# Presentation: 094468

## Parents and Health Care Professionals Working Together to Improve Adolescent Health

- Carol A. Ford MD
- Amy Davenport MPH
- Andrea Meier PhD
- Annie-Laurie McRee MPH

- Funded by Agency for Healthcare Research and Quality 1 R01 HS016021-01

## Context

- Healthy People 2010 has identified 21 Critical Health Objectives for adolescents and young adults
- Proposed strategies to achieve objectives:
- increase access to health care services
- incorporate systematic health promotion and prevention activities into health care visits
- create working partnerships among health care professionals (HCPs) and families

## Umbrella Hypothesis

- Parents can be mobilized to play an active and influential role in increasing adolescents’ access to and receipt of high-quality health care services.

## NC MARCH

- NC Multi-site Adolescent Research Consortium for Health
- New network of 50 School-Based Health Centers (SBHC) and 3 large School-Linked Health Centers (SLHC)

## Objective

- To *explore* parent and HCP perceptions of parent-HCP alliances to improve..
- Adolescents’ access to preventive care
- Quality of health care
- obesity prevention
- alcohol and substance use
- annual screening for Chlamydia trachomatis
- depression

## Methods

- Qualitative methodology
- Semi-structured interviews and focus groups
- Parents
- HCPs
- Teens
- General Content
- What can *parents* do to keep teens healthy and address health problems?
- What can *HCPs* do to keep teens healthy and address health problems?
- How can *parents and HCPs* work together to keep teens healthy and address health problems?

## Methods (continued)

- Content analyses and thematic coding (Atlas.ti)
- Describe perspectives of parents, HCPs, teens
- Triangulate perspectives to look for convergence

## Parent Recruitment

- Procedures
- Recruited from 8 SB/SLHCs in 5 communities
- Eligibility Criteria
- female primary care giver of child 12-18 yo living at home
- child seen in clinic within past 2 years - but not last 1 month
- English-speaking
- Low show at focus groups so switched to phone interviews

## NC MARCH Sites Participating in Parent Project

**1**
- Durham

- Alamance

- Alexander

- Alleghany

- Anson

**1**
- Ashe

- Avery

- Beaufort

- Bertie

- Bladen

- Brunswick

- Buncombe
**3**

- Burke

- Cabarrus

- Caldwell

- Carteret

- Caswell

- Catawba
**2**

- Chatham

- Cherokee
**1 **

- Clay

**8**
- Cleveland

- Columbus

- Craven

- Cumberland

- Dare

- Davidson

- Davie

- Duplin

- Edgecombe

- Forsyth
**3**

- Franklin

- Gaston

- Gates
**1**

**1**
- Graham

- Granville

- Greene
**1**

- Guilford
**6**

- Halifax

- Harnett

- Haywood

- Henderson
**1**

- Hertford

- Hoke

- Hyde

- Iredell

- Jackson

- Johnston

- Jones

- Lee

- Lenoir

- Lincoln

- McDowell

- Macon

- Madison

- Martin

- Mecklenburg
**1**

- Mitchell
**2**

**2**
- Montgomery

- Moore

- Nash

**3** New

- Hanover

- Northampton

- Onslow

- Orange

- Pamlico

- Pender

- Person

- Pitt

- Polk

- Randolph

- Richmond

- Robeson
**4**

- Rockingham
**4**

- Rowan

- Rutherford

- Sampson

- Scotland

- Stanly

- Stokes

- Surry

- Swain

- Transylvania

- Tyrrell

- Union

- Vance

- Wake
**1**

- Warren

- Washington

- Watauga

- Wayne
**5**

- Wilkes
**4**

- Wilson

- Yadkin

- Yancey
**2**

- Pasquotank

- Perquimans

## HCP Recruitment

- Staff of participating clinics
- Individual interviews
- lead clinician
- lead mental health
- lead administrator
- front desk staff
- Focus group of all others involved in patient care

## Teen Recruitment

- Two Focus Groups
- One Teen Advisory Board
- One peer education group

## Results (so far)

## Parent Sample

- 17 In-depth interviews in 5 communities
- Demographics
- 60% black; 30% white
- 4 HS, 4 some college, 6 college grad
- 82% employed part or full time
- Children
- Mean number 2.2 (range 1-4)
- 92% of children ages 12-18 with insurance

## Parent Perspective: What Can Parents Do?Major Themes (N=17)

| Theme | Number of Interviewees (%) | Number of Comments |
| --- | --- | --- |
|  |  |  |
| Parents monitor teens | 10 (59) | 13 |
| Keep kids busy | 8 (47) | 9 |
| Parents provide something | 8 (47) | 9 |
| Parent-teen communication | 8 (47) | 9 |
| Parents ask for-accept help | 6 (35) | 6 |
| Parents get informed | 5 (29) | 6 |

## Parent Perspective: What Can HCPs Do? Major Themes (N=17)

| 
Theme
 | Number of interviewees (%)   | Number of comments |
| --- | --- | --- |
|  |  |  |
| HCP communication style | 6 (35) | 8 |
| HCP encourages or reinforces  healthy behaviors | 5 (29) | 6 |
| HCP makes referrals | 3 (18) | 3 |
| HCP provides treatment | 1 (5) | 1 |

## Parent Perspective: HCP & Parents  Working Together?Major Themes (N=17)

| Theme | Number of interviewees (%)   | Number of comments |
| --- | --- | --- |
|  |  |  |
| HCP-parent communication | 12 (70) | 14 |
| HCP-parents health education and outreach | 7 (41) | 10 |
| HCP involvement in primary prevention | 3 (18) | 3 |

## HCP Data

- 51 Total unique participants
- 7 Focus groups
- 21 Individual interviews
- 11 NP/PA, 8 RN, 5 Health Educator/MPH, 5 LCSW/Mental Health, 5 MD, 4 RD, 3 LPN/Medical Assistant, 2 other advanced degree, 8 other (front desk, finance, administrator)

## HCP Data – OVERVIEW ONLY

- Similar themes as in parent interviews
- More on issues of privacy/confidentiality
- Interesting data on how clinics are set up re: parent consent, patient privacy, and communication with parents

## Teen Data – OVERVIEW ONLY

- 17 teens
- 2 Focus Groups
- General overview

## Parent and HCP Involvement in Teen Health Care

- Improved Teen Health Outcomes

- Teen (Patient)

- Parent

- Health Care Provider

## Next Steps

- 10 additional parent interviews
- Complete data analyses
- Develop potential models for HCP and parents working together to address specific adolescent health issues
- Series of R21 proposals to inform parent-focused interventions that target
- Depression
- Chlamydia screening
- Immunization

## Project Challenges & Lessons Learned

- School schedules
- Getting parents to attend focus groups
- NC MARCH - early phase of development
- Need to focus on the win-win
- Put “research” within a broader context

## Other NC MARCH Activities

- The White House Conference
- The Duke Endowment Proposal
- NC Adolescent and Young Adult Health Report Card
- NC Parent Survey on Teen Health
- “More Between 10 and 20” Initiative
- LEAH Training Grant Proposal

## Slide 24

## Slide 25

## Slide 26

## Exploration of intervention ideas

- All intrigued
- HOW? What will work?
- Surveys----Parents +; HCP -; Teens – ; Unlikely to work based on previous experience
- Getting parents to come to special “events” is hard
- Parent education, coaching, partnering, mentoring, online support groups—all worth exploring
- Tailor interventions to characteristics of SBHCs and SLHCs

## Slide 28