Adolescent health services in North Carolina's local health departments

The purpose of this study was to assess availability of clinical health services and special adolescent health programs for those aged 10-19 years administered by local health departments in North Carolina, and to evaluate factors that were associated with the existence of specialized adolescent programs, comprehensive services, and school services. We used self-report surveys mailed to 100 county health directors. All counties responded. One in five (21%) North Carolina youth received one or more health department service in 1990. Thirty-four health departments have programs or services specifically designed for adolescents; 7 health departments provide comprehensive services. The majority of health departments (85%) provide services in public schools, most often health education or counseling. Counties with more adolescents and with higher per capita income were more likely to have adolescent programs and more likely to provide comprehensive clinics. Health departments with school services served proportionally twice as many of their county's adolescents as those without school services. We concluded that few local health departments in North Carolina provide comprehensive health services to their youth. Community-wide participation and state support are needed to improve public sector access to comprehensive health care for adolescents in North Carolina and in other states with decentralized, county-controlled public health systems.

The evaluation of targeted outreach in an adolescent HIV/AIDS program

PURPOSE

Most HIV infected youth are unaware of their serostatus. Among adolescents who know they are HIV positive, only a small percentage are currently receiving care in age-specific programs. Establishing effective links between prevention and service programs is critical in reaching this group of young people.

METHODS

A specific outreach strategy was designed to develop more referrals from a wider variety of agencies to better serve youth at risk for HIV. A needs assessment of community-based agencies was the basis for: 1. overcoming barriers to care, 2. specifying the target population, 3. assessing existing referrals, and 4. selecting agencies for different levels of intensity of outreach.

RESULTS

Six barriers faced by potential referring agencies were identified and corresponding solutions created which were incorporated into the outreach strategy. A comparison was made of referrals in the years before, during and after the outreach strategy was instituted. A significant difference by (chi 2 analysis) was noted in the number of agencies (p < 0.05), number of individuals (p < 0.01), number of appointments kept (p < 0.01), and the number of HIV+ youth enrolled (p < 0.01) during the year when the plan was fully implemented compared to previous and subsequent years.

CONCLUSIONS

Systematic targeted outreach programs are an efficient way to maximize the time and effort of outreach staff. The result was an increase in the number and diversifity of referrals. This strategy could be used by groups caring for adults or younger children who want to expand services to include adolescents or by groups providing HIV/AIDS care who want to specifically serve adolescents.

Confidentiality in health care. A survey of knowledge, perceptions, and attitudes among high school students

OBJECTIVE

To assess adolescent knowledge, perceptions, and attitudes about health care confidentiality.

DESIGN

Anonymous self-report survey with 64 items addressing confidentiality issues in health care.

SETTING

Rural, suburban, and urban high schools in central Massachusetts.

PARTICIPANTS

Students in ninth through 12th grades from three schools.

RESULTS

A total of 1295 students (87%) completed the survey: 58% had health concerns that they wished to keep private from their parents, and 69% from friends and classmates; 25% reported that they would forgo health care in some situations if their parents might find out. There were differences in response by gender, race, and school. About one third were aware of a right to confidentiality for specific health issues. Of those with a regular source of care, 86% would go to their regular physician for a physical illness, while only 57% would go there for questions about pregnancy, the acquired immunodeficiency syndrome, or substance abuse that they wished to keep private. Sixty-eight percent had concerns about the privacy of a school health center.

CONCLUSIONS

A majority of adolescents have concerns they wish to keep confidential and a striking percentage report they would not seek health services because of these concerns. Interventions to address confidentiality issues are thus crucial to effective adolescent health care.

Demographic factors in the use of children's mental health services

OBJECTIVES

This study was designed to (1) determine mental health service use by children of varying age, sex, socioeconomic status, and urbanicity of residence; (2) compare the prevalence of mental disorder in children in these groups; and (3) determine the extent to which differences in service use are consonant with the prevalence differences.

METHODS

Data on psychiatric diagnoses and service use were taken from a random longitudinal sample of 760 children. Information was gathered by interviews of mothers and of youth aged 12 to 21.

RESULTS

Significant lags in mental health service use were found for youth 18 to 21 years of age, for those living in rural and semirural areas, and for those in middle-income families. To some extent, these service use differences paralleled differences in diagnostic rates. However, when diagnostic differences were controlled, the same patterns of service use inequalities were present.

