Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

PURPOSE: To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs). METHODS: The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care. RESULTS: SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control. Commercially insured adolescents were least likely to report discussion of sexual health issues. SBHC users had the highest mean YAHCS quality measure scores for screening/counseling on pregnancy/STDs, diet and exercise, and helpfulness of counseling provided; Medicaid-insured teens had the lowest scores on four of seven measures. Regression models controlled for demographics, use of screener, and site of care showed that use of a screener had a significant impact on six of seven quality measure models. Younger age predicted screening for risk behaviors; being female, African-American, and an SBHC user predicted screening on pregnancy/STDs. CONCLUSIONS: SBHCs may increase adolescents' access to confidential care, and SBHC providers may be more likely than those in other settings to screen and counsel patients about sexual health. Overall quality of preventive care reported by commercially insured adolescents may be better in some health content areas and worse in others compared with care reported by Medicaid-insured youth and SBHC users.

Asertividad y uso de sustancias en la adolescencia: Resultados de un estudio transversal / Assertiveness and substance use in adolescence: results from a cross-sectional study

Numerosos programas de prevención del abuso de sustancias en la adolescencia incluyen entre sus componentes el entrenamiento en asertividad. Este estudio transversal analizó la relación entre las puntuaciones de asertividad del cuestionario CABS (Michelson y Wood, 1980) y uso autoinformado de tabaco, alcohol, cannabis y drogas sintéticas en una muestra de 294 adolescentes (edad media=13,06 años, rango 11-14). Un 51,4 por ciento y un 41,6 por ciento de los sujetos, respectivamente, declaró no haber consumido nunca tabaco ni alcohol, aunque se halló un 4,8 por ciento de fumadores diarios. Muy pocos sujetos declararon haber consumido las demás sustancias (un 7,1 por ciento había consumido alguna vez cannabis y un 1,4 por ciento drogas sintéticas). Aunque las puntuaciones globales de la escala CABS no correlacionaron significativamente con el uso de sustancias, la subescala de agresividad mostró correlaciones estadísticamente significativas con el uso de tabaco, alcohol y cannabis. La ausencia de pruebas claras de la relación entre asertividad y uso de sustancias subraya la importancia de una cuidadosa monitorización de los efectos de los programas de prevención del abuso de sustancias destinados a adolescentes. (AU)

La educación en salud en la escuela fiscal ciudad de La Paz / The health education at school fiscal city of La Paz

La presente investigación tiene sus bases en la experiencia institucional del Centro de Multiservicios Educativos -CEMSE-, que desde 1986 desarrolla acciones en los sectores de la salud y la educación. En todo este tiempo la permanente preocupación ha sido la "promoción de la igualdad de oportunidades para las comunidades educativas del sector fiscal", en la perspectiva de una vida saludable y una educación con calidad, con aspiración de un mayor nivel de vida para las poblaciones excluidas de los beneficios del desarrollo

Trends in transition from pediatric to adult health care services for young adults with chronic conditions.

PURPOSE: The rationale underlying this study was the need to move the transition health services model from a theoretical framework to an empirically-based investigation. Thus, it was necessary to identify programs for youth with chronic or disabling conditions that assist in transitioning from child- to adult-focused health services by (a) discrete types, (b) functional categories, and (c) problems and issues faced by these programs. METHODS: Nominations for transition health services programs were solicited from 1025 organizational agencies at the local, state, regional, and national levels. Two solicitations yielded 277 nominees. After pilot testing, a survey of 163 forced responses and open-ended questions was mailed to each nominated transition health services program. A total of 122 programs returned completed surveys. RESULTS: Program services were categorized as adolescent-focused (38%), condition-focused (36%), and specialty-specific programs (26%). Few programs were primary care-based. Categories were subsequently collapsed into two types: adolescent-focused and condition-focused. No significant differences were noted between adolescent- and condition-focused programs regarding provision of mental health services, vocational counseling, self-efficacy training, or health education. The primary barriers to transition health services were identified as funding and access to key staff, rather than family and adolescent resistance. CONCLUSION: In general, self-identified transition health care programs do not achieve the goal of collaborative, coordinated, and integrative services to adolescents with chronic or disabling conditions. Furthermore, the barriers to attaining the goal are the limitations of the health care system itself.

Community service utilization by youths hospitalized in a state psychiatric facility.

A majority of a cohort of 62 children and adolescents who had been hospitalized in a state psychiatric facility was found to have received less restrictive services such as outpatient mental health services prior to their index admission. Also, a number had been involved with the juvenile justice system and almost two-thirds had been placed out-of-home. Ninety percent had at least one prior psychiatric hospitalization. Just over half of the cohort received case management and individual counseling post release. About a third received family counseling, and a few received other types of services. At least a third were rehospitalized within a year of release. Although 90% of the cohort received some type of service post release, a higher proportion of non service receivers were rehospitalized than service receivers. Even those who received services had a high rate of rehospitalization. These findings raise questions as to the appropriateness of service provision during and following hospitalization.