University of Maryland Adolescent and Young Adult Medicine Clinic

Occupying its own stand-alone, street-level office space in downtown Baltimore, the University of Maryland Adolescent and Young Adult Medicine Clinic is based in the community and reaches out to local teens and their families, while also drawing upon the substantial institutional resources of the university. The clinic provides continuing comprehensive primary and subspecialty health care for underserved and underinsured teens and young adults ages 12 through 24. Staff, many of whom are bilingual, have expertise in adolescent medicine, nursing, psychology, social work, nutrition, health education, and outreach.

Community outreach is deeply integrated in the clinic's approach to secure a connection between adolescents and needed health services. Clinic staff frequently participate in community events, including church programs, health fairs, and afterschool programs in efforts to better educate adolescents and those working closely with teens about adolescent health and the clinic's services. Of particular note is the clinic's work with new immigrant families who confront unique barriers in accessing health care services. The clinic has successfully engaged parents to bring their teens, particularly males, in for services. Males comprise 40% of the clinic's patient population, up from just 20% 10 years ago. The clinic also operates a teen-focused web site - www.yuhip.net where teens can connect to health experts and gather the most accurate and up-to-date information to enable them to make better decisions regarding their health. Furthermore, for the adolescents already linked to clinic services, various structures are in place for them to give feedback on services, solicit suggestions for needed resources, and share ideas that can improve clinic services. Teens can attend Community Advisory Board meetings or share their thoughts with a peer representative.

HIV prevention, treatment, and research are special areas of focus for the clinic. An interdisciplinary program called STAR TRACK (Special Teens At-Risk, Together Reaching Access, Care and Knowledge) addresses the complicated needs of adolescents who are infected with HIV through primary and subspecialty care, comprehensive counseling, case management, and support groups. Over the past fifteen years, STAR TRACK has launched community wide projects such as Project ACCESS, a multi-media social marketing campaign in 6 cities developed to encourage HIV counseling and testing among high- risk youth. Currently STAR TRACK is collaborating with Connect To Protect: Baltimore, a community based participatory research project working to create policy, procedural, and programming changes in the city to affect HIV acquisition in at-risk youth. The clinic is also a member of the national Adolescent Trial Network, which works to develop research initiatives for teens with HIV and facilitate their participation in research that has the potential to affect the lives of HIV positive youth on a national level.

Mount Sinai Adolescent Health Center (AHC)

Mount Sinai AHC (East Harlem, New York) is a freestanding hospital-based adolescent medicine clinic whose mission is to provide adolescents with inclusive, integrated health services, and, in the process, help them develop into capable young people who can advocate effectively for their own health. In support of this goal, prevention, education, and opportunities for self-development are integrated into every aspect of the program. Staff at the center include 6 adolescent medicine specialists, a child and adolescent psychiatrist, an ob/gyn, 20 clinical social workers, 3 health educators, 2 child psychologists, dieticians, nurse practitioners, physician's assistants, and ambulatory care technicians. A cornerstone of AHC's approach is to have these staff members operate as a consciously collaborative team, with the aim of providing each patient with a coordinated, highly indivdualized care program. The health center serves more than 10,000 teens a year.

Comprehensive, Integrated Care

As a part of a comprehensive physical exam, a patient receives reproductive health screening and counseling, a mental health assessment, appropriate tests and immunizations, risk-reduction counseling, and health education. For adolescents requiring mental health services, AHC provides on-site testing and diagnostic services; individual, group and family psychotherapy; and substance abuse counseling. The center also provides a wide range of ongoing peer support groups, including groups for youth with HIV/AIDS, adolescents with eating disorders, children of alcoholics and drug abusers, and teen parents.

Engaging Adolescents

The program makes a conscious effort to welcome adolescents and engage them in ways that make them feel comfortable and safe. The clinic has Saturday and evening hours and accomodates walk-in appointments. Health education and skill-building are a core part of both primary care and the wide range of specialty health programs available to teens. Whether patients make use of programs on weight management and fitness, pregnancy prevention, eating disorders, HIV/AIDS, or teen parenting, they learn how to make healthy decisions, to value themselves, and to become informed, effective health care consumers. Their development is also supported through mentoring, tutoring, legal advocacy, and GED support programs.

