Demographic and epidemiological transitions and burden of adolescent healthcare in sub-Saharan Africa: A review.

This review's main objective is to discuss how demographic and epidemiological transitions relate to the burden of adolescent healthcare in sub-Saharan Africa (SSA). The review explicitly discussed the burden of adolescent healthcare, the current African policies on adolescent healthcare, and gaps in the African policies compared with Europe and North America. We also examined how adolescent healthcare policies evolve and documented the recommended essential part of the policy for enhancing its sustainability. The burden of adolescent health is high in SSA with diseases and reproductive health-related problems prevailing among adolescents. However, variations exist in the burden of adolescent healthcare across countries in the region. While some SSA countries are currently undergoing demographic and epidemiological transition processes concerning adolescent health care, the majority are either at an early stage of the transition or yet to commence the process. Policy-makers should consider effective ways to improve adolescents' health in SSA through preventive mechanisms and a multi-dimensional approach.

Plano EVA-TO: plano de enfrentamento à violência autoprovocada do Estado do Tocantins com ênfase na atenção integral à saúde / EVA-TO Plan: plan to face self-inflicted violence in the State of Tocantins with an emphasis on comprehensive health care

O Plano de Enfrentamento à Violência Autoprovocada do Estado do Tocantins com Ênfase na Atenção Integral à Saúde foi desenvolvido para fortalecer a rede de atenção psicossocial, em colaboração com o Sistema Único de Saúde (SUS) e o Sistema Único de Assistência Social (SUAS). Elaborado pelo Grupo de Trabalho "Flor de Pequi", o plano tem como objetivo qualificar a Rede de Atenção à Saúde, orientando gestores e profissionais de saúde na prevenção da violência autoprovocada, automutilação e suicídio, além de promover o acolhimento e compartilhamento do cuidado na rede de atenção à saúde. O documento foi elaborado em resposta a demandas relacionadas aos dados de violência autoprovocada, solicitações do Conselho Estadual de Defesa de Direitos da Criança e do Adolescente e do Conselho Regional de Psicologia. A metodologia, discussão, metas, ações e monitoramento também são abordados no plano.

The Plan for Confronting Self-Inflicted Violence in the State of Tocantins with an Emphasis on Comprehensive Health Care was developed to strengthen the psychosocial care network in collaboration with the Unified Health System (SUS) and the Unified Social Assistance System (SUAS). Elaborated by the "Flor de Pequi" Working Group, the plan aims to enhance the Health Care Network by providing guidance to managers and health professionals in the prevention of self-inflicted violence, self-harm, and suicide, while promoting care and support within the health care system. The document was created in response to demands related to self-inflicted violence data, requests from the State Council for the Defense of the Rights of Children and Adolescents, and the Regional Psychology Council. The plan also addresses methodology, discussion, goals, actions, and monitoring.

El Plan de Enfrentamiento a la Violencia Autoinfligida en el Estado de Tocantins con Énfasis en la Atención Integral de Salud fue desarrollado para fortalecer la red de atención psicosocial en colaboración con el Sistema Único de Salud (SUS) y el Sistema Único de Asistencia Social (SUAS). Elaborado por el Grupo de Trabajo "Flor de Pequi", el plan tiene como objetivo calificar la Red de Atención a la Salud, brindando orientación a los gestores y profesionales de la salud en la prevención de la violencia autoinfligida, la automutilación y el suicidio, además de promover el cuidado y apoyo dentro de la red de atención sanitaria. El documento fue elaborado en respuesta a demandas relacionadas con datos de violencia autoinfligida, solicitudes del Consejo Estatal para la Defensa de los Derechos de la Niñez y la Adolescencia y del Consejo Regional de Psicología. El plan también aborda la metodología, la discusión, las metas, las acciones y el monitoreo

ASRHR in Ethiopia: reviewing progress over the last 20 years and looking ahead to the next 10 years.

Over the last two decades, improvements in Ethiopia's socio-economic context, the prioritization of health and development in the national agenda, and ambitious national health and development policies and programmes have contributed to improvements in the living standards and well-being of the population as a whole including adolescents. Improvements have occurred in a number of health outcomes, for example reduction in levels of harmful practices i.e., in child marriage and female genital mutilation/cutting (FGM/C), reduction in adolescent childbearing, increase in positive health behaviours, for example adolescent contraceptive use, and maternal health care service use. However, this progress has been uneven. As we look to the next 10 years, Ethiopia must build on the progress made, and move ahead understanding and overcoming challenges and making full use of opportunities by (i) recommitting to strong political support for ASRHR policies and programmes and to sustaining this support in the next stage of policy and strategy development (ii) strengthening investment in and financing of interventions to meet the SRH needs of adolescents (iii) ensuring laws and policies are appropriately communicated, applied and monitored (iv) ensuring strategies are evidence-based and extend the availability of age-disaggregated data on SRHR, and that implementation of these strategies is managed well (v) enabling meaningful youth engagement by institutionalizing adolescent participation as an essential element of all programmes intended to benefit adolescents, and (vi) consolidating gains in the area of SRH while strategically broadening other areas without diluting the ASRHR focus.

