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)