Adolescent health in 2012:
The view from Primary Care
Dr Jane H Roberts
Clinical Senior Lecturer and GP, Chair RCGP
Adolescent Health Group
Background
• Historically the data set is patchy
• RCGP AHG welcomes the beacons of light shone by the Key Data
• ‘Virtually no studies carried out since 2000’; ‘a scandal’
(Coleman,2011)
• Early work: Jacobson et al (1994): consultations shorter by approx
2m-used by GPs as ‘catch up’ time as YP not demanding
• Followed by studies looking at how YP and GPs view each other
(Churchill et al, 2000 Jacobson et al, 2001)
• Landmark paper ‘Tackling Teenage Turmoil’ (2002 )
• Specifically looking at consultations involving MH concerns:
Martinez et al (2006)-’the elephant in the room’
• Biddle et al (2006): GPs perceived as unskilled in MH, focused on
‘the physical’, keen to prescribe
Fig 3.2
Fig 3.3
Fig 3.4
Exploring unease in the consultation
• Embarrassment
• Concerns about confidentiality
• The Triadic consult (75% accompanied by parent/s;
Martinez et al, 2006)
•
•
•
•
Feeling hurried-insufficient time
Worries and fears not a legitimate problem for PC
GPs not interested or knowledgeable in YP
Previous negative experiences of consulting
Adolescence , agency and primary care
• An absence of qualitative research to explore GPs’
perspectives on consulting with YP
• a dominant popular narrative that YP have agency in
their own lives and can affect change
• Barnardo’s study Nov 2011
49% polled: “YP are ‘violent, angry, abusive’ “
No consideration of YP’s own experiences or ‘why’
Such narratives influence PHC workers
Confidentiality
• Ethical considerations in a legal
framework
• Relationship based care
• Dynamic
• Safeguarding vs promoting
engagement
• GPs lack confidence: YP want a
lead
Toolkit available from Oct 2011.
DH funded.
Available on RCGP website:CIRC
Policy Implications
• Knowledge from Teen Demonstration Sites 2006-08
YP at the centre, MDT working, leadership, planning and regular
review.
Plurality: Targeted & Universal services
Creativity to reach the most marginalized: inverse care law
remains with us
• ‘You're welcome’ built on this knowledge : quality criteria to
make PC youth –friendly
• Required a commitment, training ,resources.
• Funding ended May 2011. Remain as a self check list
Real life illustrations
• Main stream services made more accessible or ‘specialist
services’?
• Birthday checks? [ Chris Donovan, 1990s]-variable uptake
• Teen drop-in clinics-often Nurse led. Usually highly motivated,
mixed response from clinical teams
[RCT Walker et al, BMJ, 2002: 1516 14-15 yr olds; ‘change in
behaviour slight but encouraging’, 97% would recommend to
friend; ‘cheap’]
Develop from word of mouth. Marketing expensive, time
consuming. Over lap with school nurses role.
PCT training provided-youth workers. Communication skills.
Case examples:Washington NE
• Group practice wanting to
improve services for YP
• Ran focus groups summer
2011
YP wanted better access to
mainstream services, not
‘youth clinic’
Unsure of what was
available/what PCC could
cover
Role of PSHE in school?
Case Example: South London
• The Well Centre, Streatham
• Rate of attendance of 12-19
yrs old half of 0-14
• 1 in 5 obese; 1 in 10 MHP
• Clinicians from Herne Hill,
Redthread (youth work),
• Regional Innovation Fund
• Attached to a local youth
centre, drop-in
• Formal evaluation
Health inequalities, primary care
and young people
• GPs see YP in the context of their wider life, families
+ local communities
• Greater knowledge of the social determinants of illhealth
• See disadvantaged YP fall pregnant at young ages
and the effects of generational inequalities
• Poverty is the greatest contributor to poor health
• If we are serious about improving the health of YP
then we need to address disadvantage at a structural
level
Concluding thoughts
• We have to do better regarding promoting youth friendly
primary care
• YP are the only group who have not seen significant health
improvements in last 20 yrs (Viner & Barker, 2005)
Needs a multi-layered approach:
Education and training for practitioners,
Structural barriers-organization; payment,
Research –under resourced & under -prioritized
Commitment at Government level
Need to be more creative: working with schools, youth services
References
http://www.ayph.org.uk/publications/53_BriefingPaper2.
Biddle, L et al. (2006). Young adults' perceptions of GPs as a help source for
mental distress: a qualitative study. Br J Gen Pract, 56(533), 924-931.
Churchill RD, et al(2000).Do the attitudes and beliefs of young teengers
towards general practice influence actual consultation behaviour? The
British Journal of General Practice 50,953-57
Jacobson L, et al (1994) Is the Potential of Teenage Consultations Being
Missed? : A study of consultation times in primary care. Family Practice ;
11: 296-299.
Jacobson L, et al (2002). Tackling teenage turmoil: primary care recognition
and management of mental
health during adolescence. Family
Practice 19,No.4 401-409.
Martinez, R et al. (2006). Factors that influence the detection of psychological
problems in adolescents attending general practices. Br J Gen Pract,
56(529), 594-599.
Thank you, any questions?