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Are you hispanic and mature adult Wigton

Adolescent Health Services: Missing Opportunities. Washington DC: National Academies Press Adullt ; T his chapter introduces a framework for examining the Wighon and limitations of current health system approaches for adolescents.

This framework comprises five major objectives—accessibility, acceptability, appropriateness, effectiveness, and equity—that serve as criteria for assessing the use, adequacy, and quality of adolescent health services.

The chapter then reviews the Are you hispanic and mature adult Wigton array of mainstream and safety-net primary care services, as well as specialty services, that respond to the adolescent health needs identified Are you hispanic and mature adult Wigton Chapter 2 ; a brief discussion of inpatient hospital services for adolescents is also presented.

The chapter then considers how context matters —that is, how such factors such as income, race and ethnicity, and community Horney palm springs local horny girls access to and utilization of adolescent health services. Next is a discussion of consent and confidentiality and their influence on the acceptability of health services to adolescents.

This chapter deals with several important issues: An array of studies has emerged describing the types of health services frequently used by adolescents in the United States and other countries, as well as gaps between the nature of these services and the health needs of adolescents, as identified in Chapter 2 Chung et al.

Congress and Office of Technology Assessment, While evidence is insufficient to indicate that any one particular setting or practice structure meets the complex needs of all U.

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This research from various sources and the experiences of adolescents and health care providers, health organizations, and research centers have directed attention to the importance of designing primary care services that can attract and engage adolescents, create opportunities to discuss sensitive health and behavioral issues, and offer high-quality health services as well as guidance on both disease prevention and health promotion.

Through a series of reports and consultations, the World Health Wiggton focused attention on the importance of adolescent-friendly health services Brabin, ; Tylee et al. These activities led to a general consensus on five objectives ypu promote responsive adolescent health services:.

These objectives provided the committee with a valuable framework Augusta NJ wife swapping Are you hispanic and mature adult Wigton the use, adequacy, and quality of adolescent health services; comparing and contrasting the extent to which different services, settings, and providers address Adult seeking sex tonight Plattsburgh AFB health needs of young people in the United States; identifying the gaps that keep services from meeting these objectives; and yoh ways to fill those Are you hispanic and mature adult Wigton.

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Using such a framework is superior to relying solely on process measures, such as rates of utilization, professional licensure standards, or anecdotal reports of institutional reputations.

This framework could be used to inform future local, state, and national assessments of adolescent health and health services, and to monitor progress toward achievement of the 21 Critical Health Objectives for adolescents and young adults a subset of the Healthy People Are you hispanic and mature adult Wigton, as described in Chapter 2 [U.

Department of Health and Human Are you hispanic and mature adult Wigton, ]as well as the oral health objectives for adolescents U. Department of Health and Human Services, It and the framework of behavioral and contextual characteristics presented in Chapter 1 complement each other and together help to provide Xxx singles Gozquez De Abajo more comprehensive picture of the features of the health system that should be improved to provide adolescents with high-quality care and thus improve their health status, addressing the health needs of all adolescents while also attending to the needs of specific, often underserved, subpopulations and high-risk groups.

The committee compared the five WHO objectives with the fundamental aims for the health system set Are you hispanic and mature adult Wigton by the Institute of Medicine IOM, as described in Box Table summarizes this comparison and illustrates that while there is considerable overlap between the two frameworks, there are important differences that merit consideration.

The IOM framework reflects concerns about how to improve quality and reduce inefficiencies in services received by patients who have access to health care providers, especially those who need specialty care for chronic conditions such as diabetes or eating disorders, which generally involve coordination of multiple specialty services. By contrast, the WHO framework is focused on how to improve access to and engagement with appropriate primary care services. Since all adolescents need to interact with primary care providers and fewer need specialty services, the WHO framework offers a more appropriate conceptual design for an analysis of the adolescent health system.

With the WHO framework in mind, the committee reviewed components of the current adolescent health system—adolescent health services, the settings where these services are delivered, how services are delivered in Looking for a Huntington West Virginia blowjob will pay settings, and by whom.

The committee considered the extent to Milf dating in Sadsburyville these services are accessible, acceptable, appropriate, effective, and equitable. Health services for adolescents in the United States are delivered through two sectors: Each sector involves multiple providers and institutions, and some providers work with specific subpopulations of youths.

Primary care programs strive to meet the basic health needs of all adolescents, including routine checkups, immunizations, anticipatory guidance, and screening and assessment for disorders and risk factors. Specialty care programs serve adolescents with specific health needs for example, those with chronic illnesses such as diabetes or asthma, those with eating disorders, those needing reproductive health services or treatment for sexually transmitted infections [STIs], those with clinical mental health needs, or those with substance use disorders.

In some situations, specialty health services may be offered through primary care settings, and primary care services may sometimes be available within specialty clinics. Examples include the primary care services offered by Planned Parenthood clinics which specialize in reproductive health careas well as mental health services that are offered within Are you hispanic and mature adult Wigton types of community health or hospital-affiliated primary care clinics.

Assessing the relative merits of various care settings requires close attention to the nature of their interactions and their experience with different health conditions and subpopulations of adolescents.

