Adolescent Health Unit focuses on youth at risk

"This change represents another in a series of major expansions of the UCEDD aimed to insure a life-span perspective," says Dr. Michael Guralnick, director of the UCEDD and professor of psychology and pediatrics. The new unit contributes to the UCEDD's mission of reducing the incidence and impact of developmental disabilities with its emphasis on critical areas of adolescent health. "In line with the UCEDD's university/community partnership approach, the adolescent program has enjoyed notable success forging links between university resources and community resources to address the increasingly serious problems faced by today's adolescents," notes Guralnick.

The AHU trains health professionals to recognize and treat the special problems of adolescence, provides clinical services for adolescents in a variety of traditional and nontraditional community-based settings, and conducts research toward identifying effective interventions for high-priority adolescent health problems. Most adolescents served in the AHU's various clinical settings have complex medical and psychosocial needs. Some are older children with special health care needs. Many are teens who face high-risk health issues because of drug and alcohol abuse, homelessness and sexual behavior that increases risk for sexually transmitted diseases, including AIDS. These health issues pose particular hazards for pregnant and parenting teens whose age alone increases the chances for poor birth outcomes.

"About 85 percent of the kids we see are at increased risk for health and developmental problems due to low income, lack of family support or other environmental factors," explains Dr. Jim Farrow, associate professor of pediatrics and medicine, and AHU director. AHU trainees gain a solid foundation for tackling high risk health issues as they pursue their careers across the nation by working directly with young people with such complex needs, he points out.

"Interdisciplinary training is a major focus of the AHU," says Farrow. "All of our clinics provide services and support training, but the training mission actually outweighs the service mission."

The AHU's Adolescent Health Training Program is funded by the Maternal and Child Health Bureau (MCHB). Each year nearly 100 long-term and short-term trainees in medicine, psychology, nursing, nutrition and social work participate in the program. The Program's primary training site is the Adolescent Clinic at CHDD, which consists of an interdisciplinary primary care clinic and specialty clinics geared to meet the needs of special populations of adolescents.

One of the specialty clinics helps adolescents and young adults with developmental disabilities and chronic conditions make the transition from the pediatric health care system to the adult system. AHU physicians, nurses and social workers assist adolescents and their families in health, social and vocational planning for the future.

Another multidisciplinary specialty clinic provides comprehensive prenatal and postnatal care for pregnant teenagers 16 and younger, an age group whose children have a higher likelihood of developmental problems. By emphasizing pregnancy and childbirth education and nutritional guidance, health providers in nursing, medicine, social work and nutrition work to reduce risk for poor birth outcomes. Social workers in the clinic also provide family intervention, helping the teenage mom's family and/or partner support her effectively.

Collaborating with several community agencies, AHU faculty and trainees provide services in a variety of nontraditional locations for teens who need services, but are unlikely to go out of their way to seek them. A school-based clinic provides a wide range of services and counseling aimed at early detection and treatment of illness, promotion of healthy living habits and teaching teens how to use the health care system effectively. (See Outlook, Summer 1995)

The AHU places special emphasis on working with homeless and incarcerated youth, many of whom have developmental problems. A study of street youth in Seattle conducted jointly by faculty from the AHU and Youth Care, a community agency, found that nearly 70 percent of the adolescents in the study had some form of developmental problem such as learning disabilities, mild mental retardation, mild cerebral palsy or epilepsy.

The AHU works to improve the health of youth who live on the streets through two night clinics located in downtown Seattle that provide free services. Screening and educating about AIDS transmission is one of the major concerns at these drop-in clinics. The AHU also operates the health clinic at the King County juvenile detention facility.

In a collaborative project with the Seattle-King County Department of Health, the AHU reaches out to homeless pregnant and parenting adolescents. The goal of the project, which is known as the Out-of-Home Teen Pregnancy Project, is to improve birth outcomes and prevent child abuse. A case management team, consisting of a public health nurse and a social worker, helps pregnant teens younger than 18 who have a history of high-risk behavior and are estranged from home, family and adult supervision to stabilize their living situation and gain access to a supportive network of community services. The project also educates moms-to-be about good health practices during pregnancy and provides them training in parenting skills. (See Outlook, Winter 1995)

AHU faculty and trainees also conduct research that covers a broad range of problems in adolescent health. One study is investigating effective ways to treat drug and alcohol addiction in young mothers and improve infant outcomes. Research funding for the AHU comes from sources such as the Health Resources and Services Administration and the National Institutes of Health.

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