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Medical home's role in children's health still evolving

January 15th, 2013

by Thomas Dahlborg

In a previous blog post I stressed that we must refocus the principles of patient-centered medical homes (PCMH) to ensure compassionate care is elevated in the hierarchy of priorities if we are to truly position children to achieve their optimal health.

Since then, two additional barriers to children's health have become all too familiar--bullying and adolescent substance abuse (and the link between the two).

For example, in the online December issue of Pediatrics, researchers from the Rudd Center for Food Policy and Obesity at Yale University found that 64 percent of those surveyed report getting bullied at school (with the risk of bullying increasing relative to the child's body weight).

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And even more disturbing to me: Children also report being bullied by physical education teachers and sports coaches (42 percent), parents (37 percent) and classroom teachers (27 percent).

Moreover, the latest National Survey on Drug Use and Health has found the rate of current illicit drug use among youths aged 12 to 17 is 10.1 percent (and increases to more than 21.5 percent once they become young adults--ages 18 to 25).

And as noted above, a recent Ohio State University study has found that "youth involved in bullying were more likely than students not involved in bullying to use substances, with bully-victims reporting the greatest levels of substance use."

So is bullying the only driver of adolescent substance abuse? Absolutely not. But a link has been identified, and thus, as healthcare leaders we now have an opportunity to impact both.

I'll point to a Patient-Centered Primary Care Collaborative (PCPCC) webinar, "Promoting Innovation In Adolescent Health Care Through the Patient-Centered Medical Home," that confirmed many of my firmly held beliefs, as well as opened my eyes to new ideas.

Some key takeaways:

  • Most important to teens when thinking about what they need/want from their physician is relationship, respect, and trust, along with continuity of seeing the same physician.
  • Also high on their priority list is time ... they want time to share and for the physician take the time to truly listen.
  • Specific to mental health (MH) and substance abuse (SA) issues, they want those practitioners onsite (not just a referral)--someone their trusted physician can walk them down the hallway and introduce them to.

This is powerful information that also is diametrically opposed to how the vast majority of the healthcare system is created. There is a clear need for PCMHs to not only evolve on their current trajectory but also to expand beyond the walls of the health home into the communities where our children live, work, learn and play.

We need to be engaging coaches, teams and teachers (and educating them on the positive and negative effects they are having on our children) to create a patient-centered neighborhood connected to these individuals (and other community resources) and especially to the child and their family in the way THEY need.

We have children who are being bullied by peers and adults alike, we have children who are turning to illicit substances for many reasons (including being bullied), AND we have children asking for what they need in healthcare--and barring a few exceptional areas, the healthcare system is not listening.

These are our children, and as healthcare leaders we must listen, evolve, innovate and adapt. Many of the solutions are being told to us by our children. The question is whether we are courageous enough to listen.

Thomas H. Dahlborg, M.S.M., is vice president for strategy and project director for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being.

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