title: Improving adolescent preventive care in community health centers.
abstract: OBJECTIVE
  To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs).
  
  
  METHODS
  Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs.
  
  
  METHODS
  Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs.
  
  
  METHODS
  Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals.
  
  
  METHODS
  Delivery of and receipt of preventive services and perceived access to care.
  
  
  RESULTS
  CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (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 reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Adolescent Medicine, Strong Children's Research Center and Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York 14642, USA. jonathan_klein@urmc.rochester.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Klein
authors.forename: M J
authors.initials: MJ
authors.lastname: Allan
authors.forename: A B
authors.initials: AB
authors.lastname: Elster
authors.forename: D
authors.initials: D
authors.lastname: Stevens
authors.forename: C
authors.initials: C
authors.lastname: Cox
authors.forename: V A
authors.initials: VA
authors.lastname: Hedberg
authors.forename: R A
authors.initials: RA
authors.lastname: Goodman
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration* / Q000592:standards; D000328:Adult; D003151:Community Health Centers / Q000458:organization & administration* / Q000592:standards; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008485:Medical Audit; D016134:Organizational Policy; D011314:Preventive Health Services / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014481:United States