January 4, 1996

Media Contact: Sarah Goodwin at 404/727-5686, e-mail: sgoodwi@emory.edu

You are a teenager and live in a housing project and cannot imagine ever being anywhere else. Your older siblings have dropped out of school and some of your teenage friends have babies. You go to school most days and you seem OK to your teachers and friends. But, some days you just do not want to get up anymore, and lately you are having a hard time concentrating on school work or anything else. Are you destined to repeat the patterns of those around you?

Adolescents are giving us early distress signals, but we are not listening, says Emory University Nell Hodgson Woodruff School of Nursing Dean Dyanne D. Affonso, Ph.D. And because these early symptoms are not being addressed by our educational and health care systems, millions of children nationwide are drifting into depression, substance abuse, pregnancy, violence and suicide. Waiting until these problems already exist is waiting until it is too late, Dr. Affonso believes. And using established health care programs to address the physical ailments of teenagers while ignoring their mental health is asking for trouble.

Dr. Affonso's belief in the importance of tackling the early symptoms of distress in adolescence led her to propose a cooperative health venture with The Atlanta Project (TAP). Since Emory already had an educational partnership with TAP's Washington Cluster in Southwest Atlanta, she arranged for the nursing school to establish an Adolescent Health Care Station at Booker T. Washington High School. Although the West End Medical Clinic is already on-site at the school to take care of students' physical health problems, the new health station will focus on the psychosocial health of teenagers.

Although Washington High is surrounded by an older community populated by black professionals, many other schools in the surrounding area have closed, and seven housing projects now feed into Washington. Absenteeism and dropouts are major problems.

"What's alarming is that in the ninth grade at Washington High there are 500 to 600 students," says Emory nursing faculty member Janice Daniels, who, along with faculty member Sandra Leonard is in charge of the new health station. "In the 10th grade this drops to 350, and by the 12th grade there are only about 180 students. Obviously, our traditional medical-psychological model is not working and we are not identifying the problem."

After reviewing school records, the nurses found that ninth graders in particular are at high risk. Students who make it past the ninth grade have a better chance of staying in school. But the Emory nurses are asking if this because of the adjustment to high school or teachers or homes, and they are determined to get to the root of the problem and try to help solve it.

The new health station will provide a safe, comfortable atmosphere where students can come and talk about their problems and needs. Through focus groups this past fall, the Emory nurses have been identifying what some of these problems might be, and they include issues like interpersonal relationships, perceptions of men and women in society, depression, violence, and drugs.

The symptom distress model for the new program is based on a successful prenatal health care program that Dr. Affonso established in lower income minority groups in Hawaii through a grant from the National Institutes of Health. The Hawaiian program, which has recently been expanded to other sites, emphasizes community input and empowerment and focus groups that elicit frank discussion about the specific cultural and ethnic needs of that particular population. When women play a primary role in developing their own program, based on their particular needs, they are much more likely to support it, Dr. Affonso found.

Likewise, if the students at Washington High are empowered to help create their own mental health program based on their specific needs, Dr. Affonso believes they will support it and it will be more effective. Since teenagers are a captive audience at school, school seemed like the perfect place to motivate students in the direction of healthy behaviors by giving them a chance to talk.

The nursing school has a five-year commitment to the health station. Emory nurses Daniels and Leonard will work with students referred by teachers, the school nurse, counselors or the students themselves. Medical problems will be referred back to the school nurse or to the West End Clinic. Since Washington High is a magnet school for the health sciences, Leonard and Daniels also teach health classes during school, which is a way of marketing their program. Emory nursing school students will be involved through special programs and projects. The high school students can become more involved by volunteering for an advisory committee to help plan the program or by helping develop seminars and health fairs and leading programs for younger students.

"Our model is one of a health continuum," Daniels explains. "One end of the continuum is the illness state. A lot of interventions are geared to actual problems which occur toward that end of the continuum. We want to identify symptoms before the students have problems. Once they are on drugs, or become pregnant, or have dropped out of school, it's almost too late, like falling off a cliff."

"Teenagers are telling us their symptoms, but we aren't listening," says Leonard. "If they have vague symptoms like a headache or stomachache, we may tell them to lie down, when what they really need is someone to talk to. If we listen, we can see common things happening. The more we talk to students, the more we realize there has been a gap. Teachers are too busy to talk, and parents aren't always available."

It is partly a matter of semantics, explains Dr. Affonso. "Teens have a very different way of expressing themselves. They may come to school everyday, groom themselves, eat, and talk normally, yet they may want to kill themselves and we don't even know it. Yet no one is suddenly ill. They have distress symptoms that are not being addressed. Adults don't understand. We almost deny the challenges and the life being of teenagers. ‘You don't understand' is a crying out for help."

"We want to empower teens as future leaders and give them self-esteem in their community." says Leonard. "If you come from a housing project, you may not have hope, so why not have sex, why not do drugs? We want to help open a window of hope. We'll address issues like how you know when you want to break up with someone, or how you deal with family members on drugs. We want to help them learn anger management and give them life skills not only for making it through high school, but for making it through life. The choices you make from age 14 to 17 can change your life."

"Our model is totally different from the traditional approach," says Dr. Affonso. "A model so new demands rigorous training on our part. We can't just develop the program and take it to them. This is a tailored, customized program, but we must first find out who our customers are. We believe that if we listen, the answers are there."

For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686, or send e-mail to hsnews@emory.edu.

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