Adolescent Health: Some Observations

  • Deborah Morris
Youth Affairs

Waiariki Polytechnic, Rotorua

Thank you for the opportunity to speak here today. It is a real pleasure to have been invited back to Waiariki to address you on issues as part of your Adolescent Health Learning Unit.

Adolescent Health is an area that the Ministry of Youth Affairs has done a lot of work on in the past year, and it is also an area that I personally am very committed to.

Firstly I would like to highlight some of the key features of the youth population and some of my own observations. I will then outline three adolescent health services that are delivering good things to young people.

I am happy to take questions at the end.

Youth population
New Zealand?s youth population is a diverse group both in terms of its size and composition. For statistical purposes youth is defined as 12 - 25 years of age. This group brings with them complex needs due to their psychological, cognitive and physical development, and the transition from child to adult involves many changes which can be both exciting and traumatic.

As adolescents progress towards adulthood, young people are keen to develop their own identity separate from their families. They establish significant friendships, explore sexual relationships and develop an increasing range of skills in order to survive in a demanding adult world.

This transition period is now more complex and pressured than ever before. Prolonged economic reliance on family can be a problem for some young people because at a stage in their lives when they relish their independence, they are still relying on parental financial support.

Young people are spending more time in education, and deferring important life style decisions such as buying a house or starting a family until they are older.

These factors increase the need for effective and coordinated policies and programmes for young people, and adolescent health is no exception.

Adolescent health
There are as many health issues for youth as there are for any other generation.

The major health issues for young people that the Ministry of Health has identified are:

mental health problems, or psycho-social issues such as depression, personal problems, eating disorders and stress;
sexual health, including contraception, pregnancy, STDs and AIDS;
injuries, including those from sport, motor vehicle crashes and drunk driving, violence and sexual abuse and:
drug and alcohol abuse.
These issues are the key ones that affect young people and their health. Yet young people are much more than this picture would lead us to believe.

They are creative and can be resilient and have a tenacity that many older people could learn from.

Young people are often optimistic in the face of life's challenges, adapting readily to change. It is these characteristics that we need to remember when working with youth in developing health services.

Because young people have specific health and well-being requirements, they require appropriate health services to support these needs.

Adolescence is a key time for establishing healthy behaviours or unhealthy lifetime habits or addictions, therefore preventative health promotion aimed at maintaining and enhancing health and well-being, should be an essential part of youth health services.

Young people need a supportive environment, and access to the information, life skills and opportunities to make healthy choices.

One size does not fit all. There are health disparities between Maori and non-Maori. There are also gender differences in key areas which require different strategies for young men and young women. These things need to be taken into account when working with young people.

For example, gender specific approaches are needed in the area of: mortality from road crashes and suicide, sexual health and reproduction and sports injuries.

We must also recognise youth as a distinct population group and provide relevant material, resources and information, appropriate for different ages, gender and ethnicity. Implications for rural and urban youth also need to be recognised as part of any initiative.

Along with the community or school based health promotion programmes, new delivery options are becoming available. For example, as more young people access information through the Internet this provides an alternative tool for promoting healthy life style messages. Information for young people should be interactive, relevant, and up to date. A good web address to visit is: www.thesite.org.uk.

All of this emphasises the importance of taking an approach to adolescent development that goes beyond purely health issues. Any strategies that we develop must look at the development of the whole person as the three programmes that I am about to outline, show.

One Stop Shops
The One Stop Shop concept originated in the United States and has been supported here by the Ministry of Health as a means of improving young people?s access to health services.

One Stop Shops take a holistic approach to adolescent health by combining a number of services all under the same roof. They are designed to be age appropriate, accessible by public transport, user friendly, culturally appropriate, confidential and above all free.

By late 1997, there were eight one stop shops operating throughout New Zealand. Manukau City, Waitakere City, Wanganui, Hastings, Lower Hutt, Christchurch, Dunedin and Kapiti, all have One Stop Shops.

In all of the centres, young people are actively involved in the planning and delivery of services through:

helping determine health needs,
serving on the Trust Boards and administering services, and
working as peer educators in an advisory capacity.
This involvement is a significant factor in successfully delivering the services that young people want. For some young people a One Stop Shop health service may provide a first time contact in an environment where they feel safe and able to address a personal health problem. In addition to being both safe and accessible, the range of services delivered on site include:

clinical services (both nursing and general practice),
specialist services (eg. sexual health, contraceptive, drug and alcohol, mental health),
counselling and referral services, and
information (covering health, education, justice, income support, recreation needs).
One Stop Shops also have strong links with a range of external agencies, allowing for prompt referrals when necessary.

Peer support workers are another integral part of the service. The use of peer counsellors is a good way to promote positive health messages to young people.

Wraparound Services
A second model of health care is the Wraparound service which was developed for young people and their families. It is a community-based service founded on the concepts of:

needs assessment,
case management for each client providing 24 hour crisis support and unconditional care,
participation and empowerment, both for the young person and their family,
flexible individualised treatment plans,
integration, and
cultural appropriateness.
In the Northern Region of the HFA, several Wraparound services operate to assist those young people with emotional, mental and/or behavioural disturbances.

