Accessibility, acceptance boost teen clinics
Has your facility considered implementing special teen clinic hours in an effort to serve area adolescents? If the answer is "yes," know that it will take a commitment of resources, both in terms of staff and funding. Once the investment is made, though, be prepared to see immediate results, say those who have instituted such programs.
"When we opened in 1995, we expected to see 90 teens, and we saw well over 300 in that year," says Bobbie Anderson, MHA, executive director of Boulder (CO) Valley Women’s Health Center. The center operates a teens-only clinic from noon to 6 p.m. every Saturday. Center administrators project some 500 adolescents will visit the Teen Clinic this year.
The Seattle-King County (WA) Department of Public Health received a mini-grant from the Washington State Department of Health in 1995 to hold teen clinic hours at three of its health center sites, says Michelle Pennylegion, MPH, lead health educator for the department’s family planning program. Since that time, interest in the program has led to establishment of teen clinic hours at all 10 health department sites, Pennylegion says.
Confidentiality tops the list of young people’s requirements for teen services. Many adolescents are unwilling to go to their regular doctor or visit a traditional health center clinic for fear of being seen by parents or friends of parents. By scheduling special hours, usually after school or on weekends, teens can come to health facilities without risking detection.
If the teen clinic is scheduled at a health department site during the week, try to locate the service in a separate area so teens can feel comfortable in their own "space," says Robyn Achilles, MPH, a public health educator and coordinator for the Northshore Teen Clinic in Bothell, WA, the latest addition to Seattle-King County’s adolescent services. Every Wednesday afternoon from 3 to 6:30, staffers transform a room in the back of the building into the Teen Clinic waiting area.
Many "teen-only" clinics are just that no adults allowed. The Boulder teen clinic gave careful review before implementing a separate waiting area for parents, says Jonna Sherrill, MA, clinic manager.
"It was actually a big debate when the Teen Clinic first opened, whether to allow parents in at all, or to let them sit in the waiting room," she recalls. "But we decided we really wanted to encourage parents to come with their teens, because it’s a wonderful thing, but that for other teens, it’s definitely a confidentiality issue if they see their best friend’s mom sitting across from them."
The Northshore teen clinic encourages parents to use the main waiting area, rather than the designated teen clinic waiting room, says Linda St. Clair, an adolescent health access coordinator at the site. Both the Northshore and Boulder clinics are set up as walk-in facilities. Such flexibility helps to further break down the access barriers, since teens may have to rely on others for transportation.
Keep the costs down
For young people to access the kinds of reproductive health services offered during teen clinic hours, it is imperative that patient costs be held to a minimum, says Pennylegion. Seattle health department officials have found that even using the words "low cost" in clinic promotion may represent a barrier to those teens who have no financial resources of their own, she reports.
Allocating staff hours to such free services is a challenge, especially when those hours could be slotted for reimbursable activities, Pennylegion admits. That’s why it’s important that administrators, staff, and all involved share a common philosophy and understanding of the importance of teen clinic hours.
Given the current concern over the rise in pregnancy and sexually transmitted disease rates among teens, agencies may be able to qualify for special funding for such services. The Boulder clinic receives funds from both the city and county, as well as grants from private foundations, Anderson says.
Promoting an air of acceptance, understanding, and respect are important factors in earning a teen’s trust, says St. Clair. By establishing a good rapport, providers can more fully examine the reasons for accessing the clinic and improve the chances that patients will return.
"When the provider or health educator spends time to really get to know the teen before bombarding them with a lot of medical questions and medical history, then they tend to have more luck in having the teen to come back," Pennylegion explains. "If they build up a relationship before they address every single issue that’s going on in that teen’s life, such as any drug/alcohol issues or home situation problems, the result is they can help them with whatever issues are going on in their lives."
Teens want acceptance and a nonjudgmental attitude, Achilles says. Many adolescents who have been to the Northshore clinic have commented on the high level of respect they receive from the staff.
"We are seeing kids who live in families with multiple problems, plus kids who are homeless, but we also are seeing kids who probably have enough money to go to a doctor," she notes. "They want to come here because their comment is their own doctor didn’t treat them very well."
To help foster a nonjudgmental environment, Sherrill says, avoid lecturing, connect with young people at their level, and share information they need to know.
"They seem to be pretty hungry for information, so it’s just a matter of advertising in some way to let them know where they can get it," she offers. "Then they come in droves."
(Editor’s note: Put teen-friendly ideas into action at your facility. Review suggestions at right from Boulder and Seattle administrators and health educators.)