Ateneo General de la Residencia de Psicopedagogía: En busca de una oportunidad: Intervenciones psicopedagógicas en la clínica con adolescentes / General Athenaeum of the Psychopedagogical Residence: In search of an opportunity: Psychopedagogical interventions in the clinic with teenagers

Ateneo centrado en la intervención, la intervención psicopedagógica, y la intervención temprana y oportuna en la adolescencia. Se determinan qué imaginarios acompañan el concepto de adolescencia situando el discurso médico, normativo y social. Finalmente, se profundiza acerca de los espacios que desde el Sistema de Salud, y más específicamente desde el equipo de psicopedagogía del Hospital Vélez Sarsfield, se ofrecen a la población adolescente. Se incluyen fragmentos de entrevistas y reflexiones aportados desde la propia experiencia profesional.

Adolescent Health Series: The health of adolescents in sub-Saharan Africa: Challenges and opportunities.

OBJECTIVE: This article provides a concise overview of the current challenges that adolescents face in sub-Saharan Africa, summarises possible solutions and ongoing efforts to implement these, and briefly introduces the subsequent papers of this series. METHODS: We draw on data from the WHO Maternal, Newborn, Child and Adolescent Health and Ageing Data Portal. RESULTS: The opportunity provided by the growing number of adolescents in sub-Saharan Africa will only be realised if they survive, are healthy, receive a quality education and remain in Africa rather than joining the increasing out-migration exodus. Fortunately, there is an increasing focus on adolescent health and well-being both globally and in sub-Saharan Africa, and growing knowledge of what to do to promote adolescent health and well-being and how to do it, and a powerful resource in the form of adolescents themselves. CONCLUSION: There is no time to lose. African adolescents demand it, but are also ready to be part of the solution.

¿Hay alguien ahí?: Experiencias en la clínica psicopedagógica grupal con púberes en tiempos de pandemia / Anyone there?: Experiences in the psychopedagogical clinic group with pubescents in times of pandemic

Escrito del Equipo de Psicopedagogía del Centro de Salud Nº 10, perteneciente al Área Programática del Hospital Dr. José María Penna, de la Ciudad de Buenos Aires. Debido a la pandemia la atención clínica presencial debió ser suspendida, y se continuó con la asistencia a los pacientes de manera virtual. Con algunxs se realizaron seguimientos telefónicos con lxs referentes familiares y en algunos casos con lxs niñxs así como también se mantuvieron comunicaciones con las escuelas, derivaciones e interconsultas; con otrxs se logró cierta continuidad en el tratamiento por lo general a través de videollamadas de whastapp. Este es el caso del grupo de tratamiento de púberes del que se propone compartir y reflexionar. En la sede de este equipo, el abordaje clínico grupal data ya de varios años pero particularmente el grupo de púberes surgió en el año 2018. Por tanto, en un primer momento, se propone historizar y contextualizar al grupo de tratamiento psicopedagógico así como también compartir la concepción de la clínica grupal. Además, se comparten la conceptualización de la pubertad que sostiene el equipo y los procesos psíquicos esperables que se dan en este tiempo articulado con el contexto actual. (AU)

Dá el primer paso y los caminos aparecerán: Percepciones de los/as adolescentes sobre el taller de Orientación Vocacional Ocupacional / Take the first step and the paths will appear: Perceptions of adolescents about the vocational orientation workshop

El Equipo de Psicopedagogía del Área Programática del Hospital Vélez Sarsfield, implementa desde el año 1998 procesos de Orientación Vocacional Ocupacional (OVO) en el marco de la Atención Primaria de la Salud (APS), la cual tiene como objetivo generar la participación, autogestión y responsabilidad en el cuidado de la salud de la población en general. El proceso de OVO busca que los/as estudiantes sean protagonistas de su elección, pudiendo llegar a tomar decisiones autónomas y significativas respecto a su futuro y, de esta manera, optimizar así su calidad de vida. Particularmente en este contexto de pandemia por Covid19, se decidió re-pensar de qué modo continuar con la oferta de esta actividad a pesar del impedimento de llevarlos a cabo de forma presencial; se consideró necesario mantener estos espacios donde se pudiera acompañar a los/as adolescentes ante la incertidumbre de la elección de una carrera o trabajo. Por tal motivo, se pensó en la idea de diseñar y llevar a cabo un Taller de OVO de forma virtual y acotado en cantidad de encuentros. La presente investigación tiene como objetivo analizar las percepciones de los/as adolescentes que iniciaron y culminaron el Taller de Orientación Vocacional Ocupacional, realizado de manera virtual en el periodo de octubre a diciembre de 2020, en relación al dispositivo de Orientación Vocacional Ocupacional. (AU)

Technology Use for Adolescent Health and Wellness.

