Workshop Sessions - Thursday, March 19



2:45-4:15 p.m.

The Dual Diagnosis of Eating Disorders and Diabetes
Ovidio Bermudez, MD, FSAHM
Eating Recovery Center

Track: Clinical Advances

Description:
This presentation will review the definition, risk factors, pathogenesis, epidemiology and management of the ED-DMT1 patient in a didactic format and discussion. According to a recent study published in The BMJ, eating disorders are twice as common in teenage girls with type 1 diabetes as in their non-diabetic peers. It has also been shown that deliberate insulin omission is the most common method of purging in girls with type 1 diabetes and becomes progressively more common through the teen years.  High medical morbidity and high mortality makes this a clinical issue where early recognition and early intervention are of the utmost importance. 

This workshop will offer both a state of the art review of the topic and practical information that can be applied in the clinical setting.   In this workshop we will discuss the definition, risk factors and predictive factors associated with the development of the dual diagnosis of eating disorder and diabetes. will review the epidemiology and research supporting the importance of early detection.  We will then discuss current treatment recommendations including  practical management steps.  Lastly, we will bring forth important considerations on future directions for research related to this clinical entity.

Educational Objectives:
  1. Identify risk factors in patients with DMT1 for the development of an eating disorder.
  2. Understand the medical morbidity and mortality associated with ED-DMT1.
  3. Develop a treatment plan for the management of DMT1 and an eating disorder.


Physical Examination of the Shoulder
Keith J. Loud, MD1; Cora Collette Breuner, MD, MPH2
1Children's Hospital at Dartmouth, 2Seattle Children's Hospital

Track: Clinical Foundations

Description: Acute and chronic pain, popping, and clicking about the shoulder in adolescents and young adults are among the most vexing musculoskeletal complaints presenting to primary care and adolescent health providers due to the complexity of the anatomy and obscurity of examination techniques. Nonetheless, most complaints can be appropriately managed by generalists with a consistent approach to history-taking and physical examination. This workshop will allow participants to observe, practice, and be guided by expert adolescent sports medicine clinicians in these techniques to increase confidence in their ability to address these concerns in daily practice. Please bring a tank-top to wear and a willing attitude for this highly interactive and hands-on session.

Educational Objectives:
  1. Demonstrate superficial anatomic landmarks on the shoulder of the adolescent patient.
  2. Practice common examination techniques for assessing acute and chronic complaints about the shoulder.
  3. Recognize historical and physical examination findings that should prompt referral for imaging and/or specialty consultation.

Causes and Consequences of Sleep Deprivation in Adolescence: How Clinicians Can Help
J. Roxanne Prichard, PhD
University of St. Thomas

Track: Clinical Foundations

Description: American adolescents and young adults are among the world’s most sleep deprived populations, outside of new parents and active-duty soldiers. More than 4% of young adults under the age of 25 have reported falling asleep at the wheel in the last month, and approximately 25% of college students describe sleep as “traumatic or difficult to handle.” The obstacles to obtaining restorative, sufficient sleep include a ‘perfect storm’ of environmental, physiological, pharmacological, psychological and sociological factors. Adolescents with disturbed sleep are much more likely to contract communicable diseases and infections, engage in more risk-taking behavior, experience depressed and anxious moods, and attempt suicide. As such, recognizing and addressing sleep problems early on would likely lead to improved health and wellness across a number of clinically relevant measures. Although sleep is one of the requirements for life, most clinicians receive very little formal instruction in sleep. In fact, most medical school students receive less than two hours of training in sleep medicine. This goal of this workshop is to help clinicians feel more comfortable recognizing the signs of disturbed sleep, discussing practical ways to improve sleep, and determining when a referral to a sleep clinic is warranted.  Specifically, the workshop will include:  *an overview of the neuroscience of sleep; *a thorough discussion of the endogenous and environmental factors that most often disturb sleep in young adults; *a review of the physiological and psychological symptoms of sleep deprivation; and *a discussion of available screening tools to identify sleep disorders, pathological levels of excessive daytime sleepiness, and poor sleep hygiene.

Educational Objectives:
  1. Describe the predominate challenges in obtaining consistent, restorative sleep for adolescents and emerging adults
  2. Recognize the physical and psychological consequences of sleep deprivation and circadian rhythm desynchronization
  3. Identify symptoms of and screening tools for sleep disorders common in adolescence

Cyberbullying as a Community Challenge: Finding Collaborative Solutions
Ellen Selkie, MD, MPH1; Erik  Schlocker, LCSW2; Michael  Donlin, MA3; Peter  Moreno, JD4
1University of Washington, 2Seattle Children's Hospital, 3Office of the Superintendent of Public Instruction, Olympia, WA, 4University of Washington School of Law

