“We cannot always build the future for our youth, but we can build our youth for the future.”  – Franklin D. Roosevelt

A safe and successful transition from childhood into adolescence and then into adulthood is a right of every individual.

“Adolescents are not simply old children or young adults”. This  statement is the motto of AA-HA! guidance (Global Accelerated Action for the Health of Adolescents), released in 2017 by the WHO (World Health Organization) as a response to  the significant burden of health problems affecting adolescents.(1)

WHO defines “adolescents” as people aged 10-19. They represent 1.2 billion individuals of the global population, and comprise 10%-25% of the population in European countries.(2) The majority of adolescents are healthy, but every day over 3000 of them die from preventable or treatable causes. Morbidity particular to adolescence, such as unintentional or intentional injuries; mental health disorders (depression, substance abuse, eating disorders); infectious diseases; risky sexual behaviours; and early pregnancy and childbirth, dominate the public health scene and have both short and long-term consequences.

Although adolescent health seems to have improved during the last decades, European countries face worrisome trends in specific areas (for instance, increasing obesity and suicide rates); moreover, according to the WHO Health Behavior of School Aged Children (HBSC), the proportion of adolescents with recurrent health complaints is increasing in 9 of the 34 European countries surveyed on this topic.(3)

The situation

Among the many stakeholders who need to address adolescent health issues, healthcare professionals have a particularly important role to play. Family doctors are heavily involved in taking care of an ageing population with multiple morbidities; however, an increasing number of young adults is surviving chronic childhood conditions, and this group needs specific, skilled professional care through adolescence and into adulthood.

Some countries such as USA, Canada and Australia have already recognised the specific needs of adolescents, creating a new specialty: Adolescent Medicine. These countries have been offering training curricula in Adolescent Medicine and Health to residents for several decades now, with more formal training programmes developed recently.

In Europe, this kind of training is not yet available. By international standards, the quality of healthcare currently delivered to adolescents in Europe is suboptimal.

Training in Adolescent Medicine and Health requires both knowledge of the physiologies and pathologies seen in this unique group of individuals, and an ability to communicate and treat them competently. (4)

The concept of competency-based training is particularly relevant here. Residents should be trained to deal with specific clinical situations, using resources and tools such as interactive training sessions; bedside teaching and observation; and video discussions. Moreover, their skills should be properly assessed through, for example, patients-based simulations. (5)

The Adolescent Medicine and Health Working Group of the European Academy of Paediatrics (EAP) has developed a set of goals covering the generic prerequisites for quality-based adolescent healthcare, both in hospital settings and in ambulatory primary care environments. These goals are based on a document issued by the WHO and adapted from the “EuTEACH” modules. (6,7)

The implementation and adoption of these goals depends on both educational context and resources of each European country, as well as each country’s epidemiological situation and most prevalent health problems.

Our recommendations

Young EAP and EAP hope to build an effective workforce of highly skilled Adolescent Health and Medicine professionals who understand the unique biological, psychological, behavioural, social and environmental factors that impact adolescent health. As such, we:

– Encourage governments to lead the needs assessment and priority setting exercise for adolescent health and development, by creating national committees with decision power on programme implementation and budget allocation.

– Encourage the implementation of Adolescent Health and Medicine competencies and skills in all paediatric and adult residency programmes in Europe.

– Suggest that medical schools introduce Adolescent Medicine and Health into their training curriculum, either as a standalone topic or embedded in the teaching of adult and paediatric medicine. (4)

EAP has recently worked with the Union of European Medical Specialties (UEMS) and established a Multidisciplinary Joint Committee (MJC) to address the training requirements of professionals working with adolescents. The involvement of mental health professionals, adult medicine colleagues and surgeons, as well as the support from allied professionals, is critical to ensure our efforts are successful.

Adolescence is a critical life stage: promoting behaviour leading to lifelong health, and investing in adolescent health, will help to avert problems for the next generation. Improving Adolescent Health and Medicine competencies of healthcare providers is a promising way to decrease adolescent morbidity, improve adolescent health and enhance their quality of life.

References

1. World Health Organization. Global Accelerated Action for the Health of Adolescents (AA-HA!); Guidance to Support Country Implementation, https://apps.who.int/iris/bitstream/handle/10665/255415/9789241512343-eng.pdf;jsessionid=FABBDCC8EDAFCBB7B809429A4CD47C76?sequence=1
2. World Health Organization. Improving the Quality of Care for Reproductive, Maternal, Neonatal, Child and Adolescent Health in te WHO European Region. 2016:50 pp. Copenhagen: World Health Organization, http://www.euro.who.int/__data/assets/pdf_file/0009/330957/RMNCAH-QI-Framework.pdf?ua=1
3. Kuntesche E, Ravens-Sieberer U (2015) Monitoring adolescent health behaviors and social determinants cross-nationally over more than a decade; introducing the health behavior in schoolaged children (HBSC) study supplement on trends. Eur J Pub Health 25 (Suppl 2): 1-3. https://doi.org/10.1093/eurpub/ckv009
4. Michaud PA, Schrier L, Ross-Russel R (2017) Paediatric departments need to improve residents training in adolescent medicine and health; a position paper of the European Academy of Paediatrics. European Journal of Pediatrics, vol 177, issue 4, pp 479-487 https://doi.org/10.1007/s00431-017-3061-2
5. Hardoff D, Benita S, Ziv A (2008) Simulated-patient-based programs for teaching communication with adolescents: the link between guidelines and practice. Georgian Med Newa 156:80-83.
6. Michaud PA, Baltag V. Core competencies in adolescent health and development for primary care providers, 2015:49 pp. Genova: World Health Organization http://www.who.int/maternal_child_adolescent/documents/core_competencies/en/
7. EuTEACH (the European Training in Effective Adolescent Care and Health) https://www.unil.ch/euteach/en/home.html

Abou the Authors

Marija Slobođanac (Croatia) is a final year paediatric resident. She is the Young EAP representative within the UEMS Multidisciplinary Joint Committee for Adolescent Medicine.

Helena Fonseca (Portugal) is a paediatrician specialised in Adolescent Medicine. She has a Master in Public Health (Maternal and Child Health) from University of Minnesota. Helena is an associate professor with habilitation in Paediatrics at the Faculty of Medicine of the University of Lisbon. She is a member of the European Medicines Agency Paediatric Committee (PDCO).  She is a senior Consultant at Department of Paediatrics, Hospital de Santa Maria; and Head of the Adolescent Medicine Division and Coordinator of the Pediatric Obesity Clinic.

Robert Ross Russell (UK) is the chair of the European Board of Paediatrics and a member of the Executive Committee of the European Academy of Paediatrics. He is a Consultant Paediatrician at Cambridge University Hospitals Foundation Trust in the UK.

Pierre-André Michaud (Switzerland) is a specialist in in Adolescent Medicine, and the founder of the Multidisciplinary Unit for Adolescent Health at the Lausanne University Hospital (CHUV). He is honorary professor at the University of Lausanne (UNIL) and is the First Holder of the Chair in Adolescent Medicine in Europe. He is the founder of EuTEACH (European Training in Effective Adolescent Care and Health).