Young peoples health Adolescents and General Practice Maggie Eisner, January 2011

Young peoples point of view

Your teenage experience Think about when you were a teenager Or if you cant, 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 peoples 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 GPs 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 theyre used to it by the time theyre 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 peoples agendas Dont 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 society There are 6 million aged 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 year olds now exceed those in 1-4 year olds Main causes Accidents Violence Suicide

Contrasting agendas Young 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 dont work well for young people Health promotion sensitive to young peoples concerns

Shipley Young Peoples 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 14 th 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: 18.pdf 18.pdf Shipley Young Peoples clinic – Tues 3-6 pm - contact nurse Dilys Bruce via administrator Susan Brown on (Shipley Medical Practice)