- Email: [email protected]
224. Young Adult Transition Clinic in an Internal Medicine Residency Training Program
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Poster Abstracts / 56 (2015) S85eS129
improvements stratified by type and size of residency program using statistical analysis software Stata. Retrieved post-course feedback from residents (n¼522) about course satisfaction and knowledge levels. Surveyed supervisors (n¼7) on reasons and satisfaction with offering the ARSH E-learning course using QuestionPro. Results: Learners were from Pediatric (91%) or Family Medicine (9%) residency program. The lowest baseline scores were for the Male Adolescent SRH module (64%) and the Adolescents and STIs module (64%). The most improved post-test score was for the Contraception module with 88% of learners achieving a higher score. There were significant (p<0.05) differences with score improvements for the Male Adolescent SRH module and the complete ARSH course by type of residency program. Most residents felt like they became “knowledgeable” of each learning module (66-74%) and some indicated that they became “very knowledgeable” (1830%). Ninety-five percent would recommend this course to other resident learners. Themes that emerged from qualitative feedback of the course include: enjoyed the case-videos, liked review of key points through pre- and post-test set-up, and informative content. Most supervisors (37%) offered the course to supplement the SRH training received and to expose residents to alternative learning methods (26%). All supervisors agreed that the ARSH course provided training in adolescent specific SRH that their program lacked. When asked about barriers to offering a comprehensive SRH training, four supervisors did not indicate any; two indicated personal beliefs of faculty; and one indicated limited services due to being part of a catholic health entity. Most supervisors (67%) were very satisfied with the course content and all (100%) plan on enrolling new residents in their next academic year due to positive feedback from current residents. Conclusions: Most learners (53-88%) had improved scores for post-test exams and indicated that they became more than “somewhat knowledgeable” on each learning module. Residents and supervisors both enjoy the interactive, case-based learning and would recommend Physician’s ARSH E-learning course as a supplemental training tool for adolescent specific SRH. Sources of Support: 223. A FUTURE SELF AND FUTURE CURRICULUM: LESSONS LEARNED FROM THE FIELD Maranda C. Ward, MPH.
Methods: Focus group evaluation data was collected from four cohorts (n¼74) of co-ed youth ages 12 to 19 enrolled in the program’s Summer Leadership Institute. Partnerships were secured with two public charter schools (e.g. middle and high campuses) and a community based organization. Eight trained facilitators implemented 12 workshops using the evidence-based Project Adult Identity Mentoring (AIM) curriculum. The four pairs of facilitators included a former high school peer educator and a graduate student at the Master’s or Doctoral level. This curriculum supports youth in their efforts to reduce sexual risk taking using the Theory of Possible Selves (Markus & Nurius,1986). The youth development curriculum focuses on decision making, communication skills, goal-setting, budgeting, and career readiness through a mock interview and development of a resume, career inventory, and business card. The curriculum was supplemented with sexual health content and the use of poetry, videos, social media, and interactive activities. Grant funding was made available by the District of Columbia Pregnancy Prevention Education Program from the Office of State Superintendent of Education. Results: Middle school youth reported that they either did not think of, or take serious, their future self. Conversely, high school youth reported that this program helped solidify what they already knew or had heard. Though seemingly redundant, high school youth expressed that the program helped them draw connections between the steps involved in making decisions. When asked about other topics of interest, middle school youth noted bullying and drug use and high school youth reported an interest in learning to prepare for college and better manage time and money. All youth reported that it was important to think positively, plan around potential setbacks, prepare for interviews, and have tangible portfolios. Across cohorts, youth reported wanting more information on reproductive anatomy. Conclusions: Focus group data reveals a difference between middle and high school youth as it relates to how they perceived their future self. Across cohorts, youth noted that they have become aware of how forward thinking they must be to develop the lives they want. No one workshop topic reigned as more important than the next. As it relates to improving the curriculum, there may be a need to expand the program content to include more developmentally appropriate content for the range of youth served. Sources of Support: 224.
