Updated: January 2023

Author: Division of Maternal and Child Health, Vermont Department of Health

Adolescent annual well care allows for early detection of problems. Most adolescent morbidity and mortality is preventable (risky sexual activity, substance abuse, vehicle related injuries, violence against others, violence against self).

Adolescent annual well care is also an important opportunity for building a trusting relationship between the provider and the teen, more opportunity to promote the strengths of the adolescent, and their healthy development.

Adolescents, parents, and providers all identify barriers to annual adolescent visits.

Provider barriers to recommending annual well visits include:

• Appointment scheduling and duration, physical space and time, and practice culture
• Lack of recall and reminder systems
• Confidentiality and time alone with adolescent
• Complexity of presenting issues

Teen and parent barriers to scheduling annual adolescent visits for their teens include:

• inconvenience of appointment times,
• health care professionals not skilled with adolescents,
• offices aren't often teen friendly

The percentage of adolescents with a well care visit has increased gradually over time. For over a decade, the Youth Health Improvement team at the Vermont Child Health Improvement Program has been working with practices to improve the rates and quality of adolescent well care in Vermont. School Liaisons continue to work with school nurses and provider offices to increase their understanding of the importance of having an annual well care visit per the Bright Futures recommendation for this age cohort, and may assist in decreasing the barriers to their completion, and ultimately ensuring the information arrival in the school health services offices.

Please Note: A significant decrease is noted in the percentage of children receiving a well child visit from the 2020-2021 and 2021-2022 school years. This is likely related to the impact of the COVID-19 pandemic on access to preventive care visits in pediatric medical homes. Additionally, there is a notable decrease in the number of people responding to questions about wellness exams on annual health appraisal forms collected by schools during these time periods. We will continue to monitor these data to see if trends return to pre-pandemic ranges as families can more readily access preventive care and are encouraged to do so by their medical homes.

This indicator is part of Healthy Vermonters 2020 which documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020.

• Quality improvement initiatives to address provider level barriers to adolescent well care and improve office systems is an effective strategy.
• Educating the general public, schools and providers about the importance of adolescent well visits, the differences between preventive service and a sports clearance visit and incorporating parent and teen feedback about the visits are all important.
• School nurses, working with families, can increase access to medical homes, and access to annual adolescent well visits.

These data are from the annual Vermont School Nurse report conducted by the Health Department. The survey period starts in the fall (October-November) and responses are due by January 1st each year. This survey is completed by School Nurses located in Vermont public schools. Data from all grades K-12 is filtered to reflect only grades 5-12 for this indicator.

This is self-reported data from the caregivers to school nurses on annual health appraisal forms. The caregiver may indicate the child has had a well exam in the last year (or they provide a date indicating that), they have not had a well exam in the last year (or they provide a date that exceeds a year), or they do not respond to the school’s inquiry. The value is calculated using the total number of students indicating a well exam in the last year (for grades 5-12) and dividing that by the total number of students (for grades 5-12). Data received from the schools is aggregate data (no individual student responses) from each school. Those that did not respond to the question are also included in the denominator.