As avid users of technology, adolescents are a key demographic to engage when designing and developing technology applications for health. There are multiple opportunities for improving adolescent health, from promoting preventive behaviors to providing guidance for adolescents with chronic illness in supporting treatment adherence and transition to adult health care systems. This article will provide a brief overview of current technologies and then highlight new technologies being used specifically for adolescent health, such as artificial intelligence, virtual and augmented reality, and machine learning. Because there is paucity of evidence in this field, we will make recommendations for future research.

National Trends in Mental Health Care for US Adolescents.

Importance: The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined. Objective: To examine national trends in the care of different mental health problems and in different treatment settings among adolescents. Design, Setting, and Participants: Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019. Main Outcomes and Measures: Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined. Results: A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased. Conclusions and Relevance: This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reducing unnecessary investigations in adolescent gynaecology: The utility of pelvic ultrasonography for adolescents presenting with heavy menstrual bleeding.

BACKGROUND AND OBJECTIVES: Heavy menstrual bleeding (HMB) in adolecents is predominantly related to an immature hypothalamic-pituitary-ovarian axis. Structural causes in this population are extremely rare; therefore, pelvic ultrasonography is not required as a first-line investigation. Anecdotally, it has been observed that pelvic ultrasounds of adolescents with HMB are normal and do not change clinical care. The aim of this study was to analyse all female patients aged ≤18 years who were referred to a tertiary paediatric hospital for HMB over a 12-month period. METHOD: Medical records were reviewed to determine if pelvic ultrasonography was ordered during the diagnostic process and whether the imaging altered management. RESULTS: No pelvic ultrasounds ordered for adolescents with HMB altered clinical management. General practitioners (GP) were the most likely to refer patients to the tertiary paediatric hospital and to order pelvic ultrasonography, likely reflecting that most female adolescents are seen by a GP within the community. DISCUSSION: Providing clinical updates and ongoing education to health professionals managing female adolescent patients is recommended.

Prioritizing the needs of children in a changing climate.

In a Perspective, Lawrence Stanberry and colleagues discuss impacts of climate change on children.

Insights in Public Health: The Help Your Keiki Website: Increasing Youth and Caregiver Awareness of Youth Psychosocial Mental Health Treatment.

Increasing evidence-based practice (EBP) use in community mental health is a national priority, especially given that one in five youth will suffer from mental health concerns before adulthood. Implementation science offers a unique lens for understanding EBP use that identifies barriers and facilitators of successful adoption. Consumer engagement is often overlooked as an EBP implementation strategy. In this article, we describe the State of Hawai'i Child and Adolescent Mental Health Division's innovative effort to target consumer EBP demand via the Help Your Keiki Website. Feedback from community stakeholders and website analytics converge to suggest that the most helpful content is related to finding help, normalizing concerns, and questions to ask therapists. Future outreach efforts as well as ongoing improvement and enhancement of the website are discussed.

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology.

BACKGROUND: Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. METHODS: Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. DISCUSSION: Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. TRIAL REGISTRATION: "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

Introduction to the Special Issue on Adolescent and Young Adult Health: Why We Care, How Far We Have Come, and Where We Are Going.

This special issue on adolescent and young adult (AYA) health comprises 15 original articles. The special issue recognizes the importance of AYA-focused research, highlights unique issues across the AYA period, and showcases cutting-edge research focused on AYAs. We describe the rationale for focusing on the AYA population, themes of the special issue, and future directions.

A Clinical Care Algorithmic Toolkit for Promoting Screening and Next-Level Assessment of Pediatric Depression and Anxiety in Primary Care.

With a documented shortage in youth mental health services, pediatric primary care (PPC) providers face increased pressure to enhance their capacity to identify and manage common mental health problems among youth, such as anxiety and depression. Because 90% of U.S. youth regularly see a PPC provider, the primary care setting is well positioned to serve as a key access point for early identification, service provision, and connection to mental health services. In the context of task shifting, we evaluated a quality improvement project designed to assist PPC providers in overcoming barriers to practice-wide mental health screening through implementing paper and computer-assisted clinical care algorithms. PPC providers were fairly successful at changing practice to better address mental health concerns when equipped with screening tools that included family mental health histories, next-level actions, and referral options. Task shifting is a promising strategy to enhance mental health services, particularly when guided by computer-assisted algorithms.

Characteristic Differences Between School-Based Health Centers With and Without Mental Health Providers: A Review of National Trends.

BACKGROUND: Minority racial/ethnic pediatric populations and those living in poverty are at greater risk of exposure to trauma, development of mental health disorders, and school failure yet are less likely to have access to mental health services (MHS). School-based health centers (SBHCs) staffed with mental health providers may be one strategy for decreasing health care disparities. METHODS: Secondary analysis of the cross-sectional School-Based Health Alliance Census School Year 2010-2011 Report was conducted. Descriptive statistics and chi-square analysis were used to describe differences between SBHCs with and without onsite MHS. RESULTS: A total of 70% of SBHCs offered MHS. SBHCs with more resources, more students, a longer history, and state funding were more likely to offer MHS, and geographic location had no impact on service availability. CONCLUSION: Reviewing SBHC characteristics that enable inclusion of MHS may help stakeholders expand this model of care to address exposure to chronic childhood trauma.