Healthcare that gives adolescents and young adults a voice

Adolescence is an important time of development. Young people are developing physically, emotionally, and socially. Their brains are developing rapidly. While early childhood involves rapid brain growth, adolescent brain development is focused on a process called “pruning,” in which the existing neural pathways are refined and trimmed over time, especially in the main decision-making areas of the brain. This process goes on well into a person’s twenties. As a result, in adolescence, many neurons, including those in the reward pathways, are firing rapidly. This creates an environment for rapid socioemotional development, learning, and sometimes behaviors that involve risk-taking and high rewards. The adolescent years are a period of opportunity and vulnerability for health and development.

Adolescents grow and develop in the context of their families, friends, and communities. The people that surround them and the relationships they form help to mold the people they are and the adults they become. At an even higher level, the places and context in which young people live, learn, work, and play shape their health and development. Healthcare providers have the potential to shape adolescent health and development by supporting young people’s strengths, working with them to lessen risk, and encouraging supportive connections with family and community.

Why see an adolescent medicine specialist?

Adolescent medicine physicians are doctors who have training in caring for adolescents and young adults between the ages of 11 and 25. In addition to providing primary care for adolescents and young adults, adolescent medicine physicians care for adolescents with common, complex, and often interrelated medical, psychological, and social concerns. These can include:

• Mental health conditions
• Sexual and reproductive health concerns
• Healthy peer and romantic relationships
• Parent-teen communication
• Healthy social media use
• Adolescent pregnancy and parenthood
• Substance use, and
• Nutrition concerns and eating disorders.

Adolescent medicine physicians have expertise, not only in common adolescent health concerns but also, perhaps more importantly, in talking with teenagers and walking alongside them on their journey.

What does ideal adolescent healthcare look like?

1. Centers youth and families. Adolescent medicine physicians work with youth to promote their independence and decision-making, build supportive relationships with parents and other key adults in their lives, and provide care that meets their needs.
2. Recognizes and supports healthy development. Adolescent care meets young people where they are within the developmental process and recognizes that many common adolescent behaviors align with what we know about the adolescent brain.
3. Supports adolescent’s independence and freedom to make decisions, while facilitating parent-teen communication. Adolescent healthcare promotes adolescent agency and autonomy within healthcare. We ensure access to confidential care when needed, as protected by Minnesota State Law, such as sexual healthcare and substance use treatment. At the same time, we facilitate communication between adolescents and the supportive adults in their lives regarding common health concerns.
4. Leverages adolescent strengths to foster resilience.
5. Addresses the social drivers of health. Adolescents do not develop in a vacuum. They develop in the context of relationships, institutions, communities, society and policies that can help support healthy development and, unfortunately, in some cases, promote risk. Adolescent healthcare should encourage those protective factors in young people’s lives and work to lessen risk.
6. Uses a trauma-informed, anti-oppressive approach. We recognize that many young people have experienced trauma and that often intersecting, traumatic experiences of oppression may influence health. This approach helps to develop resilience and identity development, promotes psychological and physical safety, avoids re-traumatization, and promotes independence and decision-making.

Ultimately, the adolescent and their family are in the driver’s seat and the adolescent healthcare team often plays a supportive role in helping the young person heal, develop and, thrive.

About the author

Janna Gewirtz O’Brien, MD, FAAP is a mother, an adolescent medicine physician, a clinician-researcher, and an aspiring physician activist. She provides adolescent healthcare at Hennepin Healthcare at the Clinic & Specialty Center and provides healthcare in school-based health centers and in shelters for youth experiencing homelessness. She leads research focused on optimizing the equitable delivery of adolescent health services and addressing the health needs of youth experiencing homelessness. She also serves on the executive board of the Minnesota Chapter of the American Academy of Pediatrics and is an active member of the Minnesota School-based Health Alliance.