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Accessibility of adolescent health services.

Adolescents represent a large proportion of the population. As they mature and become sexually active, they face more serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility and multiple barriers to accessing health care. A typical descriptive and explanatory design was used to determine what the characteristics of an accessible adolescent health service should be. Important results and conclusions that were reached indicate that the adolescent want a medical doctor and a registered nurse to be part of the health team treating them and they want to be served in the language of their choice. Family planning, treatment of sexually transmitted diseases and psychiatric services for the prevention of suicide are services that should be included in an adolescent accessible health service. The provision of health education concerning sexual transmitted diseases and AIDS is a necessity. The service should be available thought out the week (included Saturdays) and within easy reach. It is recommended that minor changes in existing services be made, that will contribute towards making a health delivery service an adolescent accessible service. An adolescent accessible health service can in turn make a real contribution to the community's efforts to improve the health of its adolescents and can prove to be a rewarding professional experience to the health worker.

Adolescent↗

Disability in late adolescence. III: Utilization of health services.

Adolescent health service usage is a neglected research area. Data are important for planning of services and for prioritizing needs. A sample of 871 18-year-olds was surveyed about its use of health services in the preceding year. A significant proportion had made a consultation and were mostly satisfied with the service received. For a subsample of that cohort, who had a difficulty in their daily living, only a third had consulted a health professional for that difficulty over the past year. Help-seeking was related to the severity of that difficulty, particularly for the limitations that it imposed on everyday life. Some dissatisfactions with consultations were expressed in relation to expectations of the efficacy of treatment and to the communication of the health professionals.

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Adolescent health services in North Carolina's local health departments.

The purpose of this study was to assess availability of clinical health services and special adolescent health programs for those aged 10-19 years administered by local health departments in North Carolina, and to evaluate factors that were associated with the existence of specialized adolescent programs, comprehensive services, and school services. We used self-report surveys mailed to 100 county health directors. All counties responded. One in five (21%) North Carolina youth received one or more health department service in 1990. Thirty-four health departments have programs or services specifically designed for adolescents; 7 health departments provide comprehensive services. The majority of health departments (85%) provide services in public schools, most often health education or counseling. Counties with more adolescents and with higher per capita income were more likely to have adolescent programs and more likely to provide comprehensive clinics. Health departments with school services served proportionally twice as many of their county's adolescents as those without school services. We concluded that few local health departments in North Carolina provide comprehensive health services to their youth. Community-wide participation and state support are needed to improve public sector access to comprehensive health care for adolescents in North Carolina and in other states with decentralized, county-controlled public health systems.

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Sex, studies or strife? What to integrate in adolescent health services.

If health services for adolescents are to be successfully integrated into the existing health care system, they will need to reach out to meet the needs that adolescents themselves perceive as salient. This paper describes a study aiming to elicit the needs of adolescents in higher secondary schools in Goa, India, in 1999-2000. The objective was to generate information which could guide the development of adolescent-friendly health services by integrating the health needs identified by adolescents themselves. The study began with free-listing, followed by focus group discussions and in-depth interviews to elicit areas of concern. Then, a survey of 811 students with a self-report questionnaire was carried out. The findings demonstrate that there is clearly an unmet need for information about sexual and reproductive health, but also a large, unmet need for psychosocial support for health issues ranging from violence in schools to poor relationships with parents, stress-related health complaints and educational difficulties, which are often perceived by adolescents to be of primary importance. Integrating these issues into programmes is likely to be an essential element in developing health services and programmes which can reach out to the majority of adolescents in school settings in India.

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Long-term consequences of adolescent health behaviors: implications for adolescent health services.

The authors discuss the evidence supporting the effectiveness of adolescent preventive services to influence health outcomes, the magnitude of the long-term consequences of adolescent health-compromising behaviors, and their implications for health policies. Particular attention is given to the contribution that behaviors participated in or begun during adolescence have on long-term health, including cancer and heart disease. They postulate the health benefits that might accrue from the widespread implementation of comprehensive adolescent preventive services, assuming a conservative estimate of effectiveness, could be significant.

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Adolescent health services--through their eyes.

A descriptive survey regarding adolescents' knowledge and use of local health related services and service providers was undertaken using a two stage probability sample. Two hundred and fifty three adolescents aged 14 and 15 years, attending eight of the 16 mainstream secondary schools in Stoke-on-Trent, England, were randomly selected. They were interviewed confidentially, using a semistructured questionnaire. They had used various service providers; knowledge of some local health services was poor. The preferred service provider varied with the nature of the problem. Adolescents had clear views regarding the nature of services they would like to see provided. Factors the adolescents associated with confidentiality were identified. Adolescents need information about local services. Issues they associate with lack of confidentiality should be addressed. Their preferences for care must be taken into account in developing future services.

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Using a health concerns checklist as a bridge from reason for encounter to diagnosis of girls attending an adolescent health service.

