Connecting youth with health services: Systematic review

Jennifer Ellen Anderson; Corrine Ann Lowen

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Table 1.

Literature summary

STUDY	LOCATION	LEVEL OF EVIDENCE	N	FINDINGS
Booth et al,1 2004	Australia	II: Qualitative study; purposive sampling (by sex, age, SES, and rural or urban location)	810	Three identified barriers to help-seeking: concerns about confidentiality, knowledge of services and discomfort with disclosing health concerns, and accessibility and characteristics of services
Rickwood et al,2 2007	Australia	II: Narrative review	48 papers	For mental health problems, engaging in appropriate help is protective; school counselors, GPs, and youth workers are gatekeepers to mental health services for youth; nontraditional access points (eg, Internet) are increasingly useful to engage youth
Tylee et al,3 2007	UK, Switzerland	I: Systematic review	90 studies	Assess effects of different service models of health care provision for youth in primary care or community health settings; research provides clear guidance on barriers for young people accessing primary care; evidence has not been translated into comprehensive design of youth-friendly services
Klein et al,4 1998	US	II: Telephone survey	259, aged 14–19 y	Assess adolescents’ use and knowledge of health services, perceived access, and barriers to access; adolescents identified physicians, health centres, and hospital clinics as available services; many did not know where to go for mental health services or reproductive health needs
James,5 2007	Australia	III: Program review	4	Youth experiences of mental illness and treatment needs are different from those of adults; young people are in the best position to judge what is youth-friendly; barriers to accessing mental health services included concerns about confidentiality, lack of experience with the system, no GP, inadequate understanding of mental health issues
Santor et al,6 2007	Canada	II: Non-randomized controlled trial	1124 grade 7, 8, and 9 students	Improving pathways to care depends on providing opportunities to seek help and actively promoting their use; benefits of a school-based intervention greatest among students with specific needs, such as high levels of distress
Hobcraft and Baker,7 2006	Canada, Ghana	III: Interviews	2	Financial, logistical, and emotional challenges to accessing services; role of health care policy and resource allocation in protecting the rights of youth
Rosenfeld et al,8 1996	US	II: 4 focus groups	20, aged 13–21 y	Pilot survey; urban adolescents wanted dignified, respectful treatment and to be listened to and taken seriously by primary care providers
Oberg et al,9 2002	US	III: Narrative review	112 studies	Access to care is a socio-organizational complex of health care delivery and multiple covariable parameters; integrated community health care delivery models require collaboration among health care and other professionals
Brindis et al,10 2002	US	III: Review	NA	Access to preventive health services through annual visits to physicians increases adolescents’ knowledge and skills and improves their opportunities to assume responsibility for their own health and well-being
CIHI,11 2005	Canada	I: Literature review	133 studies	Youth with more assets report better health and higher self-worth and are less likely to engage in potentially harmful practices (eg, substance misuse)
Zachrisson et al,12 2006	Norway	I: Population-based cross-sectional health survey	11 154, aged 15–16 y	Help-seeking passes through several “filters,” each excluding some help-seekers; a minority of adolescents with mental health problems seek help; help-seeking in those with the highest symptom load is low; half the help-seekers achieved contact with GPs; few reached other services
Biddle et al,13 2004	UK	I: Cross-sectional survey	3004, aged 16–24 y	Strongest predictors of help-seeking are case severity and previous help-seeking; boys are less likely to seek help or confide than girls are
Black et al,14 2008	US	II: Convenience sample survey	57	Adolescents who experienced dating violence most often sought help from peers; when violence occurred in isolation, survivors were more likely to receive no support from others; male and female help-seeking differed
Kari et al,15 1997	UK	II: Survey	347, aged 12–18 y	Barriers to adolescents accessing primary care included stigma, service organization, and lack of knowledge
Deane et al,16 2007	Australia	I: Control group survey	506 high school students	Low rates of help-seeking and poor access to health care for adolescents are particular problems in rural locations; intervention resulted in increases in intention to seek professional health care; despite increases, intentions remained relatively low
Chandra and Minkovitz,17 2007	US	II: Purposive sample	57 grade 8 students	Five themes about mental health stigma: personal experience, personal knowledge, family conversations, peer conversations, and perceived social consequences of seeking help
Kang et al, 200518 and 200619	Australia	II: Systematic analysis of multiple service models	77 papers	Seven principles of better practice robust across all services and sectors: access facilitation, evidence-based practice, youth participation, collaboration, professional development, sustainability, and evaluation
Edwards et al,20 2007	US	II: Review of legislation and literature	NA	Building on assets ameliorates problematic behaviour and develops resiliency; school-based services have a vital role in implementing the Positive Youth Development model
Browne et al,21 2004	Canada, South Africa	I: Literature review RCTs or quasi-experimental comparison group studies with qualitative studies added	23 reviews	Programs designed to develop protective factors through increased skill or competence are more effective than those aimed at reducing negative behaviour; effective services address individual needs and address the whole child, including clustered emotional behaviour problems; recommend collaborative service delivery with an intersectoral governance structure
Anderson-Butcher and Fink,22 2005	US	II: Purposive sample; survey and regression analysis	149 youth program participants	Informal relationships and social norms developed in youth programs make a difference in the lives of youth
Butler Walker et al,23 2008	Canada	III: Report on a planning process involving health resource workers	NA	Establishes frameworks for addressing community health issues from a community perspective; identifies key individuals and agencies, background information, goals, objective, strategies, activities, and indicators for each community health issue addressed
Bruce et al,24 2003	Canada	II: Youth-designed survey, focus groups, program evaluation, and documents	152, aged 15–24 y	Three themes in the transition to adulthood: belonging and connectedness vs independence; value and need the support of adults,; and meaningful involvement with families, schools, and communities are significant builders of assets, skills, and resilience

CIHI—Canadian Institute for Health Information, NA—not applicable, RCT—randomized controlled trial, SES—socioeconomic status.

Access facilitation: Services should be flexible, affordable, relevant, and responsive to the needs of all young people (regardless of age, sex, race, cultural background, religion, socioeconomic status, or any other factor).
Evidence-based practice: Services and their programs should be developed and regularly reviewed according to evidence of best practice from the most reliable and appropriate local, national, or international sources.
Youth participation: Young people should be involved in the development, implementation, review, and evaluation of services and programs in ways that create a sense of mutual respect and a sense of ownership of, importance to, influence within, and belonging to that service or program.
Collaboration: Service providers within a service, as well as different services within and across sectors, who share common service goals and target groups, should network, communicate, and work together to plan, deliver, review, and evaluate their service provision to young people with a clear delineation of responsibilities.
Professional development: Appropriate, adequate, and ongoing professional development, support, and supervision should be available to health service providers working with young people.
Sustainability: Services should develop and implement strategies to optimize funding for the service or program, where appropriate.
Evaluation: Services should regularly examine the relevance, quality, and results of their programs using appropriate evaluation methods, which should include measuring the outcomes of the service for young people and service providers against program goals, objectives, and indicators.