Alcohol misuse: tackling the UK epidemic - London

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are more difficult to reach than others, so services must be capable of providing advice and help through
diverse environments.
Often neither children’s nor adults’ services are appropriate for adolescents. There may be difficult
transition issues, especially in mental health care provision, where adolescents can fall between CAMHS
and adult mental health services. Mental health services in particular should be capable of treating the
conditions common among adolescents in an appropriate age environment. Recently there have been
calls for every healthcare organisation to have a policy and identified lead professional for the provision
of services for young people. 198
Professionals dealing with adolescents may sometimes benefit from
specialised training.
Improving adolescents’ access to services must involve adolescents’ perceptions of the services provided.
Adolescence is often a time when individuals use health services independently for the first time. In this
sense, adolescents can be considered ‘new’ users of healthcare services and should be provided with the
necessary information, support and encouragement. 198
Adolescents should also perceive services to be
user friendly. For example, sexual health services appear to have a more positive effect on adolescents
when they are provided by youth-oriented clinics. Resources have been developed to help professionals
provide appropriate services for adolescents. 199
Taking into account the views and self-defined needs of adolescents may be one way to improve their use
of health services. Article 12 of the United Nations (UN) Convention of the Rights of the Child states that
children should have the right to express their views freely in all matters affecting them and that these
views should be given weight in accordance with the age and maturity of the child.
A key concern for adolescents, which may affect their use of services, is confidentiality. Young people over
16 are considered competent and should be assured of confidentiality in consultations. However, even
under this age, adolescents are assumed to be competent for confidentiality purposes if the clinician is
confident that they understand the consequences of their decisions. Adolescents presenting for
contraception services are generally given complete confidentiality. 198
Health services may need to
explain patient confidentiality to adolescents in order to encourage them to use the services provided.
Consent, rights and choices in health care for children and young people (2001) contains a full discussion of
adolescents’ confidentiality issues. 191
Clinical interventions
Although many interventions in adolescent health focus on prevention, clinical treatment is also
important. Treatment of adolescent addiction has not traditionally been high on the government’s
agenda. However, in the context of smoking, drinking and drug use, helping adolescents to change their
behaviour may prove to be as important as prevention. There is evidence that brief interventions,
cessation counselling and substitute prescribing may help to modify behaviour. Appropriate and effective
clinical interventions are vital for treating mental and sexual health problems. Adolescent obesity may
also be tackled in a clinical environment, though success is typically limited.
Multifaceted interventions
Multifaceted interventions involving, for example, education, the media and community, may be
successful in improving adolescent health. Multifaceted approaches have the advantage of recognising
the individual, social and environmental influences on behaviour. The most important criteria for
multifacted interventions is that the messages delivered are consistent and straightforward. For example,
the most effective way to prevent adolescents from smoking may be to use a combination of school-based
education, media campaigns, price increases, cessation support and smoking bans in public places.
British Medical Association Adolescent health