
• Have demonstrated improvement on their chosen
  quality measures
• Be able to get substance abuse treatment services
  for their patients efficiently
• Refined their interventions skills with youth
  about substance abuse and protective factors
• Helped refine an audit tool/patient visit form
  that works for everyone
• Had the opportunity to share the how of their
  successes and lessons learned from failed
  attempts with their colleagues
• Report easier community-practice interactions in
  getting things done for and with youth

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Home Education Activities Drugs Sexual
Activity/Sexual Identity Suicide/Depression Safety
H E A D S S S
Reif, CJ, Elster, AB, Adolescent Preventive
Services. Primary Care Clinics in Office
Practice, Vol 25, No 1, March 1998, WB Saunders,
Philadelphia. Goldenring JM, Cohen E. Getting
into adolescent heads. Contemp Pediatr
19885(7)75-90.
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THE CRAFFT
1. Have you ever ridden in a CAR driven by
someone (including yourself) who was high or
had been using alcohol or drugs? 2. Do you ever
use alcohol or drugs to RELAX, feel better about
yourself or fit in? 3. Do you ever use
alcohol/drugs while you are by yourself,
ALONE? 4. Do your family or FRIENDS ever tell you
that you should cut down on your drinking or drug
use? 5. Do you ever FORGET things you did while
using alcohol or drugs? 6. Have you ever gotten
into TROUBLE while you were using alcohol or
drugs?
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The Helping Skill

• Identify the Issue
• Explore Options
• Consider Consequences
• Make a Plan
• Follow-up

Comprehensive Health Education Foundation
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Parents Matter

• JAMA 98 - ADD Health Study
• Risk behaviors
• Emotional distress

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Parents

• Value the partnership with the parents and their
  input
• Identify family and youth strengths
• Knowledge and skills to build protective factors
  in their youth,eg.the helping skill
• Have access to resources to help with problems
• Value passion where ever you find it

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Role for Clinical Care

• Deliver the services
• Look for protective factors
• Use motivational strategies
• Get extra help when needed
• Engage parents if possible

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We do not Believe in ourselves until
someone reveals that deep inside us something is
valuable, worth listening to, worthy of our
touch, sacred to our touch. Once we believe in
ourselves we can risk curiosity, wonder,
Spontaneous delight, or any experience that
reveals the human spirit. e.e. cummings