Euteach: Module C5


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Module C5:

Adolescent / Youth friendly health services (YFHS)

Entry Scenario

The entry scenario addresses a variety of issues and problems associated with the module topic. It may be used at the beginning of the course to stimulate the students to identify their own needs and interests. The results may be utilized by the individual to assess own learning process, or be integrated with class objectives.

Depending on your audience you may elect to begin with scenario 1 (administrators and policymakers) or scenario 2 (clinicians)

Scenario

A recent health survey carried out in your city indicates that only 10% of youth aged 15-19 years see a health care provider regularly (at least once a year). Among the reasons cited for not seeking health services, they enumerate: lack of confidence in the staff, fear that their parents would be informed, having to be accompanied by an adult, feeling that they are being judged, or, simply, that they do not know where to go. The majority of them indicate that in case of need they would go the city hospital emergency room for acute care.

As the city council’s health officer, these results surprise you since the city hospital created an Adolescent Outpatient Clinic (open every morning Monday to Friday) four years ago, and family physicians in the four city-supported outreach clinics are due to take care of patients aged 15 and up.

Reflect on top priority objectives and settings which you would address to improve the health care of young people as well as their access to these health care

General Goals for Learners
By completing the module the participant will be able to:

Understand and detail the basic elements of youth friendly health services (YFHS)
Identify and employ strategies to implement youth friendly health services
Sensitize participants to the need of monitoring/evaluating youth friendly health services

Goal 1: Understand and detail the basic elements of youth friendly health services

Training Objectives
Key topics to be covered

Educational Methodology

Activities, Issues, and Questions

Pertinent resources

KNOWLEDGE

A. Describe the characteristics of the five major components of youth friendly health services

1. environment

2. staff

3. procedures & policies

4. locations

5. content & services

Reading

Class discussion

Small groups discussion

Interview with young people

Visit of various health care settings

Module preparation: Search for examples of YFHS on the internet.

Ask participants to reflect on their own experience as adolescent patients. What qualities of services would they have wanted?

Explore experiences of participants with YHFS in their own settings.

Groups develop the arguments in favour of youth friendly services:

a. Evidence regarding adolescents’ health status and services utilization

b. Children’s’ Rights

c. Teenagers’ needs (e.g. privacy, dignity, confidentiality, continuity of care, time)

Ask young people to attend the meeting to help professionals in identifying key components of YFHS.

List possible settings and models in which YHFS concepts can be put into practice

Discuss how a YFHS can be made culturally sensitive

Suggested follow-up to course:

Ask participants to gather a focus group of young people in their own country and review with them the basic ingredients of YFHS

Refs 1, 2

Websites 1, 2, 3

Refs 3, 4, 5

Goal 2: Identify and implement youth friendly health services

	Training Objectives Key topics to be covered	Educational Methodology	Activities, Issues, and Questions	Pertinent resources
SKILLS	A.Select best practices which facilitate the implementation of YFHS in various settings - Identify obstacles and decide how they can be overcome	Small group discussion Followed by plenary Interview of young people, of health professionals and decision-makers	Is it possible to change a traditional care setting into youth friendly instead of creating a new unit? Use the workshop scenario in annex 2 to facilitate the discussion of the following issues: -how to identify the specific needs of an adolescent population -how to identify setting in which to implement YFHS -how to get young people involved -how to convince staff to engage in such actions -how to activate a network of professionals -ensuring logistics and supplies -fund raising and resource allocation	Annex 2 Refs 6, 7
SKILLS	B.Design a basic plan for a new YFHS in a chosen setting and be prepared to advocate for it.	Small group discussion Followed by plenary	Provide a concrete example of how to set-up a new YFHS in various settings: -in a hospital -in an outpatient unit -in a group of practitioners -in a school -in a leisure center (counseling) -in a deprived area Brainstorm ideas on advocating for the implementation of YFHS in these different settings.	Refs 8-15 Module on Advocacy
SKILLS	C.Select target audiences for training intervention and outline the content of the intervention		Discuss -how to identify the professionals in need of training -how to identify potential teachers / trainers -how to assess the needs of these professionals to define the content of training -how to plan the implementation (e.g. using the EuTEACH website)

Goal 3: Sensitize participants to the need to monitor and evaluate YFHS

	Training Objectives Key topics to be covered	Educational Methodology	Activities, Issues, and Questions	Pertinent resources
KNOWLEDGE	A.Identify process, output and outcome indicators	Mini lecture and Class discussion	Taking into account the objectives of your YFHS, define and list process indicators as well as output and outcome indicators. Discuss the usefulness and limitations of these indicators. Examples: -Process indicator (the way services are organized and delivered) number of facilities opened, number of services offered, user satisfaction -Output indicator (immediate and concrete results of services): number of consultations, profile of users, change in user knowledge and practice -Outcome indicator: (the effect of the service on the health status of the target population): reduction of teenage suicides, STIs or pregnancies.	Refs 16-19 Websites 4,5,6
SKILLS	B. Describe how to involve young people in evaluating YFHS		Objective B examples: -ask young people to generate indicators and measures -involve young people in data collection -engage young people in the interpretation of the data -encourage young people to participate in the translation and dissemination of evaluation results	Website 7
SKILLS	C. Understand the importance of ethical guidelines for YFHS	Class discussion	Discuss the ethical principles that are important to YFHS. How can ethical standards be monitored?	Refs 20, 21

References

1.UNFPA, Youth friendly Health Services in Europe. Entre Nous, 2004; No. 58. (www.euro.who.int/document/ENS/en58.pdf)

2.Senderowitz, J. 1999. Making Reproductive Health Services Youth Friendly. Research, Program and Policy Series. Washington, D.C.: FOCUS on Young Adults, Pathfinder International (www.dec.org/pdf_docs/PNACK127.pdf)

3. WHO/UNFPA/UNICEF. Study group on programming for adolescent health. WHO, technical report series 886, Geneva 1999.

4.Ginsburg, K R, Slap, GB, Cnaan, A et al. Adolescents' Perceptions of Factors Affecting Their Decisions to Seek Health Care JAMA 1995; 273 (24): 1913 -1918.

