Introduction: People living in rural and remote areas have poorer health and more limited access to health services than those in urban areas. Adolescence, generally a period of optimum health, is fraught with risky health behaviours, increasing morbidity and mortality. Increasingly, mental health problems including depression, alcohol and drug use, suicide, self-harm, sexual health, inappropriate nutrition and physical activity are key areas of adolescent health concern in Queensland, Australia. To address the health and well being needs of young people the School Based Youth Health Nurse (SBYHN) Program was introduced into State high schools in Queensland in 1998. SBYHN responsibilities include individual consultations and health promotion within the high school environment. This study was undertaken to explore the referral role of SBYHN in provincial, rural and remote Queensland and to ascertain the availability of referral services. \ud Method: A self-report survey was posted to all SBYHN in Queensland. Forty-four (62%) nurses participated; 27 from provincial, 11 from rural and 6 from remote areas. \ud Results: SBYHN consult with young people in provincial, rural and remote State high schools in the areas of psychological concerns, drug and alcohol concerns and/or abuse, family conflict and/or abuse, sexual and reproductive health, social and isolation concerns and nutritional advice. However, the frequency with which SBYHN reported themselves as an appropriate source for young people to seek assistance from varied from over 90% for areas such as sexual and nutritional advice to approximately 30% for areas such as physical abuse and drug and alcohol abuse. When required by the SBYHN, referral services were locally accessible to young people less than 50% of the time. Access to some referral services was reduced because some young people do not want parental involvement in their health and the service requires parental consent. When referral services were unavailable SBYHN used phone counselling, available generalists, supported and monitored the young people until a service was available, or they accepted this as an aspect of residing outside the metropolitan areas and did the best they could. Sometimes, when a young person was reluctant to attend a recommended service or there was a long wait for an appointment, SBYHN provided ongoing support while endeavouring to persuade attendance at the recommended service. Situations like these, experienced by at least half those studied, place SBYHN in the precarious position of practicing beyond their scope of practice.\ud Conclusions: Health problems during adolescence can be reduced by ensuring assistance and support are available for young people when and if they require it. Thorough confidential individual consultations are provided by SBYHN and young people are availing themselves of this service. SBYHN are practicing at an advanced level and need to be recognised as such. Additionally, the availability of services in rural and remote regions needs consideration. As rural youth are more vulnerable to a number of health concerns, it is imperative that services are available for them. The issue of parental consent remains a barrier to young people seeking health services and it may be timely for community debate on this issue
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