The Hospitalized Adolescent.

This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, "The Hospitalized Adolescent," includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.

Unique Needs of the Adolescent.

Adolescence is the transitional bridge between childhood and adulthood; it encompasses developmental milestones that are unique to this age group. Healthy cognitive, physical, sexual, and psychosocial development is both a right and a responsibility that must be guaranteed for all adolescents to successfully enter adulthood. There is consensus among national and international organizations that the unique needs of adolescents must be addressed and promoted to ensure the health of all adolescents. This policy statement outlines the special health challenges that adolescents face on their journey and transition to adulthood and provides recommendations for those who care for adolescents, their families, and the communities in which they live.

Improving adolescent access and services in a large primary care network: report of a 10 year project.

This report describes a decade long initiative to bring a unified approach and improved quality to the process and content of adolescent health care in a large and complex urban primary care network within an academic health system. The moving force was a voluntary multidisciplinary group who comprised the Montefiore Adolescent Primary Care Initiative, known as MAPCI, led by a physician subspecialist in Adolescent Medicine. A series of needs assessments formed the basis for a multipronged effort to create policies and procedures, educational activities and materials, changes in record-keeping and billing practices, and modification of staff attitudes and behavior that would enhance access and ensure confidentiality of services for the adolescent age group. The commitment of medical center leadership contributed to overall progress which was accelerated in the second half of the decade by the addition of a full-time staff member, with the title Adolescent Program Manager. Progress in various arenas was assessed with a series of planned studies, whose positive results provided encouragement for continuing efforts. The example of this initiative and its accomplishments should provide useful and replicable methods that could be adapted for improvement of adolescent health services in some of the other large primary care networks that are an ever-expanding presence in the current health care environment.

Primary Care Providers as Mental Health Counselors: Views from Urban, Minority Adolescents.

OBJECTIVE: To examine urban, minority adolescents' preferences for receiving guidance for mental health (MH) issues from primary care providers (PCPs) or from mental health providers (MHPs). METHODS: Adolescents (13-21 years) from three community clinics and one school-based health center (SBHC) in the Bronx, N.Y. completed anonymous surveys. Characteristics of adolescents who preferred the PCP vs. MHP and adolescents' attitudes about the PCP vs. the MHP were compared. RESULTS: Adolescents (N=135), mean age 16 years, majority Hispanic participated. Although 85% strongly agreed or agreed that their PCP was knowledgeable about MH, 57% preferred to talk to a MHP. Those who preferred the MHP were younger, attend a SBHC, and trust information on MH from a MHP. Those who preferred the PCP were more likely to report feeling comfortable talking to their PCP about MH. CONCLUSIONS: Although the majority preferred a MHP, PCPs appeared to be an acceptable alternative for MH care.

Effect of telephone calls from primary care practices on follow-up visits after pediatric emergency department visits: evidence from the Pediatric Emergency Department Links to Primary Care (PEDLPC) randomized controlled trial.

OBJECTIVE: To test whether follow-up phone calls to counsel families about pediatric emergency department (PED) use and primary care availability made after an index PED visit would modify subsequent PED use. DESIGN: Longitudinal prospective randomized intervention. SETTING: An urban academic children's hospital. PATIENTS: A total of 4246 individuals aged 0 to 21 years from each of 4 participating primary care practices recording an index PED visit from April through December 2005. INTERVENTION: Follow-up phone call from the primary care practice within 72 hours of the initial PED visit to counsel about the availability of after-hours advice and when to access the PED. MAIN OUTCOME MEASURES: All subsequent visits to primary care practices, PED, pediatric subspecialists, or for inpatient hospitalization during a 365-day follow-up period. Logistic and ordinary least squares regressions estimated unadjusted and adjusted odds ratios of follow-up visits, controlling for covariates. RESULTS: Of the 2166 intervention subjects, 816 (37.7%) recorded follow-up PED visits compared with 819 (39.4%) of the 2080 control subjects (P = .26, not significant). The adjusted odds of a follow-up visit being to the PED rather than to another venue was significantly less for intervention than for control subjects (odds ratio, 0.88; confidence interval, 0.82-0.94), indicating decreased intensity of PED use. CONCLUSION: Follow-up phone calls from primary care practices after PED visits counseling patients on the use of primary care and emergency services can modulate subsequent care-seeking behavior and decrease future PED use.