Journal of the New Zealand Medical Association, 13-October-2006, Vol 119 No 1243
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:
It 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.
Primary Care Practitioner and Director
198 Youth Health Centre
198 Hereford Street
issue | Search journal |
Archived issues | Classifieds
| Hotline (free ads)
Subscribe | Contribute | Advertise | Contact Us | Copyright | Other Journals