User satisfaction with child and adolescent mental health services: the association between user satisfaction and clinical outcomes.

BACKGROUND: This study aimed to examine the association between user satisfaction and clinical outcomes with child and adolescent mental health services (CAMHS) from the perspective of young people and their parents. The evidence bases for CAMHS user satisfaction measures are limited, with few studies investigating the link between user satisfaction and clinical outcomes. In particular, the perspectives of young people are missing. METHODS: The parent and youth versions of the Experience of Service Questionnaire (ESQ), which evaluates the factors of general satisfaction (GS), satisfaction with care (SWC) and satisfaction with environment (SWE), were used to measure user satisfaction. The outcome measures were scores on the Strengths and Difficulties Questionnaire (SDQ), Children's Global Assessment Scale (CGAS), and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Hierarchical regression analysis was conducted on data collected from 233 young people and 495 parents who utilized CAMHS services. RESULTS: GS and SWC predicted outcomes for both young people (ΔR2 = 0.08, p <.05) and parents (ΔR2 = 0.01, p <.05), indicating that user satisfaction had a significant impact on clinical outcomes for CAMHS users. In addition, GS and SWC significantly predicted young people-reported outcomes in the interaction model (ΔR2 = 0.10, p <.05), while no significant association was found with parent-reported outcomes (ΔR2 = 0.02, p =.09). CONCLUSION: User satisfaction, particularly for young people, has a significant impact on clinical outcomes. The causal relationship between user satisfaction and mental health outcomes requires further study.

30 years of youth system of care lessons learned - a qualitative study of Hawai'i's partnership with the Substance Abuse and Mental Health Services Administration.

BACKGROUND: The Hawai'i State Department of Health, Child and Adolescent Mental Health Division (CAMHD) has maintained a longstanding partnership with Substance Abuse and Mental Health Services Administration (SAMHSA) to enhance capacity and quality of community-based mental health services. The current study explored CAMHD's history of SAMHSA system of care (SOC) awards and identified common themes, lessons learned, and recommendations for future funding. METHODS: Employing a two-phase qualitative approach, the study first conducted content analysis on seven final project reports, identifying themes and lessons learned based on SOC values and principles. Subsequently, interviews were conducted with 11 system leaders in grant projects and SOC award projects within the state. All data from project reports and interview transcripts were independently coded and analyzed using rapid qualitative analysis techniques. RESULTS: Content validation and interview coding unveiled two content themes, interagency collaboration and youth and family voice, as areas that required long-term and consistent efforts across multiple projects. In addition, two general process themes, connection and continuity, emerged as essential approaches to system improvement work. The first emphasizes the importance of fostering connections in family, community, and culture, as well as within workforce members and child-serving agencies. The second highlights the importance of nurturing continuity throughout the system, from interagency collaboration to individual treatment. CONCLUSIONS: The study provides deeper understanding of system of care evaluations, offering guidance to enhance and innovate youth mental health systems. The findings suggest that aligning state policies with federal guidelines and implementing longer funding mechanisms may alleviate administrative burdens.

Adolescent sexual and reproductive health needs and utilisation of health services in the Bono East Region, Ghana.

BACKGROUND: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. METHODS: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. RESULTS: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. CONCLUSION: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care.

A protocol for the formative evaluation of the implementation of patient-reported outcome measures in child and adolescent mental health services as part of a learning health system.

BACKGROUND: Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. METHODS: This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre's services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals' experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre's operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres' population. DISCUSSION: The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.

Assessing the Knowledge and Comfort Level of US Family Medicine Residents Regarding Consenting and Confidentiality in Adolescent Health Care.

OBJECTIVES: Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. METHODS: Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. RESULTS: A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). CONCLUSIONS: Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care.

Rights-based sexual and reproductive health services: a call for improved access for youth.

Constituting a valuable resource, youth deserve more attention regarding their rights through increased access to sexual and reproductive health services. Limitations in health service delivery for youth should be overcome, whether pertaining to restrictive legislation and policies or technical approaches. Clear clinical guidelines will improve quality of care thereby complying with national commitments to international legal instruments. It is apt for both decision-makers and service providers to celebrate International Youth Day on Monday 12 August, by paying special consideration to innovative approaches for the delivery of youth-friendly sexual and reproductive health services that are adaptable to local circumstances.

