RESUMEN
PURPOSE: This study examined access to technology and telehealth among young adults (ages 18-24) who were court-involved and were recruited from an alternative sentencing program in New York City. METHODS: Using sequential mixed methods design, we examined demographic factors linked with access to technology and perceived usefulness of the Internet among n = 321 young adults who were court-involved (75% male, 65% African American, 35% Latinx). We then conducted in-depth interviews with 27 young adults to elicit first-person account of their access to, interest in, and experience with technology and telehealth. RESULTS: Although most participants had access to a phone with a data plan, a substantial proportion reported inconsistent access to the technology critical to telehealth. Certain young adults were more likely to lack consistent access to the technology needed for telehealth, including Black young adults, males, those with less than a high school diploma, those with a history of homelessness, and those who had difficulties paying for basic necessities. Qualitative interviews revealed that most had a strong self-efficacy using technology, while distrust of technology, inexperience with and skepticism of telehealth, low perceived need for care, and medical mistrust were common significant barriers in this underserved population. DISCUSSION: Findings underscored the critical need to address medical mistrust and increase access to and utilization of care among young adults who are court-involved. Results can inform the development and implementation of interventions designed to improve accessibility and acceptability of telehealth.
Asunto(s)
Accesibilidad a los Servicios de Salud , Telemedicina , Confianza , Femenino , Humanos , Masculino , Adulto Joven , Negro o Afroamericano , Ciudad de Nueva York , Telemedicina/métodos , Hispánicos o Latinos , JurisprudenciaRESUMEN
A 16-year-old girl presented to her primary care physician with a one-month history of decreased appetite and abdominal pain. She had normal bowel movements and no vomiting, but her periumbilical pain limited her ability to finish most meals. She had gradual weight loss over the previous 2 years, and during the previous 4 years, she intermittently received counseling for depression after the loss of her mother. Her initial physical examination and laboratory evaluation were unremarkable. She was referred to a nutritionist, adolescent medicine, and pediatric gastroenterology. Her presentation evolved over time, which ultimately led to a definitive diagnosis.
Asunto(s)
Dolor Abdominal/diagnóstico , Apetito/fisiología , Enfermedad de Crohn/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Pérdida de Peso/fisiología , Dolor Abdominal/etiología , Dolor Abdominal/metabolismo , Adolescente , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/metabolismo , Diagnóstico Diferencial , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/metabolismo , Femenino , Humanos , Complejo de Antígeno L1 de Leucocito/metabolismoRESUMEN
BACKGROUND: Domestic minor sex-trafficked (DMST) youth experience profound medical and mental health consequences. This retrospective study reviewed healthcare utilization patterns and documented individualized risk factors of sex-trafficked youth in the 5 years prior to presenting to a healthcare setting. The primary aim of this study was to examine healthcare utilization patterns among DMST youth with the goal of determining opportunities for earlier identification within the healthcare system. METHODS: A chart review was conducted of all patients <18 years old referred for suspected or confirmed sex trafficking to a child and adolescent protection centre (CAPC) in an urban, academic children's hospital in Washington, DC from January 1, 2006 to March 1, 2017. Patients were seen by a child abuse pediatrician or a trauma-informed social worker in an inpatient, outpatient, or emergency department setting. Demographics and medical, psychiatric, and social history were abstracted from encounters within the hospital's healthcare system along with provider concern for DMST up to 5 years prior to their initial CAPC visit. Descriptive statistics were performed. RESULTS: Thirty-nine patients were identified with a mean age of 14.6 years (SD = 1.7). Ninety percent (n = 35/39) of patients were seen in the healthcare system within the 5 years prior to their initial CAPC visit, totaling 191 encounters. Of the visits, 57% (n = 108/191) occurred in the emergency department. The most common chief complaints for encounters were psychiatric (21%, n = 41/191). Less than half of the youth, 43%, had any documented provider concern for sex trafficking in their medical record prior to identification as DMST. CONCLUSION: Most of this cohort was previously evaluated within the healthcare system. However, there was limited provider documentation of concern for DMST despite the presence of risk factors. Provider recognition of youth at risk for DMST is crucial for providing care for youth.