ADOLESCENT HEALTH SERVICES:

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ADOLESCENT HEALTH SERVICES Missing Opportunities
Building Partnerships for Youth May 5, 2009
Robert S. Lawrence, MD Johns Hopkins
University Linda Bearinger, PhD University of
Minnesota Jennifer A. Gootman, MA National
Academies
Charles E. Irwin, Jr., MD University of
California, San Francisco Shay Bilchik,
JD Georgetown University
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• The National Academies
• Founded in 1863, congressional charter signed by
  Abraham Lincoln.
• Nongovernmental, nonprofit scientific
  organization located in Washington, DC.
• Four organizations comprise the Academies the
  National Academy of Sciences, the National
  Academy of Engineering, the Institute of
  Medicine, and the National Research Council.
• Membership includes elected experts from the
  physical, biological, social, and health
  sciences.
• Operates through a set of major units to develop
  committee studies in response to requests from
  Congress, federal agencies, private foundations,
  and others.

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Committee on Adolescent Health Care Services
Models of Care for Treatment, Prevention
Healthy Development Study Charge To study
adolescent health services in U.S. and develop
policy research recommendations that would
highlight critical health needs, promising
service models, components of care that could
strengthen improve health services for
adolescents and contribute to healthy
development.
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Committee Membership Robert S. Lawrence (Chair),
The Johns Hopkins University Linda H. Bearinger,
University of Minnesota Shay Bilchik, Georgetown
University Sarah S. Brown, National Campaign to
Prevent Teen and Unplanned Pregnancy Laurie
Chassin, Arizona State University, Tempe Nancy
Dubler, Yeshiva University Burton L. Edelstein,
Columbia University Harriette Fox, Incenter
Strategies Charles E. Irwin, Jr., University of
California, San Francisco Kelly Kelleher, The
Ohio State University
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Committee Membership, continued Genevieve
Kenney, Urban Institute Julia Graham Lear, George
Washington University Eduardo Ochoa, Jr.,
University of Arkansas for Medical
Sciences Frederick P. Rivara, University of
Washington, Seattle Vinod K. Sahney, Blue Cross
Blue Shield of Massachusetts Mark A. Schuster,
Harvard University Lonnie Sherrod, Society for
Research in Child Development Matthew Stagner,
Chapin Hall Center for Children Leslie R. Walker,
University of Washington, Seattle Childrens
Hospital Thomas G. Dewitt, University of
Cincinnati
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• What we plan to cover
• Overview of the current health status of
  adolescents.
• Review of current available health services for
  adolescents.
• Conclusions about the gaps between need and
  available services.
• Recommendations for improving the health services
  system for adolescents.

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Guiding Principles What Matters?

• Development
• Timing
• Context
• Need
• Participation

• Family
• Place
• Skill
• Insurance
• Policy

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• Setting the Stage
• Adolescents aged 10-19 made up 14 of the total
  U.S. population in 2006.
• The racial/ethnic makeup of the U.S. adolescent
  population is becoming more diverse.
• The correlations among minority racial/ethnic
  status, poverty and lack of access to quality
  health services for adolescents is strong.
  Disparities may increase without specific actions
  and attention to reduce them.

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• Adolescent Health Status
• Most adolescents are considered healthy as
  defined by traditional medical measures.
• Adolescence is a period of both risk and
  opportunity.

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Ten leading causes of death in adolescents aged
1019

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• Adolescent Health Status
• Some specific populations of adolescents defined
  by selected demographic characteristics and other
  circumstances have higher rates of chronic health
  problems and engage in more risky behavior
  relative to the overall adolescent population
• Committee focused on foster care, homeless,
  recent immigrants, LGBT, incarcerated,
  racial/ethnic minorities, low-income.

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• Adolescent Health Services, Settings, Providers
• Assessing the quality of services accessibility,
  acceptability, appropriateness, effectiveness,
  equity.
• Evidence shows that while primary care services
  are available to most adolescents, services are
  separate, fragmented, poorly coordinated, and
  delivered in multiple settings.

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• The Workforce
• The current professional adolescent health care
  workforce is multidisciplinary.
• Existing adolescent health care training across
  disciplines does not address many of the health
  needs.
• Current health care training programs
  insufficient in number to prepare postgraduate
  health care professionals for roles in the
  academic/research sector.
• The licensing, certification, and accreditation
  of programs for health providers are minimal,
  inconsistent, and insufficient in their inclusion
  of adolescent health content.

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• Health Insurance Coverage
• More than 5 million adolescents ages 10-19 are
  medically uninsured.
• Uninsured rates are higher among poor and near
  poor, racial/ethnic minorities, non-citizens.
• Uninsured adolescents are less likely to have a
  regular source of primary care and use medical
  dental care less often compared to those with
  insurance.
• The majority of uninsured adolescents ages 10-18
  are eligible for public coverage but not yet
  enrolled.

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• Conclusions
• Most adolescents are thriving, but
• Models of health services - not one model
• Health services are highly fragmented, poorly
  coordinated, delivered in public/private
  settings

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• Conclusions
• Health services are not organized or equipped to
  focus on disease prevention, health promotion or
  behavioral health.
• Health care providers lack the skills.
• Large numbers are uninsured or underinsured.

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• Findings, Recommendations, Next Steps
• Primary Care
• Develop implement evidence-based health
  services systems that increase quality of
  primary care services for all adolescents.
• Emphasize the health and health services of those
  vulnerable to risky behavior poor health.
• Routine Services
• Incorporate health promotion, disease prevention,
  and behavioral into routine health services.

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• Findings, Recommendations, Next Steps
• The Community
• Health care providers, health organizations, and
  community agencies should develop coordinated,
  linked, and interdisciplinary services in
  practice and community settings.
• Consent and Confidentiality
• Maintain current laws, policies, and ethnical
  guidelines for adolescents to consent for their
  care and to receive services confidentially.

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• Findings, Recommendations, Next Steps
• Providers
• Enhance the capacity of health care providers to
  provide high quality care.
• Provide financial support to expand and sustain
  interdisciplinary training programs in adolescent
  health.
• Insurance
• Develop strategies to ensure that all adolescents
  have comprehensive, continuous health insurance
  coverage.

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• Accompanying Video
• Features three personal stories of adolescents
  and their experience with health services.
• Highlights messages from the report around the
  unique needs of adolescents in the health care
  system.
• Available for viewing at www.bocyf.org/ahc.html
  or on
• Google Video at http//video.google.com/videoplay
  ?docid-5939446517701113787

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To read about project, view the full report,
accompanying video, or the workshop
report http//www.bocyf.org/ahc.html
Full Report (2009)
Workshop Report (2007)
DVD (2008)
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Special thanks to The Atlantic
Philanthropies for supporting the work of this
committee.