6.1 Health services for adolescents: mind the gap!

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Do curso por The University of Melbourne

Global Adolescent Health

47 classificações

The University of Melbourne

Global Adolescent Health

47 classificações

This course will explore the dynamic factors affecting the health and wellbeing of young people around the world, and how important it is for individuals, communities and nations that we improve the health and life chances of this important population group. With over 25% of the world’s population aged between 10 and 24 years, today’s generation of young people is the largest in human history. As the future leaders and drivers of growth, productivity and innovation, young people are our greatest assets, and investment in their health and wellbeing has social, economic and other benefits that continue across the lifespan and into the next generation. In this course we will adopt a life-course framework to take a holistic view of youth health and wellbeing. We will explore changing patterns of adolescent health and development, including why adolescence is starting earlier and ending later; how puberty and adolescent brain development may shape future health; and how what happens in adolescence can affect the start to life for the next generation. We’ll also look at the major health and social issues affecting young people and ways of addressing these through policy, practice and programming. COURSE FORMAT: This course comprises short video lectures and interviews, required and recommended readings, online discussion, quizzes and written assignments. There is no required text for this course and all readings are provided. DO I HAVE TO PAY FOR THIS COURSE? No- you may access 100% of material in this course for free. You are also welcome to do as much or as little of the course as you like, including all (or none!) of the assessment tasks- it all depends on your learning goals. The option to pay for this course is there for those who wish to receive a Course Certificate as evidence of completion (which does require you to attempt and successfully pass the assessment tasks). WHO IS THIS COURSE FOR? This course will be relevant for anyone with an interest in the health and wellbeing of young people. You do not need to be of any particular personal or professional background to benefit from this course, but having some basic undergraduate study experience will be helpful to your learning (particularly if in a health related field). WHAT IS THE MOST INTERESTING THING I'LL LEARN IF I TAKE THIS COURSE? You’ll learn how so much of what happens during adolescence can impact not only the future health of individuals, but the health of the next generation as well. You’ll develop a greater understanding of the key factors impacting upon youth health and learn how to be a better advocate for the health and wellbeing of young people.

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Week 6 - Adolescent health policy, programming and intervention (Part II)

This week we continue our exploration of the policy and practice context of adolescent health and development by focusing on the role of health services in responding to the burden of disease experienced by young people. We discuss the elements of quality healthcare for young people and what adolescent-friendly health care means at an individual practitioner and service level. We also highlight the challenge of monitoring and communicating the health status of adolescents at a national and global level, why nations need to be held to account for investing in appropriate actions that promote the health of their young people, and how to promote positive and meaningful youth participation. <br> <br>As this marks the final week of learning material for this course (Weeks 7 and 8 are devoted to the completion and evaluation of Assignment 2 for those interested), we also discuss learning and networking opportunities beyond GAH for those of you who would like to continue this journey.

6.1 Health services for adolescents: mind the gap!11:16

6.2 Health services: setting expectations8:30

6.3 Health services: clinical attitudes, knowledge and skills14:31

6.4 Making health services adolescent friendly10:54

6.5 Health services: platforms for healthcare delivery11:41

6.6 Bringing it all together: an accountability framework5:33

6.7 Bringing it all together: the role of young people6:28

6.8 Learning beyond GAH4:19

Interview with Prof Harish Pemde (India) 28:21

Interview with A/Prof Fadia AlBuhairan (Saudi Arabia) 16:41

Interview with Kikelomo Taiwo (USA/Nigeria) 16:37

Interview with Dakshita Wickremarathne (Sri Lanka) 19:44

Conheça os instrutores

Professor Susan Sawyer
Chair of Adolescent Health
Department of Paediatrics
Professor George Patton
Professorial Fellow
Adolescent Health Research

In the last few lectures, we've talked about the broader ways in which family,

peers, and community can support young people's healthy development.

We've considered how laws, taxation, marketing, and social media shape healthy

and unhealthy ideas about what it is to be young, healthy, happy, and successful.

Outmoded notions of adolescence as the healthiest stage of life have also

inadvertently been associated with beliefs about health services.

If young people are healthy, we don't need to think about health services for

them, do we?

But, having outlined the range of health issues experienced by young people

across the globe, I hope it's pretty clear that young people, just like infants,

adults, and older folk, also benefit from health services.

The increasing global attention now being given to universal health coverage

has strong resonance with adolescents,

whose health needs have arguably been most neglected by health services.

The next few lectures will focus on health services, and

the role they can play in responding to young people's comprehensive health needs,

rather than their role to simply respond to what young people present with.

One important consideration about health services is quality.

What comes to mind when you think about quality health services for adolescents?

Clearly, one aspect is that health services need to understand the burden of

disease experienced by young people in order to be able to respond.

Health services also need to appreciate what adolescents seek help for,

and what they don't seek help for.

And understand the barriers that prevent adolescents from seeking health

care more widely.

Understanding provider attitudes, knowledge, and

skills is also a critical consideration in planning quality healthcare services for

the young, in order that teaching and training can help obviate these.

The most common reasons that adolescents present to primary healthcare are for

acute healthcare needs, such as accidents and injuries, infections, including

upper respiratory tract infections, coughs and colds, and skin conditions.

So, how does this sit with our knowledge of the burden of disease that

young people experience, that I've attempted to describe in this schema here?