Track: Professional Development

Description: Cyberbullying is an emerging public health concern associated with multiple psychosocial consequences including depression, substance use, and school problems. It has been implicated as a factor in multiple high-profile cases of adolescent suicide, and is a common concern expressed by parents and patients in clinical settings. While traditional, or in-person, bullying is a familiar foe with research and prevention efforts ongoing, cyberbullying has distinct differences from traditional bullying that can prove challenging to address with current policies and programs. Cyberbullying and its effects are seen in our clinics, schools, courtrooms and other community settings as well as in cyberspace.  In this workshop, our multidisciplinary team of presenters will examine the current evidence about cyberbullying and its sequelae, and we will discuss points of intersection and divergence with traditional bullying.  The audience will be invited to discuss cases in their communities. We will then consider the evolution of applicable law including issues of privacy, criminal liability and free speech in online communications. We will then consider challenges to addressing cyberbullying in schools from a school safety program supervisor. These perspectives will be tied together through experiences of a clinical social worker who has advocated for adolescent victims of cyberbullying in clinics and communities. Throughout these discussions, audience members will be asked to consider their own communities and patients.Through our multidisciplinary presenters and audience input, we will appraise the existing resources for cyberbullying prevention and intervention, identify potential new solutions, and formulate an agenda for future direction in finding sustainable practices to improve the digital citizenship of adolescents.

Educational Objectives:
  • Consider the impact of cyberbullying on adolescents and in communities; compare and contrast attributes of cyberbullying to those of traditional bullying.
  • Examine challenges in cyberbullying prevention and intervention from policy, clinical, and educational perspectives.
  • Identify individual and community resources for adolescents who are involved in cyberbullying.


Building a Hospital-Wide Health Care Transition Planning Program: Patience, Persistence and Partnerships
Albert C. Hergenroeder, MD, FSAHM; Constance M. Wiemann, PhD, FSAHM
Baylor College of Medicine and Texas Children's Hospital

Track: Professional Development

Description: The workshop will describe 10 lessons learned based on the presenters’ experience, including background, problems and solutions in developing, implementing and evaluating a healthcare transition planning program that could serve patients regardless of disease or disability. Each lesson will be presented in a didactic format and will include data and specific strategies used when appropriate.  Each lesson will be followed by questions from the audience to be addressed by the presenters.

Educational Objectives:
  1. Describe the steps required to lay a foundation on which to build a hospital-based healthcare transition planning program.
  2. Appreciate the complexity of establishing a healthcare transition program in any setting and the time and effort required to do so.
  3. Discuss methods to evaluate healthcare transition planning activities, including process and outcomes.

Promoting Educational Tools for Adolescent Gynecology
Karen Jill Browner-Elhanan, MD1; Hina J. Talib, MD2; Paritosh Kaul, MD, FSAHM3
1Children's Hospital of Memorial University Medical Center/Mercer College of Medicine, 2Children's Hospital at Montefiore Albert Einstein College of Medicine, 3Children's Hospital of Colorado

Track: Professional Development

Description: Teaching Adolescent Gynecology is an important facet of teaching Adolescent Health and can be a challenging topic to teach without the use of aides and hands on models. The session will start with an introduction and review of the pediatric and adolescent gynecology curriculum as designed by the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Education Committee. We will then outline various interactive educational tools, such as CD-ROM cases and web-based curricula. This will be followed by simulation training including the use of a simple module. This section will then end with a review of NASPAG resources for resident education and opportunities for residents interested in research and subspecialty training in Adolescent Gynecology programs. The next part of the workshop will include three breakout stations, with every participant rotating through all three stations, to review the following hands-on demonstrations and discussions: (1) Simulation training – participants will be provided with all of the necessary equipment to perform a basic simulation session at their program, including the routine pediatric gynecologic examination, collection of microbial cultures, vaginal lavage and vaginoscopy. (2) Review on-line programs - CD-ROM cases in Pediatric and Adolescent Gynecology and PAG WebED. (3) Review the short and long curriculum and how to utilize those curricula in your program.

Educational Objectives:
  1. Apply teaching tools in adolescent gynecology to their educational curricula, including web-based education resources, hands-on simulation models, and published review articles and curriculum.
  2. Enumerate and utilize the various components of the Pediatric and Adolescent Gynecology curriculum, designed by the Education Committee of the North American Society for Pediatric and Adolescent Gynecology (NASPAG).
  3. Organize faculty who are interested in building a collaborative network of SAHM members interested in adolescent gynecology education.


Powerful Presentations: The Art and Science of Communicating Information, Ideas, and Concepts in Adolescent Health
Richard J. Chung, MD1; Joshua Borus, MD, MPH2
1Duke University Medical Center, 2Harvard Medical School, Children's Hospital Boston

Track: Professional Development

Description: At their core, adolescent health professionals are communicators. Whether in a lecture hall, at a research symposium, before a school board, or on the evening news, adolescent health advocates are often positioned to influence minds and attitudes in ways that can powerfully affect the health and well-being of adolescents. Communicating well is just as important as having something to say.  

It is estimated that 350 PowerPoint presentations are given every second around the world, yet many of them are ineffectual or even detrimental to communicating content effectively. Unfortunately, the adolescent health community is not immune to the challenges of delivering presentations that communicate adolescent health priorities effectively. Whether hiding behind soporific slides, failing to engage an audience or rambling through a bloated research presentation, our imperfections and inefficiencies as communicators detract from the value of our efforts and our collective impact as a Society. Given the crucial importance of conveying ideas and shaping attitudes in advocating on behalf of adolescents, it is fortunate that these errors are remediable.  

