Contact: Peggy Malikowski, School of Nursing, 612-624-6696 or malik025@umn.edu
Laura Stroup, Academic Health Center, 612-624-5680 or stro0481@umn.edu
Report identifies need for greater coordination of care
and better training for providers
MINNEAPOLIS / ST. PAUL (Dec. 11, 2008) - University of Minnesota School of Nursing faculty participated in an Institute of Medicine (IOM) report released this week, calling for reform in delivery of health services to adolescents and expansion of training for health providers who work with adolescents.
"We are missing opportunities to respond to young people's critical issues that may have a long-lasting impact on their health and well-being far into adulthood," said Linda H. Bearinger, Ph.D., M.S., FAAN, School of Nursing professor and director of the Center for Adolescent Nursing. The report highlights five top recommendations that will improve adolescent health services. Serving as the only nurse on the 20-member IOM committee, Bearinger chaired the committee's group focused on preparing adolescent health providers and drafted the report's chapter on this topic, along with Carolyn Garcia, Ph.D., M.P.H., assistant professor in the School of Nursing.
"We hope that this IOM report draws attention to the need for urgent reform in service delivery models for adolescents and for resources to expand and enrich our educational programs that teach health and social service providers how to work effectively with teens," Bearinger said. "Nurses serve in integral roles with young people in clinic, school, and community settings. If we can better prepare them and other providers for working with adolescents, we will see improved quality of care and better coordination across services."
The committee's report was released at Tuesday's press conference at the National Academies' Keck Center in Washington, D.C., attended by IOM committee members, National Academies staff, representatives of national organizations, federal agencies, policy makers, and member of the press. To view the full report, visit the National Academies Press Web site at http://www.nap.edu.
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To read the National Academies' original release, including the full committee roster, visit http://national-academies.org.
WASHINGTON - (Dec. 9, 2008) -- Current health services for adolescents are fragmented and poorly designed to meet the health needs of all of the nation's adolescents, says a new report from the National Research Council and Institute of Medicine. Although most U.S. adolescents are healthy, many engage in risky behavior, develop unhealthy habits, and have physical and mental conditions that can jeopardize their immediate and future health. Health care providers need better training in how to meet the specific health needs of those aged 10 to 19, said the committee that wrote the report.
"Adolescents have unique health care needs, and our health system should not approach their care the same way it does children or adults," said committee chair Robert S. Lawrence, professor of environmental health sciences and health policy at the Johns Hopkins Bloomberg School of Public Health. "As policymakers discuss how to restructure the way health care is delivered in the U.S., the distinct problems faced by adolescents -- such as risky behavior -- deserve particular attention. And because adolescence is a critical period for developing habits that build a strong foundation for health throughout one's entire life, services need to focus on promoting healthy behaviors, preventing disease, and managing health conditions."
Some young people, particularly those who are uninsured or underinsured, have little or no access to mainstream primary care services; they rely largely on "safety-net" settings such as hospitals, community centers, and school-based health centers for their care, the report says. In fact, adolescents are in the age group most likely to rely on emergency departments for routine health care.
The various services and providers that are needed and used by adolescents are often fragmented, resulting in gaps in care, the report says. For example, specialty services in mental health, sexual health, oral health, and substance abuse treatment are not accessible to most adolescents.
Federal and state agencies, private foundations, and insurers should work together to develop a coordinated health care system that improves services for all adolescents, the report says. This system should foster coordination between primary and specialty care; it should also include opportunities for primary care services to reach adolescents through safety-net settings such as hospitals, community- and school-based health centers, and youth development programs. Also, a stronger focus is needed on meeting the needs of adolescents who may be especially vulnerable to risky behavior or poor health -- for example, those who are poor, recent immigrants, or in foster care.
Federal and state policymakers also should develop strategies to ensure that all adolescents have comprehensive, continuous health insurance coverage, the report says. Large numbers of adolescents - more than 5 million Americans ages 10 to 18 - are uninsured, and these young people use care less often and are less likely to have a regular source of primary care than young people who are insured. And uninsured adolescents who are eligible for public coverage often are not enrolled. Rates of uninsurance are higher among the poor and near poor, racial and ethnic minorities, and noncitizens, the report notes.
Health professionals frequently lack the skills to interact effectively with this age group, a problem that should be remedied, the report says. At all levels of professional education, providers from relevant disciplines that serve adolescents should receive detailed education about this age group's health problems and effective ways to treat disease and promote healthy behaviors. Regulatory bodies should incorporate competencies in adolescent care in their licensing, certification, and accreditation requirements. And public and private funders should provide financial support to expand and sustain interdisciplinary training programs in adolescent health.
The report recommends that as an overarching principle, adolescents should give their own consent before their health information is shared with others, even their parents. A balance is needed between maintaining confidentiality about care for which minors are allowed to give their consent and encouraging the involvement of parents and families whenever possible, respecting their importance in adolescents' lives and health care. Federal and state policymakers should maintain current laws and policies that enable adolescents to give their own consent for health services, and to receive services -- such as contraception, mental health care, and substance abuse treatment -- on a confidential basis when necessary to protect their health.
The report was sponsored by the Atlantic Philanthropies, an international foundation. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering.
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