OBJECTIVE: We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap between the reason for encounter (RFE) described by girls entering an adolescent health service and the ultimate diagnosis. METHODS: The sample, 547 consecutive 12- to 18-year-old girls visiting an adolescent health service, first underwent a structured intake procedure, including a self-administered form on which they described their RFEs and other health concerns, as well as a psychosocial interview and medical evaluation performed by staff members. The RFEs, HCC items, and diagnoses, grouped into somatic, sexuality-related, and psychosocial categories, were then compared. RESULTS: Among the 399 girls expressing specific RFEs on entering the clinic, one-third were diagnosed with psychosocial disorders and one-fifth with sexuality-related concerns. Of the patients receiving a sexuality-related diagnosis, 57% presented with a sexuality-related request; another 26% noted it on the checklist. For those diagnosed with psychosocial problems, 22% stated this as the RFE, and another 50% indicated it on the HCC. The contribution of the HCC to the diagnosis was higher among adolescents not stating a specific RFE. CONCLUSION: The findings highlight the HCC's contribution in identifying health problems, especially among adolescents who find it difficult to verbalize sensitive issues.

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Community-based adolescent health services in Israel: from theory to practice.

Despite their engagement in health-risk behaviors and their health-related concerns, adolescents have the lowest rate of health service utilization of any age group. Time constraints during routine medical encounters generally leave little opportunity for professional screening for health-risk behaviors or for discussing psychosocial problems. In addition, providers express low levels of perceived competency in areas such as sexuality, eating disorders or drug abuse. To address these needs, a walk-in Adolescent Health Service was established by the Sheba Medical Center to provide diagnosis and short-term treatment for individual adolescents, as well as counseling and support for local care providers. A three-way model of cooperation and partnership was developed and implemented. A professional and financial partnership with local authorities were established to help define the particular needs of the community's youth and to improve the ability to reach youth with special health needs. The partnership along with the main medical provider (Kupat Holim Clalit) helped define local health needs, served as a referral source of patients with unmet health needs, and improved the continuity of care. The regional medical center (Sheba Medical Center) provided supervision and consultation for the medical staff of the service, as well as a referral center for patients. It was emphasized that the service staff was intended as a professional source for the primary physician and should not be considered a rival. The core staff included a specialist in adolescent medicine, gynecologist, mental health specialist and social worker. A structured intake procedure was developed for assessing health concerns and problems of adolescents in the context of a community clinic. Findings from the first years of services showed that the first 547 female adolescents demonstrated that a majority of adolescents presented with primary complaints of a somatic nature, while one third were diagnosed with psychosocial problems and one-fifth with a sexuality-related problem. A considerable percentage of those diagnosed with psychosocial or sexuality-related problems had not stated these issues as their "reason for encounter". This additional increment probably represents the contribution of the Health Concern Checklist (HCC), in which the adolescent was asked to mark each item for which she had concerns or would like to receive further information. The HCC can help primary care physicians as well as adolescent medical specialists approach the teenage patient and initiate productive communication. A practical approach to confidential health care for adolescents: The issue of confidentiality has not been sufficiently clarified by Israeli law or by the medical community. The need for confidentiality was strongly felt in the adolescent health service. A policy which provides all adolescents with the opportunity to meet with a physician and receive health guidance or advice at least once, even without parental knowledge or consent, was formulated and implemented. If parental consent was not feasible, the minor was allowed to give informed consent for medical and psychosocial care for himself/herself, with certain limitations.

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[Communal health promotion in child and adolescent health services -- report on the experience with a organisational model for setting up an interdisciplinary network in a socially important area].

This report focusses on health promotion for children adolescents und families and on the aspects of organisation and resources. In 1991 the Public Youth Health Care (KJGD), a community health service for children und adolescents, set up a multi-professional "district committee" of distributors in leading positions in a socially important area (social workers, school teachers, kindergarten teachers, councillors, medical personnel, architects and town planners etc.). Medical examinations of all school beginners and children with special educational needs formed the basis of the social paediatric observations and data. Until 2003 the author was responsible for the management and coordination of this local interdisciplinary district committee of leading representatives from local social and educational organisations as well as town councillors who created a local multi-professional network. The district health reports of the discussions in the district committee including the different professional aspects of health promotion were passed on to the local politician actively involved in the discussions with specialists and invested in social and health promotion projects. Social paediatric issues and preventative strategies became part of the work in social and educational organisations in the area und the city. A healthy environment for children und families was promoted. For the KJGD the conceptual work with distributors in leading positions led to initiatives for communal health promotion making time-saving use of existing resources.

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Youth perceptions of comprehensive adolescent health services through the Boston HAPPENS program.

INTRODUCTION: The Boston HAPPENS (HIV Adolescent Provider and Peer Education Network for Services) program is a collaborative network of care made up of 8 organizations that serve youth and provide coordinated care for human immunodeficiency virus (HIV)-positive, homeless, and at-risk youth aged 12 to 24 years. Learning youth perceptions about the program is essential to determine if the program is meeting their needs. METHODS: In this qualitative evaluation, 18 youth served by the network met in 4 focus groups to provide their view of the program. Services within 5 categories were assessed: (a) medical care, (b) mental health and substance abuse care, (c) HIV prevention and care, (d) case management, and (e) allocation of finances. RESULTS: Boston HAPPENS has achieved name recognition and provides many needed services for youth from a wide variety of backgrounds. The youth were comfortable receiving care and were appreciative of the comprehensive services available. They provided suggestions for how mental health services could be offered as one-on-one counseling as part of "wellness care." Young participants also requested more recreational and support opportunities for young people living with HIV. DISCUSSION: Qualitative evaluations such as this give a voice to youth to advocate for services they need. By including youth ideas and perspectives during program development and implementation, services can be more attractive to groups of at-risk youth who historically have been less likely to seek care.

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