For teenage patients, specialized adolescent medicine programs are “the best of both worlds,” says Frank Biro, MD, division director of academic medicine at Cincinnati Children’s Hospital Medical Center. “It’s where clinical expertise meets a recognition of the developmental aspects” of teenagers, he says.
“Dealing with adolescents is an art”, says Neville Golden, MD, division chief of adolescent medicine at Lucile Packard Children’s Hospital at Stanford in Palo Alto, Calif. “Our approach to delivery of healthcare is very different than the approach to younger children or to adult patients. Most adolescents do not actively seek treatment. Our goal is to engage teens in a confidential and supportive environment and motivate them to receive treatment,” he says.
While some children’s hospitals have had trouble recently retaining their teen patients, Eric Sigel, MD, of Children’s Hospital Colorado in Aurora has seen many of his patients reluctant to move on to adult providers: “They’ve gotten care here since age 12,” he says. “They’ve developed a bond with us — they don’t want to leave.”
Many aspects of the centers, from setting to approach, differentiate them from both adult and pediatric care — but all help to improve outcomes and keep patients coming back. All three exhibit proven best practices for any adolescent medicine center:
1. Ask about everything. These programs all emphasize a comprehensive approach to teen health. “We ask them a whole lot of questions” that may seem unrelated to why the patient came in, says Dr. Golden. “Helmet safety, drugs, depression, sex…we make sure to get a comprehensive assessment” of the patient, he says, to develop a comprehensive treatment plan.
This comprehensive assessment allows the physicians to diagnose what are often complex and multi-layered issues. “Adolescents face medical issues but also issues like depression, anxiety, decision-making and general ‘Who am I? Where am I going?’ problems,” says Dr. Golden.
Additionally, “so much of adolescent care is related to mental health issues,” says Dr. Sigel. Children’s Hospital Colorado has robust psychology and psychiatry outpatient therapy available to offer comprehensive treatment to the patients, he says.
2. Stress confidentiality. “There needs to be confidentiality,” says Dr. Sigel. “Adolescents need to be able to meet one-on-one with their doctor without their parent… you’ve got to get Mom out of the room and develop a relationship” to provide the best diagnosis and the best care, he says.
This relationship between the teenage patient and the physician has been embraced by parents at Cincinnati Children’s. Dr. Biro says that a recent parent survey has given the hospital high marks for engaging effectively with their teenage patients. “We never talk down to the adolescent” when discussing health issues one-on-one, says Dr. Biro, and always treat the adolescents with respect.
Dr. Golden agrees that parents see the benefit of leaving the room so the physician can talk with their child confidentially: “Parents like it, especially if there have been difficulties — they like knowing their child has a caring professional who can talk to them about these issues,” he says.
3. Offer specialized programs. Programs focused on treating a specific condition in adolescents can provide specialized care that addresses not only the medical issue but finds solutions that are appropriate for adolescents, improving outcomes.
Cincinnati Children’s Asthma Innovation Lab focuses not only on innovative treatments, but also on helping teens self-manage their condition. “We’re after the best ways to get the very best outcomes so that the patients have the highest quality of life possible,” says Dr. Biro.
At the Young Mother’s Clinic at Children’s Hospital Colorado, pregnant teenagers can receive prenatal care, and following their baby’s birth, can schedule a dual appointment with their newborn. “It’s a friendly and welcoming environment” that increases patients scheduling, and attending, follow-up appointments, says Dr. Sigel.
4. Give patients their own space. “Seeing toddlers and babies, and balloons on walls, is definitely not conducive to having teens come to pediatrics,” says Dr. Sigel. An adolescent medicine center should be more inviting to teenage patients, he says.
“We have a separate area for teens, so they’re not there with kids and infants,” says Dr. Biro. The décor of the center was made by teens, for teens, he says, to create a more welcoming and familiar environment for patients.
For teenage patients with chronic illnesses, Children’s Hospital Colorado has a teen center that provides both distractions and comforts. The center has “places to listen to music, movie nights, pool tables and a recording studio…it makes the environment more comfortable, so they don’t feel like they’re just surrounded by a bunch of stuffed animals,” says Dr. Sigel.
Adolescent medicine centers should not completely move away from the feel of pediatrics, however. “Pediatric hospitals are bright, friendly, open,” says Packard Children’s Dr. Golden. “Adult hospitals tend to be much more somber,” which might not make a teen feel comfortable, he says.
“Adolescents want to be adults, but they are really children,” says Dr. Golden. “A pediatric hospital that addresses their needs is the best place for them.”
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