Christopher J. Reif

School-based health centers and managed care health plans: partners in primary care.

School-based clinics provide important access to health care for adolescents. For the past 20 years in St. Paul, Minnesota, Health Start has been a nonprofit organization providing comprehensive primary care services in the citys public high schools. Over the past decade, Minnesota has seen the growth of managed care plans for both the private and public (Medicaid) sectors. For the past several years, Health Start has been building relationships with managed care plans in order to coordinate care for adolescents. Since managed care plans differ in their management, reimbursement, and service delivery methods, Health Start has developed several models of partnership with managed care plans for the delivery of primary care to adolescents enrolled in school.

The AMA residency training in adolescent preventive services project: report of the working group

PURPOSE To improve resident education in provision of adolescent preventive health care. The American Medical Association (AMA) Residency Training in Adolescent Preventive Services Project Working Group convened to identify specific goals and objectives (G&Os) for pediatric and family medicine resident education in adolescent clinical preventive services and recommend strategies to achieve these G&Os. METHODS Iterative review process involving members of the working group, nine experienced teaching faculty and 16 resident physicians from family medicine and pediatric training programs, and an advisory board. RESULTS We achieved consensus on appropriate G&Os for pediatric and family medicine residency education in adolescent clinical preventive services. Faculty and residents expressed concerns about achieving G&Os because of challenges to implementing effective training and evaluation strategies. Suggestions for achieving G&Os included development of an adolescent clinical preventive services curriculum and evaluation program that could be adapted for use in a variety of training program structures. Faculty and residents anticipated the success of a training curriculum would be influenced by: (a) availability of adequate numbers of skilled teaching faculty; (b) availability of time and support for faculty development and teaching efforts; and (c) exposure of residents to adequate numbers of adolescent patients in settings where there are clear expectations for delivery of comprehensive preventive services. CONCLUSIONS The AMA Residency Training in Adolescent Preventive Services Project Working Group presents G&Os for organizing training experiences in adolescent clinical preventive services in family medicine and pediatric residency training programs and recommends strategies to achieve these G&Os.

Health promotion counseling in residency training

This report describes health promotion counseling attitudes and practices in a family medicine residency that attempted to encourage such counseling. A patient “Health Habits Questionnaire” and matching patient education booklets were developed and distributed. Six grand rounds presentations on counseling were given. On three occasions, residency physicians completed questionnaires about counseling. Despite good personal health habits and positive attitudes toward counseling, the residency physicians had only moderate confidence in their counseling ability and infrequently documented counseling. The residents reported significant improvement in their ability to counsel patients about smoking cessation. Overall, the curriculum appeared to have a limited effect on health promotion.