Health Care Reform and Adolescent Health Service Delivery: Principles and Principals

Richard E. Kreipe MD, FAAP, FSAM

Society for Adolescent Medicine (SAM) Immediate Past-President

Rochester Leadership Education in Adolescent Health (LEAH) interdisciplinary Training )Project Director

Institute of Medicine May 14, 2009

SAM Mission The Society for Adolescent Medicine is a

multidisciplinary organization committed to improving the physical and psychosocial health and well-being of all adolescents through – Advocacy– Clinical care– Health promotion– Health service delivery– Professional development– Research

SAM Core Values

Excellence: SAM strives to achieve the highest attainable standard in its mission.

Leadership: SAM strives to be the preeminent organization and authoritative voice in advancing adolescent heath by increasing awareness of the health needs of adolescents and young adults through effective advocacy, communication and dissemination of knowledge.

SAM Core Values Integrity: SAM is guided by the highest ideals

and ethical standards, including respect for individual dignity, equity, and justice, and recognition that age-appropriate, developmentally-sensitive health care is a right and not a privilege.

Collaboration: SAM recognizes that advancing adolescent health depends upon effective partnerships among adolescents, families, health professionals, public and private sectors, communities, schools, and other social institutions.

SAM & Health Care Reform: Opportunities in Adolescent Health Care

Adolescence--unique opportunity to prevent health conditions and behaviors with lifelong implications for young people and for society.

Health care services– Prevention of health problems– Transition services for youth with chronic

conditions to effectively manage their health.

SAM: Principles of Health Care Reform Assure financial access to services

– Health insurance coverage for all adolescents – Publicly funded safety-net programs

• Providing special services to adolescents • Reach special populations of young people.

Establish a comprehensive benefit package– Services for prevention, screening, diagnosis,

and treatment– Full range of acute and chronic physical, mental,

and behavioral health concern.

SAM: Principles of Health Care Reform Expand workforce prepared to serve adolescents

– Support adolescent-focused education and training programs for health care professionals.

Establish reimbursement policies that provide adequate payment – Wide range of clinicians – Incentives for high-quality, cost-effective care

Establish reimbursement policies that support delivery of services in diverse settings

SAM: Principles of Health Care Reform

Ensure confidentiality protections for– Communications with health care professionals– Health care records, including electronic records

Address general needs of adolescents and young adults, as well the needs of special populations:– Foster care– Juvenile justice– Homeless and runaway youths– Pregnant and parenting teens– Immigrant and migrant youth– Chronic physical or mental health conditions

SAM/LEAH: Role in Health Promotion & Health Care Professional Development

Adolescent Health Services Systems (IOM chapter 4)

– Evidence-based, standardized screening tools, management and referral processes in 1° care offices, community-based health centers, hospital-affiliated 1° and specialty care clinics, SBHCs

– Facilitated linkages between 1° and specialty care

– Expanded connections between 1° care settings and community agencies providing health promotion, behavioral health and youth development services delivered by appropriately trained adolescent medicine professionals

SAM/LEAH: Role in Health Promotion & Health Care Professional Development

Workforce Preparation (IOM chapter 5)

– Levels: Generalist; Specialist; Educator/Scholar

– Competencies: Scope of practice; Curricular development and evaluation; Standards of knowledge and skills; Standards of Quality

– Models: Interdisciplinary; Discipline-specific; Continuing Education

– Innovations: Simulated patients; Interactive distance-learning; web-based professional development opportunities

Summary Opportunity to transition to systems of

adolescent health services that WORK

Organizational changes at SAM present an opportunity to fill gaps in health services through advocacy, promotion of effective service delivery models, professional development, and research

The MCHB LEAH interdisciplinary training model is poised to take the training of adolescent health researchers, clinical specialists and educator-scholars to scale, with expanded funding