Youth clinic model for youth sexual health

Interdisciplinary team under the same roof

As a health service centred on youth sexual health needs and problems,¹⁸ this youth clinic houses an interdisciplinary team (ie, physicians, nurses, sexologists, social workers, and a receptionist). Responding to young people’s needs by offering curative and preventive services, a youth clinic is a place that focuses on a specific aspect of health or a particular demographic group, in this case youth sexual health. At first glance, this youth clinic is a service specializing in sexual health. However, by adopting a holistic approach, as promoted by the WHO,¹⁹ and by having a variety of health care professionals on the team, the clinic’s providers can offer consultations for other health or psychosocial concerns upstream of the young people’s sexual health problems, as needed.

The clinical team is interdisciplinary, not multidisciplinary, because team members function in collaboration with one another rather than in silos^20,21: the diverse range of specialties grouped together at the same site work collaboratively and share tasks during consultations. Covering both medical and psychosocial domains, the team of 8 providers included family physicians, nurses, a sexologist, a social worker, and a receptionist. Without exception, all providers touted the importance of this cohesion between complementary specialties in providing services: on the importance of “interactions” between providers (Micheline, family physician), of a “collaborative” team spirit (Linda, social worker), and of a team that “is not hierarchical” (Lysandre, nurse) in sharing tasks and responsibilities when supporting young people. This team also works in a shared space, meaning it is a co-located service. A young person could, therefore, consult one or several professionals during a single appointment.

The providers often highlighted the benefits of their complementary specialties and their proximity to one another when providing care. For example, the sexologist illustrated how her presence on site complemented clinical services. She suggested that a youth patient “in a state of crisis” following a clinical diagnosis of herpes would need immediate practical advice on the daily management and treatment of herpes, a service frequently provided by a sexologist (Maryse, sexologist). Similarly, a family physician found that, by receiving support from an interdisciplinary team, she is better equipped to provide more in-depth care according to the problems experienced by the young person: “If, during the consultation, I suspect sexual violence or psychological abuse at the root of the young person’s problem, I can immediately send them to the social worker” (Micheline, family physician). In short, the complementary nature of these services, adapted to the clinical and psychosocial characteristics of sexual health, allows providers to offer appropriate, timely care to young people.

Beyond the interactions between complementary specialties at the same clinic, the interdisciplinary team share important relationships with other connected external services. Since the clinic is located at a CLSC, it benefits from mental health and substance use services for young people, in addition to regular family medicine services. The youth clinic providers can, therefore, easily ensure external follow-ups addressing the particular needs of young people are conducted, and support the transition toward adult care.

Particular functions of a youth clinic

A youth clinic maintains certain specific functions of its programming owing to its mandate to work with young people. First, a central reception area with a qualified receptionist is used for initial triaging. During her interview, the receptionist informed me that she is considered the “first point of contact” with a young person and that her role consists of “filtering requests, rapidly assessing the degree of urgency, seeing who the best person [provider] for the young person would be, and determining whether the situation can wait until the next week” (Carole, receptionist). The fact that the receptionist is considered part of the team of providers renders direct communication with other providers possible, allowing a suitable rate of service provision for providers and young people alike.

Next, certain medications, such as contraceptives, are covered financially in a youth clinic. The providers shared that this particular function allows young people to access certain prescriptions that would, otherwise, be inaccessible because they do not have money or private insurance. They also added that they often seek less costly therapies (eg, generic prescriptions) or free samples to avoid high costs to young people (Sandra, family physician). One provider added that financial coverage for a prescription ensures the confidentiality of young people’s choices by concealing their choices from parents who are the primary holders of private insurance (Lysandre, nurse).

Finally, providers have the benefit of working with young people at a more flexible pace with respect to time and content of a consultation, which is rarely possible within regular services. With the ability to provide consultations ranging from 15 to 60 minutes, the providers can go beyond the young person’s initial request to explain certain concepts in a more in-depth manner. According to the providers, following several cuts to sexual health curriculum in Quebec, they have observed a knowledge decline in this area: “Young people no longer know the words for STBBIs [sexually transmitted and blood-borne infections], nor for naming body parts” (Micheline, family physician). According to providers, providing young people with correct information is urgently needed to remedy a critical situation. Marguerite (family physician) explained how she finished each consultation by offering pertinent sexual health information. “The spiel is in line with the goal of the consultation, for example, the morning-after pill, forgetting to take a contraceptive pill, or pleasure and pain during sexual activities.” As such, the providers try to fill these knowledge gaps during their longer consultations, offering more in-depth explanations.

Young participants’ responses to these services

The youth participants were unanimous in feeling at ease about accessing the youth clinic. They appreciated having the reception space reserved for them. By avoiding the risk of “running into neighbours or parents” (Léa, age 22), young people said they felt “less stressed” and safer at this clinic when visiting for a consultation on subjects that are often new, sensitive, or difficult. The providers observed this appreciation from youth patients. According to Sandra (family physician), the entire consultation occurs in a less intimidating environment when reception is conducted by a familiar person demonstrating a sincere understanding of their needs.

Youth participants also shared that they appreciated that all services were in the same location. For example, when explaining why they return to the clinic, several young participants shared that access to services was “easy and simple” (Julie, age 22), and that they had all their “medical and mental health [psychosocial] stuff addressed during the same appointment” (Laurence, age 18). The youth patients added that advice received at the youth clinic allowed them to better understand the sources of their sexual health problems. For example, the educational components of the consultations allowed young people to break free of their feelings of guilt. “She [provider] took the time to help me stop feeling guilty by telling me that sexual education in schools is currently weak, and that my boyfriend at the time was also responsible” (Mélanie, age 20). The youth patients felt at ease, safe, and supported at the clinic.