Addressing the Healthcare Needs of Adolescents and Young Adults
Denise Hanisch, MD
President, South Dakota State Medical Association
August 1, 2023
Does anyone really ever experience the “lazy days of summer” anymore? Life is busier than ever for families, especially if teenagers are involved. Softball, baseball, church camps and family reunions are just a few of the activities that are crammed into the summer. If you are a primary care provider, your schedule starts to fill up with sports physical exams in late July and it feels like summer is over. Sport physical exams are often the only time we get to have conversations with our adolescent patients.
Teenagers and young adults are rarely seen for yearly physicals and these are missed opportunities to identify young people at risk for drug and alcohol abuse and mental health issues. According to the South Dakota Department of Health, suicide is the leading cause of death in the age group of 10-29. Twenty-three percent of South Dakota high school students have considered suicide and 12.3% have attempted suicide. Compare this to the percentage of adults who have Type II Diabetes in our state which is 9.2%. As physicians, we devote a significant amount of our time identifying and treating diabetes and other chronic illnesses but so many barriers exist when attempting to care for our young patients.
Even during a limited visit of a sports physical it can be diﬃcult to ascertain if a child is struggling. The South Dakota High School Association added “suggested” questions regarding possible drug and alcohol use, depression and anxiety to the standard form several years ago. It is helpful when a parent is present, but, it can be diﬃcult to ask these personal questions with a parent in the room and I am surprised at how often they are oﬀended by the questions I may ask. Several days ago, a mother aggressively voiced her thoughts about my conversation with her daughter. She did accept my explanation that, even though these questions may not be relevant for her daughter, they were important because they may help identify other kids that need a safe place to open up and I want my exam room to be that safe place for every person.
Another roadblock to provide care for our young adults is lack of insurance coverage. Hopefully this barrier will be mitigated by the expansion of Medicaid that went into eﬀect July 1. South Dakota Medicaid will now include all individuals aged 19-64 who have an income that is 138% of the federal poverty level for 2023. The Department of Health predicts that an additional 50,000-60,000 South Dakotans will now have access to healthcare. This is encouraging and an obvious step in the right direction.
The new Medicaid program also includes expansion of pregnancy coverage. This will provide care to young mothers that was previously limited to postpartum care for 60 days after delivery and for issues that were related to the pregnancy. Now, postpartum women will have full Medicaid coverage, to include any diagnosis, for a time period of 12 months. Hopefully, this will help physicians identify young mothers at risk for postpartum depression and give us the time and resources to provide adequate care so that both the mother and baby can thrive.
Young people are the best resource we have. Even with improved access to care and great strides made in public awareness regarding mental health, we are still failing. Over the past 10 years, suicide rates have increased by 50 percent in our younger population. We need to encourage them to seek care. When you see a teenager for a simple upper respiratory infection or injury, schedule them for a yearly exam on their way out. Have discussions with them during sports physicals, even if it is uncomfortable at times with parents in the room. Encourage young mothers to care for their own health as they are trying to navigate the world of caring for a newborn.
I hope all of you take some time these last weeks of summer to relax and recharge.