Researcher's Mission: Improve Adolescents' Access to Health Care

Some states haven't incorporated insurance recommendations into law

January 14, 2000

A boy who shot and killed a man when he was just 11 years old was recently convicted in a Michigan courtroom of second-degree murder. Some think the tragedy could have been avoided if the medical system had adequately screened the boy, and provided counseling for his behavioral problems.

Molly McNulty, J.D., a researcher at Children's Hospital at Strong of the University of Rochester, is doing her part to increase adolescents' access to health care - mental, physical, and otherwise. She is embarking on a 12-month, $100,000 study that will identify state policies for providing preventive services to adolescents ages 11-21.

The study will focus solely on adolescents who are enrolled in Medicaid or the State Child Health Insurance Program. The report McNulty produces will highlight ways that state legislatures and agencies can improve policies to assure that all lower-income adolescents have access to preventive health care.

"This project is nationally significant because medical guidelines about preventing health problems in adolescents have been developed during the last five years, yet little is known about the extent to which state policies have incorporated these recommendations," McNulty says.

McNulty says this is an ideal time to craft a delivery system reflecting modern medical preventive guidelines, since federal Medicaid rules now require that every state arrange and pay for a comprehensive, preventive service benefit package to adolescents.

These adolescents, who are eligible due to their low family income rather than special medical needs, are susceptible to a plethora of preventable illnesses and disabilities that disproportionately burden low-income youth, particularly racial and ethnic minorities. Examples of preventable health problems include teen pregnancies, sexually transmitted diseases, smoking, violent behavior, and suicide.

"The purpose of my research is to expand adolescents' access to prevention-oriented health care," McNulty says. "An agency here in Rochester, Threshold Center for Alternative Youth Services, was included in a national census of 'Comprehensive Adolescent Health Services in the United States.' This report developed a gold standard by which to measure adolescent health care programs."

"Despite meeting the gold standard, state choices about Medicaid policy have shrunk Threshold's budget and ability to serve low-income adolescents," McNulty adds.

The agency provides medical care and services to low-income adolescents, regardless of whether they are insured. This year, it opened a satellite office, and services are in high demand.

Threshold estimated it would serve 100 youngsters during its first year, but is on pace to help twice that many, including some from the suburbs, who are more comfortable talking to someone other than their family physician. If Threshold's service wasn't available, these adolescents might skip their doctor visits.

Because of budget considerations, though, Threshold's satellite office is only open eight hours a week and has minimal staffing. With more state funding, says medical director Lisa Handwerker, M.D., it could stay open longer, employ additional help, and serve hundreds, if not thousands, of additional patients.

McNulty's study is being paid for by The Center for Health Care Strategies. The Robert Wood Johnson Foundation and the Annie E. Casey Foundation made the grant possible.

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