Constituant une ressource précieuse, les jeunes méritent davantage d'attention quant à leurs droits grâce à un accès accru aux services de santé sexuelle et reproductive. Les limites de la prestation de services de santé destinés aux jeunes doivent être surmontées, qu'elles soient liées à des législations et politiques restrictives ou à des approches techniques. Des directives cliniques claires amélioreront la qualité des soins, respectant ainsi les engagements nationaux envers les instruments juridiques internationaux. Il convient que les décideurs et les prestataires de services célèbrent la Journée internationale de la jeunesse le lundi 12 août, en accordant une attention particulière aux approches innovantes pour la fourniture de services de santé sexuelle et reproductive adaptés aux jeunes et adaptables aux circonstances locales.

Debate: CAMHS will be at the forefront of the next generation of psychosis risk models, but further integration with early intervention psychosis services is needed to realise this potential: Re Debate: Prevention of psychosis in adolescents - does CAMHS have a role?

The detection of psychosis and its prodrome have unique considerations in a child and adolescent population. Young people attending CAMHS are already a high-risk group, which confers significant limitations in applying the current clinical high-risk (CHR) model. This has catalysed calls for a transdiagnostic approach to psychosis risk prediction, but without a clear pathway forward. We contribute to the debate opened by Salazar de Pablo and Arango (2023, Child and Adolescent Mental Health) on the role of CAMHS in this initiative. CAMHS have a key role in developing comprehensive longitudinal datasets to inform risk models. Closer integration with early intervention in psychosis (EIP) services will be needed to realise this potential. This integration is also required to reliably detect prodromes and emerging psychosis in young people. Where there is robust evidence to support prevention initiatives, we should proceed with their implementation, even in the absence of enhanced risk models.

Improving the Quality of Adolescent and Youth-Friendly Health Services Through Integrated Supportive Supervision in Four Nigerian States.

BACKGROUND: Although the unique sexual and reproductive health needs of adolescents and youth (AY) are widely recognized, the challenge remains how to integrate adolescent- and youth-friendly health services (AYFHS) effectively within a systems-based approach that is both feasible and scalable. This article provides preliminary evidence from 4 Nigerian states that sought to overcome this challenge by implementing capacity-strengthening approaches centered around a shortened quality assurance (QA) tool that has become part of the state health system's routine supportive supervision process and follow-up quality improvement (QI) activities. METHODS: A shortened QA tool was administered to assess and track the performance of 130 high-volume health facilities across 5 domains to serve its AY population with quality contraceptive services. Facility-based providers (N=198) received training on adolescent and youth sexual and reproductive health, AYFHS, and long-acting reversible contraceptive methods. To corroborate checklist findings, we conducted exit interviews with 754 clients (aged 15-24 years) who accessed contraceptive services from the facilities that met the World Health Organization's minimum standards for quality AYFHS. RESULTS: In the 4 states, the QA tool was applied at baseline and 2 rounds, accompanied by QI capacity strengthening after each round. At baseline, only 12% of the 130 facilities in the 4 states scored met the minimum quality standards for AYFHS. After 2 rounds, 88% of the facilities met the minimum standards. AY client volume increased over this same period. All 4 states showed great improvements; however, the achievements varied by state. The exit interview feedback supported client satisfaction with the services provided to AY. CONCLUSION: Integrating QA followed by QI within Nigeria's family planning supportive supervision system is not only feasible but also impacts the quality of AYFHS and contraceptive uptake by clients aged 15-24 years.

Characterizing models of adolescent and youth-friendly health services in sub-Saharan Africa: a scoping review.