The process of engaging teens also includes involving them as partners in furthering Mount Sinai's mission. A peer education program called SPEEK (Sinai Peers Encouraging Empowerment Through Knowledge) prepares teens to engage community youths and facilitate workshops on preventing pregnancy, HIV/AIDS, and other sexually transmitted infections.

Wilmington Health Access for Teens (WHAT)

In response to statistics showing that Wilmington, North Carolina teens significantly exceeded state and national averages for out-of-home placements, juvenile arrest rates, and substance use, WHAT opened its doors to area adolescents in 1997. Operating initially with generous financial support from the Duke Endowment, the center's mission was--and continues to be--ensuring access for all teens to quality physical and mental health services and providing prevention, education, and outreach services to promote optimal health.

Meeting a Need, Making a Difference

In WHAT's first year, a staff of just six employees served 1,000 teen patients. By the time the center celebrated its 10th anniversary in 2007, more than 12,000 adolescents were receiving services from a staff of 40, including the region's only board-certified adolescent medicine specialist. Most importantly, the region has seen dramatic declines in teen pregnancy rates and the number of teens seeking care for non-emergency services in hospital emergency departments.

Treating the Whole Teen

Today, WHAT operates a freestanding, not-for-profit adolescent health center as well as two school-based health centers. Staff includes pediatricians, registered nurses, physician assistants, licensed clinical social workers, a registered dietitian, and health educators. WHAT offers a range of physical, behavioral, and reproductive services, including management of chronic illnesses, STD testing and treatment, contraception, lab services, and nutritional counseling.
With an approach that emphasizes family counseling and case management, the center also provides adolescents with comprehensive counseling services for such issues as stress, school problems, relationships, drug and alcohol use, and smoking. The center accepts all insurance arrangements, including Medicaid and SCHIP, and provides services on a sliding scale to the uninsured. Continuing foundation and individual support has allowed WHAT's annual budget to grow to $2.5 million.

Youth Educating Youth

Services provided by the center extend beyond physical and behavioral health care. As part of its commitment to community outreach, the center developed a peer education program called SYNERGY that prepares teens to reach out to community youth and facilitate workshops on numerous topics, including bullying, hygiene, and preventing pregnancy and STIs. Staff has recently developed a SYNERGY program especially for Latino youth. Another program, called Question Why Tobacco Prevention Youth Empowerment, teaches adolescents to advocate for tobacco-free policies in restaurants, recreation areas, and other locations. The center also offers two pregnancy prevention programs, including one for young males called Wise Guys.

West Suburban Teen Clinic

Providing services in an atmosphere of confidentiality, acceptance, and respect is a bedrock principle of the West Suburban Teen Clinic, located in Excelsior, Minnesota, a suburb of Minneapolis. "The people are very understanding and don't make you feel bad about the stuff you've done," reports one client. The clinic's goal is to provide accurate information, teach problem-solving skills, and reinforce healthy decision-making by providing services in a relaxed and friendly environment. Feedback from adolescents has been overwhelmingly positive, with more than 90% reporting that the clinic's providers listen well, treat them with respect, take enough time with them, involve them in decision-making, and give good advice and treatment.

A Clinic of Their Own

This community-based, not-for-profit clinic is the product of a teen task force convened in 1971 by local clergy concerned about the increase in teen pregnancy and STDs in the area. Initially providing reproductive care to 600 adolescents per year, the clinic now provides a continuum of prevention and intervention services to meet the physical, emotional, and educational needs of more than 2,000 adolescents and young adults up to age 23. Because the clinic is located in an early 20th-century house, it offers a comfortable, home-like environment that helps to alleviate the anxiety many adolescent clients feel when seeking health care in traditional medical settings.

Serving the Community

In addition to medical and counseling services, the West Suburban Teen Clinic provides individual and group education programs for both teens and their parents. These programs are offered in the clinic as well as in schools, churches, and other community settings. Parent educators are available for group sessions to discuss parents' questions and concerns about raising adolescents and pre-teens, from developmentally appropriate behavior to current research on teen-related topics. Group classes are also offered on healthy sexuality for young adolescent girls and the trusted adult they each choose to bring with them. In addition, 2 peer education programs are available: the Labyrinth Program, which focuses on pregnancy and STI prevention and counseling for at-risk youth, and Dads Make a Difference, which prepares high school students to work with middle school students to understand the challenges involved in parenting and to avoid behavior that will lead to pregnancy.