EuTEACH :

european training in effective adolescent care and health

An initiative of the Multidisciplinary Unit for Adolescent Health,

University Medical Center, Lausanne, Switzerland

Prof. P.-A. Michaud, coordinator

Updated, January 2006

The EuTEACH team :

Istvan Batar (Hungary) ; K. Berg-Kelly (Sweden) ; J.-P. Bourguignon (Belgium) ; V. Chandra-Mouli, (WHO) ; H. Fonseca (Portugal) ; W.R. Horn (Germany) ; A. Macfarlane (U.K.) ; P.-A. Michaud (Switzerland) ; F. Narring (Switzerland) ; K. Pagava (Georgia) ; S.-C. Renteria (Switzerland) ; S. Stronski (Switzerland) ; J.C. Suris (Switzerland) ; R. Viner (U.K.)

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Summary

The adolescent age group (young people aged 10 to 19), despite being considered a healthy segment of the population, faces a variety of threats to health, whose origins lie increasingly in psycho-social and environmental problems as compared to traditional infectious and somatic diseases alone. In addition, due to the increasing survival of young people with diseases that were formerly lethal during childhood the prevalence of chronic diseases in adolescents has increased significantly. Little work has yet been done in a European context to prepare health care providers and professionals working with adolescents to meet these emerging health needs. In order to address this challenge, the Multidisciplinary Unit for Adolescent Health  from the University of Lausanne, Switzerland initiated a working group in 1999 with selected leaders of the field from other European countries.

II. The intended purpose of the EuTEACH initiative.

The major goal of the initiative is  to improve adolescent health in Europe by developing a training curriculum, and training session with four specific objectives:

1. To enable European health professionals involved in the care of adolescents to adequately address and manage adolescent health needs taking into consideration the specific context of the adolescent patient, as well as the crucial role of health education and prevention in this age group.
2. To set quality standards for medical education, for adolescent health care, and for public health, advocacy and policy making as applied to young adolescents
3. To enable health care professionals to effectively collaborate with families, schools and communities, to take leadership role in tailoring the delivery of health services to the unique needs of adolescents in the European and National context, and to assume responsibility for an advocacy role in relation to the promotion of adolescent health.
4. To initiate and support, in as many European countries as possible, the creation of multidisciplinary networks which promote training in adolescent health in their own countries

III. Content and structure of the intended curriculum

The curriculum includes three parts : 1. general modules, which cover issues unique to adolescence (definition of adolescence, bio-psychosocial development, gender issues, exploratory/experimental behaviour, communication skills, family interactions, impact of the socio-economic and cultural context, legal issues) ; 2. modules on specific themes (sexuality and reproductive health, mental health, medical problems including chronic conditions, substance misuse, intentional and unintentional injuries, violence, nutrition, physical activity); 3 modules on public health as applied to adolescents (epidemiology, public health, youth friendly health services, health promotion in adolescence and school health, advocacy). The long-term vision of the EuTEACH project is to target health professionals regardless of their discipline and specialty (i.e. nurses, psychologists, social workers). A curriculum is currently available that can serve as the basis for the development of training at the pre- and postgraduate level, as well as CEM level. It can also help to develop curricula by and for other professionals. Finally, this curriculum also constitutes a training tool for learners themselves.

IV. Dissemination

Contact with various national societies and supra-national organisations, including the World Health Organisation, UNICEF and UNFPA has been initiated to support the EuTEACH project. EuTEACH is also working in close connection with CESP (Confederation of European Specialists in Paediatrics). Yearly summer courses in Adolescent Care and Health (“EuTEACH summer school”) are organized at the University of Lausanne).

Background of the project

In industrialised countries, major causes of morbidity and mortality in the adolescent age group have shifted from those caused by pure infectious and somatic diseases to psycho-social and environmental problems (1-9). The health risks and problems young people are facing, such as depression and suicide, accidents, violence, sexually transmitted diseases and unplanned pregnancies, substance abuse, obesity and eating disorders, despite being  - at least partially- preventable through adequate health education and health promotion, are poorly targeted by  European health care systems (2,3,5,7,10).  A further factor is that ,due to the dramatic improvement of medical technology in the treatment of diseases formerly lethal during childhood, the prevalence of chronic conditions in adolescents has increased significantly, calling for an innovative, multidisciplinary, community-based, family-centred approach (11-16).