This scoping review provides an up-to-date overview of the evidence on adolescent and youth-friendly health services (AYFHS) in sub-Saharan African countries. We conducted a search of four databases and grey literature sources to identify English language publications from January 1, 2005, to December 14th, 2022. The review synthesized evidence on the models and characteristics of AYFHS, the application of World Health Organization (WHO) standards, and whether AYFHS have improved young people's health outcomes. In total, 77 sources were included in the review, representing 47 AYFHS initiatives spanning 19 countries, and three multi-country reports. Most commonly, AYFHS were delivered in public health facilities and focused on sexual and reproductive health, with limited application of WHO standards. Some evidence suggested that AYFHS increased young people's health service utilization and contraceptives uptake. There is a clear need to strengthen and develop innovative and multi-pronged approaches to delivering and evaluating AYFHS in this region.

Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

INTRODUCTION: In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. PROGRAM DESCRIPTION: Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. RESULTS: The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). CONCLUSION: Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

Confidentiality in the Care of Adolescents: Technical Report.

Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.

Effectiveness of an online intervention for parents/guardians of children aged 4-7 years who are concerned about their child's emotional and behavioural development: protocol for an online randomised controlled trial (EMERGENT study).

INTRODUCTION: The demand for resources to support emotional and behavioural development in early childhood is ever increasing. However, conventional interventions are lacking in resources and have significant barriers. The Embers the Dragon programme helps address the growing unmet need of children requiring support. The delivery of the current project seeks to help support parents, reduce the burden placed on pressed services (eg, Child and Adolescent Mental Health Services) and to help improve the emotional and behavioural development of children. METHODS AND ANALYSIS: This project aims to investigate the efficacy and acceptability of Embers on parenting and children's psychosocial outcomes. 364 parents/guardians of children aged between 4 and 7 will be recruited via the internet, schools and general practitioners (GPs). This is an online waitlist-controlled trial with three arms: (1) control arm, (2) access to Embers arm and (3) access to Embers+school. Participants will be randomised (1:1) into (1) or (2) to evaluate the use of Embers at home. To evaluate scalability in schools, (3) will be compared with (2), and (1) to test efficacy against treatment as usual (not receiving the intervention). Qualitative interviews will also be conducted. Primary outcomes are the Parental Self-efficacy Scale, Strengths and Difficulties Questionnaire and qualitative interviews. Outcomes will be compared between the three groups at baseline, 8, 16 and 24 weeks. ETHICS AND DISSEMINATION: Ethical approval has been granted by the London South Bank University ethics panel (ETH2324-0004). To recruit via GPs, NHS ethical approval has been applied for, and the IRAS (331410) application is under consideration by the Central Bristol REC. The results of the project will be submitted for publication in a peer-reviewed journal. Parents/guardians will provide informed consent online prior to taking part in the study. For the interviews, assent will be taken from children by the researchers on the day. TRIAL REGISTRATION NUMBER: ISRCTN58327872.

Adolescent health care and perceptions in a provincial hospital in Papua New Guinea.

OBJECTIVES: Adolescents make up an estimated 22 % of the 11.8 million population of Papua New Guinea (PNG), yet, as in many low and middle income countries, there are limited specific services for adolescents, who in traditional health service design fall between paediatric and adult patients. With more survivors of chronic illnesses, including tuberculosis and HIV, congenital and acquired heart disease, epilepsy and cerebral palsy, diabetes, cancer and other chronic conditions, there are gaps in the care of such young people, and in their eventual transition to adult services. Moreover, traditional health service design rarely addresses many adolescent health concerns - mental health, self-esteem, substance use, and adolescent-friendly sexual and reproductive health. This study, amongst a cohort cared for in a provincial hospital in Milne Bay Province, Papua New Guinea, aimed to explore the perceptions of adolescents on the health care they receive, and their views on their health priorities. METHODS: A qualitative study was carried out from April to August 2022, amongst adolescents (persons aged 10-19 years) attending or admitted to Alotau Provincial Hospital. Data were collected via semi-structured wide-ranging interviews, and contextual data obtained from their medical charts. Thematic data analysis was done. RESULTS: Fifty-four adolescents were interviewed. Adolescents were generally content with the care they received, although many raised concerns regarding feeling out of place in a ward with older adults or infants, and staff attitudes towards them including not directly communicating. Forty four adolescents preferred an adolescent-friendly setting, as opposed to the adult or children's wards, stating that it would allow for positive peer-interaction, improve their experience in the hospital, and improve the quality of health care received. Many adolescents with chronic illnesses had concerns regarding loneliness and isolation, and uncertainty of their future. Pregnant adolescents highlighted the lack of education on sexual and reproductive health, and experiences of gender-based violence. CONCLUSIONS: This study shows that adolescents can perceive the need for adolescent-friendly health services and advocate for improvement in the quality of health care they receive, and the breadth of adolescent health care concerns.

