Nearly Half of Adolescents Lack a Patient-Centered Medical Home

Adolescence is a unique period of change when many mental health disorders are known to first emerge.

According to experts, approximately 20 percent of adolescents report symptoms of mental health problems, and half of lifetime cases of mental health disorders begin showing symptoms by age 14.

Yet despite the known prevalence of mental health issues during this critical time in a young person’s life, nearly half of adolescents are lacking a medical home – family-centered, coordinated and continuous health care – according to a new study from UC San Francisco’s Department of Pediatrics. This study is timely as expansion of medical home models are being implemented through the Patient Project and Affordable Care Act.

“A higher percentage of adolescents have mental health conditions rather than physical conditions, which really drives home the importance of coordinating care and giving referrals,“ said lead author Sally Adams, RN, PhD, a specialist in the Division of Adolescent Medicine at UCSF.  

“There’s a big problem with trying to coordinate mental health care and the system is failing families,” she added. “If mental health is addressed early, it can lessen the impact, so it’s important to be proactive.” 

The American Academy of Pediatrics recommends that all infants, children and adolescents should receive their care in the medical home model.

The model provides comprehensive team-based care led by a primary care physician who coordinates all elements of a patient’s care.  The pediatric care team works together to help a patient and family coordinate, and understand specialty care, educational services, out-of-home care, family support, and other public and private community services that are important for the overall health of the child and family.

Racial and Economic Disparities

UCSF researchers conducted the first study ever to comprehensively examine medical homes for adolescents. They reviewed the rates of medical home attainment from the 2007 National Survey of Children’s’ Health (NSCH), a national survey of 91,642 parents, including roughly 45,000 who had children aged 10 to 17.

The researchers then analyzed the past-year medical home rates, whether they varied by age, and whether or not the medical home status was related to an adolescents’ mental health status. They also looked at whether the adolescents were given referrals when necessary.

The researchers found that 46 percent of adolescents lacked a past-year medical home, with lower rates for lower-income, minority and uninsured youth. Adolescents with depression, anxiety, ADHD, learning disabilities, developmental delays are autism diagnoses all had lower medical home rates than those without mental health conditions.  

Medical home rates for Hispanic (33 percent) and black (42 percent) adolescents were significantly lower than rates for white (64 percent) adolescents. Those from non-English speaking households were less likely to have a medical home, receive family centered care and referrals when necessary.  

The study, “Medical home for adolescents: low attainment rates for those with mental health problems and other vulnerable groups,” was published in the March-April issue of Academic Pediatrics.

The study provides an important national baseline for the proportion of adolescents receiving care in a medical home, and can be used to measure progress.

The next phase of research will involve analyzing data from the recently released 2011 NSCH which will provide an initial evaluation of changes in medical home status following initiation of the Affordable Care Act.

“Our results document significant shortcomings in adolescents’ receipt of care within a medical home,” said Adams. “Now that we’ve highlighted the disparities it is clear there are huge needs for families with adolescents struggling with mental illness.”