PROBLEM
To best define the most pressing adolescent health issues over the next five years, as well as to clarify the training needs and priorities, Minnesota’s LEAH collected and/or analyzed data from a large number of youth serving groups including: MCH Directors, State Adolescent Health Coordinators, national experts, clinician in practice, and current as well as former Minnesota LEAH fellows. Areas identified resulted in the establishment of 23 leadership and adolescent knowledge and skills areas: interdisciplinary leadership, cultural competence, personal management/human resource development, life-long learning, communications (written and verbal), health and health systems, education, advocacy, program development and evaluation, community assessment, grantwriting and fundraising, research. The adolescent health domains included: cross cultural issues, family development and relationships, the impact of the media on youth culture/social marketing, positive youth development, adolescent development, nutrition and physical activity, chronic and disabling conditions, sexual and reproductive health, substance use (alcohol, tobacco, marijuana, and other substances), violence/abuse, mental health and eating disorders.
When we look at the national survey of clinicians we conducted recently and compare it to that of 1985, it is clear that we have made significant advances. But it is also clear that we have a long way to go if we are to have a health provider network and a national health services delivery leadership who have the skills to meet the challenges of the years ahead.
GOALS & OBJECTIVES
It is the training mission of the University of Minnesota's Leadership Education in Adolescent Health program to engage and prepare the next generation of adolescent health practitioners for the knowledge and skills to be leaders in the public health and academic sectors within the changing social, economic, and political contexts that influence youth health and development. To accomplish this mission we have five core training outcome goals: 1) leadership development; 2) assuring technical assistance to Maternal and Child Health;
3) expanding the University of Minnesota capacity in adolescent health; 4) supporting continuing education for local, state, and regional MCH health professionals; 5) addressing health disparities. For purposes of this training, we focus on the age range of 10-24 years providing learners with training opportunities that relate to early, middle, and the later adolescent years.
METHODOLOGY
The LEAH seeks to prepare health care professionals from the fields of medicine, nursing, nutrition, psychology and social work to assume leadership positions in both academic, public health, and community sectors. All fellows have had previous educational and work experience in adolescent-related areas, having demonstrated the capability for assuming positions of leadership in adolescent health. Specifically, LEAH seeks applications from those whose goals extend beyond primary individual patient/client care and whose work efforts will enhance the field of adolescent health care through the training of others, research, the development of service models and other creative efforts in the field of adolescent health care. Given this goal, the LEAH is designed for master's, doctoral and post-doctoral fellows. Current recruitment efforts are particularly focused on minority applicants.
Fellowships are of varying duration, depending on discipline-specific needs, certification requirements, funding, and the fellow's concurrent completion of a graduate degree. Currently, physicians are accepted for a two- or three?year fellowship. For the other disciplines, full completion of the LEAH Curriculum Requirements necessitates a minimum of a 12-month full-time program, although some may choose to pursue the fellowship 50% (20 hours per week) over a two-year period.
The LEAH has been designed to provide fellows with deliberately constructed, broad-based experiential and didactic opportunities which draw heavily upon the resources of the University of Minnesota and the Twin Cities of Minneapolis and St. Paul and build upon the unique strengths of the various Centers and Institutes, as well as research and demonstration projects within the LEAH. To accomplish the above, the curriculum is conceptualized as a four-component model comprised of: Leadership Knowledge and Skills; Adolescent Health Knowledge and Skills; Clinical Knowledge and Skills; Focal Areas of Expertise
As a unified curriculum, the four components provide not only for extensive study of adolescent health, but offer a vehicle for intensive research and clinical development in an identified focal area combined with leadership preparation for professional work in either academic, public health, or community settings.
The clinical requirements for all fellows take place in multiple clinical sites. Clinical components are determined by interdisciplinary and discipline-specific training objectives as well as the individual training plan of the fellow. In addition to clinical requirements, all fellows in the LEAH are required to complete a research project, which will lead to submission of an abstract for presentation at a national meeting and a manuscript to a peer-reviewed journal.
COORDINATION
Coordination with MCHB exists on many levels. Within the University of Minnesota, students in any of the MCHB?supported training programs are invited to participate in LEAH courses, seminars, and workshops. At the state level, linkages exist with the state’s Title V program, Family Planning (Title X), and Minnesota Services for Children with Special Health Care Needs. At the regional level, continuing education activities are coordinated through joint planning, with continuing education workshops proposed for five Upper Midwest states are to be offered in conjunction with the State MCH Adolescent Health Coordinators. At the federal level, LEAH faculty serve on the National Initiative to Improve Adolescent Health by the Year 2010 Steering Committee. Additionally, close collaboration exists with the Office of Adolescent Health through the cooperative agreement of the Konopka Institute has to provide technical assistance and training to State Adolescent Health Coordinators.
EVALUATION
The LEAH utilizes both process and impact evaluation to provide information for training program and curriculum development and modification. These evaluations are tied directly to the overall goal of training health care providers for leadership in academia and public health sectors, and to specific objectives related to interdisciplinary adolescent health and leadership knowledge and skills, as well as discipline-specific objectives for medicine, nursing, nutrition, psychology and social work. Specific, measurable objectives and an evaluation structure assure that the overall goals as well as the target training objectives are met. Likewise, we propose a structure to evaluate Minnesota’s LEAH against the seven LEAH performance measures currently under consideration. The process evaluation focuses on the activities of the training program, and provides for ongoing monitoring of the research, teaching, clinical service, and other programmatic activities, with each objective linked to specific methods which, in turn, are linked with evaluation methods. The impact of adolescent health training on learners' knowledge and skills is assessed through several mechanisms. The acquisition of knowledge is assessed for LEAH's core seminars and core classes through examination and other performance evaluations. Broader impact of post-fellowship activities is assessed through surveys of trainees' professional activities, accomplishments, and demonstrations of leadership in academic and public health settings. This survey permits a periodic monitoring of the post-fellowship activities of fellows, which is particularly pertinent in light of the mission of LEAH, oriented toward leadership training of a select number of trainees. Additionally, impact is assessed every five years through a national survey of Adolescent Health Coordinators and MCH directors at the state and regional levels.
ANNOTATION
The goal of the Leadership Education in Adolescent Health at the University of Minnesota is to improve the health status of youth through the training of health professionals in medicine, nursing, nutrition, psychology and social work who will assume leadership positions in academic and public health sectors. Given this goal, the training objectives are focused on development of core knowledge and skills in adolescent health as well as interdisciplinary leadership competencies in research, teaching, and public health administration. The Leadership Education in Adolescent Health at the University of Minnesota has been designed to provide fellows with broad-based experiential and didactic opportunities which draw heavily upon the resources of the University of Minnesota and the Twin Cities, and build upon the unique strengths of the various Centers and Institutes, as well as research and demonstration projects, that comprise the LEAH. The curriculum also offers opportunities for intensive research and clinical development in an identified focal areas in chronic illness and disability, adolescent sexuality, substance abuse, or minority youth health.
KEYWORDS
Adolescent Health, Population-based Interventions, Care Coordination
Nutrition, Adolescent Research, Sexuality
Nursing, Public Health Administration, Social Work
Psychology, Continuing Education, Substance Abuse
Chronic Illness, Interdisciplinary Training, System of Care
Medicine, Minority Health, Training
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