MEDICAL CARE OF UNACCOMPANIED ASYLUM-SEEKING ADOLESCENTS AT THE GENEVA UNIVERSITY HOSPITALS, SWITZERLAND : A QUALITATIVE STUDY TO EXPLORE THE CHALLENGES OF THEIR TRANSITION TO MAJORITY

Purpose: The number of unaccompanied asylum-seeking adolescents (UASA) has increased in Switzerland in 2015, prompting medical teams to improve management of these young people and their transition towards adult medical care. About 5% of all UASA received in Switzerland are resettled in the region of Geneva. In 2015-2016, it locally represented a population group of 226 adolescents with numerous and complex health care needs (infectious and tropical diseases, nutritional deficiencies, long-standing illnesses and psychological distress). They all benefited from a medical check-up and follow-up by an adolescent medicine physician at the Geneva University Hospitals' Adolescents and Young Adults (AYA) Program. The aim of our project was to assess how this program prepared for the transition to the Adult Migrant Health (AMH) Program of the same hospitals. Methods: Semi-structured interviews were conducted from January to March 2017 with 6 health professionals (1 paediatrician, 1 physician in adolescent medicine, 1 Psychiatrist, 1 Psychologist, 1 Nurse and one adolescent physician working in private office) all working with unaccompanied minors in order to explore what preparations took place for minors reaching the age of majority. Interviews lasted in average 31 minutes and covered 5 main topics: 1) general information (previous professional experience with UASA, role in the transition), 2) medical and social situation of UASA before the age of 18, 3) anticipation of transition to majority, 4) challenges and opportunities of turning 18 and 5) proposals for better practice in the future. Results: Health professionals are challenged when their patients reach majority by difficulties with network coordination, school integration and unadapted foster homes. The process of transition is described as an area of uncertainty. The need for continuity in health care was recognized; nevertheless the topic of the legal age and its consequences on the social status were rarely addressed in consultation, health professionals questioning themselves about the adequacy of their role in addressing this issue. Participants underlined the emotional consequences of this period of transition for these young people and worried about its impact on the most vulnerable. They also underlined that UASA should be considered in priority as proper adolescents before asylum seekers. This research identified the need to develop a structured medical and social transition program between the AY