ADOLESCENT HEALTH SERVICES:

Missing Opportunities

Advancing Adolescent & Young Adult Health:

Preparing the Adolescent Health Workforce for 2020

May 14, 2009

Charles E. Irwin, Jr., MDUniversity of California, San Francisco

Jennifer A. Gootman, MANational Academies

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.

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.”

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

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 Children’s

Hospital

Thomas G. Dewitt, University of Cincinnati

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.

Guiding Principles: What Matters?

Development

Timing

Context

Need

Participation

Family

Place

Skill

Insurance

Policy

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.

Adolescent Health Status

Most adolescents are considered healthy as defined by traditional medical measures.

Adolescence is a period of both risk and opportunity.

14.1%

0.5%

0.6%

0.7%

0.9%

2.5%

3.0%

6.9%

11.2%

12.1%

47.4%

Homicide

Ten leading causes of death in adolescents aged 10–19

Others

Unintentional Injury

Malignant neoplasmsHeart diseaseCongenital abnormalitiesChronic lower respiratory diseaseInfluenza and pneumoniaCerebrovascularBenign neoplasms

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.

Adolescent Health Services, Settings, & Providers

Assessing the quality of services: accessibility, acceptability, appropriateness, effectiveness, & equity.

Adolescent Health Services, Settings, & Providers

Evidence shows that while primary care services are available to most adolescents, services are separate, fragmented, poorly coordinated, and delivered in multiple settings.

Specialty care services also fall short.

Safety-net services serve many adolescents.

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.

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

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.

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.

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.

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.

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

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)

Special thanks to…

The Atlantic Philanthropies

for supporting the work of this committee.