ADOLESCENT HEALTH SERVICES:

Missing Opportunities

Advancing Adolescent and Young Adult Health

May 14, 2009

Workforce Preparation to Improve Adolescent Health

Linda H. Bearinger, PhD, MS, FAAN

ADOLESCENT HEALTH SERVICES:

Missing Opportunities

Workforce charge to the IOM Committee:

What kinds of training programs for health care providers are necessary to improve the quality of health care for

adolescents?Linda H. Bearinger, PhD, MS, FAAN

Thomas G. Dewitt, University of Cincinnati Julia Graham Lear, George Washington University

Movement toward assuring adolescent-focused practice

1957 J. Roswell Gallagher first articulates the need for specialists in pediatrics – adolescent medicine

1977 First federal call for interdisciplinary adolescent health training proposals – MCHB/HRSA/DHHS

1978 AAP task force recommends pediatrics as the lead specialty for improving adolescent health services

1986 American Academy of Pediatric Dentistry adopts adolescent-specific guidelines for practice

1986 Health Futures of Youth articulates core curricular components for adolescent health training across all health disciplines

1994 First certification exam in adolescent medicine in pediatrics, followed by first accreditation of fellowship programs in medicine

2000 American Nurses Association approves first position statement on adolescent health

Other providers involved in health care for adolescents?

Chiropractors

Counselors

Dental hygienists

EMTs

Health educators

Laboratory technicians

Occupational therapists

Optometrists

Pharmacists

Physician assistants

Physical therapists

Receptionists

Social service assistants

Speech therapists

Three levels of providers

1)Generalists: those serving populations that include adolescents

2)Specialists: those specializing in health services for adolescents

3)Educators and/or scholars: those with recognized expertise who have capacity to educate the workforce and conduct research contributing to the science of adolescent health and health services

What matters: Cross-cutting competencies to guide curricula

Health within context

Unique health needs

Developmental changes

Families as partners

Participation of adolescents in care, confidentially

Linked with community health and social services

Interplay between financing systems and policy

Assessing workforce competence:

Finding the gaps

Self-reported competencies

Chart reviews

Exit interviews with adolescent patients

Observations of patient encounters

Indicators of inadequacies

Surveys of providers, by discipline or by health concern show similar gaps: “self-perceptions of being ill-equipped to address even some of the most common health problems of adolescence”

Example: 25% of nurses who work with adolescents indicated low levels

of knowledge/skills in 14 of 28 common health concerns:- including depression, eating disorders, and violence

The more vulnerable the group – foster care, homeless, GLBTQ – the poorer the self-reported skills

Conclusions: Adequacy of the workforce

1. Health care providers lack necessary skills.

Conclusions: Adequacy of the workforce

1. Health care providers lack necessary skills.

2. Existing adolescent health care training across disciplines often fails to address key health needs of young people.

Regulatory bodies assuring adolescent health competencies

Individual level: Licensing, board certification

Institutional level: Accreditation of entry-level, professional, graduate, and residency/internship programs

Regulatory bodies assuring adolescent health competencies

Individual level:

Licensing, board certification

Institutional level: Accreditation of entry-level, professional, graduate, and residency/internship programs

Finding: Beyond medicine and psychology, regulatory bodies lack requirements for adolescent-health focused curricular content, knowledge, and skills.

Conclusions: Adequacy of the workforce

1. Health care providers lack necessary skills.

2. Existing adolescent health care training across disciplines fails to address many of the health needs.

3. Inconsistency or lack of an adolescent focus in the criteria of regulatory bodies

Conclusions: Adequacy of the workforce

1. Health care providers lack necessary skills.

2. Existing adolescent health care training across disciplines fails to address many of the health needs.

3. Regulatory bodies are inconsistent or lack criteria for content and knowledge/skills in adolescent health.

4. Insufficient number of adolescent health training programs translates into inadequate workforce.

Current training modalities Discipline-specific programs and certification for specialists and educators/scholars

Single-disciplinary outnumber interdisciplinary

Master’s and doctoral programs (nursing, nutrition, social work, psychology)

Post-residency fellowships in medicine

Continuing education programs – maintenance of licensure or certification

–may or may not be adolescent-focused

–may be single-discipline or interdisciplinary

Current training modalitiesInterdisciplinary adolescent health programs

MCHB-funded Leadership Education in Adolescent Health (LEAH)

Focus on leadership for clinical care, public health practice, research, and advocacy

Preparing specialists and educators/scholars

5 disciplines – medicine, nursing, nutrition, psychology, social work

7 LEAHs in the US; $2.6 million; nearly level funding for 30 years

The only federal funding mechanism targeted for interdisciplinary adolescent health training

Current training modalitiesNovel approaches for training

Intensive interdisciplinary learning institutes

On-line continuing education and academic credit courses

Train-the-trainer curricula with on-line access (EuTEACH)

National Adolescent Health Information Center (NAHIC at UCSF)

Partners in Program Planning for Adolescent Health (PIPPAH)

Together, have improved accessibility of training options, articulated curricular content,and expanded access to resources for trainers/educators

Insufficient numbers of training programs to assure adequate workforce

To note: only medicine requires board certification for those specializing in adolescent health

1 adolescent medicine physician per 105,000 adolescents in the US

AAP’s recommendation: 1/6,000 7 states without any certified adolescent medicine

physician

Recommendations for Improving Workforce Capacity

To insure that an adequate number of providers are equipped to work with adolescents:

Regulatory bodies should incorporate a minimal set of adolescent health competencies for licensure, certification, and accreditation requirements.

Public and private funders should provide targeted financial support to expand and sustain interdisciplinary training programs in adolescent health – with priority on preparing specialists and educators/scholars.