What community health centers can offer teens
By Anita Brakman, MS
Director of Education, Research & Training
Physicians for Reproductive Choice and Health
New York City
Melanie Gold, DO, FAAP
Clinical Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician
University of Pittsburgh Student Health Service
Implementation of the Patient Protection and Affordable Care Act of 2010 (ACA) will be an ongoing process, but one major change that already has begun is the expansion of community health centers (CHCs).
The new law provides $11 billion to CHCs over five years for these centers to expand capacity to meet increasing demand as more Americans receive public or private health insurance. A significant portion of the newly insured population visiting CHCs will be adolescents and young adults, because ACA expands eligibility for Medicaid for children ages 6-18 and provides young adults up to age 26 with the option to remain on a parent’s private insurance plan, regardless of financial dependence or academic status.1 In addition to expanding the number of insured adolescents, pediatric services and preventive services, both of which include a range of health care services for adolescents, are among the ACA’s 10 required areas of essential benefits.
Community health centers already are providing care for adolescents. In 2010, 19% of patients at federally qualified health centers were between ages 13 and 24, with 8% falling into the younger group (ages 13-17) and 11% in the older group (ages 18-27).2 If CHCs provide comprehensive and adolescent-friendly health services, including sexual and reproductive health, they will be better able to serve their current teen patients as well as the growing number of insured adolescents and young adults. Of course, CHCs, providing a safety net to those in need, also serve uninsured and underinsured adolescents.
How can they be more teen-friendly?
There are several guides to providing adolescent health services created by professional organizations. One of the most widely known is the American Academic of Pediatrics’ Bright Futures.
Bright Futures, a broad set of principles, strategies, and tools, can be used to improve the health and well-being of children through culturally appropriate interventions that address current and emerging health promotion needs at family, clinical practice, community, health system, and policy levels.3 The National Association of Community Health Centers, the American Academy of Family Physicians, and many other organizations are partners in Bright Futures. Among the resources available for adolescent health are sample visit forms and medical, developmental, behavioral, and psychosocial assessment and screening tools, as well as resources for talking to parents and teens.
Additionally, the Society for Adolescent Health and Medicine (SAHM) is an essential source of information for providers and sites trying to expand or improve services for adolescents. The SAHM website, www.adolescenthealth.org, includes administrative tools on billing and coding as well as a wide variety of clinical resources on topics ranging from confidential care to vaccines and sexually transmitted infections.
Confidentiality is key
Among all available tools, a few practices stand out as critical to creating an adolescent-friendly environment, regardless of practice setting.
First, confidential services must be available to teens. While it remains important to promote family communication, this priority should not create barriers to minors accessing preventive care or treatment. To this end, it is necessary to establish clear confidentiality policies, to educate staff at all levels as well as patients and parents in advance, and to stay aware of state laws governing minors’ confidentiality and ability to legally consent for care. When considering newly insured young patients, especially those using their parents’ insurance, it also is crucial to include billing and insurance practices in creating effective confidentiality protocols.
Second, a center should be physically accessible to teens and young adults. This accessibility can mean many things, but some practices to consider include having a teen-friendly waiting area or dedicated clinic days or hours where teens are encouraged to make visits. Even if a dedicated teen clinic is not possible to implement, it is important that a clinic is open during hours that are convenient for adolescents, such as after school or on weekends.
By taking advantage of community health centers’ focus on integrated and primary care, teens can benefit from comprehensive services, another important part of adolescent-friendly care. While a young patient might be in clinic for a sports physical, this time also is an opportunity to check in about the teen’s health more broadly and to discuss topics such as home life, school, mental health, diet and exercise, sexual health, and healthy relationships.
Fortunately, some provisions of the ACA also make these services easier for youth to access. As of Aug. 1, 2012, preventive services including well visits, vaccinations, domestic violence screenings, and contraceptive counseling are available to patients without co-pays. While not all services can be available on site, CHCs should build strong relationships with other health centers and community organizations in the area to provide referrals to resources such as dental care, mental health services, nutrition and dietary counseling, substance abuse assessment and treatment, abortion care, and support in finding housing, educational opportunities, and employment. In return, the CHC can offer itself as a resource for primary care, health information, education, and health advocacy.
If community health centers act now to integrate adolescent health services, they will be prepared as the number of youth and demand for preventive health care grows during ACA implementation and beyond.
References
- English A, Park MJ. The Supreme Court ACA Decision: What Happens Now For Adolescents And Young Adults? Chapel Hill, NC: Center for Adolescent Health & the Law and San Francisco: National Adolescent and Young Adult Health Information Center; 2012.
- U.S. Department Health and Human Services. Health Resources and Services Administration. 2010 data snapshot. Accessed at http://1.usa.gov/Z60Rl9.
- Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.
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