Healthy People 2020 Summary of Objectives

1. Healthy People 2020 Summary of Objectives Adolescent Health Tami Thomas Imelda Reyes Laura Searcy

2. Healthy People 2020 Summary of Objectives What is Healthy People 2020 and how does it relate to my Pediatric Practice ?

3. Healthy People 2020 Summary of Objectives AH-1 Increase the proportion of adolescents who have had a wellness checkup in the past 12 months AH-2 Increase the proportion of adolescents who participate in extracurricular and/or out-of-school activities AH-3 Increase the proportion of adolescents who are connected to a parent or other positive adult caregiver AH-4 (Developmental) Increase the proportion of adolescents and young adults who transition to self-sufficiency from foster care AH-5 Increase educational achievement of adolescents and young adults AH-6 Increase the proportion of schools with a school breakfast program

4. Healthy People 2020 Summary of Objectives AH-7 Reduce the proportion of adolescents who have been offered, sold, or given an illegal drug on school property AH-8 Increase the proportion of adolescents whose parents consider them to be safe at school AH-9 (Developmental) Increase the proportion of middle and high schools that prohibit harassment based on a student’s sexual orientation or gender identity AH-10 Reduce the proportion of public schools with a serious violent incident AH-11 Reduce adolescent and young adult perpetration of, and victimization by, crimes

5. Healthy People 2020 Summary of Objectives AH-3 Increase the proportion of adolescents who are connected to a parent or other positive adult caregiver Clinical Application: Screen Intervene Refer Follow up Practitioners are encouraged to promote the involvement of the adolescent and family in meaningful activities through local community centers, schools, churches, and other organizations serving youth.

6. Healthy People 2020 Summary of Objectives AH-4 (Developmental) Increase the proportion of adolescents and young adults who transition to self-sufficiency from foster care. Clinical Application: Screen Intervene Refer Follow up Adolescents in foster care experience complex health care needs and face multiple barriers in receiving the necessary and appropriate health care services. Developing a plan is essential to the future of these emerging adults.

7. Healthy People 2020 Summary of Objectives AH-5 Increase educational achievement of adolescents and young adults. Clinical Application: Screen Intervene Refer Follow up Many adolescents’ lives are characterized by poverty and high levels of social disorganization and disadvantage. Indicators of widening polarization between those who do and do not appear headed for a secure economic future, screening for learning disabilities and referring these adolescents is essential.

8. Healthy People 2020 Summary of Objectives AH-9 (Developmental) Increase the proportion of middle and high schools that prohibit harassment based on a student’s sexual orientation or gender identity. Clinical Application: Screen Intervene Refer Follow up Advocacy - Parents and other formal and informal caregivers such as youth workers and foster parents were found to exert a large influence on the behaviors that bolster mental health among high-risk youth marginalized by poverty, social stigma, personal and physical characteristics, ethnicity, and poor social or academic performance.

9. Adolescent NutritionNutrition and Weight Statusand Physical Activity • Reduce the proportion of adolescents aged 12 to 19 years who are considered obese • Baseline: 17.9% • Prevent inappropriate weight gain in adolescents • Use available tools: HEAT guidelines or AAP guidelines

10. Identifying Overweight and Obesity in Pediatrics • In literature, Melamed et al. and Bardia et al. found that providers accurately coded obesity 19-24% of the time. • We know that patients respond positively to recommendations • Must identify early and plot accordingly and discuss with patients and families • Discuss some recommendations

11. Motivational InterviewingPrevention and Management • Successful in smoking cessation, shows promise in promoting healthy lifestyles • When you become proficient in MI, may not take much longer than traditional questions • Are you happy with your weight? • How does your current weight make you feel? • Use available tools to showcase current status

12. Documentation and Follow-up • Reimbursement is an issue, depends on the insurance your practice works interacts with • Not all states recognize and reimburse appropriately, but things are improving • Abnormal weight gain 783.1 • Coding BMI accurately • Within 5-85th percentile v85.52 • 85-94th percentile v85.53 • Greater than 95th percentile v85.54 • Use in conjunction with: • v65.3 dietary surveillance and counseling • v65.41 exercise counseling • https://www2.aap.org/obesity/pdf/ObesityCodingFactSheet0208.pdf

13. Community Resources • CHOA’s Strong4Life training coming to your community • Provider toolkits offer some good resources for all ages • Health for Life clinics use multiple providers • Some group such as Amerigroup may reimburse for Weight Watchers • Engage the whole family in life changes

14. Underage Drinking and the Role of the Pediatric Health Care Provider in Recognition and Prevention

15. Scope of the Problem • Underage Drinking is a leading public health problem in this country • Alcohol is the most widely used substance of abuse among youth U.S. Department of Health and Human Services (HHS), The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. HHS, Office of the Surgeon General, 2007.

16. Scope of the Problem • The average age when youth first try alcohol is: 11 years for boys 13 years for girls  • 41% of children have had at least one drink by the age of 14. • The average age at which Americans begin drinking regularly is 15.9 years old

17. Effects of Alcohol on the Developing Brain Hippocampus: • Important for learning and memory, converting short term memory to more permanent memory, and for recalling spatial relationships • Long term alcohol use results in 10% smaller hippocampus • Short term or moderate drinking impairs learning and memory more in youths than adults http://odp.idaho.gov/underage_drinking_files/Final%20tabloid_files/Final%20Tabloid.pdf

18. Consequences of Underage Drinking • Annually, more than 5,000 deaths of people under age 21 are linked to underage drinking. Nearly a third of all youth traffic fatalities involved crashes with alcohol-impaired young drivers • 10 to 12% of high school students have reported driving after drinking • 28% of high school students reported riding in a car in the past month with someone who had been drinking http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf

