1. Young people’s health Adolescents and General Practice Based on Maggie Eisner, January 2011, Modified Heather Naylor October 2014

2. Teenagers!  http://www.bvtv.co.uk/kevin-becomes-a- teenager-bbc-comedy/ http://www.bvtv.co.uk/kevin-becomes-a- teenager-bbc-comedy/

4. Aims of today  1. To recognise the barriers adolescents may face in accessing primary care services  2. To highlight areas of clinical concern in adolescent health  3. To consider issues and challenges around consultations with young people  4. To discuss how GP practices can be made more teenage friendly

5. Young people in our society There are 6 million aged 10-19 in UK

6. Why is adolescent health important?  Death rates in 15-19 year olds now exceed those in 1-4 year olds. Main causes  Accidents  Violence  Suicide  25% of young people have seen their GP in the last 3 months, but there is evidence that some young people find it difficult to access health services appropriately.

7. Young people’s point of view

8. Your teenage experience  Think about when you were a teenager (or 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?  What made/ may make these contacts more difficult than for adults?

9. Barriers for teenagers in accessing primary care  Concern about confidentiality  Embarrassed about symptoms  Lack of information about services  Appointment system  Geography/ transport

10. 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

11. The GP’s point of view

12. 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?

13. Issues in the consultation  Communication/rapport  Confidentiality  Consent  Access  3 way consultations  Presenting problem vs hidden agenda vs health promotion

14. 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

15. 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 consultation makes you feel you should ask

16. 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

17. Consultations with young people  1 Evie  2. Ruth

18. Organising primary care for young people

19. Improving access  What can a practice do to provide a service which teenagers will use?  Resources:  RCGP “Getting it right for teenagers in your practice” 2002

20. 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

21. Useful resources  For teenagers: For teenagers:  www.teenagehealthfreak.org www.teenagehealthfreak.org  www.brook.org.uk www.brook.org.uk  www.likeitis.org www.likeitis.org  For parents:  www.familylives.org.uk www.familylives.org.uk  (Choose “Advice”,“teenagers”)