The George Washington University. YOUNG ADULT TRANSITION CLINIC IN AN INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM Lee S. Shearer, MD. Purpose: Promising Futures is a youth development pipeline serving adolescents ages 11 to 24. The program aims to actively engage youth in their own development through culturally relevant curriculum and leadership opportunities. The program began as a hip hop educational conference series to train providers to address youth sexual risk taking via popular culture-based messages. Now it is regionally esteemed as a youth-led community based program that capitalizes on “edutainment”, including hip hop, theatre, and poetry, to address a range of youth development topics. The three-pronged pipeline of middle youth ambassadors, high school peer educators and college/graduate team advisors celebrates the inherent talents of youth, refines the transferrable skills needed for youth to productively transition into adulthood and invests in them throughout the process.
Weill Cornell Medical College - New York Presbyterian Hospital.
Purpose: The transition from adolescence to young adulthood is a vulnerable one, especially for those individuals with chronic illnesses, special needs, complex psychosocial situations, or reproductive health needs. There are few models for successful transition between pediatric and adult care, particularly generalist primary care. Compounding the problem, many Internal Medicine trainees and practitioners are not frequently exposed to adolescents and young adults, are not familiar with chronic conditions of childhood or with reproductive health, and are not comfortable providing comprehensive care for this group. In response to this need, a Young Adult Clinic (YAC) was established at the resident
Poster Abstracts / 56 (2015) S85eS129
outpatient practice of a large Internal Medicine training program at an urban academic center. The goals of the program are to improve the transition of care for young adult patients into the Internal Medicine practice and to enrich Internal Medicine resident education in Young Adult health, specifically targeting the specific health needs of this group, including preventive health, reproductive health, chronic disease, and psychosocial health. Methods: The YAC is a weekly Internal Medicine clinic situated in a combined faculty/resident practice affiliated with a large urban academic center. It is precepted by an Internal Medicine faculty member board certified in Adolescent Medicine. Each intern participates in four YAC clinic sessions over the course of two months. They receive a formal didactic curriculum on aspects of young adult health and interact with patients as primary outpatient caretakers. The session is supported by the Department of Medicine as a part of the outpatient rotation of the residency training program. Patients draw from various sources, including patients transitioning from the institution’s Pediatric practice, patients referred from Pediatric and Internal Medicine sub-specialty practices, and transitioning patients from the community. Patients may also be referred for consultation by residents/attendings within the Internal Medicine practice. Patients are male or female, 18-30 years old, with or without chronic medical conditions or special needs. A formal protocol exists to facilitate the transition of patients within the institution. The EMR supports referral orders, sign-out documentation, and a letter describing the process to the patient. A real-time tour of the Internal Medicine practice for the transitioning patient and their family is available. Patients seen in YAC are ultimately transitioned into an intern’s continuity panel. Results: After 36 YAC sessions, the educational experience has been well received by Internal Medicine interns. A survey-based needs-assessment will assess intern attitudes, confidence, and self-reported knowledge regarding Young Adult health prior to YAC exposure. A post-test will help determine whether these parameters change after exposure to the YAC experience. Conclusions: Within the existing structure of an Internal Medicine training program, a young adult teaching clinic has been established that may successfully address a prior gap in medical education in Young Adult health. Sources of Support: 225. BE HEALTHY BE SUCCESSFUL: A HEALTH CONSUMERISM AND PRIMARY CARE RESOURCE CONNECTION PROGRAM FOR TEENS AND YOUNG ADULTS Suzanne M. Piotrowski, MD. University of Rochester.
Purpose: Rochester, New York, local and national data suggests that teens are less likely to have health insurance and less likely to utilize primary care services as compared to their K-Grade 6 peers. Enrolling teens in health insurance programs, connecting them to primary care services and providing education regarding the use of primary care services significantly imporves important health indices. Be Healthy Be Successful is a health consumerism program which targets urban teens and young adults. The goal is to create proactive healthcare consumers who are connected to health insurance, health literacy programs and primary care services. Methods: Population served: Urban teens who are at risk for high school dropout. These teens are highly engaged in a community-
S115
based organization(CBO) which emphasized academic and parttime employment success. The CBO staff are trusted adults in the lives of the urban teens. These CBO staff strongly recommended the health consumerism program and participated in follow-up healthcare resource connection. Setting: school and/or worksite; Core Program Theory: Self Determination Theory of Behavior Change; Community partners included CBOs-both nonprofit and for-profit; employers of teens, school district, health care facilities, health insurance companies and enrollment agencies; Program paid for by community foundation grant. Results: 1021 young adults attended a standardized health consumerism workshop; HEALTH INSURANCE: 17% reported no insurance; 31% unsure; 28% of those stating insured status were unable to cite insurance name; SERVICES REQUESTED: 27% medical care; 31% vision care; 41% dental care; All students were contacted using a stuctured protocol and if contacted, connected with requested services. Conclusions: Teens are very interested in their health and healthcare and often serve as conduits for their families and friends. Teens enthusiastically respond to the SDT approach to behavior change in the setting of health consumerism and healthcare connection. The recommendation and/or endorsement of the health consumerism program by a trusted adult was critical to active student participation. Health consumerism education and healthcare resource connection programs have the potential to create a new generation of proactive healthcare consumers who positively influence their present and future families. Sources of Support: 226. ‘GP CHAMPIONS’ IN ENGLAND; FAMILY PHYSICIANS AND YOUTH WORKERS COLLABORATE IN A NEW MODEL OF YOUTHFRIENDLY PRIMARY CARE PRACTICE TO ADDRESS UNMET NEED Jane H. Roberts, MD, PhD 1, Frances Perrow, BA 2. 1
RCGP; 2Association of Young People’s Health.
