By Ed Martinez – April 12, 2011
A 2008 report by the Institute of Medicine (IOM) and National Research Council (NRC) stated that the nation’s health care system has failed to “deliver the best possible care to 42 million adolescents in the U.S.” Public health literature has also documented that at least 5 million adolescents lack health coverage of any kind. This lack of coverage generally results in lack of access to basic services that address long-standing health disparities such as high rates of obesity, depression, suicide attempts, drug and alcohol abuse, unplanned pregnancy and sexually transmitted diseases. Minority adolescents generally experience the most pronounced health disparities among the adolescent population.
Existing health services for adolescents are generally delivered in pediatric and adult medicine office practices. Studies have documented that adolescents feel uncomfortable in receiving health services in these traditional medical settings because pediatric offices are generally organized to treat younger children and adult medicine offices are often oriented to treating older adults with chronic conditions. In addition, many private practice offices fall short of meeting the expectations of adolescents relative to confidentiality issues; nor do they offer the comprehensive mix of services and personnel needed to address common adolescent concerns – such as issues of sexuality, substance abuse and serious depression.
Clearly, our nation’s health care system must do better in addressing access to care and quality health services for adolescents. Experts in the adolescent health services have suggested the following building blocks for effective adolescent-specific services:
- A holistic/interdisciplinary approach: Adolescents often seek care for multiple conditions simultaneously (e.g., medical, sexual/reproductive health, substance abuse, sexually transmitted diseases or behavioral issues). Accordingly, the continuum of services should include these core areas of clinical specialization.
- Emphasize health promotion, disease prevention and youth development. An interdisciplinary approach to adolescent services offers multiple opportunities to coordinate care among the primary care provider, behavioral counselor, substance abuse case manager and family planning health educator.
- Deliver services via an adolescent care team. Interdisciplinary adolescent care teams are professionally committed to comanaging patients within a specific care setting that incorporates health-related and community-based services.
- Create a teen-friendly care, setting. Adolescents are more likely to access a care facility that visibly projects its focus on services specifically aimed at them.
Maintain adolescent confidentiality. Confidentiality is the key prerequisite for adolescents when considering seeking medical intervention for an acute condition. Although California passed legislation in 2010 allowing adolescents to access reproductive and behavioral health services without parental consent, many medical offices have yet to establish adequate standards to safeguard the confidentiality of adolescents.
At San Ysidro Health Center, we have recently initiated steps to reach out to adolescents in the community to provide essential health services. According to the 2010 census, there are more than 725,000 adolescents in San Diego, and approximately 36 percent are minorities. Public health literature clearly documents that minority adolescents generally experience the most pronounced health disparities among the adolescent population.
In response to a community needs assessment performed in 2010, our clinic recently initiated a two-phase program to address the unmet health needs of youth residing in Southeast San Diego.
The first phase of this new initiative provided mobile health services through our Healthy Steps Outreach Program. Services provided by the mobile care unit included: school arid sport physicals, immunizations, tuberculosis skin testing, minor sick visits and assistance with health coverage enrollment. The program’s second phase included the establishment of a school-based health clinic at Lincoln High School. This new program is staffed by our clinic’s health professionals including a physician’s assistant, a medical assistant and a certified application assistant.
By investing and supporting innovative outreach programs, the San Ysidro Health Center has demonstrated the benefits of a truly patient-centered approach to adolescent health services that is easily accessible, evidence-based, prevention-oriented and teen-friendly.
San Ysidro Health Center urges legislators to continue to invest in and support new models of health care delivery that are more accessible and appropriate for youth, adolescents and transitional age youth. At this time, we anticipate new opportunities to expand adolescent health services via new health reform legislation that allows the Center for Medicare & Medicaid Innovations to invest $10 billion over 10 years in patient care, coordinated care and community health services.
Ed Martinez is a resident of El Cajon and former CEO/President of San Ysidro Health Center