Unlike the One Stop Shop concept, which provides a universal service, Wraparound is very tightly targeted to young people with specific multi-sectoral needs, in health, education, welfare and often youth justice.

First Point Of Contact
The third initiative I would like to mention is ?First Point of Contact'. A trained social worker, nurse or community worker is attached to a school in order to help identify the physical, psychological, social and emotional needs of young people.

The service is not restricted to school pupils, but locating the service in schools enables better follow up care. This approach ensures that co-ordinated care is tailored to the needs of the individual. It also allows liaison between young people, their families, school and health providers in the safety of the school environment.

The First Point Of Contact service has predominantly been targeted to schools in lower socio-economic areas with high proportions of Maori and Pacific Island students. It is being well received and it provides additional support at a time when teachers are stretched.

Each of the examples I have outlined, have a high level of client interaction.

This is important because when young people are concerned about their health, they need services that recognise their youthfulness and cater specifically to them.

In my view, the most successful youth services will always those that have been designed as a result of youth involvement and consultation. Young people need a range of quality services available to them, whatever model we adopt.

The last area I want to talk about today is the importance of programmes designed to assist teenage mothers.

Teen parents and their educational needs The 1996 Census shows that there were 561 single parents aged 15 - 19 years of whom just over half (52%) have no formal qualifications and only 17% have a qualification equivalent to School Certificate or above.

With few educational qualifications and life experiences to fall back on, this group can be seriously limited in both their future employment options as well as their ability to parent.

Teenage parents are not a new phenomena but what has changed from 20 years ago, is the number of young women who decide to keep their child but who lack the support of a male partner. Previously, unmarried women who got pregnant either married or put their child up for adoption. They rarely brought up the child on their own. Now they often have little choice.

An example of a programme that is making a difference in the lives of a number of teenage parents ? both men and women is He Huarahi Tamariki which you may have seen featured on television last Sunday night.

He Huarahi Tamariki
Based in a small room in the suburb of Cannons Creek in Porirua, the programme is designed to meet the needs of young parents who have had their schooling interrupted due to the birth of their children, while still teenagers themselves.

Susan Baragwanath the Manager of He Huarahi Tamariki, in Porirua, was concerned about the number of young women leaving the education system once they became parents.

After identifying similar programmes in the United States, Susan decided to do something for those teen parents living in Porirua. Her school offers both a second chance at education and solid parenting skills.

He Huarahi Tamariki has grown from having 14 students enrolled in 1995, to 40 plus in 1998. The school now includes a number of teenage dads who are also keen to return to their education. Key features of the school include:

activities geared to youth involvement in a supportive atmosphere,
students are involved in managing He Huarahi Tamariki,
a conscious attempt to empower teenage parents and to develop their leadership skills, and
the personal health needs of parents can be addressed.
Students learn about a range of things including, English language, driver education, independent living and budgeting, access to the law, and home economics.

He Huarahi Tamariki is focused on ways parents can cope with children through the various stages of development. Parents as First Teachers (PAFT) are active participants, as is Plunket, the Early Childhood Development Unit of the Ministry of Education and other agencies.

The children are catered for in the creche, enabling mothers to continue breast feeding, or maintain contact with their pre-schoolers throughout the day.

Teamwork is part of the ethos with chores shared by students and staff. The natural support system is enhanced with grandparents, partners and friends encouraged to attend when they wish.

Students are supported by paid staff and many volunteer tutors who are able to respond to the needs of individual students. They also share their life experiences with students. Minor accomplishments are recognised and compliments are used to reinforce and encourage further work.

Teenage parents are still adolescents themselves, but He Huarahi Tamariki responds to the conflicting behaviours and ideas associated with adolescence by providing a balance between nuturing and limit setting.

Although other teen parent programmes are available in New Zealand, they do not combine parent/child learning in the same building. The He Huarahi Tamariki programme provides a ?best practice? model which integrates a range of health, education and welfare needs for both teen parents and their children.

These needs are unlikely to be met by any one agency but require an ability to coordinate inter-agency services and funding to fill gaps based on assessment of varying local needs and services for this group.

Conclusion
When working with young people it is important that we view them, and their issues in context. Young people are part of many systems - family/whanau, peer groupings, schools, work places, clubs and churches, all of which are part of a wider cultural, societal context

Young people need to maintain a sense of connection to the systems to which they belong. They also need encouragement to explore and discover their own ideas, thoughts and opinions. This may require adults to develop new ways of relating, parenting and teaching.

I believe that it is important that young people are able to determine for themselves what's appropriate for them in the way of health education. By including their views we can ensure that the services developed for them actually address their needs.

Youth must be the architects and agents in solutions. I am certain that many of the health problems faced by youth are the result of being treated as a sub-group of pre-people. So in addition to good, youth -specific services we should also assess the way each of us treats youth.

In closing can I say that you have already shown your commitment to other people and your community by training in such a difficult area, and I commend you for that.

As is often said, the youth of today are our future. I want the future to be safe, healthy and enterprising.

We've all got a role to play if that is to be achieved.

I wish you all the best in your studies, and hope that you have a satisfying career in nursing or whatever other field you choose to follow.

Thank you. Are there any questions?