Review of the evidence for adolescent and young person specific, community-based health services for NHS managers

Published date16 March 2015
Pages57-75
Date16 March 2015
DOIhttps://doi.org/10.1108/JCS-09-2013-0029
AuthorGemma Ryan
Subject MatterHealth & social care,Vulnerable groups,Children's services
Review of the evidence for adolescent
and young person specific, community-
based health services for NHS managers
Gemma Ryan
GemmaRyan is Senior Lecturer/
Head at the Health & Social Car e
Research Gr oup, Faculty of
Education,Health & Science,
Universityof Derby, Derby,
UK and is Honorary Research
Fellow, at the Leicestershire
Partnership NHS Trust,
Leicester,UK.
Abstract
Purpose The purpose of this paper is to provide an overview of the evidence surrounding the design
and delivery of adolescent-specific health services for young people aged 14-25. This aims to make
recommendations for National Health Service (NHS) senior management teams on the available literature
relating to service design for childrens and young people's services within the UK.
Design/methodology/approach This paper presents a mini-review carried out in Spring 2013 using
EMBASE, BNI, PSYCHinfo, MEDLINE and Google Scholar to systematically search available published and
unpublished research papers. Systematic reviews, meta-analyses and evaluations of service models were
included within this review. Adapted GRADEcriteria were used to appraise the evidence.
Findings Of 70 papers found, 22 met the inclusion criteria. There were five main service designs found
within the literature: hospital-based; school-linked or school-based; community based; combination and
integrative; and other methods which did not fit into the four other categories.
Research limitations/implications This review is limited to the literature available within the inclusion
criteria and search strategy used. It intends to inform management decisions in combination with other
parameters and available evidence.
Originality/value There is range of research and evidence syntheses relating to adolescent services, but
none of these have been conducted with a focus on the UK NHS and the information needs of managers
re-designing services in the current climate within England.
Keywords Servicedelivery, Adolescent services, Community services, Service design, Youngpeople, Health
Paper type Literature review
Introduction
Adolescent and young personshealth
Adolescents aged between 13 and 19 have greater and unique health needs, experiencing
a range of challenges as part of their transition from child to adulthood (Royal College of
Paediatrics and Child Health, 2003; Kurtz and Thornes, 2000; Hagell and Colemanm, 2012). An
estimated 300 young people aged 15-24 die every day in the European Union; added to which
are increasing numbers experiencing mental health difficulties and health problems which impact
on emotional well-being (Department of Health, 2011). The health of young people and
adolescents is often given low priority by policy makers, even though it is known that serious
diseases and premature death in adulthood can have roots in adolescence (World Health
Organisation, 2012). Therefore, the health and well-being of young people is important for the
future health of the UK.
The Kennedy Review (2010) argues that one of the main` problems affecting young people is that
their health needs are not recognised as distinctly different from those of children and adults.
Many thanks to Professor Dawn
Forman, Director, Interactive
Leadership and Management
Development; Adjunct Professor,
Curtin University & Auckland
University of Technology; Visiting
Professor, Chichester University for
her input and support with
amendments to this paper.
DOI 10.1108/JCS-09-2013-0029 VOL. 10 NO. 1 2015, pp. 57-75, © Emerald Group Publishing Limited, ISSN 1746-6660
j
JOURNAL OF CHILDRENS SERVICES
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PAG E 57
For example, adolescents are more likely to be exposed to high-risk behaviours and peer and
societal pressures, and the World Health Organisation (2012), Hagell and Coleman (2012), Royal
College of Paediatrics and Child Health (2003) and Lawrence et al. (2009) argue that more
attention needs to be paid to developing adolescent-friendly health services, particularly as young
people who are healthy are likely to have a stronger foundation for good health later in life
(Chief Medical Officers Report, 2007).
Adolescent services in the UK
In April 2013 the way in which health services in the UK are commissioned was changed, shifting
responsibility to primary care commissioning groups. This has raised awareness among service
managers of the importance of efficient, cost-effective service design and delivery. Healthcare
providers are increasingly required to consider the need for adolescent services to address young
peoples physical, psychological and social needs in an integratedand multi-disciplinary way
(Royal College of General Practitioners et al., 2013).
Austerberry et al. (2008) outlines three distinct methods of service delivery for teen health:
enhancing or developing teenage-specific, holistic services; creating or enhancing health
provision in non-health and community settings; and enhancing mainstream provision to
include adolescents more effectively. The Royal College of General Practitioners et al. (2013)
identify that the UK has high rates of sexually transmitted diseases, teenage pregnancy,
obesity and mental health disorders and it is known that young people have high rates for
consultations with their general practitioner (Patton and Viner, 2007). However, if adolescent
health services are to be accessible, efficient, productive and cost effective, consideration
needs to be given to the way in which they are delivered in both primary and community
care settings.
Community care
For the purpose of this paper the context of community services is considered as separate from,
yet complementary to, that of primary care and general practice. The NHS Confederation (2009)
identified three levels of community-based services, which included:
1. core (or universal) services, e.g. health visiting, district nursing, school nursing;
2. specialist services, e.g. Child and Adolescent Mental Health Services (CAMHS); and
3. services provided with other agencies, e.g. childrens centres.
The Royal College of General Practitioners et al. (2013) further suggest that community and
primary care services will increasi ngly be provided by a combination or in tegration
of specialists, nurses experienced in treating psychological disorders, and CAMHS, and
generalists, such as community nursing teams or assistant practitioners working in the core
community provision.
There is a range of possible service designs for the delivery of adolescent health. These may
include stand-alone specialist provision where teams provide services to a clearly defined age
group, such as 11-19 year olds, or provision that is embedded in the sense that it is delivered
within current community coreand specialistservices. Alternative models provide more
specific services through clinic delivery, such as sexual and reproductive health clinics based in
the community and delivered by school nurses and counsellors (Centre for Disease Control
and Prevention, 2013).
Aims
This paper poses the question, Are adolescent-specific services more efficient and effective in
achieving health outcomes and service user satisfaction than integrated or combined provision
in community health services?and seeks answers by reviewing the available evidence on the
effectiveness of different models of service delivery. From this exercise, recommendations for
potential models of adolescent healthcare delivery are made.
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