CONCLUSIONS

Mental health service use rates for youth vary by age, urbanicity, and family income. The underservice of middle-income and rural children may reasonably be ascribed to access problems; we explore explanations for the underservice of older youth.

School-based adolescent health care. Review of a clinical service

OBJECTIVE

To provide recommendations regarding the establishment and maintenance of school-based clinics, based on analysis of data from a clinic located in a New York City high school.

DESIGN

Review of demographic, medical, and psychosocial data collected during student visits.

SUBJECTS

During 2 1/2 years, 1283 students were seen. The students were 53% girls and 47% boys; 65% black and 25% Hispanic; and 65% grades 9-10 and 35% grades 11-12.

RESULTS

There were 7920 visits. Visits were for acute or chronic medical problems (44%), physical examinations and immunizations (25%), gynecologic or sexuality-related issues (17%), and mental health concerns (14%). Psychosocial characteristics of the 378 students who enrolled during the 1989-1990 academic year indicated that only 27% lived with both natural parents, 55% were foreign-born, 37% had repeated a grade at least once, 44% were sexually active, 13% drank alcohol, and 14% had past or present suicidal ideation.

CONCLUSIONS

These data demonstrate that a school-based clinic can be involved in the management of a wide range of health care needs for large numbers of at-risk youth. In addition, school-based clinics can serve as a major site for the teaching of medical students and residents, and as a valuable resource for clinical research.

Referral rates to a regional adolescent psychiatric service: a comparison of visited and unvisited general practitioners

A survey was undertaken through personal visits to general practitioners to determine the effectiveness of distributing information about a Regional Adolescent Psychiatric Service for emotionally and conduct disordered adolescents. The referral rates to the Unit over the four years before, and over the four years after the period of the visits were recorded both for those GPs who were visited and those who were not. The findings show an immediate significant increase in referral rates among the visited general practitioners, which was still evident after four years. This finding supports the hypothesis that a personal approach is more likely to be an effective means of disseminating information than posted printed materials. This paper also contains a description of other valuable, but unquantifiable results.

Outreach health services for street youth

A voluntary health agency operated a clinic at a drop-in center for street youth. Six hundred nine youths were seen, with an average age of 16 years, 9 months. There were 2,086 diagnoses made during 1,895 visits. Respiratory, dermatologic, and gynecologic problems represented 56% of all diagnoses. Pregnancy tests accounted for 38% of all procedures, 50% of all medications dispensed were either oral antibiotics or decongestants, and 17% of the visits resulted in referrals. This chart review revealed that street youth seen at a drop-in center sought care for common medical problems. Problems related to substance abuse and sexually transmitted diseases were seen much less frequently than anticipated. Elements critical to the success of this clinic included its on-site location, hours of operation when teenagers were using other services, close working relationships between clinic and center staffs, the capability to perform a few simple laboratory procedures, and an on-site pharmacy.

HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.

The medical care of street youth

Our clinical contacts with street youth support the view that their numbers are growing and that their medical needs are largely neglected. We describe our experience in providing medical care to street youth in Seattle, with attention to their medical presentations and patterns of health care utilization. We address aspects of adolescent street life that are unique to that particular mode of living or importantly formative in the lives of persons drawn to it.

Legislation and reality in public dental services in Norway: dental health services for children and adolescents in 1975 and 1985

The act relating to dental health service implied a reorganization of the public dental health services in Norway in 1984. The act intended to extend the target group of public dental health services and to achieve social and geographic equality in the distribution of dental health services among children and adolescents. The purpose of this study was to assess the degree to which these intentions had been fulfilled. The material comprised two nationwide, stratified, and randomly selected samples of 3,356 and 2,970 children and adolescents in the age group zero to 18 years. Data were collected in 1975 and 1985. Both the theoretical and the empirical models applied structural and individual resources to explain individual variation in use of dental health services. The results showed that the proportion of zero- to 18-year-olds who had seen a dentist within the past 12 months was higher in 1985 than in 1975 (81.7% and 75.8%, respectively). Bivariate and trivariate table analyses showed that statistically significant associations between structural resources and use of dental health services disappeared when controlling for a third variable. Use of dental health services among children and adolescents in Norway was not systemically influenced by the same factors, as was the use of dental health services in the adult population. Thus, the Public Dental Health Service in Norway seems to have had the capability of compensating for most of the discriminating effects that individual and structural factors may have on the use of dental health services both before and after the reorganization of the public dental health service.