Purpose: To develop a national network of GP Youth Health Champions working in collaboration with the voluntary youth sector to improve young people’s access to health services. General practitioners (GPs) are primary care family physicians in the UK. Everyone is expected to register with a GP as their medical home; children are registered by their parents at birth. If they move to another community, they re-register. GPs treat all ages, and can develop relationships with young people through adolescence, but research suggests that better engagement is needed. The project will test the GP Youth Health Champion model in ten areas, resulting in new resources, including a guidance toolkit adaptable to different areas. GPs’ knowledge of the voluntary sector and its role in meeting health needs will increase. In parallel, the voluntary sector’s understanding of health needs will improve. New services will be initiated where there are gaps, and better partnerships will be secured between commissioners, young people, GPs and others. The project aims to assist GPs, Directors of Public Health, Directors of Children’s Services, Clinical Commissioning Groups and NHS England in their new roles. Methods: The project launched in 2012, inviting youth workers to develop local initiatives with a neighboring GP. Ten study sites were selected across a range of rural to inner city populations. A series of one day national ‘learning sets’ were designed and delivered. Year 1 learning themes included evidence and trends in
Poster Abstracts / 56 (2015) S85eS129
improvements stratified by type and size of residency program using statistical analysis software Stata. Retrieved post-course feedback from residents (n¼522) about course satisfaction and knowledge levels. Surveyed supervisors (n¼7) on reasons and satisfaction with offering the ARSH E-learning course using QuestionPro. Results: Learners were from Pediatric (91%) or Family Medicine (9%) residency program. The lowest baseline scores were for the Male Adolescent SRH module (64%) and the Adolescents and STIs module (64%). The most improved post-test score was for the Contraception module with 88% of learners achieving a higher score. There were significant (p<0.05) differences with score improvements for the Male Adolescent SRH module and the complete ARSH course by type of residency program. Most residents felt like they became “knowledgeable” of each learning module (66-74%) and some indicated that they became “very knowledgeable” (1830%). Ninety-five percent would recommend this course to other resident learners. Themes that emerged from qualitative feedback of the course include: enjoyed the case-videos, liked review of key points through pre- and post-test set-up, and informative content. Most supervisors (37%) offered the course to supplement the SRH training received and to expose residents to alternative learning methods (26%). All supervisors agreed that the ARSH course provided training in adolescent specific SRH that their program lacked. When asked about barriers to offering a comprehensive SRH training, four supervisors did not indicate any; two indicated personal beliefs of faculty; and one indicated limited services due to being part of a catholic health entity. Most supervisors (67%) were very satisfied with the course content and all (100%) plan on enrolling new residents in their next academic year due to positive feedback from current residents. Conclusions: Most learners (53-88%) had improved scores for post-test exams and indicated that they became more than “somewhat knowledgeable” on each learning module. Residents and supervisors both enjoy the interactive, case-based learning and would recommend Physician’s ARSH E-learning course as a supplemental training tool for adolescent specific SRH. Sources of Support: 223. A FUTURE SELF AND FUTURE CURRICULUM: LESSONS LEARNED FROM THE FIELD Maranda C. Ward, MPH.
