A Focus on Women's Health
••Winter 2005/Vol. 9, No. 1

Clinical Contributions

Teen Challenges | to pdf >>
By Jennifer Cullen

Ask any teen what is bothering them, and you'll get a range of responses: problems with friends, not getting along with parents and family, being stressed out about money and their future--not to mention teens who face pregnancy, addiction, abusive relationships, and depression. Circumstances such as these affect teenagers on a daily basis and have a lasting impact on their health and well-being. Providing teens with a safe place to share, working with them to problem solve, and helping them to make positive, healthy choices in the future is the collective aim of adolescent providers.

... sounds great, but how does one really accomplish this? On an individual basis, it is not easy to get teens to be honest about their behavior. Another challenge is finding methods that appeal to adolescents and engaging them in thinking about health choices. And what about those teens with whom there is no opportunity to assess and educate because they don't come in for visits with their physician? How do clinicians treating adolescents get them to tell what is going on with them so that appropriate education, resources, and treatment can be offered?

The Kaiser Permanente (KP) Santa Rosa Teen Clinic may have the answer. It's called Teen Choices and Challenges, a Web site devoted to teenagers. The Web site addresses many of the everyday concerns that teenagers face, including health, weight, body image, relationships, stress, smoking, alcohol, drugs, and more. Covering a variety of health and lifestyle topics, the Web site gives teenagers a place to privately get answers to questions and to learn about issues that are important to teens. Mandy Weltman, Pediatric Clinical Health Educator at KP Santa Rosa, manages the program at the KP Santa Rosa Teen Clinic, where almost 100 teens have logged on to participate. She sees that the Web site fills a need for adolescent members. "A lot of kids have problems and concerns," Ms Weltman said. "But they don't want to or don't know how to talk to someone about them."

Teen Choices and Challenges serves as both an assessment tool and an educational component of adolescent care. When teens register on the Web site, they are asked to complete a questionnaire about themselves. Upon completion, a personalized report is generated, that teens can print, read, and keep. Their report includes health education material, tailored health messages based on the teen's responses to the questionnaire, and local KP and community resource information.

The Web site also fills a need for the clinic's clinicians and other staff. Ms Weltman has a password that allows her to log on to the Web site and view a summary report of individual teens' behaviors and risk areas. If a high-risk behavior is triggered, Ms Weltman contacts the teen, engages in a counseling intervention, arranges for the teen to come to the clinic for a physician visit, or refers the teen to appropriate services. Ms Weltman and the clinicians treating adolescents at the clinic worked together to develop a "care path," or decision tree of protocols she follows for each behavior triggered by the assessment tool and appearing in her summary report. Recently, Ms Weltman called a 14-year-old member who had triggered a risk area for sexual behavior. Initially, the girl did not want to talk to Ms Weltman. But two weeks later, the girl called back and discussed the issue with Ms Weltman, seeking an understanding ear and advice.

Designed with the help of teens, the Web site has a look and feel that appeals to teenagers. And it is confidential. Ms Weltman cannot see the answers adolescents provide in the questionnaire; instead she is alerted to high- and medium-risk areas that require her further professional assessment. Security of the Web site is maintained by password-required access for teens and clinicians, firewalls, and encryption. In addition, deidentified aggregate data are available on the Web site for the clinic to evaluate teen behavior and population-based problem areas that providers can collectively address.

How it Works for Adolescents

• Accessible from any computer with an Internet connection, the Teen Choices and Challenges questionnaire can be completed by teens from home, school or on-site in the clinic at a computer station.
• Teens are provided with an access code to enter the Web questionnaire.
• The questionnaire covers 11 different topic areas that capture health and mental health issues faced by teens, including nutrition, weight, and body image; drug, alcohol, and tobacco use; physical activity; safety; stress and depression; sexual behavior; personal relationships, and conflict resolution; and general health.
• The questionnaire can be customized to include specific topics for more focused learning, such as a "weight management module" covering weight, nutrition, physical activity, and body image.
• Upon completion, teens can view and print their personalized results, including health information and local community and/or KP resources.
• Although no one can view their questionnaire responses, clinicians, counselors, and health educators may have access to a summary report of a teen's risk areas. Upon review of summary reports, clinicians and other staff can contact individual teens to arrange appointments, conduct a counseling session, refer to services, and provide outside resources or other support.
• Teens are provided the contact information of someone at their clinic (often a counselor, nurse, or clinical health educator) to contact with questions or to discuss their results.

How it Works for Providers and Staff

• Teen Choices and Challenges is available both to KP Clinics and to community organizations at no charge.
• Physicians, health educators, nutritionists, counselors, and other professionals can initiate participation of a clinic or department.
• A password created for the clinician is tied to their teen member's access code and allows access to the Web-based teen summary reports.
• Clinicians can search for an individual teen's report by looking for the teen's name or by searching for teens who have completed the questionnaire in the past day, week, or other period of time.
• A staff person can be appointed to monitor the teens' results, contact teens to counsel and offer services, and coordinate with clinicians on the basis of teen participants' level of need.
• Outreach approaches can be conducted to contact teens who have not recently seen their physician and to encourage them to complete the questionnaire from home.

Next Steps

Teen Choices and Challenges is available to KP and community-based sites. Because it is Web-based, the questionnaire is easy to implement. KP Regional Health Education provides training and support. Please contact Jennifer Cullen at 510-987-3511 or jennifer.cullen@kp.org to learn more.

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