Chlamydia screening in young people as an outcome of a HEADSS; Home, Education, Activities, Drug and alcohol use, Sexuality and Suicide youth psychosocial assessment tool

A systematic scoping review of primary health care service outreach for homeless populations

BACKGROUND

Homeless populations (HPs) have difficulties obtaining necessary medical care, and primary health care service outreach (PHSO) might be useful to bridge this gap.

OBJECTIVE

Using the Centre for Evidence-Based Management Critically Appraised Topics framework, to provide systematic evidence of the usefulness of PHSO interventions for HPs.

METHODS

A systematic search was conducted in 4 electronic databases: PubMed, Web of Science, CINAHL, and Cochrane (publication dates between January 1980 and November 2020). In total, 2,872 articles were identified. Primary research about PHSO for HPs in high-income countries were included. Data were extracted from eligible studies, summarized, and collated into a narrative account.

RESULTS

Twenty-four studies that described and evaluated PHSO interventions for adults experiencing homelessness were selected in the final synthesis. Most studies had a nonrandomized design. PHSO was found to successfully address some barriers to health care access for HPs through flexible appointments in convenient locations, fostering an understanding relationship between doctor and patients, and provision of additional basic necessities and referrals. Outreach was provided for a range of health care concerns, and several solutions to engage more HPs in primary care, improve continuity of care and to decrease the running costs were identified. Outreach also helped to implement preventative measures and reduced emergency service admissions.

CONCLUSION

Our review adds to the evidence that PHSO likely improves health care access for HPs. Further studies over longer time periods, involving collaborations with experts with lived experience of homelessness, and utilizing randomized study designs are needed to test outreach efficacy.

Nurses on the Front Lines: Improving Adolescent Sexual and Reproductive Health Across Health Care Settings

: Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents' sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent sexual and reproductive health as both a health care and a human rights issue.

Opportunistic adolescent health assessment in the child protection unit

AIM

Adolescent health assessments are recommended to identify health-risk behaviours. Adolescents who experience maltreatment are more likely to engage in such behaviours. This study (i) describes the frequency of health-risk behaviours amongst adolescents attending a hospital-based child protection unit (CPU) and (ii) determines whether use of a health assessment questionnaire increases the identification of these behaviours.

METHODS

A retrospective audit was performed of case notes of adolescents (aged ≥ 12 years) presenting to the CPU over 5 years (2007-2011). Data regarding health-risk behaviours were extracted. In 2012, following the introduction of a standardised HEADSS-based four-page questionnaire, health-risk data were collected prospectively over 18 months. The proportion of subjects reporting health-risk behaviours, before and after questionnaire introduction, was analysed.

RESULTS

Two hundred fifty-eight subjects, median age 13 (range 12-18) years, 78% female, were included in the pre-questionnaire period; and 85 subjects, median age 14 (range 12-17) years, 86% female, were included following introduction of the questionnaire. Questionnaire use was associated with an increase in the frequency of health-risk behaviours identified in the following domains: Education (odds ratio 4.48 [confidence interval 2.56-7.96] P < 0.001), Activities (16.18 [6.70-42.74] P < 0.001), Drugs/alcohol (4.00 [2.23-7.16] P < 0.001) and Suicidality (8.27 [4.59-14.92] P < 0.001). Participants reported higher rates of health-risk behaviours than the national population.

CONCLUSION

Adolescents attending a hospital-based CPU report high rates of health-risk behaviours. A standardised questionnaire results in increased identification of such behaviours.