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| Journal of the New Zealand Medical Association,
13-October-2006, Vol 119 No 1243
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Survey of the Network of Youth Health Service
Providers (NYHSP): affiliated to New Zealand Association for Adolescent Health
and Development (NZAAHD)
The age group 10–25 years is the only population group
in New Zealand in which the mortality rate hasn’t
improved.1
Primary healthcare services specifically for young people
have been gradually developing over the last 10–15 years. School health
services have been growing, alongside community “one-stop shop”
services.
School health services have been (and still are) very
variable across the country. Schools are providers of education services, but
they also recognise that poor physical, mental, and emotional health is a
barrier to educational achievement.
Under the Education Act of 1989, all schools have a
responsibility to provide a safe physical and emotional environment for
students. Most schools have policies around health issues, and some level of
health service.
All schools are implementing the new health curriculum,
although not all have dedicated health teachers. Nearly all have guidance
counsellors and some have visits from public health nurses. Some have enrolled
nurses on site and some have registered school nurses on site. Some have visits
from Family Planning nurses and some from GPs. Some schools have wellness
centres providing a variety of services from alcohol and other drug counselling
and social work to physiotherapy and general practice care.
Some doctors are funded through the local Primary Health
Organisation (PHO), and other schools fund the health service through their own
resources. The Ministry of Health has recently published a booklet Improving
the Health of Young People: Guidelines for school-based health care (June
2004). This details how primary health care professionals might work with
schools to improve health outcomes for the students. It does not examine any
holistic provision of health in the broad sense of whole school health
promotion.
These advances are to be commended but there is a long way
to go before there is a consistent, comparable, high standard service in all
schools. In addition, the most high risk students, who often have the biggest
health needs, leave school early. Students may need health care in the holidays
when they are away from school. Young people between 16 and 24 still have
developmental needs that are not well met by adult focused health care. These
factors have led to the development of youth specific services in the community.
Sometimes these are called “one-stop shops”, but
it is hard to define what makes up a “one-stop shop” as none of the
current services provides everything. Most agree that there needs to be
provision for physical, mental, emotional, and social health needs and they all
work within a development paradigm, and involve young people in the running of
the service.
History—Community youth health
services started with the Wanganui Health Service and was then known as the
Youth Advice Centre or YAC. It was started in 1994 by a Public Health Nurse who
then drew in other services to do sessions at the Centre such as a local GP, the
local Family Planning Association (FPA), and Sexual Health Service, the Child
and Adolescent Mental Health Service (CAMHS), and Alcohol and Drug Service. The
Youth Services Trust now runs it. The following year, the Youth Health Trust in
Christchurch opened the 198 Youth Health Centre, which had a different model.
Total funding was negotiated with the Community Trust for
start up funding and then a contract developed with the then Regional Health
Authority (currently the District Health Board DHB). Staff included a 30 hour a
week doctor, nurse, counsellor, social worker, and young people, in addition to
administrative staff. All workers were employed by the Trust.
Since then, services have grown up throughout New Zealand,
most of which follow either of the two aforementioned models or a mixture. In
addition, services also have developed other contracts and sources of funding to
make up for the deficiencies in the health funding. There are approximately 14
services from Auckland to Dunedin.
The Otago Youth Wellness Centre in Dunedin is different from
the others as it started to provide services for young people who truant from
school. The wrap around-service involves different agencies but not much in the
way of health on site and referrals are made to outside health services. In
Manukau, until very recently, the Manukau Youth Centre used to provide a drop-in
youthwork service, but again referred out for health services. It has recently
closed.
The Palmerston North one-stop shop provides a drop-in
youthwork service, and has recently added in a health component. There are about
four or five centres all planning to set up services at the present time around
New Zealand
In 2002, the Government published the Youth Health
Action Plan to complement the Youth Development Strategy Aotearoa. The
development of school and community youth-specific health services was among the
many recommended actions. Funding for primary healthcare now flows from DHB to
PHOs, and there has been more and more difficulty in funding not only new youth
health services but also maintaining funding for current services.
The nature of the behaviour of young people when accessing
health services means that the PHO model of funding is not a sustainable one for
a small practice.2
Method—To obtain information about
the funding sources of current community youth-health services, a survey was
performed by email with follow-up by phone or further email. Survey forms were
sent to the 14 services in July 2005
Nine services returned completed forms:
Five services did not respond:
Results—The services
are open for between 30 and 50 hours a week, and provide free services for young
people between 10 and 25 years, with some variation around the top and bottom
age by 1–2 years. See Table 1 for a summary of responses.
Staffing—Five services have
young people working there—of the four who don’t,
one has volunteer young people at the centre and one has a youth advisory
group.
