The DiSS program model of care adopts the WHO Adolescent-Friendly health service approach (described here as Youth-Friendly services) as an evidence-based and best practice approach to providing high-quality care in combination with qualities that young people demand. Adolescent-friendly or Youth Friendly care models essentially seek to overcome many of the previously described barriers that young people face in accessing healthcare.
Many of the barriers that young people face in attending health services occur prior to first contact. For this reason, developing Youth-Friendly health services is a collaborative endeavour that requires a whole school community and health service approach.
Youth-Friendly care requires a developmentally appropriate approach to patient-centred care. It takes into account the young person’s age and stage of cognitive, social, emotional and physical development and requires careful consideration about the young person’s capacity and competence to make decisions about their healthcare, elicit appropriate and timely supports and balance risks. Furthermore, high-quality Youth Friendly care aims to support the development of self-efficacy, advocacy and agency, whilst providing appropriate safeguarding and support, as appropriate to the young person at that point in time.
The focus is on the whole person in the context of their social, family and cultural environments. Preventative screening and advice are offered, time is taken to provide education and, when done well, young people develop health skills, adopt healthy behaviours and develop capacities required to make decisions about their health. Young people value clinicians who provide information at the appropriate rate for them and do not make them feel too rushed or as though they were making mistakes in the process of the health consultations.
In order for young people to access services, students ideally:
- Have a degree of health literacy regarding health and illness, healthy lifestyles and problem behaviours and services that SBHSs offer
- Students have some awareness about how, when and where to access services
- Find services convenient to access
- Are supported to access services initially and ongoing, according to their needs
- Trust that they can feel comfortable, supported and safe in accessing health services
- Feel secure that they will receive a confidential service (and that they can expect their attendance to be treated discreetly by the school community)
General Practitioners and Practice Nurses work with the school to provide health literacy education in the classroom and through whole school events and work with young people in consultations to build their health literacy opportunistically. Wherever possible, they provide education in accessing the SBHS and other health services in the community and provide prevention and health promotion education proactively.
Clinicians working in the DiSS program clinics undertake face-to-face training and continue ongoing medical education to enhance technical competence in adolescent-specific healthcare provision in the Victorian context. Face-face training and ongoing training aim to provide:
- Understanding of Adolescents and their families
- Understanding the school and clinical context
- Understanding networks and team-based care in the school and community context
- Communications skills that are culturally safe and trauma aware
- Psychosocial assessment and risk and resilience screening
- Deepen understanding of relevant medico-legal and ethical frameworks
- Enhance clinical effectiveness with adolescents and their families
Through the DiSS program, clinicians receive ongoing support for their work through point-of-care advice phone lines, de-identified case discussions with specialist peers, GP and PN peer support through formal Community of Practice (CoP) activities and support by medical advisors through the program. Clinicians have access to ongoing formal continuing medical education with experts in the field of adolescent health, through the University of Melbourne and their training partners.
As described previously, the WHO Adolescent-friendly conceptual model of care has been adopted by the DiSS program, as the model of best practice care for young people. Health providers within the DiSS program receive training in this model of care and ongoing support so as to maintain a high standard of care across SBHS in Victoria operating under the DiSS program. Health professionals operate within local legislative and medico-legal frameworks and have a duty of care to uphold the rights and safety of young people attending their services.
Author: Dr Bianca Forrester, 2018