Methods: Focus group evaluation data was collected from four cohorts (n¼74) of co-ed youth ages 12 to 19 enrolled in the program’s Summer Leadership Institute. Partnerships were secured with two public charter schools (e.g. middle and high campuses) and a community based organization. Eight trained facilitators implemented 12 workshops using the evidence-based Project Adult Identity Mentoring (AIM) curriculum. The four pairs of facilitators included a former high school peer educator and a graduate student at the Master’s or Doctoral level. This curriculum supports youth in their efforts to reduce sexual risk taking using the Theory of Possible Selves (Markus & Nurius,1986). The youth development curriculum focuses on decision making, communication skills, goal-setting, budgeting, and career readiness through a mock interview and development of a resume, career inventory, and business card. The curriculum was supplemented with sexual health content and the use of poetry, videos, social media, and interactive activities. Grant funding was made available by the District of Columbia Pregnancy Prevention Education Program from the Office of State Superintendent of Education. Results: Middle school youth reported that they either did not think of, or take serious, their future self. Conversely, high school youth reported that this program helped solidify what they already knew or had heard. Though seemingly redundant, high school youth expressed that the program helped them draw connections between the steps involved in making decisions. When asked about other topics of interest, middle school youth noted bullying and drug use and high school youth reported an interest in learning to prepare for college and better manage time and money. All youth reported that it was important to think positively, plan around potential setbacks, prepare for interviews, and have tangible portfolios. Across cohorts, youth reported wanting more information on reproductive anatomy. Conclusions: Focus group data reveals a difference between middle and high school youth as it relates to how they perceived their future self. Across cohorts, youth noted that they have become aware of how forward thinking they must be to develop the lives they want. No one workshop topic reigned as more important than the next. As it relates to improving the curriculum, there may be a need to expand the program content to include more developmentally appropriate content for the range of youth served. Sources of Support: 224.
The George Washington University. YOUNG ADULT TRANSITION CLINIC IN AN INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM Lee S. Shearer, MD. Purpose: Promising Futures is a youth development pipeline serving adolescents ages 11 to 24. The program aims to actively engage youth in their own development through culturally relevant curriculum and leadership opportunities. The program began as a hip hop educational conference series to train providers to address youth sexual risk taking via popular culture-based messages. Now it is regionally esteemed as a youth-led community based program that capitalizes on “edutainment”, including hip hop, theatre, and poetry, to address a range of youth development topics. The three-pronged pipeline of middle youth ambassadors, high school peer educators and college/graduate team advisors celebrates the inherent talents of youth, refines the transferrable skills needed for youth to productively transition into adulthood and invests in them throughout the process.
Weill Cornell Medical College - New York Presbyterian Hospital.
Purpose: The transition from adolescence to young adulthood is a vulnerable one, especially for those individuals with chronic illnesses, special needs, complex psychosocial situations, or reproductive health needs. There are few models for successful transition between pediatric and adult care, particularly generalist primary care. Compounding the problem, many Internal Medicine trainees and practitioners are not frequently exposed to adolescents and young adults, are not familiar with chronic conditions of childhood or with reproductive health, and are not comfortable providing comprehensive care for this group. In response to this need, a Young Adult Clinic (YAC) was established at the resident
Poster Abstracts / 56 (2015) S85eS129
outpatient practice of a large Internal Medicine training program at an urban academic center. The goals of the program are to improve the transition of care for young adult patients into the Internal Medicine practice and to enrich Internal Medicine resident education in Young Adult health, specifically targeting the specific health needs of this group, including preventive health, reproductive health, chronic disease, and psychosocial health. Methods: The YAC is a weekly Internal Medicine clinic situated in a combined faculty/resident practice affiliated with a large urban academic center. It is precepted by an Internal Medicine faculty member board certified in Adolescent Medicine. Each intern participates in four YAC clinic sessions over the course of two months. They receive a formal didactic curriculum on aspects of young adult health and interact with patients as primary outpatient caretakers. The session is supported by the Department of Medicine as a part of the outpatient rotation of the residency training program. Patients draw from various sources, including patients transitioning from the institution’s Pediatric practice, patients referred from Pediatric and Internal Medicine sub-specialty practices, and transitioning patients from the community. Patients may also be referred for consultation by residents/attendings within the Internal Medicine practice. Patients are male or female, 18-30 years old, with or without chronic medical conditions or special needs. A formal protocol exists to facilitate the transition of patients within the institution. The EMR supports referral orders, sign-out documentation, and a letter describing the process to the patient. A real-time tour of the Internal Medicine practice for the transitioning patient and their family is available. Patients seen in YAC are ultimately transitioned into an intern’s continuity panel. Results: After 36 YAC sessions, the educational experience has been well received by Internal Medicine interns. A survey-based needs-assessment will assess intern attitudes, confidence, and self-reported knowledge regarding Young Adult health prior to YAC exposure. A post-test will help determine whether these parameters change after exposure to the YAC experience. Conclusions: Within the existing structure of an Internal Medicine training program, a young adult teaching clinic has been established that may successfully address a prior gap in medical education in Young Adult health. Sources of Support: 225. BE HEALTHY BE SUCCESSFUL: A HEALTH CONSUMERISM AND PRIMARY CARE RESOURCE CONNECTION PROGRAM FOR TEENS AND YOUNG ADULTS Suzanne M. Piotrowski, MD. University of Rochester.
