Conversations with Teens - PowerPoint Presentation

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Conversations with Teens

Juanita Hodax, MD

Pediatric Endocrinology

Gender Clinic Co-Director

March 18, 2021

Pediatric Bootcamp

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ObjectivesDescribe confidentiality laws regarding medical care for teens

Demonstrate and practice asking sensitive questions

Construct responses and plans for next steps in management when patients make disclosures

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H

E

A

D

SS

Home

Education/Employment

Activities

Drugs

Sexuality

Suicidality

/Depression

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HEADSS Assessment

Who?

Any patient 11 years and older

Where?

Well child check

Inpatient hospitalization

Emergency room

Subspecialty visitWhen?At least yearlyWhy?Discuss sensitive topicsBuild trust with patient

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Confidentiality

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www.healthit.gov

/sites/default/files/appa8-1.pdf

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Consent

In Washington State, age of consent varies depending on the type of care being accessed.

Age 13: mental health care

Age 14: sexual health and reproductive care

For all other care, patients under 18 need parental consent.

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Documentation

Make sure you know how your EMR and patient portal shares notes

Find out age that this becomes confidential

EOB on insurance bills may list itemized charges

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What is not confidential?

Any concern for safety must be disclosed

Suicidal ideation

Homicidal ideation

Child abuseSexual abuse

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HEADSS Assessment

Review confidentiality of discussion

Can be helpful to do this with parent in the room

Use open ended questions

Know what to do if teens disclose info

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Practice Cases

“Tell me more about that…”

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Patient 116-year-old girl

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Debrief

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Depression & Suicidality

Questions to ask:

Do you have times where you feel depressed or down?

Any feelings of hopelessness?

Any thoughts of hurting yourself?Any thoughts of suicide?

How often, any plans, what do you do when you have those thoughts?

Signs to be concerned about:

Social withdrawlFlat affect

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Depression & Suicidality

Therapy referral

Make a safety plan

Enter suicide prevention lifeline # into phone

Must tell someone if patient is actively suicidal or you have concerns about safetySend them to the ED

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Patient 217 year old girl

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Debrief

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SexQuestions to ask:

Are you interested in men, women, other, all, none?

Have you ever been sexually active?

How many partners?

Have you had oral/vaginal/anal sex?Have you ever had an STI?Have you ever been pregnant?

Have you ever been forced to do something you didn’t want to do?

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Things to Consider

Age of consent

Sexual abuse

Sex trafficking

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Consent to Sexual Activity

www.ageofconsent.net

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Child Abuse & Neglect

Mandatory reporting of abuse or neglect:

Injury, sexual abuse, sexual exploitation, negligent treatment or maltreatment of a child by any person under circumstances which indicate that the child's health, welfare, and safety is harmed.

Consider:

Current interaction with abuserCurrent safety of patient

If unsure what to do: Call SW or Child Abuse team

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Sex Trafficking

Individuals performing commercial sex through the use of force, fraud, or coercion

Includes any minors under the age of 18 engaging in commercial sex

Sex traffickers frequently target victims and then use violence, threats, lies, false promises, debt bondage, or other forms of control and manipulation to keep victims involved in the sex industry for their own profit

Humantraffickinghotline.org

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Things to Consider

STI screening

Need to know whether vaginal/anal/oral screening is needed

Contraception

Pre Exposure Prophylaxis (PrEP) for high risk

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PrEP

Once daily oral pill (

Truvada

) for HIV prevention

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Teen Resource

Scarleteen.org

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Patient 313-year-old girl

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Debrief

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Gender Identity

Gender identity

is how a person defines their own gender, as male, female, both, or neither, based on how they feel in their head and in their heart.

Gender dysphoria

refers to the discomfort a person may feel if their body does not align with their gender identity.

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Conversations about Gender

What age to start talking about gender?

No “right answer.” Gender identity begins forming around age 2 or 3

Often fluid over the lifetime, and not all trans youth will identify or experience gender

dysphoria

at a young age

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Conversations about Gender

What questions?

How do you identify your gender?

Do you think of yourself more as a boy, girl, neither, both, something else?

What pronouns do you use?

I have ___ listed as your legal name, do you go by that or do you have a different name you prefer?

How long have you been exploring your gender? How has that evolved for you?

What are your gender goals or goals of transitioning?

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Next StepsAsk if patient is ready to talk to family about it

Consider therapy referral

Provide resources

Ask about interest in hormone therapy or referral to Gender Clinic

www.seattlechildrens.org

/clinics/gender-clinic/

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Patient 414-year-old boy

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Debrief

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Drug AbuseQuestions to ask:

What type of drugs?

How often?

Source of drugs?

Driving under influence?Interfering with school/activities

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Resources

Screening – Brief Intervention – Referral to Treatment

www.aap.org

/en-us/Documents/

substance_use_screening_implementation.pdf

www.samhsa.gov

/find-help/national-helpline

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Questions?

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