Adolescents and Family-Centered Health Care

Overview

Family-centered health care recognizes that families – even those struggling with problems – can provide invaluable support for adolescents facing acute or chronic health problems.

Family support of an adolescent's health care can take several forms. Parents and others can offer insight into the adolescent's behavior, spot contributing factors to the problem and help assess the practicality of proposed treatment plans, according to a position paper on family friendly adolescent health care by the Canadian Paediatric Society.

Also, families may be the only constant source of emotional stability for adolescents with health problems. And, they can provide support networks and spiritual resources that lead to optimal healing, the Canadian society notes.

Sometimes, health professionals face the dilemma of providing confidential, developmentally appropriate care to adolescents while respecting the family's role and its values. Though these two goals are not mutually exclusive, the Canadian society notes that fulfilling both these obligations can be difficult.

American has about 34 million adolescents ages 10 to 19 years old, according to the Adolescent Health Section of the Maternal and Child Health Bureau , a federal agency. The most prevalent health risks facing adolescents today result from psychosocial, behavioral, and economic factors, says the bureau. Here's a statistical overview compiled by the bureau:

Unintentional injury is the leading cause of death in adolescents, and accounts for more deaths than all other causes combined.
Homicide is the second leading cause of death for adolescents ages 15 to 19 years and the third leading cause of death for adolescents ages 10 to 14 years. The homicide death rate for black older adolescents is eight times higher than for whites of the same age.
Suicide is the third ranking killer of adolescents ages 15 to 19 years and the fourth leading killer of younger adolescents.
About 3 million adolescents contract a sexually transmitted disease annually.
More than 1 million adolescent U.S. females become pregnant every year, the highest rate of the world's developed countries.
Among adolescents ages 12-17 years, 15.9 percent report illicit drug use and 41 percent report use of alcohol.
One out of five teenagers will be smoking regularly by the time he or she finishes high school.
An estimated one in every five adolescents ages 10 to 18 years has no health insurance.

Dr. Robert Blum, a University of Minnesota pediatrician and researcher, notes that broader social issues, such as poverty, the lack of economic opportunity for certain segments of youth, educational failure and economic policies that result in parents spending less with their children, also contribute to teens' health problems.

Sources: Canadian Paediatric Society, the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services and Dr. Robert Blum.

Principles of Family-Centered Adolescent Care

Promote many images of families, as opposed to one single ideal.
Ask adolescents whom they wish to have involved in discussions about their care.
Consider families' requests for exceptions to policies or procedures
Offer linguistically and culturally sensitive services
Welcome spiritual resources and family support services
Help families respect the adolescents' need for privacy, informed consent and peer interaction
Understand the different ways families cope with their adolescents' problems
Seek tangible ways family members can help with adolescents' care
Consider the needs of the whole family (i.e. providing flexible visiting hours)
Encourage family-to-family support networks
Offer methods for family members to voice concerns or questions
Provide educational materials, such as videos, pamphlets and tours

Adapted with permission from Family-Friendly Places for Health Care, a brochure published by the BC Council for the Family , Vancouver, British Columbia.

