Challenges in Adolescent Health Care Workshop Report (2007) / Chapter Skim
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4 Making the System Work
4 Making the System Work
Pages 41-50
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From page 41... ...
PROVIDING CARE TO ADOLESCENT GIRLS AND YOUNG WOMEN1 Offering the perspective of a nongovernmental entity, Kristin Adams of Girls, Inc., spoke about the ways in which this national group serves a population of largely low-income, minority females. Girls, Inc., is an umbrella for more than 100 member organizations, each of which is its own nonprofit entity, serving communities throughout the United States and Canada.
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From page 42... ...
Confidentiality can also be a particular concern for adolescent girls and young women when they need reproductive health care. For all these reasons, health education is a prime concern for the organization, although it does not provide health services.
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From page 43... ...
Rural health centers, funded jointly by the state and the federal government, provide a significant portion of care for West Virginia adolescents. Collectively and working in partnership with communities, they see 13,000 medical patients of all ages each month and an additional 4,720 dental patients.
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From page 44... ...
. PROVIDING CARE TO URBAN ADOLESCENTS The director of the adolescent health center and counseling services at The Door, a multiservice youth development agency in New York City, Rhonda Braxton, turned the focus to the challenges of providing adolescent care in an urban setting.
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From page 45... ...
Juszczak drew on several sources of current data, as well as her own experience, to describe some of the benefits and challenges to delivering care through the schools.2 The school location makes it much easier to reach some of the adolescents who are least accessible to providers, such 2Juszczak mentioned the 2004 to 2005 National Assembly on School-Based Health Care Census, which provides information on the demographic characteristics of students using the centers, staffing and services, and quality indicators and evaluation efforts, a 2006 survey of state agencies, which provides information on funding, data collection efforts; and Medicaid and State Children's Health Insurance Program policies; and professional literature from original research and articles in peer reviewed journals and evaluation reports to states, foundations, and others. It also includes policy statements and endorsements from professional organizations such as the Society for Adolescent Medicine, the American Medical Association, and the National Association for Pediatric Nurse Practitioners.
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From page 46... ...
Other selected examples of school-based health centers successfully targeting risk behaviors among adolescents include substance use, including tobacco use, school attendance truancy, and discipline problems. A number of challenges remain, however.
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From page 47... ...
, so itemized bills are not required, although copayments may be required at the time of service. Kaiser is thus able to offer comprehensive care for adolescents, including contraception and care for sexually transmitted diseases, on a confidential basis.
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From page 48... ...
Moreover, many adolescents present themselves with multiple needs at once, coming to centers with urgent needs for major dental work, asthma, and a sexually transmitted disease, for example. Approximately 70 percent of the young women who enter the juvenile justice system, Ewashko explained, test positive for a sexually transmitted disease, while 76 percent of the male and female population entering that system have a history of substance abuse.
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From page 49... ...
Because the most vulnerable adolescents have such complex needs, it is critical that providers address not just health issues, such as substance abuse or the consequences of risky sexual behavior, but underlying causes as well. There may be a need for legal services for the foster or biological family, a need for other kinds of support so that the caregiver can succeed in his or her role, or a need to set up a system to make sure the child takes prescribed medication regularly.
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From page 50... ...
Baltimore has not been able to put in place interventions there is reason to believe can be very successful, such as screening for sexually transmitted diseases among middle school students, or to cover all the adolescents who could be helped by others, such as the Operation Safe Kids violence prevention program. Sharfstein reiterated the lack of reimbursement for mental health services as a critical deficit.
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