“Adolescents Often Poorly Served by Flawed U.S. Health Care System”


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


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