Adolescent Health and Medicine

Dr. Curren Warf, Division Head

Dr. Curren Warf, Division Head

The mission of the Division of Adolescent Health and Medicine is to improve the health of adolescents through clinical services, education and training, advocacy, health promotion and research. The Division seeks to define best practices for youth, educate and train health professionals in these best practices, facilitate youth involvement in program planning and evaluation, identify and address adolescent health issues, and develop partnerships for clinical services, training and research.

The Division supports two main programs at B.C.’s Children’s Hospital: the Youth Health Program and the Eating Disorders Program. Within the broader community, the Division ensures that Children’s Hospital plays a strong provincial role in developing partnerships to address health issues for B.C.’s adolescent population.

 

 

 

Over the past several years, members of the Division have supported numerous research initiatives that have been developed and funded within the Youth Health Program.

Current research projects include:

  • Evaluation of the On-TRAC clinical pathway;
  • Development and evaluation of the Family Care Book, a tool to assist families of youth with chronic health conditions to be active participants in their care, and to obtain knowledge about the resources and services that are available to meet their ongoing needs;
  • Partnering with the BCCH Division of Rheumatology and others to investigate the biopsychosocial impact of steroid therapy on adolescents;
  • Partnering with the Hospital for Sick Children in Toronto to examine how adolescents adapt to childhood chronic illness;
  • Development of a 'Program Logic Model' to facilitate program planning, delivery and evaluation and also establish a baseline against which the program can measure itself in the future;
  • Research into the hormonal response to a mixed meal in adolescents with anorexia nervosa and exogenous obesity; and
  • Participation in the Adolescent Research Consortium, an inter-university collaboration (UNBC, UVIC, SFU and UBC) of those currently involved in adolescent health initiatives. The group is attempting to build adolescent health research capacity, with the plan to develop into a more formal research network.

The Division of Adolescent Medicine is responsible for providing academic leadership in UBC educational activities related to adolescent health. The Division educates medical students, residents and others from multiple disciplines in medical and biopsychosocial issues related to adolescent health and offers an adolescent medicine subspecialty residency (fellowship) program for future adolescent medicine specialists. The Division also offers weekly Adolescent Medicine seminars, including lectures from the Division faculty and others on topics related to adolescent health.

Medical Student Education

Adolescent Medicine faculty direct the Adolescent Health week for the Nutrition, Growth and Development block in the second-year medical student curriculum. Adolescent Medicine faculty also participate in the Clinical Skills course for second-year medical students, training students in interviewing techniques with adolescents. The Division also offers Adolescent Medicine electives for third and fourth year medical students interested in adolescent health.

Resident Education

The Division offers a four-week elective rotation for pediatric residents at BC Children's Hospital, as well as visiting residents. During this rotation, residents receive training and experience in inpatient and outpatient adolescent health consultations and eating disorders. Adolescent Medicine faculty also regularly conduct Academic Half Days for pediatric residents, training pediatric residents in specialized areas of adolescent health including eating disorders, adolescent growth and development, risk and resiliency, clinical interviewing techniques, transition to adult care, and chronic illness management.

Sub-specialty Education

The Adolescent Medicine Subspecialty Residency ("Fellowship") Program at British Columbia Children's Hospital (BCCH) in Vancouver was accredited by the Royal College of Physicians and Surgeons of Canada in 2010, and is the only accredited Adolescent Medicine training program in Western Canada. BCCH is the only pediatric hospital in British Columbia and is the referral center for medically complex pediatric and adolescent patients for the entire province. Clinical training is conducted through outpatient consultations at the Youth Health Program, inpatient consultations at BCCH, the Provincial Specialized Eating Disorder Program in affiliation with Child and Adolescent Psychiatry, and a network of Youth Clinics in community settings in Vancouver. In addition, the Division of Adolescent Medicine participates in a developing Social Pediatrics Initiative in the lowest income area of Vancouver through which the Resident will work clinically, and contribute to program development, to address social determinants of health of marginalized youth. The Division of Adolescent Medicine works closely with the McCreary Centre Society (http://www.mcs.bc.ca/), a unique resource that conducts a periodic Adolescent Health Survey and related research on the physical and emotional health of youth in British Columbia, the largest survey of its kind in Canada.

Subspecialty residents participate in a formal weekly participatory and didactic curriculum covering critical topics of adolescent health including interviewing, assessment and counseling skills, evaluation and management of specific medical and mental health conditions, adolescent development, risk and resiliency, and public health. Residents receive formal training in Epidemiology and Biostatistics. In addition, residents take graduate-level classes at the University of British Columbia on population based research methodology, multidisciplinary perspectives on adolescent health, and youth in the child welfare and delinquency systems. Distributed through the two years are formal curricula on Medical Education and on Ethics.

Residents have protected time and mentorship to pursue a research project. The program is individualized to match the career goals and strengths of individual trainees, and ongoing feedback and mentorship is provided by Division faculty. Our program emphasizes models and principles of resilience and positive youth development. We aim to prepare graduates of this program for successful careers in Adolescent Medicine as leading clinicians, scholars, and educators in Canada and internationally.

Now is a very exciting time to get involved in Adolescent Medicine in Canada, and British Columbia in particular. The field is now entering a growth phase, with opportunities for leadership. There is tremendous interest, energy, and potential to do new and creative work, and make a real difference in the lives of youth. Vancouver and British Columbia also offers a high quality of life, with a beautiful natural setting, a mild climate, a diverse population, and a wealth of cultural and athletic opportunities.