Key web sites

Center for Adolescent Studies – Based at the University of Indiana School of Education in Bloomington, this site provides support to adults working with youth, investigates current social issues and offers tools for teens to learn and practice new, healthy behaviors. Includes a page with information sorted by health risk , a page of resources for violence prevention and conflict resolution and a page with common teen mental health issues (eating disorders, depression) .
Zero to Three – This site, for parents and professionals, is devoted to healthy development of infants and toddlers.
National Information Center for Children and Youth with Disabilities -- Has information on specific disabilities, early intervention, special education and related services, individualized education programs, family issues, disability organizations, professional groups, education rights, transition to adulthood and more. Information available in Spanish.
Band-aides and Blackboards -- This site, developed by Joan Fleitas, R.N., Ed.D., an assistant professor of nursing at Fairfield University in Fairfield, Connecticut, is dedicated to sharing what it's like for people with chronic illness to go to school. It includes true stories as well as what experts suggest for coping with problems. Includes sections for kids, teens and adults.
Teens Only! – A University of Indiana web site that offers electronic resources for teens including zines, television and movie reviews by teens, among other things.
BC Council for the Family – Run by a nonprofit group, this web site lists more than 150 resources.
Adolescent Health Resources (ERIC Clearinghouse for Teaching and Teacher Resources) – A listing of health resources for educators.
AMA Adolescent Health On-Line – A site, run by the American Medical Association, specifically dealing with adolescent health.
CWeb Medical Web sites -- A quick overview of the field of child and adolescent health care issues from the Maternal and Child Health Bureau. This includes the most common health risks. Also, the American Medical Association provides online information for primary care physicians and other health providers addressing adolescent health.
Society of Adolescent Medicine -- This group promotes the development, syntheses, and dissemination of scientific and scholarly knowledge relating to the health needs of adolescents. The site offers a forum for discussion of teaching, research, and other concerns of mutual interest. It also publishes the Journal of Adolescent Health and holds an annual meeting.
National Campaign to Prevent Teen Pregnancy -- The group's mission is to prevent teen pregnancy by supporting values and stimulating actions that are consistent with a pregnancy-free adolescence. The Campaign's goal is to reduce the teen pregnancy rate by one-third by the year 2005. This site includes a searchable database and an excellent list of related web sites .

Research highlights

Reducing the Risk: Connections That Make at Difference in the Lives of Youth. Blum, Robert Wm. and Peggy Mann Rinehart. 1997. Minneapolis, MN: Division of General Pediatrics and Adolescent Health, University of Minnesota.
"Protecting Adolescents from Harm: Findings from the National Longitudinal Study of Adolescent Health," Resnick, Michael D., Peter S. Bearman, Robert Wm. Blum, Karl E. Bauman, Kathleen Mullan Harris, Jo Jones, Joyce Tabor, Trish Beuhring, Renee E. Sieving, Marcia Shew, Marjorie Ireland, Linda H. Bearinger, J. Richard Udry. Journal of the American Medical Association 278(10):823-832 September 10, 1997.
"A Research Design for Studying Romantic Partners," Udry, J. Richard. 1997. pp. 309-319 in J. Bancroft (ed.), Researching Sexual Behavior. Bloomington: Indiana University Press.
Survey of Health of Adolescent Girls The Commonwealth Fund, 1997
Survey of Health of Adolescent Boys by Cathy Schoen, Karen Davis, Catherine DesRoches, and Alexander Shekhdar, The Commonwealth Fund, June, 1998.

Models/best practices

American Medical Association Guidelines for Adolescent Preventive Services (GAPS) is a comprehensive set of recommendations that provides a framework for preventive health services. The recommendations are aimed at promoting adjustment to puberty and adolescence, safety and injury prevention, physical fitness, healthful dietary habits, healthy psychosexual adjustment and parents' ability to respond to the health needs of their adolescents.

Strategies and public policy approaches

Health care and social services professionals must do more than simply stand at the bottom of the cliff with an ambulance to pick up young people who die or are injured, asserts Dr. Robert Blum, a University of Minnesota pediatrician and researcher. Rather, he says, we need to:

Integrate services to a far greater extent than we currently do. Health, education and employment are inextricably linked, but these services are often fragmented.
Realize effective health interventions may not look like health care services at all. Given that the root cause of some of our health problems among young people lie in other domains (e.g., lack of safe communities) we will not make significant strides in improving the health of young people if we focus solely on the health care sector.
Provide parents with guidance about what diminishes risk during the teenage years. Every parental approach does not work equally well. While we often help parents of young children, we assume that by the time their children attend school, parents will know what to do. Parents need skills to better parent their teenage children.
Increase communications and connections between adolescents and their parents. Most parents want to do this. And, teenagers may be open to this. In a national poll of teenagers, the majority said the persons they admire the most are their parents.