Young people aged 13 to 16 who attend alternative education because they have been excluded or suspended from mainstream education often find it harder than their peers do to access primary health care.
These young people are often at risk for sexualised and other risk-taking behaviours. They may lack health literacy, or general literacy. They may face practical barriers to seeing a doctor or nurse, such as a lack of funds or identification documents.
Lee-ann O’Brien is an adolescent nurse specialist at Nelson Bays Primary Health. She runs health clinics that assess the needs of every young person who comes into alternative education in the Nelson region.
Many of the students Lee-ann sees are not registered with a GP, or can’t remember who their family doctor is. Some do not even know what a GP is. ‘It’s a foreign language and a foreign concept to them,’ says Lee-ann.
Lee-ann developed a programme to equip these young people with the language and skills they need to access a GP by simulating real experiences. She developed and taught the programme with a third-year social work student, and implemented it with five students aged 15 years at Youth Nelson, an alternative education centre serving three mainstream schools.
The programme was held over Terms 3 and 4, and comprised six one-hour sessions:
- an introduction to the programme, and to the idea of what a family doctor does
- reasons for seeing a GP, and role-playing how to make an appointment
- a discussion about necessary documentation for making and attending a doctor’s appointment
- a visit to Nelson Family Medicine to familiarise students with the clinic environment and to let them practise making an appointment with a receptionist
- a visit to a paediatric outpatients service, to let them practise having an appointment with a doctor
- presentation of certificates, a quiz and an evaluation questionnaire.
Many alternative education students don’t have student ID cards, which mainstream students use for identification and service discounts, so the programme created cards for them. Similarly, it provided funding for them to get a birth certificate if they lacked one. It gave them practical help to set up bank accounts and obtain community services and EFTPOS cards.
The programme assessed the students’ learning using questionnaires and verbal feedback from students, Youth Nelson staff and the doctor involved in the visit to paediatric outpatients. At the end of the programme, students showed increased confidence. ‘It increased their information and their confidence in their ability in general,’ says Lee-ann. ‘Completing the programmes also gives students literacy credits in oral language skills and filling out forms.’
Lee-ann is using feedback from the completed programme to refine its future shape. One issue she recognises is that, because participants are minors, they still rely on parents or caregivers to set up bank accounts on their behalf. She is aware that students’ home situations sometimes made this difficult.
The barriers to health care access faced by Youth Nelson students may also be experienced by students at other alternative education units across New Zealand. Lee-ann plans to roll out her programme to other education centres and is currently training a colleague to deliver the programme in Blenheim.