Adolescent Health and Behavior: Best Practice Strategies for an Underserved Population
Jonathan Ellen, MD,* and Julia McMillan, MD†
Considered neither adult nor child, the adolescent experiences abundant biologic and psychosocial changes. Growth in the area of healthcare provision to patients in this unique stage of life has lead to the development of the adolescent medicine subspecialty. Preventive medicine and confidentiality are 2 primary cornerstones at the heart of successful healthcare for adolescents. Because adolescents undergo dramatic developmental changes at various stages, their healthcare needs are complex and dynamic. Not only is each adolescent undergoing dramatic change, but the adolescent population as a whole has also changed over the past 15 years—in size and in racial and ethnic composition. In addition, the school environment has changed, with a decrease in the total number of schools, growth in the number of middle schools, and an increase in the size of schools. The purpose of this issue of Advanced Studies in Medicine is to review some of the challenges providers might encounter when caring for this distinct group of patients.
More than 4 decades ago, the Society for Adolescent Medicine was founded. Since that time, public and professional awareness about the importance of the physical and psychosocial health of adolescents has grown. As described in the first section of this issue, adolescents encounter many problems in accessing healthcare, including lack of health insurance, service-site location problems, scheduling difficulties, concerns over confidentiality, unavailability of experienced providers, and unavailability of providers who are sensitive to cultural, ethnic, and social diversity in the adolescent population. Current clinical guidelines support an annual, confidential, preventive services healthcare visit for adolescents; however, many adolescents are not receiving appropriate screening and education at these yearly interactions. A review of several factors to be considered in providing quality healthcare services for this population is provided.
Dr Jonathan Ellen provides an overview of the challenges to providing care to adolescents. He discusses how unique cognitive, biologic, and social developmental features of adolescence shape how care should be delivered, including the need for confidential services and well-trained providers.
Adolescents are prone to engage in a variety of risky behaviors as they struggle to feel autonomous and separate from their families. Unfortunately, these risky behaviors are not without consequence and are consistently associated with morbidity and mortality. In this issue, Dr Daryl Lynch provides an overview of some risky behaviors commonly associated with adolescents. Screening and preventive services that focus on these risky behaviors are clinically and socially important, as adolescents carry forward many dangerous habits into adulthood. Dr Lynch describes intervention techniques for the healthcare provider caring for adolescents.
Although major advances in the development and application of vaccination have resulted in the prevention and reduction of a number of infectious diseases, immunization efforts have generally focused on the preadolescent patient. The consequent elimination and reduction of many preventable infectious diseases, the changing epidemiology of many pediatric illnesses, and the introduction of new vaccines have shifted the focus of vaccination strategies to the adolescent population. Dr Lawrence J. D'Angelo reviews which vaccinations to administer by the onset of and during adolescence.
To be most effective, healthcare services directed toward the adolescent patient should provide for the biologic, psychologic, and sociologic needs of the patient and must be modified for the individual patient's developmental status. Adolescents receive healthcare advice from a variety of avenues, including school and the Internet. Dr Charles J. Wibbelsman reviews concepts essential for the ideal adolescent-medicine healthcare visit. Of utmost importance for the adolescent healthcare visit is confidentiality. The protections and limits of confidentiality must be explained to the adolescent in language modeled to meet his or her specific developmental needs. Advantages that the managed care environment offers for adolescents are reviewed, including prepaid healthcare in a quality, confidential, comprehensive clinic. Two adolescent patient cases in a group model health maintenance organization are presented, with an emphasis on confidentiality issues.
In adolescent medicine, the provision of effective screening and education has important health and social implications. As the general population continues to age, much of today's healthcare resources have shifted to the elderly. Providers of adolescent healthcare, however, must remain steadfast in their dedication to this important group of patients struggling to become healthy adults.
*Associate Professor of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
†Professor of Pediatrics, Vice Chair for Education and Residency Program Director, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. E-mail: firstname.lastname@example.org.