Adolescent Health Services Missing Opportunities (2009) / Chapter Skim
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5 Preparing a Workforce to Meet the Health Needs of Adolescents
5 Preparing a Workforce to Meet the Health Needs of Adolescents
Pages 240-264
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From page 240... ...
• The licensing, certification, and accreditation of programs for health care providers in disciplines and specialties that may serve adolescents are minimal, inconsistent, and insufficient in their inclusion of adolescent health content and competencies. • Current adolescent health care training programs, including those that are high quality and interdisciplinary, are insufficient in num ber to prepare postgraduate health care professionals for roles in the academic sector.
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From page 241... ...
Given the adolescent health issues and health service needs presented in Chapters 2, 3, and 4, an important goal for the training of health care providers is for all those who will offer health services for adolescents in their practices to enter the workforce equipped to work effectively with this age group. This chapter begins by reviewing the composition of the current workforce providing adolescent health care services.
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From page 242... ...
Second, what means can be used to expand the number of adolescent health specialists, educators, and scholars with the advanced teaching, leadership, and research skills necessary to work effectively in the salient educational and research settings? COMPOSITION OF THE CURRENT WORKFORCE PROVIDING ADOLESCENT HEALTH SERVICES The uniqueness of adolescent health problems -- their social and behavioral origins, their developmental nature, and the multisystem needs involved -- demands a multidisciplinary workforce.
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From page 243... ...
among various subpopulations of adolescents, as described in Chapter 2. Each discipline has differing pathways and levels at which basic education, specialization, and continuing education may and can occur.
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From page 244... ...
To meet the national need for providers equipped to work with adolescents, many more such providers will need to enter the workforce over the next decade. For example, considering just pediatricians who are certified in adolescent medicine, there is on average a ratio of 1 adolescent medicine Partnershipin Program Planning for Adolescent Health: https://grants.hrsa.gov/web External/FundingOppDetails.asp?
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From page 245... ...
, the committee identified three levels of providers necessary to ensure a qualified adolescent health care workforce: • Generalists -- professionals who serve populations that include ado lescents and provide health care services for adolescents full- or part-time, even though they are not defined as adolescent health care providers or specialists (e.g., pediatric or family physicians; nurse practitioners; physician assistants; women's health care pro viders, such as gynecologists and midwives; general and pediatric dentists; psychologists; dieticians; and social workers)
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From page 246... ...
Self-Perceived Inadequacies in Training Health care providers' self-assessments of their competencies offer evidence of the limitations and inadequacies of their current training. Multiple disciplines have conducted surveys of graduates and professionals practicing in the field of adolescent health to determine their self-perceived competencies in meeting the physical, mental, and social health service needs of adolescents.
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From page 247... ...
Generally, surveys aimed at determining self-perceived competencies in adolescent health solicit self-reports from respondents drawn from the rosters of professional organizations whose members are likely to have had adolescents in their practice populations (e.g., the American Academy of Pediatrics, National Association of Pediatric Nurse Practitioners, American Dietetic Association, American School Health Association)
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From page 248... ...
Preventive Services Task Force (1996) ; the Clinical Guideline on Adolescent Oral Health Care of the American Academy of Pediatric Dentistry (2005)
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From page 249... ...
were the least likely to use the GAPS protocols, particularly in addressing adolescents' psychosocial health issues and concerns. Finding: Existing adolescent health care training across disciplines fails to address many of the health needs of adolescents.
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From page 250... ...
. Since the publication of that report, only one discipline/ specialty -- pediatrics -- has identified elements of curriculum required for board certification in an adolescent medicine subspecialty.
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. With respect to financing, currently only one federal agency in the United States -- the Maternal and Child Health Bureau within DHHS -- offers training grants focused solely on adolescent health.
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From page 252... ...
Models for Formal Training Programs Interdisciplinary Adolescent Health Programs In 1977 the Maternal and Child Health Bureau began funding the interdisciplinary LEAH programs with the specific goal of preparing leaders in the field of adolescent health. The intent was to create a cadre of adolescent health specialists and educators/scholars who in turn would advance clinical practice, research, and the training of an expanded workforce by assuming leadership roles in the academic and public health sectors.
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From page 253... ...
Adolescent medicine is not a primary discipline like, for example, pediatrics; therefore, options include adolescent medicine subspecialties in pediatric, family, and internal medicine, as well as master's and clinical and research doctorates focused on adolescent health in the areas of nutrition, nursing, psychology, public health, and social work, to name but a few. Unquestionably, medicine has led the other disciplines in defining training requirements and establishing a certification process for adolescent health care.
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From page 254... ...
According to the American Board of Pediatrics, the American Board of Family Medicine, and the American Board of Internal Medicine, from 2004 to 2005 the number of pediatrician, family medicine physician, and internal medicine physician fellows in adolescent medicine (i.e., pursuing subspecialty certification) decreased by 10 percent, from 74 to 66.
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From page 255... ...
Although there are no uniform requirements or competencies for such training as there are for fellowships in adolescent medicine, adolescent health courses generally include content covering some or all of the competencies identified above. In contrast to the defined criteria for board certification in the subspecialty of adolescent medicine for physicians (e.g., length and content of fellowship training, adolescent medicine exam)
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From page 256... ...
One strategy involves using adolescents as simulated patients to teach health care providers across multiple disciplines and at various levels (e.g., medicine and nursing students, medical residents, nurse practitioners, pharmacy students)
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From page 257... ...
The National Adolescent Health Information Center (NAHIC) , located at the University of California, San Francisco, offers another online resource. Guided by a team of nationally renowned adolescent health researchers and with funding from the Maternal and Child Health Bureau, NAHIC offers a variety of resources and tools for adolescent health care providers and educators/scholars, including fact sheets, reports synthesizing research data, and guides for program development.
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From page 258... ...
One mission of this initiative is the training of health care providers through the creation of online toolkits, policy briefs, tip sheets, and a listing of recommended resources. An example of a product resulting from this initiative is the continuing education online course available through the American Nurses Association.10 Findings: • urrent adolescent health care training programs, including those C that are high quality and interdisciplinary, are insufficient in num ber to prepare postgraduate health care professionals for roles in the academic sector. • few innovative discipline-specific and interdisciplinary adolescent A health care training programs have been instrumental in defin ing curricular content, clinical practicums, and effective teaching modalities.
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From page 259... ...
Educators raise the question of what curricular content can be eliminated to allow for the addition of content on adolescent health. As a result, classroom lectures, textbooks, and overall curricular plans often neglect adolescent health content, instead moving from childhood to adulthood with little attention to the unique concerns and needs of the adolescent population.
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From page 260... ...
For drug and alcohol counselors, expectations include formal curricular plans; in contrast, an apprentice model guides the training of mental health counselors. Along with these differing training expectations, certification requirements vary from state to state.
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From page 261... ...
The responsibility for adequately equipping health care providers with the essential knowledge and skills needed to work with adolescents rests with educational programs. Yet evidence from providers reporting on their own self-assessed competencies in adolescent health, as well as data gathered from chart reviews and patient reports, reveals that educational programs are falling far short of fulfilling this responsibility.
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From page 262... ...
. Adolescent medicine training in pediatric residency programs: Are we doing a good job?
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From page 263... ...
. The pediatric subspecialty of adolescent medicine-Help wanted!
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From page 264... ...
. Annual ADEA survey of dental school seniors: 2004 graduating class.
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