5.Booth ML, Bernard D, Quine S, Kang MS, Usherwood T, Alperstein G, Bennett DL. Access to health care among Australian adolescents. Young people's perspectives and their sociodemographic distribution. J Adolesc Health 2004; 34(1): 97-103.

6.Cavet J, Sloper P. The participation of children and young people in decisions about UK service development. Child Care Health Dev 2004; 30(6):613-21.

7.Curtis K, Liabo K, Roberts H, Barker M. Consulted but not heard: a qualitative study of young people's views of their local health service. Health Expect 2004;7(2):149-56.

8.Wilf-Miron R, Sikron F, Glasser S, Barell V. Community-based adolescent health services in Israel: from theory to practice Int J Adolesc Med Health. 2002;14(2):139-44.

9.Fothergill K, Ballard E. The school-linked health center: a promising model of community-based care for adolescents. J Adolesc Health 1998;23(1):29-38.

10.Beddard D, Chandiok S, James P, Russell A. A 6-month pilot of a collaborative clinic between genitourinary medicine services and a young persons' sexual health clinic. J Fam Plann Reprod Health Care 2003; 29(2):40-2. Erratum in: J Fam Plann Reprod Health Care 2003 ;29(3):159.

11.AR Watson. Hospital youth work and adolescent support. Arch Dis Child 2004; 89(5): 440 - 442.

12.Viner R, Keane M. Youth matters: evidenced-based best practice for the care of young people in hospital. London: Caring for Children in the Health Services, 1998.

13.D Payne, C Martin, R Viner, and R Skinner. Adolescent medicine in paediatric practice. Arch Dis Child 2005; 90(11): 1133 - 1137.

14.Michaud PA, Suris JC, Viner R. The Adolescent with a chronic condition. Part II: healthcare provision. Arch Dis Child 2004;89:943-049.

15.Viner R. Transition from paediatric to adult care. Bridging the gaps or passing the buck? Arch Dis Child 1999;81:271-75.

16.Klein JD, Graf CA, Santelli JS, Hedberg VA, Allan MJ, Elster AB. Developing quality measures for adolescent care: validity of adolescents' self-reported receipt of preventive services. Health Serv Res 1999;34(1 Pt 2):391-404.

17.Pastore DR, Juszczak L, Fisher MM, Friedman SB. School-based health center utilization: a survey of users and nonusers. Arch Pediatr Adolesc Med. 1998;152(8):763-7.

18.Mmari KN, Magnani RJ. Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia. J Adolesc Health 2003;33(4):259-70.

19.Juszczak L, Melinkovich P, Kaplan D. Use of health and mental health services by adolescents across multiple delivery sites. J Adolesc Health.2003; 32(6 Suppl):108-18.

20.Doucet H. Les soins: considérations éthiques. In Michaud PA, Alvin P et al. La santé des adolescents : approches, soins, prévention. Lausanne, Paris, Montréal : Payot, Doin, PUM, 1997 : 535-48.

21.Diaz A, Neal WP, Nucci AT, Ludmer P, Bitterman J, Edwards S. Legal and ethical issues facing adolescent health care professionals. Mt Sinai J Med 2004; 71 (3): 181-5. (http://www.mssm.edu/msjournal/71/71_3_pages_181_185.pdf)

Websites:

1.Adolescent friendly health services: An agenda for change. www.who.int/child-adolescent-health/publications/ADH/WHO_FCH_CAH_02.14.htm

2.WHO: Global consultation on Adolescent friendly health services www.who.int/child-adolescent-health/New_Publications/ADH/WHO_FCH_CAH_02.18.pdf

3.The Mount Sinai Adolescent Health Centre: www.mountsinai.org/msh/msh_program.jsp?url=clinical_services/ahc_about.htm

4.www.unicef.org/health/guidelinesformonitoringavailabilityofemoc.pdf

5.WHO. Evaluation of missed opportunities for comprehensive adolescent health care. Geneva. (www.who.int/child-adolescent-health )

6.Monitoring reproductive health: Selecting a short list of national and global indicators http://www.who.int/reproductive-health/publications/hrp_97_26/HRP_97_26_table_of_contents.en.html

7.www.youthinfusion.com

Annex 1: Basic components of youth friendly services

Annex 2: Workshop example for Goals II A and B

Use the following scenario to set the scene of the workshop:

You are a paediatrician in group (two persons) practice who also works part-time in a well-baby clinic of the local hospital in a working-class city of 60,000. Your 16 year-old daughter confides in you that a girl in school is planning to sneak away to a larger city for “help” with a suspected pregnancy. The girl is apparently embarrassed and afraid to go to a local doctor and she doesn’t trust the nurse who visits the school irregularly. Although you think your own daughter would consult you with her problems, you have doubts about your 15 year-old son who is fast maturing, risk-taking, and non-communicative. You feel something must be done about health services for youth in your city, and you resolve to do something about it.