Please see the Royal College of Physicians and Surgeons website for more general information on the subspecialty of Adolescent Medicine, including requirements for applicants and for training programs:

http://rcpsc.medical.org/information/index.php?specialty=402&submit=Select

We are currently recruiting Canadian applicants for subspecialty residency through the CaRMS match (http://www.carms.ca/). The CaRMS match process generally runs from January to June, the calendar year prior to the July 1 start date of the subspecialty residency. Applicants must be in, or beyond, their PGY-2 year to apply. The most current CaRMS timelines are posted on the CaRMS website: http://www.carms.ca/eng/peds_1stIteration_e.shtml

Please view our Program Description for further details. Please contact Dzung Vo, MD, Associate Director of the Adolescent Medicine Fellowship Program (dvo@cw.bc.ca), to learn more about the subspecialty residency program.

Download the Adolescent Medicine Subspecialty Residency Program Description.

Patient Care

The goals of the Division's clinical programs are to: (1) develop and maintain best practices for youth health; and (2) provide training opportunities for medical students and residents.

Outpatient Services

The Youth Consultation Clinic provides consultation services for youth with complex health conditions. This unique clinic focuses on at-risk youth, a traditionally hard-to-reach population. Since its inception in November 1999, the Clinic has provided service to approximately 450 patients and families and currently provides two scheduled half-day clinic sessions per week. There is an established, informal liaison with the Department of Psychiatry.

The Sexual Health Consultation Clinic provides youth and their families with reproductive health services, counselling and education in order to meet the developmental and sexual health needs of youth with chronic health conditions.

The Eating Disorders Clinic provides ongoing medical and dietary assessment and management of patients, as well as individual and family psychotherapy.

The Youth Health Program Transition Model (On-TRAC) was introduced to the ambulatory clinics at Children's Hospital two years ago. This model aims to provide uninterrupted, developmentally appropriate care for young people prior to and throughout their transfer into the adult health care system. All multi-disciplinary subspecialty teams on site have now received training in the transition model. Division members provide education, workshops and liaison with specialty programs and inpatient units to provide implementation support.

Inpatient Services

The new Child and Youth CTU, a 10-bed acute care medical unit, is a result of the merger between 3H (previously an isolation unit) and the Adolescent Care Unit. It serves as the new Centre for Excellence in Adolescent Care, modeling best practices and providing teaching and training opportunities for staff and students.

The Eating Disorders Inpatient Unit and the Cappella (Day Treatment) Program provide a continuum of comprehensive services for patients requiring intensive treatment for moderate to severe eating disorders. The Inpatient Unit consists of four beds. The Cappella Program operates five days a week for up to ten patients. Treatment is primarily group-based. Patients remain in the Program for varying lengths of time, depending on treatment needs and progress achieved. Services include ongoing medical and dietary assessment and management of patients, as well as individual and family psychotherapy, and nursing support and education.

Youth Involvement

The Youth Health Program enhances the capacity of Children's Hospital to facilitate meaningful youth involvement in program planning and implementation. An infrastructure for youth involvement has been developed with six areas of emphasis:

  • Youth Activities (e.g. Grand Youth Rounds, RAP peer support group)
  • Advocacy (e.g.Youth Advisory Council)
  • Education & Training (e.g. nursing education days, Undergraduate medical curriculum)
  • Policy Development (e.g. Consent to Treatment and Access to Charts)
  • Communication (e.g. "Wassssssup", a calendar of events on site for youth, TAG ["The Adolescent Gazette"] and the Youth Admissions Guide)

Evaluation and Monitoring

One of the innovative components of the Youth Health Program is the involvement of youth themselves in Divisional planning and program initiatives, ensuring the relevance and quality of our services to youth. Over the past year, the Youth Involvement Initiative has been directed by two youths, and this Youth Involvement Team has built an effective framework for peer support networks and youth advocacy strategies on site, and provided opportunities for Children's Hospital staff to learn peer support and youth involvement facilitation skills. In addition, the Team provides input into the administrative activities of the Division to ensure that projects, policies and new initiatives are consistent with youth-friendly practice.

Several projects are currently underway to further enhance the goal of helping youth living with chronic, recurrent or disabling conditions to become increasingly self-reliant as they learn to make educated decisions that will affect the overall quality and sense of fulfilment in their lives, including:

"Cocktails: Getting The Facts About Booze, Drugs & Meds", a workbook and youth-friendly teaching tool which details interactions between medications and with other substances such as alcohol and recreational drugs;

"Just Ask Me", a video project supporting youth in learning self-advocacy skills and in making decisions around their own health care;

Building a Youth Resource Network, to include Ability OnLine, a world-wide computer network initiative where youth with chronic illness can connect with each other as well as with their friends, family members, caregivers, and supporters; and

Youth Health Web sites including the Children's Hospital web site; a youth-designed site, www.youthealth.ca; and www.justaskme.com, a website to accompany the advocacy video.

Faculty:

Dr. Curren Warf, Clinical Professor and Division Head
Dr. Pei-Yoong Lam, Clinical Assistant Professor
Dr. Eva Moore, Clinical Assistant Professor
Dr. Tara Tandan, Clinical Instructor
Dr. Dzung Vo, Clinical Assistant Professor

Staff:

Winnie Lam, Division Secretary
Daisy Yin, Fellowship Program Coordinator