Creating an Equitable System of Care for Minoritized Youth and Addressing Systemic and Structural Barriers.

We provide an overview of the systems of care and the barriers faced by minoritized youth. We discuss ways to address barriers by forging alliances, improving communication with cultural humility, and a nonjudgmental approach. We underscore the importance of a holistic evaluation of minoritized children while leveraging their resilience to create a comprehensive and multipronged plan of action.

Innovative Strategies for Addressing Adolescent Health in Primary Care Through Telehealth.

With recent gains in telehealth access across health sectors, this editorial explores adolescent-specific health issues where innovative use of virtual care is improving outcomes and access for adolescents. These include contraception, obesity, gender-affirming care, mental health, and eating disorder care. Clinicians caring for adolescents should be aware of advances in this field to maximize opportunities for their patients to receive evidence-based care in a manner that supports health equity and confidentiality concerns while understanding the evolving regulatory landscape of telehealth.

A review of information sources and analysis methods for data driven decision aids in child and adolescent mental health services.

OBJECTIVE: Clinical data analysis relies on effective methods and appropriate data. Recognizing distinctive clinical services and service functions may lead to improved decision-making. Our first objective is to categorize analytical methods, data sources, and algorithms used in current research on information analysis and decision support in child and adolescent mental health services (CAMHS). Our secondary objective is to identify the potential for data analysis in different clinical services and functions in which data-driven decision aids can be useful. MATERIALS AND METHODS: We searched related studies in Science Direct and PubMed from 2018 to 2023(Jun), and also in ACM (Association for Computing Machinery) Digital Library, DBLP (Database systems and Logic Programming), and Google Scholar from 2018 to 2021. We have reviewed 39 studies and extracted types of analytical methods, information content, and information sources for decision-making. RESULTS: In order to compare studies, we developed a framework for characterizing health services, functions, and data features. Most data sets in reviewed studies were small, with a median of 1,176 patients and 46,503 record entries. Structured data was used for all studies except two that used textual clinical notes. Most studies used supervised classification and regression. Service and situation-specific data analysis dominated among the studies, only two studies used temporal, or process features from the patient data. This paper presents and summarizes the utility, but not quality, of the studies according to the care situations and care providers to identify service functions where data-driven decision aids may be relevant. CONCLUSIONS: Frameworks identifying services, functions, and care processes are necessary for characterizing and comparing electronic health record (EHR) data analysis studies. The majority of studies use features related to diagnosis and assessment and correspondingly have utility for intervention planning and follow-up. Profiling the disease severity of referred patients is also an important application area.

Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study.

OBJECTIVE: Indian adolescents experience several health challenges requiring acceptable, equitable, appropriate and effective healthcare services. Our objective was to assess the compliance of Adolescent Friendly Health Clinics (AFHCs) in two of India's largest states, using both national benchmarks (under Rashtriya Kishor Swasthya Karyakram-RKSK) and global standards (by WHO). DESIGN: Cross-sectional study comprising structured observations and interactions (November 2021 to June 2022). SETTING: Fourteen AFHCs across all levels of health system were included from two districts of Maharashtra (n=8) and Madhya Pradesh (n=6). These AFHCs were observed using checklist, and few items of checklist were verified by interactions with AFHC's health workers (medical officers/auxillary nurse midwives/counsellors) handlings adolescents. The developed checklist included 57 items based on adapted global standards and 25 items using national benchmarks. RESULT: High compliance of AFHCs with RKSK's benchmarks was attributed to various items including the accessibility through local transport (n=14, 100%), clean surroundings (n=11, 78.5%), presence of signage (n=10, 71.4%), convenient operating days and time (n=11, 78.5%), and secure storage of records (n=13, 92.9%). Concurrently, items that showed low compliance encompassed, the availability of Information, Education and communication (IEC) resources, which were deficient in 57.1% of AFHCs (n=8). Similarly, designated areas for clinical services (n=10, 71.4%) and commodity disbursement (n=9, 64.3%) lacked in more than half of the recruited AFHCs. Additionally, lack of guidelines for referrals (n=13, 92.9%), as well as standard operating procedures to ensure equity, non-judgemental attitude, competence, confidentiality and referral as per WHO standards. CONCLUSION: Evidence spotlights the strengths and gaps in AFHCs, aligning with, government's priorities on adolescent health. Addressing the identified gaps is crucial to creating healthcare facilities that are adolescent-friendly, easily accessible and effectively navigate adolescent health challenges. This concerted effort would contribute to their development and transformation, playing a pivotal role in India's progress.

