Adolescence can be a time of vulnerability, high-stakes choices, relationships, risks and unattended health problems. These can be stressful and can result in profound consequences later for adult health and well-being.
Results of the 2015 New Mexico Youth Risk and Resiliency Survey completed by high school students show that youth in Bernalillo County are at particular risk for: unintentional injury (text/email while driving and rarely/never wore seat belt); violence (in a physical fight, sexual dating violence); marijuana and other substance use, and mental health problems (self-injury and feeling sad or hopeless).
In general, adolescents can benefit greatly from physical and behavioral health care, yet they access health care less than any other segment of society. Youth do not get the preventive or counseling services they need through the conventional health-care structure. As a result, health risks are missed as is illustrated in the risk screenings of high school students using New Mexico school-based health centers (SBHC):
• 32 percent felt down, depressed, irritable, hopeless;
• 12 percent thought, planned or attempted suicide;
• 48 percent were having sex, while only 64 percent of those were using condoms;
• 14 percent were physically, sexually or emotionally abused.
Adolescents should be actively targeted by our health-care system for preventive services, proactive follow-up and timely management of current medical and behavioral health issues, including referral, if needed.
In Albuquerque, the school-based health centers have been effective in addressing this need. They offer youth-friendly preventive services and provide students access to the health care they need in a place they trust that is convenient so they can stay in class, ready to learn. The centers can have a positive effect on students’ health, improve school attendance and can reduce student discipline referrals. They also help keep parents and families on the job.
School-based health centers are active in only eight Albuquerque high schools, five middle schools and one elementary school. Recent reductions in the state budget now threaten the continuation of the centers; five of their contracts were cut in last year’s Department of Health budget.
University of New Mexico Hospital will receive continued financial support with the vote to extend the Bernalillo County mill levy for the next eight years, which will amount to around $95 million per year. Until very recently, these funds were used to offset the costs of uncompensated care services provided to uninsured indigent residents of the county. However, since the advent of the Affordable Care Act and expansion of insurance, particularly Medicaid, in New Mexico, the number of uninsured indigent patients has sharply fallen. As reported in a Nov. 2, 2016, Albuquerque Journal article, “Indigent care costs have been cut nearly in half at the University of New Mexico Hospital system over the course of two years, thanks in part to the expansion of Medicaid …”
This has released some of the mill levy from the need to offset indigent care and opens up discussion of other needs the hospital might be able to cover on behalf of the county’s residents. These should include focusing hospital operations on increasing preventive and anticipatory services strategically aimed at high-risk groups with the intent of reducing risks, future burdens of disease and injury and their costs and addressing shortened life expectancy.
One easy example would be improving the health of children and youth by increasing access to care through school-based health clinics. UNM has experience with this model of care and could expand it so more children and youth are served.
Establishing SBHCs in all APS high schools and middle schools should be prominent on the list of priorities for UNMH’s mill levy.
Dr. William Wiese is a former chair of the University of New Mexico Department of Family and Community Medicine, former director of the Department of Health public health division and an advocate for better adolescent health care.