KEY ACTIVITY #16A:
Provide Proactive Inreach and Outreach to Help Adolescents Engage in Behavioral Healthcare
This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; behavioral health integration.
Overview
The COVID-19 pandemic spurred rising rates of mental health disorders and distress, including a marked increase in adolescent ER visits for mental health conditions.[1] This reality heightens the need for effective inreach and outreach to adolescents for behavioral health services.
Outreach consists of identifying the behavioral healthcare (BH) needs of adolescents in the community, while inreach involves identifying the same among your practice’s patients. An initial step in both inreach and outreach is communicating with the community and your patients and their families about behavioral health conditions and the availability of BH services.
In California, a large statewide investment relevant to pediatric care is the Children and Youth Behavioral Health Initiative (CYBHI), which aims to expand access to school and community-based mental health counseling, virtual behavioral health services, and eConsults regardless of insurance coverage. See the resources below for more information about this initiative.
How are inreach and outreach different for adolescents?
Adolescence and early adulthood is a time in life when mental health problems may arise for the first time, though the age of onset varies with the particular behavioral health diagnosis.[2] While significant numbers of adolescents experience behavioral health needs, young people seeking care from mental health professionals often report that their concerns are invalidated by healthcare practitioners.[3][4] Contact with mental health and healthcare providers can threaten young people’s sense of agency, turning them away rather than towards connecting with mental health services. School-based counselors can be instrumental in providing effective outreach and inreach to adolescents.
These help-seeking patterns are complicated by the fact that many adolescents may be struggling with multiple sensitive issues, including but not limited to substance use, emerging ideas about sexual orientation and gender identity, bullying and abuse, body dissatisfaction, relationship issues, and changing physical development. Unfortunately, these are topics that not all adults feel comfortable discussing.
Implementation considerations
Rather than make singular recommendations regarding inreach and outreach to adolescents, teams should consider the combination of patient and family needs and staff capacity. Adolescence is not a single entity. The social and emotional needs of a patient at age 12 differ from that of a 17-year-old and, therefore, their relationships to family and peers change as well. Additionally, not all adolescents' developmental stages correlate with their chronological ages. Teams should consider opportunities for inreach and outreach that reflect these variations and nuances, especially when determining whether or not outreach is directed at the family unit or to the individual adolescent.
Inreach (reaching adolescents within the practice):
- Train primary care providers and medical assistants in nonjudgmental, empathic communication in order to increase the likelihood of adolescents disclosing when they are having mental health or other difficulties.
- Develop patient-facing materials for adolescents, including posters in the waiting room and brochures in exam rooms that affirm the confidentiality of disclosures made to the healthcare team and the behavioral health services available at the practice. Additional considerations and resources around consent for adolescents are discussed in Key Activity 16C: Manage Treatment of Adolescents’ Behavioral Health Needs in Integrated Person-Centered Ways.
- Screening universally for behavioral health conditions as a core part of an inreach strategy. See Key Activity 16B: Screening Adolescents for a Range of Behavioral Health Needs.
Outreach:
- As suggested above, many adolescents do not seek help for behavioral health from their primary care provider. The practice may consider partnering or building on existing partnerships with organizations, such as schools, churches or community centers, to promote the availability of behavioral health services and care. Potential community partners will vary based on a clinic’s setting and should be contextually driven.
- Practices can offer community presentations, workshops or classes directed at parents within the community to share supportive information and resources for families with adolescents.
Implementation tips
- Engage staff who are closer in age to adolescents and can incorporate communication strategies that better reflect adolescent preferences.
- Develop adolescent-specific treatment competencies with existing staff or consider hiring employees that come into practice with those skill sets and experience.
Resources
Endnotes
- Villas-Boas SB, Kaplan S, White JS, Hsia RY. Adolescent Total and Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(10):e2336463. doi:10.1001/jamanetworkopen.2023.36463
- Solmi, M., Radua, J., Olivola, M. et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27, 281–295 (2022). https://doi.org/10.1038/s41380-021-01161-7
- Bergen, C., Bortolotti, L., Tallent, K., Broome, M., Larkin, M., Temple, R., Fadashe, C., Lee, C., Lim, M. C., & McCabe, R. (2022). Communication in youth mental health clinical encounters: Introducing the agential stance. Theory & Psychology, 32(5), 667-690. https://doi.org/10.1177/09593543221095079
- Fischer, J. A., Kelly, C. M., Kitchener, B. A., & Jorm, A. F. (2013). Development of Guidelines for Adults on How to Communicate With Adolescents About Mental Health Problems and Other Sensitive Topics: A Delphi Study. SAGE Open, 3(4). https://doi.org/10.1177/2158244013516769