Adolescent Health in an Evolving Health Care Landscape: Part One

A group of multiracial adolescent friends hugging and looking at each other as they face away from the camera.

As health care providers who work with adolescents, we know that they face many challenges around health care as they transition to adulthood, while also experiencing issues with growth, brain development, increasing exposure to alcohol and drugs and increasing independence. We see firsthand how important it is for adolescents to learn how to navigate a complex system – sometimes without the assistance of parents and caregivers – identify when and where to seek care and determine how to prioritize their needs, all while balancing other competing issues, such as school, jobs and extra-curricular activities.

With a changing health care landscape on the horizon, including the possibility of the repeal of the Affordable Care Act, paying close attention to the issues facing this vulnerable population is more important than ever before.

Consider the case of Alexandra, an 18-year old college freshman with a new boyfriend whose school is a four-hour plane ride from home. While away at school, she and her boyfriend decide to have sex. A few weeks later, Alexandra finds herself in the local emergency department seeking care for a sexually transmitted infection (STI). The emergency room providers recommend that she find a local health care provider who can help address her long-term reproductive health needs, like STI prevention and contraception.

To help adolescents avoid situations like these, there are some basic steps pediatric providers and parents can take to help adolescents as they transition to adult care. Starting in the early teen years, pediatric providers should have private time with adolescents to help them become comfortable with talking about their own health needs. Providers, parents and caregivers should encourage teens to sign up for services that allow them to independently manage their health care, such as text messaging or email services that allow communication with health care providers, and also guide adolescents to identify new providers before leaving for college (including college student health services, reproductive health services and mental health services) so they know where they can go before the need arises.

Health care policies can make the transition process easier or harder. Given the expectation that the health care landscape will change substantially over the next four years, it is important that we examine how key policies may change and affect adolescents' ability to develop health care management skills.

Here at PolicyLab, we are committed to identifying the best evidence to support programs and policies that address the special health care needs of adolescents. This blog post is the first of a three-part series that will highlight the evidence and policies supporting adolescent transitions in care for those trying to access reproductive health services, those with mental health conditions and those with complex, chronic medical problems. This post focuses on adolescent reproductive health.

We are currently working on multiple research projects in this area, including:

  • Expanding the use of expedited partner therapy (EPT) to treat the partners of patients diagnosed with gonorrhea or chlamydia, through identification of barriers to the practice and development of policy and procedural solutions that will allow for consistent practice of EPT within and across states.
  • Improving access to sexual and reproductive care in the emergency department, where many teens at high risk for pregnancy and STIs seek care. We hope to identify strategies for brief contraceptive counseling that are appropriate for the emergency setting, and improve linkage to care around long-acting reversible contraceptives (LARCs) for this vulnerable population.
  • Developing strategies to improve the delivery of contraceptive services to adolescents in primary care, including: a program of peer contraceptive advisors; an initial reproductive health visit and accompanying website to educate adolescents and their parents about recommended reproductive health care; and a health coaching program to help adolescent contraceptive users identify and address potential barriers to continuing contraceptive use to avoid unintended pregnancies.
  • Exploring why pediatricians are not performing adolescent HIV testing by asking them to review real cases and charts of previous patients instead of relying on hypothetical questions or scenarios.
  • Relaunching and continuing the evaluation of the iknowushould2 social media campaign to increase awareness among youth in Philadelphia about STI/HIV testing and new prevention strategies including PrEP- a once daily pill that is more than 90 percent effective in preventing HIV infection.
  • Creating family-focused and clinician-focused decision support tools that when used alone or together effectively accelerate HPV vaccination rates for adolescent girls, which can in turn help them prevent multiple forms of cancer.

However, given the likely seismic shift in health care and health policy that could result following the recent presidential election, we’ll also be watching out for any threats to access to reproductive health services for adolescents, including:

  • Potential cuts in Medicaid, which could limit access to reproductive health providers or to critical reproductive health services, like STI testing and treatment and contraceptive services
  • Possible changes in regulations and coverage around contraception as a preventive health benefit, which could reverse the low rates of unintended pregnancies and their related costs that we’ve been able to achieve today
  • Funding cuts to Title X, a federal program that provides individuals with comprehensive family planning and preventive health services, which could lead patients to visit health care providers less frequently for STI testing, treatment and contraceptives resulting in delayed diagnosis of HIV or other sexually-transmitted infections

There are many unknowns about the future of health care policy and how it could impact adolescents’ health. By contributing interdisciplinary research that enables PolicyLab and our partners to advocate for what’s best for adolescents’ health, we hope to help shape policies as they are developed, help adolescents access the reproductive health services they need and want and, ultimately, ensure adolescents have a smooth transition into adult care.