Only one centre has no doctor, one has a
doctor full time, and the rest have a doctor working part of the time the centre
is open.
All but one of the services employs a
nurse. The nurse was present full time except for one centre in
which the nurse was part time.
Only four services have counsellors, most
of whom are part time except one where there are two FTEs.
Five services have full time social
workers, the rest have none
Services—Three services provide
recreation programmes, and two are closely linked with other services that
provide both art and recreation activities. In addition to primary health care,
most provide health promotion and education, and some provide primary mental
healthcare.
Four services provide outreach clinics to schools—one
is a school for young parents.
Table 1. Summary of survey
responses
Funding sources of contracts: DHB, MOH,
PHO, NCSP, CPU, Toi te Ora, Energy Trust, Rotary, Child Youth and Family
(CY&F), Arts Council, Work and Income New Zealand (WINZ), Community
donations, Council, Pub charities, Lottery, Public health.
Funding sources—All services had a
contract with the MOH or DHB; four had additional contracts with their local
PHO. All had additional sources of money from sources such as the City Council,
Charitable Trusts, Pub Charities, etc. One had funding from WINZ and the Crime
Prevention Unit, and two from CYF. The number of contracts ranged from 1 to 9,
with an average of 4.
Future development—All services would
like more funding. All would like to expand their hours, and those without
counselling/mental health services see a need to provide them. Most would also
like to expand the group work they do and to include parenting and anger
management. Those that do not run arts or youth development programmes would
like to be able to do so. Those without a social work service would like to be
able to provide this service especially in the area of youth justice. Most
services would like to be in a position to run more outreach clinics either to
rural areas, schools, or youth justice facilities.
Discussion—A literature review of the
outcomes of youth-specific services, both school and community based, has
revealed very little research on this topic. A recent review by Karen
Mathias2 found 23 studies, which quantitatively
evaluated youth-specific primary health care for 10–24 year olds with some
measure of health outcome. Seventeen of the studies looked at access and
utilisation, and all of them found high utilisation rates with enhanced access
for the socioeconomically deprived and also at risk young women.
Studies looking at mental health show much improved access
to primary mental healthcare, especially for young
men,3,4 however there was no evidence for
improved self-reported mental health status among clinic users. These studies
also described significant reductions in emergency department use. None of the
studies provided sufficient evidence to determine the effectiveness of
youth-specific primary health services, and the review makes the point that more
research is desperately needed in this area.
The Youth 2000 study5 was
the first “snapshot” of health and development factors present in
the lives of New Zealanders aged between 13 and 17, attending secondary school.
Amongst many other self-report items contained in the survey healthcare
utilisation was asked about. 83.4% said they had a family doctor and
approximately 50% felt there were no barriers to obtaining healthcare.
The most common barriers to healthcare identified by the
others were:
Other factors identified in
the Mathias Review included:
Many of the
youth-specific services in New Zealand did surveys of the young people in their
area to find out what they wanted in terms of healthcare, two of which from
Auckland and Wellington, have been
published.6,7
The youth-specific health service in Christchurch was
evaluated in 1997 by Nicola Geddes.8 This was
limited by lack of a comparison group, however the vast majority of attending
young people found the service accessible, appropriate, and acceptable, with the
most common reason for attending (77%) being ‘no cost’ and 30%
saying that they would not have gone anywhere else if the service didn’t
exist.
In Rotorua, the youth-specific service has been running for
3 years. Recently it has been having approximately 400 visits a month. In
Rotorua, there is only one PHO so it is relatively simple to observe the numbers
of young people attending. During the same time period there was no drop in the
numbers of young people attending GPs.9
A recent review of best practice in school clinics by Doone
Winnard10 has found four critical success
factors that best practice and evidence recommends. These
success factors are:
ConclusionIt has been shown that barriers to healthcare include many
factors outlined above. Youth Specific health services have been set up in New
Zealand to overcome these barriers. This survey shows that they have great
potential. Standards and frameworks have been drawn up to enable them to be cost
effective in their delivery of service. The survey also shows that services
currently are patchy and often non-existent.
In September 2002, the Government released Youth Health:
A Guide to Action (Ministry of Health: http://www.moh.govt.nz/moh.nsf/wpg_Index/Publications-Youth+Health:+A+Guide+to+Action).
It had 10 goals to improve the health of young people. The provision of
high-quality, youth-friendly, accessible health services was one of the goals.
It is time to deliver services for young people that are consistent, drawn up to
a national plan, and provided throughout the country in a way that will reduce
the inequalities that currently exist.
Sue Bagshaw
Primary Care Practitioner and Director 198 Youth Health Centre 198 Hereford Street Christchurch References:
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