In the US, Canada and Australia, the lack of adequate confidential health services for youth and the deficiencies in provider training have been well recognised.  Specific intervention strategies and services are being developed and refined in those countries, including a multidisciplinary training for medical and non-medical professionals which takes into consideration the bio-psycho-social context of youth together with emerging issues such as poverty and ethnic/cultural differences (17-24). This trend has been slower in Europe (25-39). Recognising the lack of adequate training opportunities in this region of the world, as well as the lack of a European educational forum in adolescent health, the Multidisciplinary Unit for Adolescent Health  University of Lausanne, Switzerland in 1999 initiated a working party with selected leaders in adolescent health and medicine from university and community settings from currently eleven  countries. The prime aim of the working party was  to exchange information on adolescent health needs and health care providers’ training needs in their respective countries, to collaboratively explore strategies on developing a European curriculum in adolescent health, to define its content and to develop a network for future collaboration. This document  presents the objectives and organisation of the project.

Since 1999, the working has had regular three-day meetings in Switzerland in order to develop and up-date the content of the curriculum. Two series of presentations prepared by the group members on the epidemiology of adolescent health, the structure of health services for adolescents, formal medical education and existing initiatives in teaching adolescent health in their respective countries revealed that health care needs of adolescents are much the same in each country, although some differences exist in various ‘content’ areas (28-39). For instance the degree to which corresponding services are provided both by the health and the school sector differ greatly among countries. An overriding theme in most countries is that the health care needs of adolescents are  inadequately met by the existing health services. In addition, while significant differences exist in the formal education of health care professionals between countries, it has become clear that all countries share the same one overall problem - that of lack of formal training in adolescent health and medicine (10,16,25,27,30,35,40).

Intended purpose of the EuTEACH project and network

The leading goal of the project is to improve adolescent health and well-being in Europe by developing an appropriate  training curriculum. The group created the acronym EuTEACH ( = European Training in Effective Adolescent Care and Health) to highlight the importance of this goal. The term  « health » is defined in its most complete sense so as to  include somatic, mental and psychosocial aspects of well being.  Taking into account the work that has already been done in the field (18-24,40,41), the aims of the project are:

1. To enable European health professionals involved in the care of adolescents to adequately address and manage adolescent health needs taking into consideration the specific context of the adolescent patient, as well as the crucial role of health education and prevention in this age group.
2. To set quality standards for medical education, for adolescent health care, and for public health, advocacy and policy making as applied to young adolescents
3. To enable health care professionals to effectively collaborate with families, schools and communities, to take leadership role in tailoring the delivery of health services to the unique needs of adolescents in the European and National context, and to assume responsibility for an advocacy role in relation to the promotion of adolescent health.
4. To initiate and support, in as many European countries as possible, the creation of multidisciplinary networks which promote training in adolescent health in their own countries

The group recognises that adolescent health depends on many different factors and that improving the training of health care providers is only one of many possible approaches in the promotion of  adolescent health.  However, an essential premise of the EuTEACH project is that at the level of health services, adolescent health care goes  beyond simply  providing care to ill adolescents to  promoting  and safeguarding the bio-psycho-social development and health of « well »  adolescents, and by elaborating the  principles for working with adolescents that are useful in the training of all professionals involved with youth.(42-47).

The specific objectives of the EuTEACH project are:

1. To define the content of a core curriculum  (a set of knowledge, attitudes and skills) essential for European professionals involved in the care of adolescents or working at a public health level. The content that is unique to adolescence at the bio-medical, psychological and social level, and that are considered to be the basis for effective work with adolescents, are defined at the level of prevention, health promotion, health education, and specific disease management. The European countries will be free to adapt the structure and content of the curriculum to the needs of their own specific adolescent population.
   
2. To develop, implement, and evaluate a training package that covers the content of the core curriculum. The curriculum is organised in modules, each of which provides specific training tools and evaluation procedures. Each module includes learning objectives, suggestion for educational strategies, teaching materials, (including case studies, references), as well as proposals regarding the format and the evaluation of the courses. The organisation of the curriculum emphasises the use of interactive, up-to-date training/learning methods.
   
3. To initiate and support, in as many European countries as possible, the development of adolescent health multidisciplinary networks which are able to promote training in adolescent health and the development of adequate structures and policies in their countries by :
   

Content and structure of the intended curriculum

The curriculum has three parts: 1) general issues that form the foundation of care and management of adolescents   2) specific topics such as sexuality, substance use or eating disorders. 3)  public health themes dedicated to the organisation of adequate health care structures, the development of sound strategies for prevention and health promotion as well as the improvement of policies and environment with potential impact on adolescent health. The curriculum is designed to be adaptable to the specific needs of professionals from different fields and disciplines. The structure of the curriculum is diagramed in the attached figure. As shown, the set of modules is complemented by several documents such as ‘training’ and ‘evaluation tools’, as well as a set of basic references, links with other sites and a list of the members of the EuTEACH working group. Both the content of the curriculum as well as the pedagogic approaches which are used  (48-51) take into account the experience of  training initiatives from the United States, Canada, Australia and the World Health Organisation (17-24,28,31,52-55), as well as various European recommendations. The curriculum is designed to be adaptable to the specific needs of professionals from different fields and disciplines working in different countries (27,29,30,32,33,34,36-39).

