Improving adolescent preventive care in community health centers

Objective. To evaluate implementation of the Guidelines for Adolescent Prev entive Services (GAPS) in Community and Migrant Health Centers (CMHCs). Design. Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs. Participants. Eighty-one preintervention and 80 one-year postintervention p roviders and 318 preintervention and 331 postintervention 14- to 19- year-o ld adolescent patients being seen for well visits at 5 CMHCs. Intervention. Health center staff were trained to implement GAPS and were p rovided resource materials, patient questionnaires, and clinician manuals. Main Outcome Measures. Delivery of and receipt of preventive services and p erceived access to care. Results. CMHC systems changes were related to stronger leadership commitmen t to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implem entation, adolescents reported increases in having discussed prevention con tent with providers in 19 of 31 content areas, including increased discussi on of physical or sexual abuse (10% before to 22% after), sexual orientatio n (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48 %). Adolescents were also more likely to report knowing where to get reprod uctive or mental health services and were more likely to have received heal th education materials. Implementation also increased documentation of reco mmended screening and counseling in 51 of 79 specific content areas assesse d in chart reviews. Conclusion. Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.