In the last few lectures we discussed gap that is experienced between the burden of disease and young people and what they seek help for, highlighting it is the responsibility of the clinician to provide comprehensive care in order to help reduce that gap. We discuss the importance of the clinician setting expectations for both the parent and the adolescent about how increasing maturity has flawed effects in relationship to the young person not actively engaging in their own health care. And in the last lecture we overviewed some of the attitudes, knowledge, and skills required of clinicians regardless of their discipline to work more affectively with adolescent patients. In this lecture, we'll discuss how the motion of adolescent friendly healthcare is not simply the responsibility of individual clinicians, but rather something that is the responsibility of the health service as a whole. Let's remind ourselves of the principles of adolescent friendly healthcare as outlined here, by which we mean health services that provide quality comprehensive care to adolescents. We're talking about health care that is universally accessible by young people. Where there is equity of access regardless of gender, age, marital status, ethnic or religious background, sexual orientation, or sexual minority status. We're talking about the importance of confidential health care, and health care that is delivered in a respectful, non-judgemental manner, with staff who have been trained to work with adolescents. We're talking about delivering care from a service that has adequate resources, including the necessary time to provide quality health care to the young. And we're talking about health care that is safe, private, non-stigmatising. Care that is comprehensive in scope and preventively oriented. When I look at this list, it feels slightly overwhelming, but it is certainly what I expect from my health service. And why should young people expect less? Global initiatives are increasingly urging countries to prioritize quality within health services as a way or reinforcing human right's based approaches to health. The World Health Organization report Health for the World's Adolescent, Second Chance in the Second Decade, suggests to make progress toward universal health coverage ministries of health and the health sector more generally will need to transform how health systems respond to the health needs of adolescents. This report recommends developing and implementing national quality standards and monitoring systems as one of the actions necessary to make this transformation. As stated previously, a health service that is adolescent friendly does not have to be a stand alone service. Rather, it is the competencies of its staff and the context in which care is delivered that make it more appropriate for the young. It is particularly disappointing that important causes of mortality, disease burden, and risk factors in adolescence have failed to gain appropriate attention in many contemporary initiatives that have been labeled adolescent friendly. The majority of these purportedly adolescent friendly health services have focused largely on sexual and reproductive health. Yet the burden of mental disorders, of violence related morbidity and mortality, substance use, and chronic diseases reinforces the value of more comprehensive services also being provided in addition, obviously, to sexual and reproductive health. The provision of comprehensive services is consistent with young people's views on quality healthcare, as well as consistent with what we know about the clustering of health related behaviors, as we talked about earlier on in the lectures. Meaning that young people with one health related behavior, such as smoking, are more like to have others, for example bullying behaviors. A particular challenge is the stigma of attending stand alone services, whether they be sexual and reproductive health services, or whether they be mental health services. In this regard, it is also apparent that generalist services, to which young people can attend for any health complaint, may be more acceptable to the young at the heart of every health system is the work force. The skills required to work effectively with young people do not reside within one discipline but are embodied by a range of professionals who, in working together within a system, can help deliver universal health coverage for adolescents. The full gamut of health services need to be considered, including primary care and community based services, school based services, specialist services, emergency departments in hospitals. And it's not just clinicians and in all of their shades of multidisciplinary that matter here. When we're talking about adolescent friendly health services perhaps of equal importance are the personal characteristics or perceptionists and clerks as these are the initial point of contact for most health services. And a critical element of whether young people fell welcomed and respected within that health service. Greater attention is required on professional development to ensure staff have the necessary competencies around the developmental and contextual aspects of adolescent health. And to enhance the necessary competencies within individual consultations, around interpersonal communication with adolescents, but also around interdisciplinary aspects of clinical care. To support this, a shift is required from the current episodic or acute care model to a more chronic and preventive care approach. Shawn, here is a document recently developed by the world health organization that aims to help countries develop competency based educational programs in adolescent health and development in both pre service, if you like undergraduate training and in service education, which you may wish to check out. National governments are also considering ways of holding health services accountable in terms of such standards. I've outlined here the you're welcome criteria from the United Kingdom. An important initiative that supports quality care delivery from primary care, to increasingly engaged specialist services as well. Linked to this framework is an assessment framework by which health services are held accountable to the government around the quality of care that is delivered. Including the voices of young people in feedback, monitoring, and evaluation is an important criteria of the You're Welcome list. Individual health services need to implement such care on the ground. In my own institution we've made efforts to assist the hospital as a health system to appreciate the responsibility it has to manage adolescents as well as younger children they managed. And to think about what skills and resources I required for my hospital as a system to deliver high quality care comprehensive care to adolescents. An important piece in making health services accountable for the quality of care they provide as just described is a measurement framework. At my own institution, for example, we have committed strategically to become a more adolescent friendly children's hospital. We first developed a conceptual framework around quality care in a hospital setting, that I've outlined here on the right. This relates to both a positive experience of care by both young people, as well as by their families and the delivery of evidence informed care to young people. Following this we developed a set of indicators around quality care in a hospital environment, and have subsequently developed a survey tool to measure the quality of care, again, from both the perspectives of young people and from their parents. We aim to use this as a benchmark to measure our service over time. So, hopefully demonstrate that we're doing better with time as well. This is increasingly what the World Health Organization is expecting of all health services. It's not enough to simply state that you think that your health service is providing quality health care to adolescents. Measuring the elements of what is being provided well and including young people's perspectives is an important aspect of quality improvement. So in summary, the list here outlines various actions that can be taken to improve the quality of care provided to adolescence. I'm not going to go through the list of these here. But, an important aspect that I'd like to now hand over to you is in terms of sharing with our online group more broadly. What are some of the interventions that you have made within your own health service? Whether that's in primary care, in the community, in a school-based service, in a hospital. I I would love to have some sharing of some of those individual actions that have been implemented, in order to improve the quality of care that you have provided within your own setting. And don't forget to be thinking about sharing with the group perhaps some of the resources that you might have developed. It's a bit sad really in terms of the copyright limitations that we have here. We can't provide this sort of vibrancy of many of the resources that I know are out there for a range of Copyright limitations, but it would be fabulous to have some sharing of resources, some linkage to where these resources can be found, in order that other people who speak the same language as you do, could potentially access those same resources. I look forward to hearing your responses online.
