Richard G. MacKenzie

HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth.

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.

Runaway and homeless youth in Los Angeles County, California

Data collected over one year from agencies in Los Angeles County serving homeless youth suggest that shelter and outreach/drop-in agencies serve different populations. Shelters serve about equal numbers of males and females, almost half of whom are 15 years old or younger. Slightly more than half of these young people are minority youth who live in Los Angeles County. Seven of 10 go on to live in a stable environment. Outreach/drop-in agencies serve predominantly males, almost all of whom are 16 years old or older. These clients are primarily white and from outside Los Angeles. Four of 10 get off the streets. Both shelters and outreach/drop-in agencies serve primarily multiproblem chronic runaway or homeless youth who have neither families nor independent living skills and have survived as best they could. To help these young people, more emergency shelter beds and transitional living programs are needed. The geographic location and program structure of services however must be carefully considered.

Risk profile of homeless pregnant adolescents and youth

Pregnant homeless young women have special service needs. This article examine those needs by comparing the risk profiles of 55 pregnant homeless youths and 85 pregnant youths who live with their families. These young women were seen in a primary health care clinic and underwent extensive lifestyle interviews during their physical examinations. Clinical social workers provided social services and follow-up. The homeless pregnant youths were younger, primarily white, and from outside Los Angeles County. They were more likely to be diagnosed as depressed, to have previously attempted suicide, to have histories of sexual and physical abuse, and to be diagnosed as drug abusing. Review of pregnancy outcomes showed the difficulty of serving homeless pregnant youth and the lack of services for them. Following this study, the clinic instituted new monitoring procedures and established a team case management approach to serving homeless pregnant teens and youths.

The Clinical Utility and Evaluation of Drug Screening Techniques

A better understanding of the methods of drug detection, their sensitivities, and limitations increases the efficiency of medical decision making for better patient care. Many of the sociomedical and medicolegal questions are yet to be answered through court challenge. The physician must remember his or her role as a clinician, and practice the art in a fashion that best serves the interest of his or her teenage patient.

The society for adolescent medicine's role in promoting education

The first Adolescent Medicine Newsletter, created in February, 1965, for those “interested in the medical care of adolescents,” makes reference to a new kind of education for physicians—a need to broaden our view of what creates the “dis-ease” of adolescents. Dale Garell, then editor, and later to be a founding charter member, Executive Secretary, and the third President of the Society, wrote “The growth and the development of clinics for the medical care of adolescents has [sic] been most rapid in the last five years. Well over thirty clinics are now in existence and thirty-five inpatient services have been established. Interest is extremely high among pediatricians, internists and generalists to develop additional programs in the future. Adolescent medical care is being taught in many medical schools throughout the country. It has become part of the regular rotation in the training of residents and has offered postgraduate courses to physicians in the community interested in improving their skills in dealing with the adolescent age patient” (1). The Society was established primarily by academically based physicians to provide a forum for information, exchange, and collegiality. Although during these early years informal discussions about the education and training of professionals were frequent, no formal approach was made by the Society to examine these issues until 1972. Teaching about the special needs of adolescents had become part of the training experience of medical students and housestaff in many institutions across the United States. The need for fellowship training at the postresidency level had also been recognized. The first fellowship was established in 1953 by Roswell Gallagher in Boston and had a focus on clinical training and developmental issues in the hospital setting. In 1964, Felix Heald, then Director of Adolescent Medicine at Children’s Hospital in Washington, DC, received a grant from the Children’s Bureau of the Federal Department of Health, Education, and Welfare for an annual symposium to address topical issues in the medical care of the adolescent. The first of such meetings was held in the spring of 1965. Dr. Gallagher also initiated annual 1-month training sessions and a 5-day conference on the Medical Care of the Adolescent. In 1967, the Children’s Bureau provided funding for 14 physician fellowships in adolescent medicine programs in Cincinnati, Seattle, Birmingham, Dallas, Denver, Los Angeles, and Washington, DC. Although other centers offered fellowship training, these programs, many of which are still in existence today, became the backbone and foundation that defined the fellowship experience. Through convergence of these interests, activities, and discussions, an Adolescent Medical Society was proposed in 1965. It was anticipated that this organization would better define the field, promote interest, and encourage research, education, and training. The Society for Adolescent Medicine (SAM) was organized on April 28, 1968, and recognized at the Adolescent Medicine Seminar held in Washington, DC. A forum thus existed for ongoing discussion of biopsychosocial issues relating to the adolescent. Biannual meetings provided an opportunity for informal discussions about postmedical school training in adolescent medicine. During an informal session at SAM in March 1971, a discussion of fellowship training focused on the need for standards, developing a liaison with the American Boards of Pediatrics and Internal Medicine, surveying the present scope of programs and the expansion of programs into 2 years to include a year of research. To promote fellowship training, in 1972 the Society initiated publication of fellowship information (2) known to the Society’s business office. In 1972, the American Academy of Pediatrics (AAP) stated, “The purview of pediatrics . . . begins in the period prior to birth when conception is apparent. It continues through childhood and adolescence when the growth and developmental processes are generally completed.”(3) This statement JOURNAL OF ADOLESCENT HEALTH 1998;23S:135–142

Treatment of adolescents with anorexia nervosa: a paradigm for multidisciplinary intervention and interdisciplinary function.

Since 1976, physicians and psychologists at the Teenage Health Center (a comprehensive outpatient health facility designed especially for adolescents and located in a general pediatric hospital) of Childrens Hospital of Los Angeles have been treating adolescents with anorexia nervosa with a combination of appropriate medical care, individual and family psychotherapy, and hospitalization when necessary. Comprehensive and coordinated physical and psychological care are provided through the use of a multidisciplinary approach and interdisciplinary function. At times, patient care is a cooperative venture between physician and mental health professional with the physician primarily responsible for medical care only. More often, physicians manage the total care with psychologists either as co-therapists or supervisors. Treatment of anorexia provides an excellent training opportunity because of the multifaceted nature of the problem. Medical Fellows who are enrolled in a two year post-residency Fellowship program in Adolescent Medicine are supervised by staff physicians and psychologists. Treatment of adolescents in a non-psychiatric facility, particularly when hospitalization has been required, has been seen to have several advantages. Evaluation of the program by the adolescents, families, trainees, and hospital personnel has been positive.

A multidisciplinary program for high risk youth: a potential model for third world nations.

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“Turning on” a National Agency: The Job Corps Drug Workshop Experience

The authors describe the sometimes painful process of developing a series of drug training workshops for a non-health agency. They then discuss the principles and procedures they followed to achieve a successful result, and make suggestions for others who are planning drug education programs.