Challenges in Adolescent Health Care Workshop Report (2007) / Chapter Skim
Currently Skimming:
3 Needs of the Most Vulnerable Adolescents
3 Needs of the Most Vulnerable Adolescents
Pages 24-40
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 24... ...
The workshop presenters highlighted gaps in care for vulnerable adolescents that are of a different order from those that affect young people who are less vulnerable or disadvantaged. Adolescents whose life circumstances are seriously disadvantaged may go years without seeing a doctor, may have serious and multiple untreated physical or mental illnesses, or may live without necessary vaccinations, preventive reproductive, dental, and other care, for example.
|
From page 25... ...
Matthew Morton, who at the age of 22 is the vice chair of the National Council on Youth Policy of the National Network for Youth, described for the audience the most pressing issues he sees facing three groups of adolescents: those in foster care, those in the juvenile justice system, and those who have run away from home or are homeless. His views on the needs of these young people have been shaped by his own childhood, during which he was orphaned and cared for, as he explained, "in a home marked by alcoholism, cocaine addiction, neglect, and occasional police visits." Shawn Denise Semelsberger, who spent many years in foster care and serves on the board of directors of a crisis intervention center, followed up on Morton's presentation with her observations about issues that affect adolescents in foster care.
|
From page 26... ...
While adolescents in foster care families are generally eligible for Medicaid, they nevertheless often receive inadequate preventive care, oral and mental health services, and treatment for substance abuse.3 Moreover, as adolescents age out of foster care, they often find themselves with no health coverage at all, even though states do have the option of extending Medicaid coverage for them during the period of transition from care to self-sufficient adulthood. The federal Administration for Children and Families has estimated that more than 65,000 adolescents age 16 and older left foster care in 2005, only about 25,000 of whom were ready for complete emancipation (Administration for Children and Families, 2005)
|
From page 27... ...
Where Medicaid coverage has been terminated, it can be very difficult for young people to reactivate their coverage once they leave the juvenile justice system. Moreover, Morton explained, many juvenile justice systems do little to help adolescents reactivate their coverage or make other connections with the social services that can help them address their health and emotional problems once they leave the system.
|
From page 28... ...
, and they often lack access to any health care at all, despite their particular vulnerability to health problems associated with life on the street, such as substance abuse and sexually transmitted diseases. The health of homeless adolescents with chronic medical conditions, such as diabetes or positive HIV status, is at particular risk because it is very difficult for them to take critical medications regularly.
|
From page 29... ...
Coleen DeFlorimonte, a pediatric nurse practitioner with the Woodson Adolescent Wellness Center in Washington, DC, described the needs she sees in a group whose primary shared characteristic is poverty. Run jointly by the District of Columbia Department of Health, the Maternal and Family Health Administration, and the DC public school system, the Woodson program provides comprehensive
|
From page 30... ...
Among the most common services requested at the clinic are required vaccinations, sports physicals, treatment for sexually transmitted diseases, HIV counseling, contraceptive management, laboratory testing for such diseases as sickle cell anemia, and dental services. The clinic finds itself not only providing basic primary care services but also addressing problems, particularly violence, which are especially prevalent in large urban areas.
|
From page 31... ...
. A significant body of research has explored the efficacy of various treatments for these and other common mental disorders of adolescence.
|
From page 32... ...
Some states have focused on ensuring that adolescents receive the mental health care that has been demonstrated to be most effective -- Hoagwood cited 12 states that have worked to implement this goal.4 In others, the care may be haphazard. Given that situation, she observed that recent efforts in schools, primary care settings, home-based services, and family-based services may offer the most promise for implementing research-based practice with adolescents.
|
From page 33... ...
. Although screening for risky behaviors in primary care settings is recommended by the American Medical Association, the American Academy of Pediatrics, and the Institute of Medicine (see for example, the description of one such tool in Box 3-1, the CRAFFT screening test for adolescent substance abuse)
|
From page 34... ...
Weisner suggested modeling a system that effectively addresses substance use problems as one in which clinicians: • make use of effective links among primary care, specialty care, and community agencies to offer all available resources to patients; • use illness self-management practices; • screen for all comorbid conditions; • routinely ask patients and families for permission to share clinical information with other providers; and • make use of evidence-based care and coordination. She further recommended that health plans cover screening and care for these disorders and support the coordination of information and care, perhaps using electronic record-keeping.
|
From page 35... ...
He described the Broadway Youth Center in Chicago, a program opened in 2004 by the Howard Brown Health Center, which serves LGBTQ adults, to focus on the needs of LGBTQ and homeless adolescents. The center serves between 4,000 and 5,000 adolescents per year and offers comprehensive services, including housing assistance; case management; medical care and counseling; food, showers, and laundry; general education development and job training; and mentorship.
|
From page 36... ...
These adolescents have a high rate of incarceration or residential placement, and 60 percent of those incarcerated come from low-income families. In addition, among those incarcerated at the Texas Youth Commission, 34 percent say they are members of a gang, 46 percent have a high need for drug treatment, 41 percent have severe mental health problems, and 36 percent have been abused or neglected (Texas Youth Commission, 2007)
|
From page 37... ...
The deficits in health care for these adolescents begin with basic services that even very vulnerable groups in other parts of the country may take for granted. OBSERVATIONS Morton believes that many programs that serve disadvantaged adolescents fail to capitalize on the strengths that even highly stressed young people have.
|
From page 38... ...
Morton also identified some concrete needs for mental health services, substance abuse treatment, and oral health care, some of which often are not covered by government-funded health plans. Moreover, adolescents who have little support and guidance from responsible adults tend to lack awareness of the need for and availability of these kinds of services.
|
From page 39... ...
• Lack of specialty care -- while primary care can be available even to those who lack health insurance, access to specialized ser vices -- including mental health and substance abuse treatment, dental care, and other important kinds of care -- is even more difficult. For example, while approximately 60 percent of chil dren in out-of-home care have moderate to severe mental health problems, only one-third of them are receiving the care they need (Child Welfare League of America, 2006)
|
From page 40... ...
However, participants noted that hierarchies within and among the professions can work against coordination among programs and even against collaboration among colleagues. Both nurses and social workers, for example, may have relevant educational credentials and experience, yet informal protocol may inhibit a nurse or social worker from making recommendations to a physician or documenting key points.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.