Adolescent health in 2012: The view from Primary Care

1. Adolescent health in 2012: The view from Primary Care Dr Jane H Roberts Clinical Senior Lecturer and GP, Chair RCGP Adolescent Health Group

2. Background • Historically the data set is patchy • RCGP AHG welcomes the beacons of light shone by the Key Data • ‘Virtually no studies carried out since 2000’; ‘a scandal’ (Coleman,2011) • Early work: Jacobson et al (1994): consultations shorter by approx 2m-used by GPs as ‘catch up’ time as YP not demanding • Followed by studies looking at how YP and GPs view each other (Churchill et al, 2000 Jacobson et al, 2001) • Landmark paper ‘Tackling Teenage Turmoil’ (2002 ) • Specifically looking at consultations involving MH concerns: Martinez et al (2006)-’the elephant in the room’ • Biddle et al (2006): GPs perceived as unskilled in MH, focused on ‘the physical’, keen to prescribe

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6. Exploring unease in the consultation • Embarrassment • Concerns about confidentiality • The Triadic consult (75% accompanied by parent/s; Martinez et al, 2006) • Feeling hurried-insufficient time • Worries and fears not a legitimate problem for PC • GPs not interested or knowledgeable in YP • Previous negative experiences of consulting

7. Adolescence , agency and primary care • An absence of qualitative research to explore GPs’ perspectives on consulting with YP • a dominant popular narrative that YP have agency in their own lives and can affect change • Barnardo’s study Nov 2011 49% polled: “YP are ‘violent, angry, abusive’ “ No consideration of YP’s own experiences or ‘why’ Such narratives influence PHC workers

9. Confidentiality • Ethical considerations in a legal framework • Relationship based care • Dynamic • Safeguarding vs promoting engagement • GPs lack confidence: YP want a lead Toolkit available from Oct 2011. DH funded. Available on RCGP website:CIRC

10. Policy Implications • Knowledge from Teen Demonstration Sites 2006-08 YP at the centre, MDT working, leadership, planning and regular review. Plurality: Targeted & Universal services Creativity to reach the most marginalized: inverse care law remains with us • ‘You're welcome’ built on this knowledge : quality criteria to make PC youth –friendly • Required a commitment, training ,resources. • Funding ended May 2011. Remain as a self check list

11. Real life illustrations • Main stream services made more accessible or ‘specialist services’? • Birthday checks? [ Chris Donovan, 1990s]-variable uptake • Teen drop-in clinics-often Nurse led. Usually highly motivated, mixed response from clinical teams [RCT Walker et al, BMJ, 2002: 1516 14-15 yr olds; ‘change in behaviour slight but encouraging’, 97% would recommend to friend; ‘cheap’] Develop from word of mouth. Marketing expensive, time consuming. Over lap with school nurses role. PCT training provided-youth workers. Communication skills.

12. Case examples:Washington NE • Group practice wanting to improve services for YP • Ran focus groups summer 2011 YP wanted better access to mainstream services, not ‘youth clinic’ Unsure of what was available/what PCC could cover Role of PSHE in school?

13. Case Example: South London • The Well Centre, Streatham • Rate of attendance of 12-19 yrs old half of 0-14 • 1 in 5 obese; 1 in 10 MHP • Clinicians from Herne Hill, Redthread (youth work), • Regional Innovation Fund • Attached to a local youth centre, drop-in • Formal evaluation

14. Health inequalities, primary care and young people • GPs see YP in the context of their wider life, families + local communities • Greater knowledge of the social determinants of ill-health • See disadvantaged YP fall pregnant at young ages and the effects of generational inequalities • Poverty is the greatest contributor to poor health • If we are serious about improving the health of YP then we need to address disadvantage at a structural level

15. Concluding thoughts • We have to do better regarding promoting youth friendly primary care • YP are the only group who have not seen significant health improvements in last 20 yrs (Viner & Barker, 2005) Needs a multi-layered approach: Education and training for practitioners, Structural barriers-organization; payment, Research –under resourced & under -prioritized Commitment at Government level Need to be more creative: working with schools, youth services

16. References http://www.ayph.org.uk/publications/53_BriefingPaper2. Biddle, L et al. (2006). Young adults' perceptions of GPs as a help source for mental distress: a qualitative study. Br J Gen Pract, 56(533), 924-931. Churchill RD, et al(2000).Do the attitudes and beliefs of young teengers towards general practice influence actual consultation behaviour? The British Journal of General Practice 50,953-57 Jacobson L, et al (1994) Is the Potential of Teenage Consultations Being Missed? : A study of consultation times in primary care.  Family Practice ; 11: 296-299. Jacobson L, et al (2002). Tackling teenage turmoil: primary care recognition and management of mental health during adolescence. Family Practice 19,No.4 401-409. Martinez, R et al. (2006). Factors that influence the detection of psychological problems in adolescents attending general practices. Br J Gen Pract, 56(529), 594-599.

17. Thank you, any questions?