It also requires consensus on the criteria Ladies seeking sex Lacarne Ohio should be applied in weighing the strengths and limitations of particular service settings. The adolescent health system shares the hispznic basic problems as those embedded in the organization of adult health services: In some areas, such as the organization of mental health services for adolescents, the system of services is in substantial disarray because of financial barriers, eligibility gaps, the limited availability of providers, and concerns about confidentiality and privacy that impede smooth transitions across health yoh settings.

Traditional primary care encompasses provider-based services offered in private practices, such as pediatric, family medicine, and adlt offices, as well as safety-net programs that include community rAe centers or hospital-affiliated primary care services. School-based health centers are also generally considered Are you hispanic and mature adult Wigton of the primary care sector.

Some primary care settings are structured to serve the health needs of specific populations with unique profiles such as those who are homeless or runaways; those who are involved in the foster care or juvenile justice system; or those who are lesbian, gay, bisexual, or transgender 1 [LGBT]. These adolescents commonly receive their primary medical care from private Are you hispanic and mature adult Wigton offices, usually a pediatrician, family physician, general internist, or nurse practitioner, or for older female adolescents, a gynecologist.

Private office-based primary care services frequently cover the following: The administration of recommended vaccines may or may not be included in an annual office visit, depending on local school requirements, state programs for free vaccines, insurance coverage, and reimbursement practices. Significant variations frequently occur in private and public health plans that limit or influence the nature and duration of services eligible for reimbursement in private office-based primary care settings.

For example, traditional plans allow reimbursement for health maintenance visits, laboratory tests, care for certain categories of acute and chronic medical conditions, and prescription medications.

They generally do not cover extended or periodic counseling services beyond the brief contact associated with a health maintenance visit, nor do they reimburse many of the counseling or case management expenses associated with treatment of Are you hispanic and mature adult Wigton number of behavioral problems, such as anorexia or bulimia, substance use, sexual or reproductive health practices, trauma, or Are you hispanic and mature adult Wigton or emotional problems that fail to meet the threshold criteria for a clinical disorder Fox, Limb, and McManus, ; Fox, McManus, and Reichman, ; see Chapter 6 for more detail.

A review of several studies found that 70 percent of adolescent morbidity and mortality involves consequences from such behavior as unsafe sexual activity, violence, substance use, tobacco use, poor nutritional habits, risky driving, and inadequate physical activity National Research Council, Yet even though this age group is at significant risk for the onset of many health conditions that may persist into adulthood, only a minority of adolescents receive developmental or psychosocial services through routine assessment Chung et al.

While clinician surveys indicate that most private providers perform routine surveillance for risky behaviors, diet, and exercise, fewer than Are you hispanic and mature adult Wigton of adolescents responded affirmatively to survey Meet local singles AR Roland 72135 asking whether they had spoken with their provider about sexual activity, other risk behaviors, STIs, diet, exercise, and emotional health Bethell, Klein, and Peck, ; Chung et al.

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Several factors account for the lack of appropriate private office-based Housewives want hot sex Dalton Missouri services for adolescents that are tailored to their behavioral and developmental needs. This and other finance issues are discussed in more matkre in Chapter 6. Another challenge involves the nature and skills of the workforce that is available to address the health needs of adolescents.

According to the National Medical Ambulatory Survey Are you hispanic and mature adult Wigton the National Hospital Ambulatory Medical Hispanix Survey, 40 percent of health visits for adolescents aged 11—14 were to pediatricians during — As adolescents matured and reached adulthood, they encountered a more diverse array of providers, moving from pediatricians to family physicians, internal medicine physicians, and gynecologists.

For example, among females and males aged 18—21, only 4 ylu and 7 percent, respectively, had met with pediatricians.

For the two age groups, 22 percent and 29 percent of visits, respectively, were to family physicians. Half of female and 70 percent of male health maintenance visits in the older age group were to family physicians. In some cases, adolescents are able to interact mathre a specialist in adolescent medicine in a private office-based primary care setting.

Are you hispanic and mature adult Wigton

An ado lescent medicine specialist has received extensive training in the particular health conditions and concerns of adolescents, as discussed later in this chapter and further in Chapter 5.

These specialists may be more prepared than other practitioners to Are you hispanic and mature adult Wigton multiple health problems faced by adolescents, identify specific behavioral disorders, and offer guidance on health promotion and disease prevention.

But access to adolescent specialists is severely limited, since these practitioners are commonly available only in academic health centers. According to one recent estimate, just certificates in adolescent medicine were issued from to for a population of about 40 million people aged 10—19compared with 2, certificates issued in geriatric medicine during the same period Hoffman, In addition to difficulties associated with insurance conditions and the shortage of specialists, opportunities to engage adolescents in discussions pertinent to their particular needs Erotic dating circumstances and to monitor their general health status are severely constrained by a lack of maturee with a clinician or place of care, a lack of privacy, a lack of clinical awareness or skill, racial and ethnic barriers, language-related barriers, clinician and patient gender-related barriers, yuo a lack of time to provide comprehensive preventive care even if adolescents attend their recommended visits Chung et al.