Clearly, there is a gap.

Young people less commonly seek health services for

the conditions that have the greatest impact on their burden of disease,

both now, as well as in the future.

One example of this is mental disorders.

This figure depicts the burden of mental disorder in Australia

by age as measured by DALYs.

We can appreciate that if health services do not have a strong understanding of

adolescence as the time of the greatest upswing in the incidence of mental

disorder, they will be less able to deliver quality healthcare to the young.

Why?

Because the majority of young people with mental disorders

do not present to health services with explicit mental health conditions.

These conditions will commonly remain hidden, unless clinicians have

the skills to identify them when young people present with other health concerns.

So what issues do adolescents experience?

And what do they seek help for?

In this study in India, the author surveyed a group of

high school students who had a mean age of about 15 and a half years.

Two-thirds of both boys and girls reported their health to be good or very good.

But still, 81% reported having had a health problem in the previous months

that the authors categorized into the following five groups, as outlined here.

The leading psychological problems reported by young people were tensions

about future careers, concerns about physical appearance,

difficulty concentrating, and masturbation.

The most common behavioral problems were the inability to express feelings,

feeling hypersensitive, feeling lonely, misunderstanding parents, and

lack of confidence.

Now, I find it hard to differentiate the content of what these authors have

placed within the psychological from the behavioral category.

The issues in the top box, to me,

feel very similar to the issues in the bottom box.

Were we to combine these two categories, we can see that two-thirds of respondents

had concerns around what are broadly called a psychosocial domain.

When we then look at what constitutes medical and

general health concerns, we are faced with a similar challenge.

I would also tend to combine these two categories.

And, again, if we do that, then around a third of young people

also had health issues within the physical health domain.

So, did these young Indian students seek help for their problems?

And if so, from whom did they seek help?

We can see that boys were most likely to seek help from their friends and

their families.

While girls were most likely to seek help from their mothers, friends, and

also female family members.

We don't know how well these sources of help addressed the problem.

Hopefully they did.

What we do know is that only a minority have seen a health professional.

In this case, a doctor was the only named option for

a health professional in their survey.

I was surprised by the proportion who had been accompanied to the doctor by a family

member, expecting it would be higher, for boys, but particularly for girls.

This same study wet out to explore whether there were differences in the rate of

seeking help at two different types of clinic.

A school-based clinic and a community-based clinic,

both run by the same health professionals at no cost to students.

Convenience seems to matter, with over double the number of students seeing

a health professional at the school-based clinic than at the community-based clinic.

What was pleasing to see, not shown here,

is that it is not just older adolescents who were able to access these services.

About 60% of students attending the school-based clinic were aged between

13 and 15 years.

There was, however, a very different pattern of health

issues that students presented to each clinic with.

The community-based clinic saw young people primarily for

medical concerns, physical health issues.

In comparison to a more balanced presentation at the school-based clinic.

It'd be interesting to think about why this might be the case.

What do you think might explain this?

Young people experience many barriers to accessing healthcare

that are common to both genders and across all socioeconomic groups.

Prominent barriers include lack of knowledge of services, fears about

confidentiality, and embarrassment about discussing particular health concerns.

Accessibility is not just about just the physical aspects of being able to

get to a clinic in terms of its particular geographic location.

A health service that is youth-friendly must be accessible geographically, but

also physically in terms of disabled access, particularly culturally,

and in all of its procedures, including financial and administrative arrangements.

On a practical level, a most important consideration for

young people is the access to free or minimal-cost healthcare.

And, this needs to consider not only the costs of the consultation, but

also diagnostic testing and, where possible, treatments,

such as drug costs and other treatment costs.

Most clinicians receive little training in working with adolescents and young adults.

We should, therefore, not be surprised that many clinicians report that

adolescents are the age group that they are least confident consulting.

Specifically, health professionals, including general practitioners,

report that consultations with young people take more time.

That young people are challenging to work with in terms of communication

difficulties.

And the doctors are uncertain about the medical legal status

of treating those under 18 years.

And are uncertain also about how they manage consultations,

with parents present, or indeed, when parents aren't present?

The good news is that training in adolescent and young adult medicine

positively improves the clinical performance of undergraduates and

experienced healthcare providers alike from all health disciplines.

The gap between the burden of disease experienced by the young, and

their help-seeking behavior, is one that the healthcare system, and

the community, is responsible for reducing, rather than young people.

A decade ago,

the World Health Organization coined the term Adolescent Friendly Health Services,

as shorthand for quality healthcare for adolescents.

The notion of Adolescent Friendly Health Care

does not refer to standalone health services, but rather denotes that

quality health services provide care to adolescents that meets their needs.

That responds to the burden of disease that young people are experiencing now,

including health-related behaviors.

And that also provides comprehensive, preventable healthcare and

anticipatory guidance.

In almost all settings, adolescents access healthcare

through the same services that provide healthcare to the general population,

together with some specific opportunities, such as school-based services.

The principles of adolescent friendly healthcare echo those of

quality health systems for all ages within a population.

Namely, healthcare that is accessible,

acceptable, appropriate, effective, equitable,

namely, being able to be reached by all,

and healthcare that is safe will also provide quality healthcare to adolescents.

It is how these aspects are implemented and experienced by the young that

differentiates the delivery of healthcare to young people and their families,

and it's these issues that we will address in the following lectures.

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