Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement

Most morbidity and mortality among adolescents results from their participation in health-compromising behaviors. Recent guidelines for clinical adolescent preventive services recommend that primary care clinicians routinely screen for and counsel adolescents about these behaviors, identify and address related social, psychological, and biologic factors. Office-based counseling can influence adult health behaviors, but little is known about the effectiveness of office-based counseling for adolescents. In this review we: (a) evaluate available information about the effectiveness of office-based health counseling to improve outcomes; (b) report what is known about the health counseling adolescents receive from primary care clinicians; and (c) critically review different approaches that have been, or might be, used to measure the content and quality of health counseling provided during adolescent medical visits. With the emphasis on accountability in the current health care environment, evidence supporting the effectiveness of counseling is needed to justify investment in this aspect of clinical adolescent preventive services. Challenges to studying the effectiveness of health counseling include the lack of well-defined theory-based models for adolescent office-based counseling, the complexity of measuring counseling quality, and the many factors that influence adolescent outcomes. Reliable and valid measures of counseling quality are needed both to study and to ensure the quality of counseling received by adolescents. No single measure can be expected to fully capture counseling quality, although patient self-report deserves further development.     

The challenge to meet the mental health and biopsychosocial needs of the poor: expanded roles for hospital social workers in a changing healthcare environment

Despite the absence of coordinated federal health care reform, social workers in hospital settings have opportunities to identify, develop, advocate for, and facilitate access to innovative health care services, resulting in improved capacity to meet the mental health and biopsychosocial needs of the poor and, potentially, reduced hospital costs over time. There are opportunities for expanded roles for social workers in forging better linkages between hospital services and the community, developing an integrated biopsychosocial healthcare delivery system within hospitals and primary care settings, utilizing information systems as tools in an integrated system, and advocating for a client-centered approach to mental health services.     

Adolescent pregnancy prevention in managed care

Efforts by the US government, employers, and insurance industry to address women's health issues have neglected the problem of adolescent pregnancy. 30 million of the 37.4 million US adolescents have health insurance coverage and 20-40% of them are enrolled in managed care plans, either through private insurance or Medicaid. Each year, managed care insurance plans pay for 150,000-300,000 adolescent pregnancies, half of which end in a live birth. There are many gaps in current approaches to adolescent health care that can be filled by physicians and managed care organizations. Prevention of adolescent pregnancy would have immediate, cost-effective results. Managed care insurance, with its organizational structure, has the potential to address the traditional obstacles to adolescent reproductive health of lack of confidentiality and difficulties with access. An adolescent health care coordinator could be hired to track teen care within the insurance plan, educate staff, and arrange and enforce protocols. It would be instructive to see whether such case management could achieve reductions in repeat adolescent pregnancies by targeting follow-up activities to this risk group. Finally, managed care organizations should analyze teen pregnancy prevention programs in their own setting and select the most effective interventions on the basis of cost and medical outcome rather than political expediency.     

Mental health services to children and adolescents: A national view of public policies.

Summarizes and discusses the implications of a national study conducted by the present author (1982) on public policies affecting the delivery of mental health services to disturbed children and adolescents. Relevant state officials and advocacy organizations were surveyed, state reports and child and adolescent mental health statutes were analyzed, federal programs and policies were reviewed, and responsive program models were identified. Findings suggest that there is more knowledge about how to help children and adolescents in need of mental health services than is reflected in the organization, funding, and delivery of these services. Three encouraging developments, policy recommendations, and implications for psychologists are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sacred adolescence: Practical suggestions for psychologists working with adolescents' religious and spiritual identity.

This article explores the relevance of adolescents' spiritual, religious, atheist, and agnostic identity development in the therapy process and the potential difficulties that psychologists face in effectively working with adolescents around spiritual/religious issues. Psychologists' limited personal and professional opportunities for increasing their self-awareness around their spirituality and religion may impact their ability to adequately address issues related to the spiritual/religious identity development of their adolescent clients. Psychologists' limited knowledge, awareness, and skills in reference to the process of adolescents' spiritual/religious/nonreligious identity may result in their neglect of spiritual/religious issues in psychotherapy. In such cases, adolescent clients may feel unsure if therapy is a safe place to discuss spiritual, religious, atheist, agnostic questions or issues that arise for them. The article concludes with practical suggestions that are framed around six critical concerns that are relevant for adolescents: (a) the relationship between spirituality/religion and health and coping, (b) negotiating multiple social identities, (c) religious cults, (d) religious conversion experiences, (e) anti-religious sentiment or religious discrimination, and (f) ethical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of copper(II)-pyruvaldehyde bis (N-4-methylthiosemicarbazone) for tissue blood flow measurement using a trapped tracer model