Module topics:

General modules:

1. Definition of adolescence and bio-psychosocial development during adolescence
2. The family : influences and dynamics
3. Setting, communication and clinical skills, multidisciplinary working & networking
4. Confidentiality, consent, rights, access and personal advocacy
5. Context and impact : socio-economic, cultural, ethnic and gender issues
6. Resources, resilience, exploratory and risk behaviours

Specific modules

1. Growth and puberty
2. Nutrition, exercise and obesity
3. Sexual and reproductive health
4. Common medical conditions of adolescence
5. Chronic conditions
6. Mental health
7. Eating disorders.
8. Substance use and misuse
9. Injuries and violence, including accidents, self-harm, abuse, etc.

Public health modules

1. Overview of adolescent health : epidemiology and priorities
2. Public health as applied to young people aged 10 to 19 years
3. Health education and promotion, including school health
4. Youth friendly health services
5. Advocacy for the health of young people aged 10 to 19 years

Initially , the content of the curriculum has been designed for physicians at the ‘Continuing  Medical Education (CME) level.  Further developments have included the development of a core of public health modules for professionals involved in administration and policy making or the development of youth friendly health services. It is envisioned to progressively adapt the content of the curriculum to other disciplines, including:

• clinical and public health nurses
• psychologists and sociologists
• specialists allied to medicine such as physio therapists, speech therapists, nutrionalists
• social workers
• teachers, educators, health educators
• lawyers
• politicians

Structure and Organisation of the Network

The network consists of a working group (link with members of the working group) which is supported by  consultants and experts (link with the list of consultants) whose expertise can be requested as needed. Interested European and other international professional associations and organisations are linked to the network with designated representatives. All of them will periodically be informed about  the progress of the work of the central working group.  

The members of the working group collectively agreed on limiting the number of active participants in the interest of  maintaining an maximally efficient working style. Interested professionals from other countries will be linked to the network through e-mail exchanges and electronic newsletters. Currently, consultants with expertise in specific areas are being recruited to enlarge the network of interested professional organisations from different disciplines. This will also help reflect  the essential the multidisciplinary nature of adolescent health. Also, they will be progressively invited to become EuTEACH trainers, through the organisation of yearly TOT (training of trainers) courses. Formal collaboration is established with supra-national organisations such as  the International Association of Adolescent Health (IAAH), the World Health Organisation (WHO), and the United Nation Population Fund (UNFPA) as well as the European Confederation of Specialists in Paediatric.  (CESP) which is currently implementing the area of adolescent health within the European training curriculum for paediatricians. Participants of the working group, as well as other interested professionals, are encouraged to disseminate information about EuTEACH program in their own individual countries.

International training sessions (EuTEACH "summer school")

In addition to formal presentations of the curriculum at various scientific meeting (Lausanne, Athens, Frankfort, Liege, Rome, Beijing, Bahia, Prague, Stuttgart, Istanbul, Naples, etc.), it was decided in 2002 to set up a formal international one-week training course for European professionals involved in adolescent medicine and health. The courses have taken place in 2002, 2003 and 2005, gathering a growing number of participants (from the first 20-25 physicians to a group of 40 in 2005). The profile of interested participants has progressively evolved from pure clinicians (pediatricians, internists, gynecologists, etc.) to professionals involved in public health and policy making, including representatives from supra-national agencies. Participants come from more than 20 Eastern and Western European countries, including Azerbaijan, Austria, China, Czech Republic, Croatia, Egypt, France, Georgia, Germany, Greece, Hungary, Ireland, Iceland, Lebanon, Macedonia, Portugal, Slovenia, Sweden, Russia, Turkey, Ukraine, U.K..A French speaking course took place in July 2004 in Besançon and will be repeated in 2006.  

The one week ‘Summer School’ program is usually set-up, based on an assessment of training needs expressed by the participants in advance of the meeting. Each half-day session (~3 hours)  focuses on a definite module, with a mixture of basic and specific themes. The course is delivered by members of the EuTEACH working group, with a balance between interactive plenary lectures and group sessions (including discussion on clinical cases, role playing, etc.). To date, most participants have indicated that their overall knowledge on the subjects had been much improved, that the course would change their practice and that they would recommend the course to a colleague.   The next course will take place in 2006, during the second week of July  in Lausanne, Switzerland

From 2007 it is planned to conduct a yearly T O T (training of trainers) courses for experienced physicians who are actively involved in training activities.

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