Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, July 29, 1994 TAG: 9408020074
SECTION: EDITORIAL PAGE: A-13 EDITION: METRO
SOURCE: By CHARLES HITE
DATELINE: LENGTH: Long
``Well, that's the other problem,'' said the 17-year-old who came in with a raging sore throat. The nurse had asked whether there was any reason not to put her on medication. ``I've missed a few periods. I think I might be pregnant.''
Delivering health care to adolescents means treating the usual assortment of illnesses, injuries and diseases found in nearly any adult population. But it also means dealing with an age group that is discovering the meaning of freedom and temptation. Adolescents believe the aftermath of risk-taking behavior - pregnancy, sexually transmitted diseases, alcohol-related accidents, drug addiction, failure in school - will always happen to someone else. They believe they are invincible. Until something happens to them.
The Roanoke Adolescent Health Partnership operated three health centers during the past school year in an effort to make care more accessible to adolescents.
Health centers at Patrick Henry High School, Ruffner Middle School and the Hurt Park Housing Community treated 1,359 adolescents during more than 6,000 visits. The health centers are a service of a partnership formed by Carilion Health System, Roanoke City Public Schools, the Roanoke City Health Department, and the Roanoke Redevelopment and Housing Authority. The centers offer physicals, pregnancy testing, birth-control prescriptions, and treatment for minor ailments and illnesses such as headaches, respiratory infections, wounds and injuries. There is no charge for the services. The health centers are funded through a $400,000 grant from Carilion, a $65,000 grant from the Virginia Health Care Foundation, and financial and staff support from the schools, health department and housing authority.
Many of the students receiving these services would have had to leave school or stay home if the health centers hadn't been available. Some would simply not have gotten medical attention if the health centers weren't operating. Some students came to school sick knowing that they would be able to get treated at the health center.
Adolescents see physicians less than any age group despite having a higher rate of acute medical conditions. When they do get medical treatment, it's often at hospital emergency rooms where costs are high and no mechanism is in place to assure follow-up care. The emergency rooms at Roanoke Memorial Hospital and Community Hospital of the Roanoke Valley had nearly 4,800 visits by adolescents for non-emergency conditions in the year ending June of 1993. Those non-emergency treatments cost $1,137,206. It's far more economical, convenient and effective to bring health care to adolescents at school or in the community.
The health centers also offered counseling, self-esteem and peer-education programs designed to encourage adolescents to stay in school. Staff members frequently found themselves talking to parents about how to better communicate with their adolescent children and deal with the emotional ups and downs during this stage of development.
Adolescents are trying to deal with the whole issue of independence and risk-taking behavior. Parents need to realize that pulling away is a normal developmental stage and to find the proper balance between too much freedom and too many restrictions. Staff members at the health centers don't have all the answers. But parents feel a lot better when they realize, ``It's not just my family that's having these problems.''
Once they establish a level of trust with students, health-center staff members help students overcome emotional problems or steer them to other resources in the community for assistance. They nearly always encourage students to discuss problems with their parents. They give advice about how to talk to parents. And how to listen.
Sometimes adolescents pay more attention to advice from their peers. That's why the health centers' counselor recruited and trained 10 ``peer educators.'' These are teens who know how to talk to other teens about high-risk behaviors, ranging from the dangers of sex, drinking and driving or smoking to the long-term consequences of dropping out of school.
At other times, adolescents benefit from the example of adult role-models. The partnership has established two mentor programs - one where women in the community work with female students and another where men work with male students. The partnership also has created a self-esteem program in which female students learn skills to build their confidence - including writing, public speaking and etiquette.
During the year, 28 adolescents tested positive in pregnancy tests. The health center at Patrick Henry began a teen mothers' support group this spring as a way to make sure pregnant adolescents were getting the proper prenatal care and other services. It meets once a month. Members of the group share their problems and discuss ways to overcome barriers to getting health-care services and education.
The obstacles for adolescent mothers can seem insurmountable. I was told about a 16-year-old mother of two who had dropped out of school and was living at home. She saw herself as basically a failure. All the feedback she was getting seemed to be so negative. But after working with the health-center counselor for a month, the student decided to sit for a high-school equivalency diploma. She passed on the first attempt and is making plans to go to community college.
Perhaps that's one of the major benefits of the health centers. They empower adolescents. Adolescents are not treated as numbers. Every encounter is seen as an educational experience. Students are told what's being done and what their options are. Their privacy and confidentiality are respected. They are treated with dignity. And they respond to that. They learn to treat others the same way.
Charles Hite is director of Biomedical Ethics for Carilion Health System and a member of the policy board for the Roanoke Adolescent Health Partnership.
by CNB