PURPOSE: Adolescent childbearing is twice as common among Native Americans as among all US races combined. Despite this, little is written about the psychosocial context or prenatal care of pregnant Native American adolescents. The objective of this study was to explore the reactions and prenatal care of Navajo and Apache adolescents delivering infants at Shiprock Indian Hospital, New Mexico, between January and March 1991, and Whiteriver Indian Hospital, Arizona, between May and June 1991. METHODS: Of the 25 eligible adolescents aged 19 years and younger, 15 Navajo and 5 Apache participants were interviewed within 24 hours of delivery. The interview consisted of 121 questions divided into 5 areas: sociodemographics, personal and family reactions to the pregnancy, knowledge and attitudes toward prenatal care, barriers to care, and ways to improve access to care. RESULTS: The mean age was 17.4 +/- 1.1, 6 were married, and 13 were primiparous. According to the Maternal Health Services Index, 5 adolescents received adequate, 13 intermediate, and 2 inadequate prenatal care. During the pregnancy, 3 adolescents used tobacco, 3 used alcohol, and none admitted to other drugs. Although only 1 adolescent planned the pregnancy, 15 were not using contraception when they became pregnant. In exploring reactions to the pregnancy, 13 adolescents were afraid to tell their families and 4 concealed the pregnancy until confronted. During the pregnancy, 7 adolescents described loneliness and 6 expressed suicidal ideation. Although over half reported no barriers to obtaining prenatal care, barriers that were noted by the remainder included transportation, family problems, and missing school. CONCLUSION: We conclude that pregnancy among many American Indian adolescents is unplanned and characterized by uncertainty and fear of disclosure, resembling the reactions to pregnancy of other adolescent populations. Furthermore, despite universal access to health services, many American Indian adolescents continue to experience barriers to care and receive intermediate or inadequate prenatal care. These preliminary findings suggest further research may help clarify how adolescent reactions to pregnancy and knowledge of prenatal care affect health care utilization.     

Investments in behavioral health services: Strengthening the safety net.

As the primary Federal agency at the U.S. Department of Health and Human Services for improving access to health care services to the medically, financially and geographically vulnerable, the Health Resources and Services Administration (HRSA) is committed to improving health outcomes and achieving health equity by funding access to quality services, a skilled health workforce, and innovative delivery programs. Furthermore, HRSA recognizes the importance of access to quality behavioral health services. This article describes HRSA's current efforts to address behavioral health needs within the safety net through the delivery of quality health services and a strengthened workforce. Also, it highlights HRSA's commitment to providing good quality mental health and substance abuse services through key federal and nonfederal partnerships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Strengthening mental health services in Head Start: A challenge for the 1990s.

Steps must be taken to strengthen mental health services by building on Head Start's philosophy and by translating innovations in mental health services for older children and adolescents into improved services for young children and their families. Recommendations for strengthening Head Start's mental health program include creating a unified vision that reaffirms a holistic, family-focused, and comprehensive services approach; ensuring that mental health services are responsive to the diversity in families served; increasing coordination of mental health services and linkages with new initiatives; increasing resources and providing assistance in gaining access to new sources of funding; supporting innovation; and integrating the new paradigm for children's mental health services into more traditional approaches to intervention within Head Start. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investing in our future: Unrealized opportunities for funding graduate psychology training.

Purpose: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. Conclusion: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived parent-child relationships and early adolescents' orientation toward peers.

Examined the links between children's perceptions of the manner in which they and their parents adjust their relationships during early adolescence and early adolescents' orientation toward parents and peers. A sample of 1,771 children completed self-report questionnaires during the spring of their 6th and 7th grades. As predicted, early adolescents who believed their parents asserted and did not relax their power and restrictiveness were higher in an extreme form of peer orientation. Also as predicted, those who perceived few opportunities to be involved in decision making, as well as no increase in these opportunities, were higher in both extreme peer orientation and peer advice seeking. Discussion focuses on the importance for parent–child relationships to adjust to early adolescents' changing developmental needs, as well as the implications of early adolescent peer orientation for later development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Processes linking adolescent well-being, marital love, and coparenting.

This study examined coparenting in a sample of 177 two-parent families with firstborn adolescents by using annual home interview data from mothers, fathers, and adolescents. With a path-analytic approach and with earlier problem behaviors controlled for, coparenting conflict predicted relative increases in adolescent risky behavior over 2 years. In addition, evidence for 2 types of mediation was found. Marital love mediated the link between adolescents' early risky behavior and coparenting 1 year later, and coparenting conflict mediated the link between marital love and adolescents' risky behavior 1 year later. Linkages did not emerge for coparenting cooperation or triangulation. Interventions that are focused on the marital and coparental relationships in families with adolescents may modify trajectories of adolescent risky behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent health care: A public policy perspective.

