ADOLESCENT HEALTH SERVICES: Missing Opportunities

1. ADOLESCENT HEALTH SERVICES: Missing Opportunities Grantmakers in Health June 19, 2009 Linda Bearinger, PhD University of Minnesota Shay Bilchik, JD Georgetown University

2. The National Academies • Founded in 1863, congressional charter signed by Abraham Lincoln. • Nongovernmental, nonprofit scientific organization located in Washington, DC. • Four organizations comprise the Academies: the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council. • Membership includes elected experts from the physical, biological, social, and health sciences. • Operates through a set of major units to develop committee studies in response to requests from Congress, federal agencies, private foundations, and others.

3. Committee on Adolescent Health Care Services & Models of Care for Treatment, Prevention & Healthy Development Study Charge “To study adolescent health services in U.S. and develop policy & research recommendations that would highlight critical health needs, promising service models, & components of care that could strengthen & improve health services for adolescents and contribute to healthy development.”

4. Committee Membership Robert S. Lawrence (Chair), The Johns Hopkins University Linda H. Bearinger, University of Minnesota Shay Bilchik, Georgetown University Sarah S. Brown, National Campaign to Prevent Teen and Unplanned Pregnancy Laurie Chassin, Arizona State University, Tempe Nancy Dubler, Yeshiva University Burton L. Edelstein, Columbia University Harriette Fox, Incenter Strategies Charles E. Irwin, Jr., University of California, San Francisco Kelly Kelleher, The Ohio State University

5. Committee Membership, continued Genevieve Kenney, Urban Institute Julia Graham Lear, George Washington University Eduardo Ochoa, Jr., University of Arkansas for Medical Sciences Frederick P. Rivara, University of Washington, Seattle Vinod K. Sahney, Blue Cross Blue Shield of Massachusetts Mark A. Schuster, Harvard University Lonnie Sherrod, Society for Research in Child Development Matthew Stagner, Chapin Hall Center for Children Leslie R. Walker, University of Washington, Seattle Children’s Hospital Thomas G. Dewitt, University of Cincinnati

6. What we plan to cover… • Overview of the current health status of adolescents. • Review of current available health services for adolescents. • Conclusions about the gaps between need and available services. • Recommendations for improving the health services system for adolescents.

7. Guiding Principles: What Matters? • Development • Timing • Context • Need • Participation • Family • Place • Skill • Insurance • Policy

8. Setting the Stage • Adolescents aged 10-19 made up 14% of the total U.S. population in 2006. • The racial/ethnic makeup of the U.S. adolescent population is becoming more diverse. • The correlations among minority racial/ethnic status, poverty and lack of access to quality health services for adolescents is strong. Disparities may increase without specific actions and attention to reduce them.

9. Adolescent Health Status • Most adolescents are considered healthy as defined by traditional medical measures. • Adolescence is a period of both risk and opportunity.

10. Ten leading causes of death in adolescents aged 10–19 Unintentional Injury 47.4% Homicide 12.1% Suicide 11.2% Malignant neoplasms Heart disease Congenital abnormalities Chronic lower respiratory disease Influenza and pneumonia Cerebrovascular Benign neoplasms 6.9% 3.0% 2.5% 0.9% 0.7% 0.6% 0.5% Others 14.1%

11. Adolescent Health Status • Some specific populations of adolescents defined by selected demographic characteristics and other circumstances have higher rates of chronic health problems and engage in more risky behavior relative to the overall adolescent population. • Committee focused on foster care, homeless, recent immigrants, LGBT, incarcerated, racial/ethnic minorities, low-income.

12. Adolescent Health Services, Settings, & Providers • Assessing the quality of services: accessibility, acceptability, appropriateness, effectiveness, & equity. • Evidence shows that while primary care services are available to most adolescents, services are separate, fragmented, poorly coordinated, and delivered in multiple settings.

13. The Workforce • The current professional adolescent health care workforce is multidisciplinary. • Existing adolescent health care training across disciplines does not address many of the health needs. • Current health care training programs insufficient in number to prepare postgraduate health care professionals for roles in the academic/research sector. • The licensing, certification, and accreditation of programs for health providers are minimal, inconsistent, and insufficient in their inclusion of adolescent health content.

14. Health Insurance Coverage • More than 5 million adolescents ages 10-19 are medically uninsured. • Uninsured rates are higher among poor and near poor, racial/ethnic minorities, & non-citizens. • Uninsured adolescents are less likely to have a regular source of primary care and use medical & dental care less often compared to those with insurance. • The majority of uninsured adolescents ages 10-18 are eligible for public coverage but not yet enrolled.

15. Conclusions • Most adolescents are thriving, but… • Models of health services - not one model • Health services are highly fragmented, poorly coordinated, & delivered in public/private settings

16. Conclusions • Health services are not organized or equipped to focus on disease prevention, health promotion or behavioral health. • Health care providers lack the skills. • Large numbers are uninsured or underinsured.

17. Findings, Recommendations, Next Steps • Primary Care • Develop & implement evidence-based health services & systems that increase quality of primary care services for all adolescents. • Emphasize the health and health services of those vulnerable to risky behavior & poor health. Routine Services • Incorporate health promotion, disease prevention, and behavioral into routine health services.

18. Findings, Recommendations, Next Steps The Community • Health care providers, health organizations, and community agencies should develop coordinated, linked, and interdisciplinary services in practice and community settings. Consent and Confidentiality • Maintain current laws, policies, and ethnical guidelines for adolescents to consent for their care and to receive services confidentially.

19. Findings, Recommendations, Next Steps • Providers • Enhance the capacity of health care providers to provide high quality care. • Provide financial support to expand and sustain interdisciplinary training programs in adolescent health. • Insurance • Develop strategies to ensure that all adolescents have comprehensive, continuous health insurance coverage.

20. Accompanying Video • Features three personal stories of adolescents and their experience with health services. • Highlights messages from the report around the unique needs of adolescents in the health care system. • Available for viewing at www.bocyf.org/ahc.htmlor on Google Video athttp://video.google.com/videoplay?docid=-5939446517701113787

21. To read about project, view the full report, accompanying video, or the workshop report: http://www.bocyf.org/ahc.html Full Report (2009) Workshop Report (2007) DVD (2008)

22. Special thanks to… The Atlantic Philanthropies for supporting the work of this committee.