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It's expected that teens and tweens will worry their parents - and often drive them to distraction - during their transition to adulthood and the experimental behavior and angst that goes with it.
Negotiating medical issues common to that age group often requires additional expertise. That's one of the reasons the University of Mississippi Medical Center has established an Adolescent and Young Adult Health Clinic at three different locations in the metro area.
It adds three experts in adolescent medicine to the physicians and psychologists who staff UMMC's Center for the Advancement of Youth, said Dr. David Elkin, a professor in the Department of Psychiatry and Human Behavior and the center's executive director.
And, it doubles the patient capacity of the center, also known as CAY, Elkin said.
"Adolescence is definitely the big time of transition," said Dr. Sadhana Dharmapuri, assistant professor of pediatrics and adolescent medicine and new chief of the Division of Adolescent Medicine within the Department of Pediatrics. "It's a time when youth are trying to figure out who they are. They're having a lot of physiological changes, and they have issues that need to be addressed."
That can be overwhelming for physicians who aren't expert in those fields - among them, eating disorders, anxiety and depression, or teen gynecological issues, Dharmapuri said. "It's been definitely seen as a need to have providers specialized in adolescent medicine," she said.
The Adolescent and Young Adult Health Clinic operates Monday afternoons, Friday mornings and Friday afternoons at the Jackson Medical Mall off Woodrow Wilson Avenue; Tuesday and Thursday mornings and Friday afternoons at UMMC's Grants Ferry multispecialty clinic, 1010 Lakeland Place in Flowood; and Tuesday mornings and afternoons at the Select Specialty Hospital Clinic, 5903 Ridgewood Road in Jackson.
The Adolescent and Young Adult Health Clinic falls under the umbrella of CAY, but is a separate clinic, Elkin said. CAY is open weekdays from 8 a.m.-3 p.m. at UMMC's Children's Specialty Clinic, but effective Sept. 29 moves to the Select Specialty Hospital clinic.
"The hallmark of what we do at CAY is screening and triage for kids referred by their primary care physician, but now we're adding an entire adolescent arm," Elkin said. "Some of the patients are examined so that we can reach a diagnosis and then refer them for the services they need. Others will be sent straight to treatment."
A physician referral to the new clinic is required for youth and young adults ages 10-18. Services are confidential, but they include collaboration with family members. The goal is to support teens and pre-teens through their transformation to adulthood and to teach them to self-advocate as they prepare for a successful and healthy future.
Those seen at the new clinic will be evaluated by the adolescent medicine team along with a psychologist. "They will ask the standard adolescent medicine questions," Elkin said. "We already ask those questions of kids who are old enough, but now we have experts to do that."
"We focus a lot on reproductive health issues, menstrual management and high-risk behaviors. We provide screening for sexually transmitted diseases and contraception," Dharmapuri said. "Unfortunately, Mississippi is one of the top two states in the nation for teen pregnancy. That definitely fits in with our practice."
She and her team - Dr. Nneka Holder, associate professor of pediatrics and adolescent medicine, and Dr. Maria Demma Cabral, assistant professor of pediatrics and adolescent medicine - are trained to treat a number of health issues that can be serious or even deadly. All three are new to UMMC, and new to Mississippi.
"What looks like typical adolescent behavior could truly be depression or anxiety. We can get those patients the services they need and refer them to the right therapist," Dharmapuri said. "And we definitely have specialized training in eating disorders. That's a very special population, and it usually shows up in the adolescent years. With good screening and early intervention, this can be handled very successfully."
The questions asked by the adolescent medicine team can reveal other areas where patients are in need of evaluation or treatment. "If we have a 13-year-old who comes in for suspected depression and gets sent for treatment, they may also need to be referred to gynecological service for medical care," Elkin said. "We will refer them appropriately through the UMMC system."
Some of the health issues facing today's youth are hard for them and their parents to talk about. That can include contraception and counseling for its use, dealing with high-risk behaviors in social settings, and health care for special populations, including teen mothers and LGBTQ youth.
"What we're seeing in the schools is more suicide ideation, more threats," said Diane Chaney, president of the Mississippi School Nurse Association and lead school nurse for the Pascagoula-Gautier school district. "They're exposed to more violence. They're constantly hit with different sexual things.
"We do see a lot of mental health issues - a lot of depression and a lot of anxiety," said Chaney, a nationally board-certified school nurse. Some students "are contemplating self-destructive behaviors, such as increasing drug and alcohol use and an increase in sexual behavior. All of those things can require intervention."
Sometimes, it's hard to put a finger on what might be wrong.
"A pediatrician might think, 'There is just something off about Johnny.' I'd encourage that physician to send that particular teen to us," Dharmapuri said. "Boys go through puberty not quite sure how to handle the changes, and boys are still 10 percent of the population on eating disorders."
The new clinic, which bills patients and accepts insurance, focuses on all youth and young adults, not just special populations, and not just on female issues, Dharmapuri said. "All teenagers are high risk because that's just the nature of being an adolescent, whether it's with relationships, driving a car, or even their immunizations. All teens have teenage issues."
The medical teams at both CAY and the new clinic want to ensure that no matter the health challenge, teens receive the specialized care that addresses it.
"This is such a big time for kids," Dharmapuri said. "They are developing autonomy, and we can help them make informed decisions and communicate with their parents or guardians. We can get them the services they need, or refer them to the right therapists.
"We want to help them to be the healthiest person they can be, and to live long and healthy lives."
Jessica Hassell, M.D.Dr. Jessica Hassell, a recent pediatric resident at Nationwide Children’s Hospital, Columbus, Ohio, has joined the Medical Center faculty as an assistant professor of pediatrics. After receiving her B.S. in psychology summa cum laude from Ohio State University,
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