19. Consequences of Underage Drinking • 69.3% of 9th through 12th graders who consumed liquor in 2005-2006 reported having trouble with police • High alcohol consumption is associated with lower GPAs, lower academic achievement, and lower wage potential http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf

20. Consequences of Underage Drinking • At least one half of all violent crimes involve alcohol consumption by the perpetrator, the victim, or both • Youth alcohol use is related to an increased risk of sexually transmitted disease and unplanned pregnancy • Fourteen- and 15-year-olds who use alcohol are 4 and 7 times as likely, respectively, to have sexual intercourse as their peers who do not consume alcohol, and these 15-year-olds have as many as 4 sexual partners Cochrane Database Syst Rev. 2002;(3):CD003024

21. Consequences of Underage Drinking • Alcohol use is also associated with an increased risk of physical or sexual abuse often by an acquaintance of the same age and has been implicated in one third to two thirds of sexual assault and acquaintance or date rape cases among adolescents and college students • College students who experienced being drunk for the first time before age 13 were twice as likely to have unplanned sex and 2.2 times as likely to have unprotected sex due to drinking http://monitoringthefuture.org/data/

22. Resources for the Provider THE MESSAGE PARENTS NEED TO DELIVER “Until you turn twenty-one, our rule on alcohol is simple: You are not to drink, if for no other reason than it is against the law. Once you’re of legal age, then it will be your decision whether or not to use alcohol. Illicit drugs, you are never to take; I don’t care how old you are.”

23. Role of the Pediatric Health Care Provider SBIRT (Screening Brief Intervention and Referral to Treatment) • Providers should Screento identify individuals with problems related to alcohol and our other substance use. • Brief interventionfocuses on increasing insight and awareness regarding substance use and motivation toward behavioral change. • Referral to treatment provides those identified as needing more extensive treatment with access to specialty care. Screening, Brief Intervention and Referral to Treatmet: New Populations, New Effectiveness Data; SAMHSA Newletter, Volume 17, number 6 Nov/Dec/2009

24. Role of the Pediatric Health Care Provider Screening Instruments that are validated include • ASSIST • AUDIT • DAST • CRAFFT

25. Role of the Pediatric Health Care Provider CRAFFT Questions to Identify Adolescents With Alcohol Abuse Problems* C Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs? R Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A Do you ever use alcohol or drugs while you are by yourself, or ALONE? F Do you ever FORGET things you did while using alcohol or drugs? F Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? T Have you ever gotten into TROUBLE while you were using alcohol or drugs? * Two or more “yes” answers suggest that the adolescent has a serious problem with alcohol abuse. Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch PediatrAdolesc Med. 1999;153:591–59

26. Role of the Pediatric Health Care Provider • Brief interventions (5-15 minutes) with follow-up provided to adult problem drinkers in primary care settings have been found to reduce alcohol consumption • Such interventions have been recommended as part of standard care for underage drinkers 35 Am J Med Genet.2000;96(5):671– 677 Arch Gen Psychiatry. 2003;60(12): 1256 –1264

27. 5 A’s

28. Role of the Pediatric Health Care Provider “What else can I do”? • Participate in local school, community, and state efforts to promote alcohol-abuse prevention in youth • Example of a community coalition: • http://www.cobbat.org/

29. References Alriksson-Schmidt, A. I., Wallander, J., & Biasini, F. (2007). Quality of life and resilience in adolescents with a mobility disability. Journal of Pediatric Psychology, 32(3), 370-379. doi: jsl002 [pii] 10.1093/jpepsy/jsl002 Bardia, A., Holtan, S. G., Slezak, J. M., & Thompson, W. G. (2007). Diagnosis of obesity by primary care physicians and impact on obesity management. Mayo Clinic Proceedings, 82(8), 927-932. Barrow, F. H., Armstrong, M. I., Vargo, A., & Boothroyd, R. A. (2007). Understanding the findings of resilience-related research for fostering the development of African American adolescents. Child and Adolescent Psychiatric Clinics of North America, 16(2), 393-413, ix-x. doi: S1056-4993(06)00122-2 [pii]10.1016/j.chc.2006.12.004 Compas, B. E. (2006). Psychobiological processes of stress and coping: implications for resilience in children and adolescents-- comments on the papers of Romeo & McEwen and Fisher et al. Annals of the New York Academy of Sciences, 1094, 226-234. doi: 1094/1/226 [pii] 10.1196/annals.1376.024 Fonseca, H. (2010). Helping adolescents develop resilience: steps the pediatrician can take in the office. Adolesc Med State Art Rev, 21(1), 152-160, xi. Haight, W. L. (1998). "Gathering the spirit" at First Baptist Church: Spirituality as a protective factor in the lives of African American children. Social Work, 43(3), 213-221. Lopez, P., & Allen, P. J. (2007). Addressing the health needs of adolescents transitioning out of foster care. Pediatric Nursing, 33(4), 345-355. Melamed, O. C., Nakar, S., & Vinker, S. (2009). Suboptimal identification of obesity by family physicians. The American Journal of Managed Care, 15(9), 619-624. Resnick, M. D. (2000). Resilience and protective factors in the lives of adolescents. Journal of Adolescent Health, 27(1), 1-2. doi: S1054-139X(00)00142-7 [pii] Rew, L., & Horner, S. D. (2003). Youth Resilience Framework for reducing health-risk behaviors in adolescents. Journal of Pediatric Nursing, 18(6), 379-388. Tusaie, K., Puskar, K., & Sereika, S. M. (2007). A predictive and moderating model of psychosocial resilience in adolescents. Journal of Nursing Scholarship, 39(1), 54-60. Ungar, M. (2004). The importance of parents and other caregivers to the resilience of high-risk adolescents. Family Process, 43(1), 23-41.