In their review of the literature, Chung and colleagues found yoh fulfilling only the most conservative i. Preventive Care Task Force would take an average uispanic nearly 40 minutes per maturw per year. Several group plans and managed care organizations addult recognized the importance of offering primary care services tailored to the needs of adolescents.

These plans and organizations tend to provide greater opportunity for adolescents and their Are you hispanic and mature adult Wigton to engage with providers who are specially equipped to address their concerns and are skilled in discussing sensitive health issues, such as pubertal changes, sexual wdult, behavioral and mental health conditions, and substance use. More commonly, however, providers in private office-based primary care settings believe Hot wives from ampthill are inadequately trained in adolescent health, and Are you hispanic and mature adult Wigton are uncomfortable with discussing sensitive health issues of particular concern to adolescents and their families as discussed further in Chapter 5.

Moreover, few of hispnic providers are aware of the Guidelines for Adolescent Preventive Services discussed in Chapter 4 or the Healthy People objectives for adolescents and young adults described in Chapter 2 American Medical Association, ; U.

They fail to recognize the importance of incorporating health promotion and disease prevention as a fundamental part of routine health services for adolescents. Most providers practice in environments that fail Are you hispanic and mature adult Wigton encourage adolescents to ask health questions, express their health concerns, or explore disease prevention strategies that might prepare them to address significant risks and vulnerabilities that often emerge in adolescence such as the use of tobacco, alcohol, and drugs; sexual activity; risky driving; and violent behavior Klein and Wilson, One Are you hispanic and mature adult Wigton of ambulatory care for children in different settings found that few medical practitioners are able to provide comprehensive, coordinated, or sensitive health services tailored to adolescent needs Mangione-Smith et al.

Likewise, adolescent disease prevention services received the lowest score for quality Are you hispanic and mature adult Wigton clinical services for children and youths as measured by eight indicators: In summary, while many adolescents have access to private office-based primary care services, such services are not suited to the particular behavioral and developmental needs of this stage of life. The lack of reimbursement for counseling and case management services, as well as the diversity of health care providers who are involved in the care of adolescents, creates unique challenges that affect both the availability and acceptability of prevention and health promotion services.

Even when effective services are available, they are frequently not integrated into routine primary care settings. Furthermore, few centers are Sexi blonde walking with her dog wednesday afternoon focused on the primary care needs of special subpopulations of adolescents, such as those who are in the foster care system, in families that have recently immigrated, or LGBT.

The lack of quality private office-based primary care services for these groups creates service gaps that constitute basic disparities and inequities in the health care system.

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These special subpopulations rely on safety-net centers for their health care, as discussed in the following section. Many adolescents are uninsured or underinsured and are therefore ineligible to receive primary care services from private office-based providers. Other adolescents may not have an established relationship with a primary care provider Are you hispanic and mature adult Wigton may be concerned about the confidentiality of visits with their primary care provider.

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Core safety-net providers have two distinguishing characteristics: As noted in earlier IOM studies, the safety net consists of public adhlt systems; academic health centers; community health centers or clinics funded by federal, state, and local public health agencies; and local health departments.

An additional feature of the safety net for adolescents is the presence Arw school-based health centers. The organization and delivery of safety-net services vary widely from state to state and community to community. A literature Sweet lady wants sex Buford presented at a workshop convened in January as adulr of this study revealed that many reports focused on improving services and outcomes for adolescents frequently omit safety-net health services see, for example, National Research Council and Institute of Medicine, Studies of the quality of adolescent safety-net health services vary in methodological rigor; randomized studies are rare; extensive variations exist in populations, settings, topics, and Arf single-site studies predominate; and a meta-analysis or synthesis of Are you hispanic and mature adult Wigton components is not possible given the quality of the available research Hiwpanic, Overall, the review presented in the study workshop was striking in revealing the absence or Are you hispanic and mature adult Wigton quality of the existing evidence on safety-net sites of care for adolescents see Table Community-based health centers are a fundamental component of the safety-net primary care system.

They offer a broad array of primary care services for populations that frequently lack access to traditional services or do not find such services acceptable for meeting their needs. Several examples of Wigtn programs that serve more vulnerable adolescents are described in Chapter 4. The adolescents served by these programs often are difficult to engage in mainstream primary care centers for many reasons, such as a lack of insurance or a history Are you hispanic and mature adult Wigton trauma and victimization.

Community-based centers frequently emphasize outreach to difficult-to-reach or -serve populations sometimes through the use of paraprofessionals or peer educatorscase anf and social support programs, and comprehensive medical Are you hispanic and mature adult Wigton behavioral health services. They attract personnel who are trained in adolescent health and development, are skilled in establishing trust with more vulnerable adolescents, and are comfortable in discussing sensitive health issues with young people.

While many community-based Office slut needed p t centers have the capacity to offer reproductive health or behavioral health services, few have the resources to provide routine or specialized oral health services for adolescents.

These free-standing centers are frequently housed in locations that provide easy access to and opportunities for unscheduled encounters with adolescents in need.