Current Problems in Pediatric and Adolescent Health Care最新文献

College health centers are an important source of health care for large numbers of young adults throughout the country. With 16.9 million students enrolled in 2023 in post-secondary institutions in the United States, the potential impact that health centers at these institutions have is significant. Late adolescence and early adulthood is a particularly vulnerable stage of both cognitive and psychosocial development, and college health centers that provide comprehensive medical and mental-health care play an important role in providing comprehensive care for this age group. As we move into a post-pandemic era, colleges and universities across the country continue to navigate all the changes that have been brought about by the COVID-19 pandemic. It is perhaps now more important than ever to review and assess the clinical care college health centers provide, who they provide this care to, and identify opportunities for improvement and where there may be need for change.

The college years are one of excitement and often thought of as a dream like setting of growth, creativity, and independence. This exciting time can be marred by the onset or exacerbation of mental health conditions, alcohol, and/or drug dependence. This writing looks to explore the world of college mental health and the changes the provisions of this type of care has undergone during and after the COVID-19 pandemic. We look at the staggering rates of diagnosed mental health diagnoses and mental health related symptoms that may undermine a student's ability to meet their full growth and academic potential. We look to explore different health settings where college age students are accessing care and how that care is being delivered (e.g. community vs on-campus, telehealth vs in-person). We also aim to highlight specific mental health conditions (e.g. anxiety, depression, suicidality, PTSD) and specific student stressors (e.g. participating in athletics, socioeconomic pressures) to underscore the message that the mental health of college age students is an area that needs continued study and engagement of all parties involved in student development and well-being.

School-based health centers (SBHCs) provide a critical point of access to youth in low-resource communities. By providing a combination of primary care, reproductive health, mental health, vision, dental, and nutrition services, SBHCs improve the health, wellbeing, and academic achievement of the students they serve. SBHCs operate in collaboration with schools and community primary care providers to optimize the management of chronic health conditions and other health concerns that may result in suboptimal scholastic achievement and other quality of life measures. Conveniently located in or near school buildings and providing affordable, child- and adolescent-focused care, SBHCs reduce barriers to youth accessing high quality health care. SBHCs provide essential preventive care services such as comprehensive physical examinations and immunizations to students without a primary care provider, assist in the management of chronic health conditions such as asthma, and provide reproductive and sexual health services such as the provision of contraceptives, screening and treatment for sexually transmitted infections (STIs), and management of pregnancy. Additionally, some SBHCs provide vision screenings, dental care, and nutrition counseling to students who may not otherwise access these services. SBHCs have been demonstrated to be a cost-effective model of health care delivery, reducing both health care and societal costs related to illness, disability, and lost productivity.

School based health centers (SBHCs) have been providing preventive, acute and chronic care in schools across the United States (US) for the past 40 years. A discussion of that care is provided in a companion article to this one. Several major societal issues of the 2020s, affecting the care provided in SBHCs, have taken place over the past 4 years. These issues, which will be discussed in this article, include the following: 1. The COVID pandemic had a major impact on utilization and services required at SBHCs, both at the peak of the pandemic, when schools were closed and since the peak of the pandemic, when schools reopened. 2. The transformation of mental health services, due both to increasing mental health needs of youth, as well as progression to new therapeutic modalities, has required expansion of services provided at SBHCs. 3. New immigrant health care needs and services have required a response by SBHCs to the substantial increase of new immigrants, most of whom are impacted by significant trauma, entering public schools nationally. 4. Telehealth integration into SBHC medical and mental health services, and its expansion to incorporate new technologies, have provided avenues for increased provision of services by SBHCs.