Young people’s health Adolescents and General Practice Maggie Eisner, January 2011
Mar 28, 2015
Young people’s
healthAdolescents and General Practice
Maggie Eisner, January 2011
Young people’s point of view
Your teenage experience
Think about when you were a teenager
Or if you can’t, think of a teenager you know well
What health concerns did you/they have?
What contacts did you/they have with health professionals?
What did the health contacts feel like?
Young people’s health agendas
Sexual health – c/c, pregnancy (TOP/parenthood), STDs, sexual orientation
Mental health – self esteem, exam stress, adolescent adjustment, home and school relationships
Appearance – skin, body image, size
Minor illness – not minor to them, not familiar with it
Chronic illness – may express resentment by non compliance
The GP’s point of view
Your medical experience
Think about consultations with teenage patients
In any context – not just GP
What were the issues?
How did the consultations differ from adult or child consultations?
Issues in the consultation
Communication/rapport
Confidentiality
Consent
Access
3 way consultations
Whom do you identify with?
Presenting problem vs hidden agenda vs health promotion
In the consultation Relate directly to young children so they’re
used to it by the time they’re teenagers
Extra explanation time for common problems (flu, cystitis)
Be very patient centred esp with non compliant teenagers with chronic diseases
Health promo sensitive to young people’s agendas
Don’t make assumptions
Get their mobile phone number
A scheme for assessing troubled teenagers (HEADSS)
Home – can you talk to your parents?
Education – ask about actual school performance
Activities – what do you like doing? Do you have friends you can trust?
Drugs (incl smoking and alcohol) – explain why you want to know
Sex – ask permission to ask the questions
Suicide risk – if consn makes you feel you should ask
Young people in our societyThere are 6 million aged 10-19 in UK
Young people bear most acutely the effects of change in
society Inequality
Poverty
Unemployment
Homelessness
Family breakdown
Drugs and alcohol
Sex
Changes in transport
Changes in leisure activities (electronic devices, Internet)
Media pressure
Consumer pressure
Academic pressure
Culture clash/conflict for children of immigrants and minority ethnic groups
Mortality in teenagers
Death rates in 15-19 year olds now exceed those in 1-4 year olds
Main causes Accidents Violence Suicide
Contrasting agendasYoung people
Sexual health – c/c, pregnancy (TOP/parenthood), STDs, sexual orientation
Mental health – self esteem, exam stress, adolescent adjustment, home and school relationships
Appearance – skin, body image, size
Minor illness – not minor to them, not familiar with it
Chronic illness – may express resentment by non compliance
Health professionals
Lifestyle issues – smoking, alcohol, drugs, diet, exercise
Sexual health – c/c, STDs, pregnancy
Mental health – suicide prevention, behaviour in school
Organising primary care for young people
Improving access
What can a practice do to provide a service which teenagers will use?
In the practice
Confidentiality made clear
Staff trained to be welcoming
Accessibility – advance appts don’t work well for young people
Health promotion sensitive to young people’s concerns
Shipley Young People’s Service The service
Nurse led, staffed by 2 practice nurses, admin worker, youth worker GP support if required (e g for referral for TOP) Started in 2000 – grew v slowly at first Write to all practice patients for their 14th birthday Serves the locality as well as the practice Drop in at practice 3-6 pm Tues (80% female, 95% white, mostly 14-16)
Outreach service, no longer funded Shipley Youth café (70% male, 95% white, mostly 12 –15) Owlet Family Centre (60% male, 100% white, mostly 14 – 16) Local secondary schools (70% male, 80% white, mostly 13 – 16) Shipley College (90% male, 90% Asian, 16 – 19) Youth clubs and street corners
Main issues 90% sexual health (c/c, STD screening and Rx, preg testing and advice) 50% need support with mental health issues/life problems (1% referred to
CAHMS) 70% of drop in clients are binge drinkers, 30% low level drug users
Further information
RCGP curriculum statement – Children and Young People (but should young people be in same chapter as children?)
RCGP ‘Getting it right for teenagers in your practice’ 2002
GMC guidance for children and young people: http://www.gmc-uk.org/guidance/archive/GMC_0-18.pdf
Shipley Young People’s clinic – Tues 3-6 pm - contact nurse Dilys Bruce via administrator Susan Brown on 01274 531153 (Shipley Medical Practice)