Purpose: Rochester, New York, local and national data suggests that teens are less likely to have health insurance and less likely to utilize primary care services as compared to their K-Grade 6 peers. Enrolling teens in health insurance programs, connecting them to primary care services and providing education regarding the use of primary care services significantly imporves important health indices. Be Healthy Be Successful is a health consumerism program which targets urban teens and young adults. The goal is to create proactive healthcare consumers who are connected to health insurance, health literacy programs and primary care services. Methods: Population served: Urban teens who are at risk for high school dropout. These teens are highly engaged in a community-
S115
based organization(CBO) which emphasized academic and parttime employment success. The CBO staff are trusted adults in the lives of the urban teens. These CBO staff strongly recommended the health consumerism program and participated in follow-up healthcare resource connection. Setting: school and/or worksite; Core Program Theory: Self Determination Theory of Behavior Change; Community partners included CBOs-both nonprofit and for-profit; employers of teens, school district, health care facilities, health insurance companies and enrollment agencies; Program paid for by community foundation grant. Results: 1021 young adults attended a standardized health consumerism workshop; HEALTH INSURANCE: 17% reported no insurance; 31% unsure; 28% of those stating insured status were unable to cite insurance name; SERVICES REQUESTED: 27% medical care; 31% vision care; 41% dental care; All students were contacted using a stuctured protocol and if contacted, connected with requested services. Conclusions: Teens are very interested in their health and healthcare and often serve as conduits for their families and friends. Teens enthusiastically respond to the SDT approach to behavior change in the setting of health consumerism and healthcare connection. The recommendation and/or endorsement of the health consumerism program by a trusted adult was critical to active student participation. Health consumerism education and healthcare resource connection programs have the potential to create a new generation of proactive healthcare consumers who positively influence their present and future families. Sources of Support: 226. ‘GP CHAMPIONS’ IN ENGLAND; FAMILY PHYSICIANS AND YOUTH WORKERS COLLABORATE IN A NEW MODEL OF YOUTHFRIENDLY PRIMARY CARE PRACTICE TO ADDRESS UNMET NEED Jane H. Roberts, MD, PhD 1, Frances Perrow, BA 2. 1
RCGP; 2Association of Young People’s Health.
Purpose: To develop a national network of GP Youth Health Champions working in collaboration with the voluntary youth sector to improve young people’s access to health services. General practitioners (GPs) are primary care family physicians in the UK. Everyone is expected to register with a GP as their medical home; children are registered by their parents at birth. If they move to another community, they re-register. GPs treat all ages, and can develop relationships with young people through adolescence, but research suggests that better engagement is needed. The project will test the GP Youth Health Champion model in ten areas, resulting in new resources, including a guidance toolkit adaptable to different areas. GPs’ knowledge of the voluntary sector and its role in meeting health needs will increase. In parallel, the voluntary sector’s understanding of health needs will improve. New services will be initiated where there are gaps, and better partnerships will be secured between commissioners, young people, GPs and others. The project aims to assist GPs, Directors of Public Health, Directors of Children’s Services, Clinical Commissioning Groups and NHS England in their new roles. Methods: The project launched in 2012, inviting youth workers to develop local initiatives with a neighboring GP. Ten study sites were selected across a range of rural to inner city populations. A series of one day national ‘learning sets’ were designed and delivered. Year 1 learning themes included evidence and trends in