Focuses on the importance of psychosocial and behavioral components of health care in the area of adolescent health care. The authors contend that it will ultimately be as a direct result of psychology's tangible (and visual) successes in areas such as adolescent health that will lead to psychological services becoming fully accepted within the overall health care system. The underlying policy notion is that if psychology addresses society's perceived needs, society (i.e., the nation's public policy/political leadership) will strive to meet the mental health profession's needs. The majority of problems adolescents face, regardless of apparent physical symptomatology, are essentially behavioral (psychosocial) in nature. The symptom distress model provides for a school-based integration of psychological knowledge with clinical and educational expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting adolescent mental health in primary care: a review of the literature

High levels of psychological disturbance amongst adolescents have been linked to behaviours which can damage physical health, and with mental health problems in adulthood. The aim of this review was to see if published literature supports the hypothesis that primary care is a suitable setting in which mental health problems in adolescents can be prevented by early detection and treatment. Medline, BIDS, SIGLE and Psychlit databases (January 1990-February 1997) were systematically searched for English language studies on adolescent health promotion and mental health in primary care; reference sections were checked for earlier work. When offered, adolescent health checks and clinics have been well received with attendance rates of 73% and 83% reported, respectively. Primary care offers a setting for the prevention and detection of mental health problems in adolescents. Further research is needed to determine cost effective ways of using these opportunities.     

Hidden problems in current health-care financing and potential changes.

Health-care costs in the US have risen significantly in the past 10 yrs, markedly affecting access to quality medical and mental health care. Deficit financing of our federal health-care expenditures adds billions of dollars annually to our national debt. Health-care reform is being hindered by both the inability of the government to pay for the uninsured and the unremitting spiral of the Medicare and Medicaid entitlement programs. The reasons for the total health-care cost increases include higher provider charges, overutilization of services, and the burgeoning technology; problems of malpractice, overspecialization, and consumer demands have also fueled the higher costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medicaid policy: Psychology's overlooked agenda.

Although psychologists are recognized as autonomous providers under almost every major federal health care initiative, they are not federally recognized as such under Medicaid because of Medicaid's unique federal–state partnership. State-by-state information on the access to psychologists under state Medicaid regulations are presented. As the move toward national health care reform becomes increasingly evident in the 1990s, psychologists have the responsibility and the opportunity to design innovative, behaviorally oriented health care delivery models in response to the national concerns of adequate coverage, access, and quality care. To do this, psychology as a profession must gain formal recognition under the various state Medicaid plans, either on a state-by-state basis or by way of federal mandates (as it was achieved by professional nursing). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-informed perspective in their practices to enhance the quality of care for these children. This includes making sure that children and adolescents are screened for trauma exposure; that service providers use evidence-informed practices; that resources on trauma are available to providers, survivors, and their families; and that there is a continuity of care across service systems. This article reviews how traumatic stress impacts children and adolescents' daily functioning and how various service systems approach trauma services differently. It also provides recommendations for how to make each of these service systems more trauma informed and an appendix detailing resources in the National Child Traumatic Stress Network that have been produced to meet this objective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

U.S. mental health policy: Proactive evolution in the midst of health care reform.

Argues that it is vital that psychological and behavioral health care perspectives be explicitly recognized during the coming reform of the US health care system. Mental health policy should not be treated as a mere extension of physical health policy; to do so extends all the flaws of the physical health system into the psychological care arena, resulting in a mismatch with the actual health care needs of the nation. Furthermore, organized psychology must remind policymakers that psychologists provide health services in areas of health care beyond mental health. The challenge to psychology is to ensure the continuation of adequate and timely access to appropriate psychological and behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent sexual and reproductive behavior: a review of the evidence from India

Despite the fact that adolescents represent almost one quarter of the Indian population, their reproductive health needs are poorly understood and ill served. This paper documents the existing research on sexual and reproductive health, explores the knowledge and attitudes among this population in India, and highlights limitations of methodologies currently employed in research on adolescent reproductive health in India. One serious limitation is the lack of attention in almost every dimension of their reproductive health, including sexuality, reproductive morbidity, abortion-seeking and reproductive choice. What is needed is more behavioral research that explores the levels, patterns, and sociocultural factors underlying adolescents' reproductive health; assesses adolescent reproductive health needs and ways in which health and information services can be structured to respond to these needs in light of the social, cultural and economic constraints that adolescents face; and explores appropriate methodological alternatives, recognizing the need for community-based research, as well as the difficulties of conducting such research under the sociocultural constraints prevailing in India. At the same time, this review argues for far more attention within programs to address adolescent reproductive health service and information needs.     

The political agenda of health care for African Americans

Health care reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in health care services. To this end, the Volunteer State Medical Association has been involved in state health care reform. Its goals are to resolve the current financial crisis at black medical institutions; to assist in the survival and development of local black managed care organizations; to assure that all licensed black physicians have continued access to patients; and to develop black-owned health-related businesses. The association has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of health care reform.