Spotlighting our Soldiers' teens
November 15, 2010
- The secondary effects of prolonged stress from war on military Families and children are being recognized at Madigan
- One of the ways Madigan is caring for Soldiers' teens is by transitioning to a medical home environment
- A medical home is characterized by comprehensive, holistic care within the department
- The concept involves having the adolescent meet with a team in one location for all health care-related matters
The events surrounding America's latest wars have affected not only our service members, but also their Families. The secondary effects of prolonged stress from war on military Families and children are being recognized at Madigan Healthcare System.
One of the ways Madigan is caring for Soldiers' teens is by transitioning to a medical home environment within the Adolescent Specialty Clinic. A medical home is characterized by comprehensive, holistic care within the department. The concept involves having the adolescent meet with a team in one location for all health care-related matters.
The staff in the Adolescent Clinic no longer just performs physical check-ups. When adolescents come into the clinic they are screened from a whole-person perspective. They monitor not only height and weight, but also relationships, grades, behavior and feelings. Triage nurses are learning to create a relationship with patients and assist with identifying when a teen may need more than a check of their vital signs. In many cases, they can meet with Dr. David DeWine, a pediatric psychologist, before they leave the clinic if they are identified as needing possible help with behavioral or emotional issues.
"The way that you assess risk and emotional concerns in adolescents is by developing a relationship with them. And if you see a different person every time you come in you are never going to develop that relationship," said Maj. (Dr.) Keith Lemmon, chief of the Division of Adolescent Medicine. "The idea is to form an environment where they feel comfortable talking with you about some of the emotional issues they are experiencing. If you see a different person every time you come in, you're never going to develop that relationship."
The Adolescent Clinic staff is working hard to develop a relationship with the patients, from the medical support assistant who checks patients in, to the nurses and doctors assessing their health needs. The goal is to have patients understand that they are being cared for in a comprehensive way.
"Only through feeling comfortable is it possible for the teens to feel like they can talk about depression, substance abuse and sexuality issues they might be facing," Lemmon said. "The whole concept of the Adolescent Clinic is that there is probably something going on in an adolescent's life that is a bigger threat to their health than whatever they came in for. So they may have come in for their sprained ankle, but there may be more serious issues affecting them like are they sexually active' Are they depressed' Are they cutting themselves'"
The benefit of having DeWine in the adolescent clinic means that the teens, which have opened up, won't be waiting for a referral before they speak to someone. The teen may be led to someone right there in the clinic. DeWine often serves as a conduit to a longer-term care plan, but the key is ensuring that when a teen is ready to open up, someone is available to speak with them.
In addition, the primary care physicians in the Adolescent Clinic are being trained to recognize when physical symptoms are really a sign of an emotional or behavioral issue at hand.
"People don't go straight to their psychologist or psychiatrist; they come to their primary care doctor with headaches or stomach aches or chest pain. A lot of physical symptoms in kids are a manifestation of emotional and behavior issues; most kids are healthy. They don't generally have organic causes for headaches," Lemmon said.
As a part of the medical home model the clinic is training doctors to recognize common symptoms which are factors in behavioral and emotional issues. When those are presented and serious health issues are ruled out, physicians can now turn to therapies which will help to identify the issues at hand. This can lead to the adolescent being taught coping mechanisms with a doctor they are comfortable with early on before problems become too large.
If an issue is identified and longer-term therapy is needed, the Adolescent Clinic and DeWine work in concert with the Family Assistance for Maintaining Excellence and Child Guidance Clinic to identify needs and therapy options available. In fact, FAME and Child Guidance can provide extensive support for all Family members who need assistance with deployment-related issues.
In next month's story, the Child and Family Assistance Center's contributions to assisting teens with deployment issues will be discussed. The CAFAC now encompasses both FAME and Child Guidance.