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Confidentiality in Primary Care: Engaging Teens and Encouraging Parents.Three Tips for improving critical conversations.

Reframing the chaos of health care reform creates opportunities for innovative primary care. Functioning in this rapidly changing environment is overwhelming to everyone. What we know to be true is that when crisis and opportunity collide, winning innovation for teens, parents and health care systems happens. The stakes are high. We hope our experience helps health care providers implement high-quality primary care for emerging adults. We have encountered and overcome barriers to confidentiality, and hope these three tips help you navigate these turbulent waters of reform.

A LITTLE PERSPECTIVE

We were surprised at the responses we received during the early days of presenting our research. People who approached us after a presentation of the OPTIONS Model of Sexual Risk Assessment were more interested how the presentation resonated with their lives than with our methods.

“I wish I had this for my son!”

“I needed this for my daughter!“

Emails from concerned parents said, “How can I get my daughter’s doctor to use this with her?”

Researchers are intrigued by what we do, but parents are passionate about the OPTIONS App and its potential. Young people are more comfortable answering sensitive questions with technology than they are with a face-to-face conversation.  Ideally, teen-friendly primary care creates safety. When possible, parents play an influential role supporting, promoting, and encouraging healthy choices about intimate relationships.

According to the Centers for Disease Control’s (CDC) 2013 analysis, direct lifetime, medical care for the 20 million new infections cost the American healthcare system nearly $16 billion. These figures reflect medical costs for eight common STIs, but how do we quantify the loss of productivity experienced by young people just starting their lives? What number would adequately reflect the pain and suffering associated with these infections? What about the adverse emotional and psychological effects of infertility for young couples? Or, the emotional consequences of intimate relationships too soon? Young people carry too much of the burden of this epidemic. Over half of all new infections occur in people 15 – 24 years of age. I remember the heartbreak of watching one of my former students lose her dream job due to frequent absenteeism related to treatments for the HPV disease that ravaged her body.

RETHINKING TEEN-FRIENDLY PRIMARY CARE STRATEGIES

Creative solutions to improve health outcomes are desperately needed today. Historically, however, primary care clinics have struggled to implement effective strategies. Many issues play into this and one seems to dominate. How do providers balance teen-friendly needs with parental rights? It’s more art than science. Emerging adults need to feel safe to share confidential information. While no one method will work with all situations, it is possible to maximize critical conversations with primary care providers. Primary care is an underutilized tool that can reduce costs associated with this epidemic. Reducing sexually transmitted infections by just 1% would make significant impacts on health care systems. These field-tested tips may help clinics design winning strategies.

Tip 1: Increase communication touch points with parents. Hospital systems set parents and providers up for blunders by not informing them about the need for a confidential conversation with their teens. Parents may feel undermined by being asked to leave without the chance to communicate their values, hopes, and fears. Giving parents a call before the appointment, providing access to skill-building tools, websites, and brochures foster vital parenting skills. A provider-initiated conversation with parents before wellness visits validates them for their critical role in supporting healthy choices.

Tip 2: Use digital health technology to bridge the gap between providers and teens. Young people are more comfortable and honest answering sensitive questions using technology than with face-to-face interviews. Providers have access to more information with the click of a button facilitating tailored approaches. One doctor said, “The OPTIONS App opened up conversations with my patients that I don’t think would have occurred without the App.”

Tip 3: Be creative with follow-up. High-risk teens need to build skills and have support for healthy choices. Technology offers new possibilities including mobile applications, telehealth, and small group integrated health models.  Cost-effective efforts paired with standardized assessment go a long way to making positive impacts on outcomes.

TEEN-FRIENDLY PRIMARY CARE WORKFLOW

Teen-Friendly Primary Care

Step 1- Staff make a quick phone call to parents the night before the visit for verbal approval “Would it be possible to come a few minutes early tomorrow? We would like your permission for your child to take a health and relationships survey before meeting with the doctor.” Staff hand parents and teens a letter about confidentially during the exam when they check in.

Step 2- Medical assistant says, “I am going take your child to the exam room to get started on the screening and take vitals. The doctor will be here shortly to chat with you.”

Step 3 For Teens– Teens receive the tablet and completes the assessment alone in the exam room or private area. The medical assistant assures the patient that the information is confidential and necessary to stay healthy. When complete, the medical assistant gives results to the provider to review.

Concurrently

Step 3 For Parent– The provider welcome’s the parent to their office. “What do you want me to know about your son/daughter today? “What concerns you?”

Step 4- After validating parental concerns, desires and hopes for their child, the provider says,

“Can I get your help with something? After our initial visit, I may ask you to step out of the room for a private conversation with your child okay?”

“Or, you can choose to go to the waiting room now. What works best for you?”

Step 5– After meeting together, the provider asks the parent to step out. The provider emphasizes safety,

“I want you to know that confidentiality is important. It helps me to know how to help you stay well.”

Structured screening reports enable precise tailored questions, advice about assessing the risks and benefits of reproductive health decisions, and assist with arranging follow-up. Action steps agreeable to both the teen and their physician end their time together.

Teen-friendly primary care partnerships support healthy choices and maximize critical conversations in primary care settings. Engaging parents and teens within the primary care workflow encourages safe and efficient health promotion practice. To get started, click here for a free trial of the OPTIONS App and mHealth follow-up.