Sexual health services for adolescents on Reunion Island: results from a descriptive interview-based study.

OBJECTIVES: To describe the experiences of sexual health services available for adolescents aged 15-19 years on Reunion Island. DESIGN: A qualitative descriptive study was conducted from 3 December 2022 to 24 October 2023. Data were analysed using the phenomenological interpretative method. SETTING: Centre Hospitalier Universitaire of Reunion Island. PARTICIPANTS: 15 participants were recruited through convenience sampling, but 3 of them did not attend the interviews. INTERVENTIONS: Face-to-face or videoconferencing open-ended individual interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: Barriers and facilitators to access sexual health services, relationship between adolescents and healthcare professionals when using these services and suggestions made by adolescents for improving access to care and quality of care. RESULTS: In total, 12 adolescents were included with most being female (11 with a mean age of 18 years). Most interviewees were in a relationship, lived in urban areas and had sexual intercourse (nine, respectively). Participants attended high school, university and preparatory college (four, respectively). Most interviews were face to face (11). The mean duration of the interviews was 32 min. Two themes revealing the experiences of sexual health services emerged. Participants described maintaining sexual health as a difficult journey in their quest for information about sexual health and the available services provided. Participants demonstrated that they had the ability to cope with the consequences of unprotected sex. CONCLUSIONS: To date, sexual health services available on Reunion Island may not meet the needs of adolescents. Implementation of a strategy aimed at providing young people with skills, addressing their needs and working with them in a collaborative manner may be necessary. Appropriate teaching methods and the training of healthcare professionals should also be considered.

Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health.

An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.

A Quality Improvement Initiative to Improve Health Care Transition Planning at Adolescent Well Visits.

OBJECTIVE: Health care transition (HCT) planning supports adolescents as they move from pediatric to adult health care and is recommended for all youth. HCT planning uptake remains low, with little known about HCT in the adolescent well child check (WCC) setting. We sought to increase rates of HCT planning at WCCs by adapting best practices for HCT from specialty and chronic care. METHODS: This quality improvement initiative at 12 to 17-year-old WCCs at four Internal Medicine-Pediatrics primary care clinics, was based on the first three of the "Six Core Elements" of HCT framework and integrated into the electronic health record. Two uptake measures were assessed via chart review after three plan-do-study-act (PDSA) cycles, with two provider surveys and an implementation science analysis further informing interpretation. RESULTS: By the final PDSA cycle, the percentage of 14 to 17-year-old WCCs at which HCT planning was discussed and a screening tool completed increased from 5% to 31%, and the percentage of 12 to 13-year-old WCCs at which the HCT policy was discussed increased from 6% to 47%. Provider survey results revealed endorsement of HCT goals, but time and technological barriers, which were further elucidated in the implementation science analysis. CONCLUSIONS: This quality improvement initiative increased rates of HCT planning during adolescent WCCs. While limited to three Core Elements and Internal Medicine-Pediatrics clinics, strengths include measures capturing all WCCs, contextualized by provider surveys and an implementation science framework. Lessons from this effort can inform future tailored HCT initiatives at adolescent WCCs.