By Dr Jeannie Knapp.
Overview
Working with young people can be both challenging and rewarding. They are different from their parents and need accessible and sensitive health care – including reassurances about confidentiality.
Young people prefer to see practitioners at a trusted practice, so there are a few simple things practitioners can all do to make our practices more youth-friendly.
Understanding adolescence
Adolescents (aged 10–24) make up 18.8% of the population of Australia and Victoria (ABS census 2016).
Adolescents are busy developing emotionally, physically, cognitively, psychologically and socially. From a Western perspective, the major developmental tasks of adolescence are:
- Achieving independence from parents and other adults
- Developing a realistic, stable, positive self-identity
- Formulating a sexual identity
- Negotiating peer and intimate relationships
- Developing a realistic body image
- Formulating their own moral/value system
- Acquisition of skills for future economic independence
Source: NSW Health.
Barriers to care for adolescents
Understanding what adolescents see as barriers to care can help practitioners to think about how we can improve our practices. Numerous studies (including Booth et al. and Access SERU) have identified the following major barriers to appropriate health care for adolescents:
Confidentiality
The most significant barrier identified by adolescents is fear about confidentiality and trust. This includes concerns about a GP disclosing information to their parents, lack of privacy in the waiting room and reception staff not protecting their confidentiality.
GP attitudes and communication style
Adolescents have concerns that GPs will have unsympathetic, authoritarian and judgmental attitudes. A GP’s approach and communication style has a significant impact on the young person’s comfort level and ease of communication.
Access and clinic environment
The clinic environment can have a negative impact on adolescents’ comfort in using the service. Many adolescents feel intimidated by a formal clinic and waiting room environment, appointment booking procedures, and may perceive a lack of sensitivity and awareness from reception staff. Clinic opening hours and long waiting times can lead to young people foregoing health care.
Cost
Cost can be a major barrier because many adolescents do not understand the Medicare system and few have their own Medicare card. Many have difficulty meeting the costs of medical care (especially when practices do not bulk bill) and other related expenses. Many believe that they cannot access a GP without payment or without their parents finding out.
Developmental characteristics of young people
Many adolescents have a poor understanding of their own health needs, a lack knowledge about available health services and how to use them, and have difficulty expressing their concerns because of the sensitivity of many of their health issues. They often feel self-conscious and anxious about being asked personal questions and defer treatment until a crisis stage. They are reluctant health consumers, often brought along by parents or other caregivers.
A few simple changes can make your practice more youth-friendly
The practice
- Be friendly, respectful and non-judgemental.
- Provide a range of youth-oriented magazines, for example: surfing, music and car magazines.
- Display posters and resources aimed at specific cultural groups, including CALD, LGBTIQ, and Aboriginal and Torres Strait Islander young people (resources are available on the Centre for Multicultural Youth and Minus18 websites).
- Display information about the practice’s privacy policy. The RACGP has a resource on Ensuring the privacy of patient health information and a sample privacy policy template for practices to use.
- Have access to online bookings.
- Consider bulk billing or reduced fees for adolescents.
In clinical practice
- Explain to adolescents why they have to wait, as they may not understand the process of medical consultations.
- Reassure the person you are seeing about confidentiality. Younger patients often do not understand that health practitioners take privacy and confidentiality very seriously.
- Spend some time with the adolescent on their own if they are accompanied by an adult.
- Consult the person on the best way to contact them if a follow up is needed, in order to protect their confidentiality.
- Understand people’s health rights and explain Medicare procedures to all adolescents who present alone.
- Keep an individual file for adolescent patients (separate from the family’s file).
Education for the practice team
- Educate reception staff on how to assist a young person (15 years and older) to apply for their own Medicare card.
- Provide an education session for your staff on consent, the Gillick/mature minor principle and confidentiality for young people to help them understand the mature minor principle for consent in those aged under 18.
- Educate the practice team on the changes around My Health Record for young people and how to assist a young person (14 and older) to set up their own My Health Record.
How does this help my business?
Adolescents make up nearly one fifth of the population, are reluctant consumers and have high health needs. Making your practice more adolescent-friendly will not only provide much needed access to a high need group, but also potentially improve your income.
Where can I find more information?
North Western Melbourne Primary Health Network is hosting a session on ‘Managing adolescent health and wellbeing in general practice’ for GPs, nurses and practice managers on 11 September 2019. Register for that session here.
HealthPathways Melbourne has pages on Consent and Tips and Resources for Adolescent Health.
If you do not have access to HealthPathways please contact info@healthpathways.org.au
Read about the nurse-led Teen Clinic at Bega Valley Medical Practice.
Medicare has specific legislation on how to get a Medicare Card at 15 years old. There is also information for parents on changes for children as they age from 13 to 19+.
From the age of 14 years, a young person can start to manage their own My Health Record. More information is available on the My Health Record website and this fact sheet for young people.
The Royal Children’s Hospital has a guide to creating adolescent-friendly services.
The World Health Organisation has a useful guide to adolescent responsive health systems.
References
NSW Health, Adolescent Health GP Resource Kit – Practice Points
NSW Health, Adolescent Health GP Resource Kit – Creating a Youth Friendly Practice
Disclaimer: This article was provided by Dr Jeannie Knapp. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
