Keeping Up With Teen Care
Half a block from the children’s hospital in Minneapolis is a comfortable old Victorian house that’s been converted into a health clinic dedicated to teenagers. Patients don’t have to grapple with the monolithic main hospital or sit in waiting rooms stuffed with crying babies and coughing seniors. Instead of dealing with terse or stodgy providers, they are seen by staff members who are experts in adolescent health care and who, most importantly, actually enjoy teenagers.
Dr. Victor Strasburger, chief of the Division of Adolescent Medicine at the University of New Mexico, cites this clinic and its teen-friendly staff as an ideal model for providing adolescent health care. “Teens need their own space,” he says. “And providers should be able to interact with them well. Because, like Holden Caulfield, teens can spot a phony a mile away.”
Strasburger would like to see a dedicated adolescent health clinic here in New Mexico, a vision that’s approaching reality. UNM is moving forward with plans to expand its adolescent health services. Although no firm dates have been set, Strasburger says that the goal is to open at least one new clinic dedicated to providing adolescent primary care around October or November.
UNM’s expansion comes at a crucial time for New Mexico. The new 2010 Kids Count Data Book ranks New Mexico dismally low in teen health, with some of the worst rates of teen death and teen pregnancy in the country. For instance, the state's teen birth rate climbed nearly 10 percent between 2004 and 2007. With these numbers in mind, Strasburger says the new clinic aims to bring more family planning and adolescent gynecology services.
Strasburger cites a shortage of dedicated providers as one reason for gaps in care. There are only four adolescent specialists in the state, he points out. Another objective of the clinic is to create a teaching site for future providers. “Our goal is not to see every teenaged patient around, but to teach others how to see teenagers,” Strasburger says.
Funding is another chronic roadblock to teen health, with New Mexico school-based health center budgets slashed by up to one-third in the past two years. Medical institutions are hesitant to invest in adolescent health, since teen care usually doesn't include profitable procedures (like colonoscopies or coronary bypass surgery).
“And providers should be able to interact with them well. Because, like Holden Caulfield, teens can spot a phony a mile away.”
Dr. Victor Strasburger
Providers often need more time to see adolescent patients, too, because complex social issues like family dynamics, school performance and budding sexuality affect teen health. “Adolescent medicine is not a big moneymaker, and in academic medicine these days, that’s the kiss of death,” says Strasburger. “Adolescent medicine is a really tough sell.”
But where there’s a will, there’s a way. New Mexico has made substantial progress in bringing services to teens, even in the face of budget cuts. In addition to UNM’s coming clinic, the state boasts a robust network of school-based health centers. School clinics offer familiar, convenient locations and free health care services for students.
School clinicians such as Bosha Gordon, the nurse practitioner for Wilson Middle School’s clinic, can write prescriptions and manage primary care problems like asthma and diabetes. She ensures that students receive mental health services, and she can refer those needing more complex medical care. She even ventures into the classroom, promoting health education with topics like obesity and suicide prevention. “That’s the more creative part of my job,” she says with a smile.
Gordon says the highlight of her job is working alongside social workers, educators, nurses, psychiatrists and therapists to deliver comprehensive care to higher-risk children and adolescents. This approach is a major strength of New Mexico’s in-school clinics.
Research supports her enthusiasm. Students who are seen in school health centers spend more time in the classroom, according to an August 2010 study in the Journal of School Health. Another September 2010 study in the American Journal of Public Health concluded the clinics save Medicaid money and may help close health care disparity gaps.
Still, some argue that there is room for improvement within New Mexico’s system. For instance, providers in APS clinics can prescribe contraception but cannot hand out condoms or birth control. Some providers in other districts aren't allowed to offer contraceptive counseling or reproductive education. Many argue that the restrictions limit health care options for financially or socially vulnerable teens.
“School boards and administrators think that if they bring up this issue, there will be a huge public outcry because a few people make a lot of noise," UNM's Strasburger says. "But every national survey has shown that American adults and parents would rather have teenagers contracept than be pregnant or have abortions. So APS should man up.”
School clinics are limited by their facilities and equipment. Students with complex ailments must be referred to outside providers, but they don’t often use the referral, sometimes for financial reasons.
So school health officials are looking to team up with community clinics to prevent these students from falling through the cracks. Adopting what’s called a “medical home” model would allow in-school providers and their patients access to fully equipped nearby community clinics. Under this model, providers like Gordon would be able to see their patients at their school-based clinic or at an affiliated community clinic. Since UNM operates community clinics and partners with state agencies on the school-based health program, these avenues already exist.
Ultimately, whether teens in New Mexico receive health care in a beautiful old Victorian house or a rural school clinic matters little, so long as all teens have access to comprehensive, effective care. “We have to do right by teenagers, we have to keep them safe, we have to get them through adolescence as unscathed as possible,” says Dr. Strasburger. “Where’s our next source of adults coming from?”