Borrowing concepts from the business, psychology, design, and performing arts worlds, adolescent health advocates can maximize the impact of their ideas, opinions, and research findings and create truly powerful presentations. In this workshop, learners will first review key concepts in learning theory that allow communicators to understand how audiences receive, digest, and apply information and ideas. During this initial 20 minute period, participants will be divided into small groups to discuss how these concepts lay the groundwork for creating an effective presentation.  During the next 30 minutes the group will learn about and discuss critical concepts in creating a message including knowing your audience, finding meaning and focus, mapping a story, and finding emotional engagement, among others. Each small group will pick an adolescent health topic and scenario, such as presenting about adolescent sexual health needs before a school board, and collaboratively create an effective message.  During the next 20 minutes, the group will learn about principles of slide design and how to effectively comingle verbal and visual communication to maximize effect. Participants will critique example slides and brainstorm ways to improve the given examples. Commonly asked questions about slide design and delivery will be addressed, incorporating the evidence base available.   

Finally, delivery of the message will be discussed, covering oral/physical presentation skills and the art of storytelling. Video examples of storytelling effectively incorporated into presentations will be shown. Throughout the workshop, participants will be asked to share personal experiences and perspectives to augment the data and concepts at hand.  In summary, the workshop will guide participants through an exploration of both the art and science behind powerful presentations. Close attention will be paid to providing each learner with specific ideas and plans for optimizing his or her own strategies for crafting and delivering messages.

Educational Objectives:
  1. Describe core concepts in formulating a presentation and key vehicles for effective communication including storytelling.
  2. Summarize the evidence available to guide presentation design and delivery.
  3. Synergize the art and science of powerful presentations and create a personal action plan to strengthen one’s delivery of content across contexts.


4:30-6:00 p.m.


Transition of Care for Adolescents and Young Adults with Polycystic Ovary Syndrome (PCOS)
Paula J. Adams Hillard, MD; Neville H. Golden, MB, ChB, DCH, FRACP, FSAHM; Sophia Yen, MD, MPH
Stanford University School of Medicine

Track: Clinical Advances

Description: This session will consist of initial didactic PowerPoint presentations from Drs. Hillard, Golden, and Yen, outlining  the diagnostic criteria for PCOS, the challenges of making the diagnosis of PCOS in adolescents, and PCOS as a condition that may be written off as "normal adolescence."  In adulthood, PCOS is often managed in a siloed fashion by various subspecialists (eg, the "blind men and the elephant" phenomenon).  The workshop will acknowledge the challenges of helping adolescents and young adults understand the chronic nature of the diagnosis and its need for ongoing management, and will focus on issues around the challenges of transition of care for adolescents with PCOS.  PCOS is a chronic health conditionsuch that may influence not only an adolescent's current health, but also their health throughout their life.  Dr. Hillard will speak  about the reproductive health concerns for adult women with PCOS, related to fertility, risks of endometrial hyperplasia/cancer, and the risks of diabetes and metabolic syndrome.  Dr. Golden will review variability in the menstrual cycle during adolescence (what is normal and what is not),  how adolescents with PCOS may present clinically, and how the diagnosis may be missed in early adolescence.  Dr.  Yen will present an evidence-based approach to management of PCOS and describe how non medical therapies (diet and exercise) are important in management, and how  the choice of medical therapies are influenced by medical discipline (pediatrics, adolescent medicine, endocrinology, gynecology). The faculty will describe a toolkit that may facilitate transition of care for adolescents and young adults with PCOS that would serve as a resource for patients/parents as they transition to adult care. The didactic presentations will be followed by case-based presentations with audience interaction.  Attendees will be encouraged to share their experiences and expertise in transitioning young women with PCOS to adult care.

Educational Objectives:
  1. Identify adolescents and young adults with PCOS or with symptoms that suggest PCOS who would benefit from tools to facilitate transition of care from the pediatrician/adolescent medicine specialist to adult primary care of ob/gyn
  2. Counsel an adolescent/young adult and her parent about the importance of ongoing care related to her PCOS, and the chronic nature of this syndrome
  3. Work with adolescents/young adults with PCOS to develop a packet of information/history of care form/toolkit to facilitate her transition of care.
 
Adaptive Sexual Health Care and Education for Youth with Intellectual Disabilities: Puberty, Relationships, and Social Safety
Mary R. Ciccarelli, MD1; Lynn F. Davidson, MD2; Jason F. Woodward, MD3
1Indiana University School of Medicine, 2Children's Hospital at Montefiore, 3Cincinnati Children's Hospital Medical Center

Track: Clinical Advances

Description:
In this workshop, participants will explore their comfort and skill in caring for the sexual health needs of youth with intellectual disabilities through puberty and into young adult life.  Sexual health clinical care includes assessment and education of youth and their parents or caregivers,  as well as advocacy for adaptive training opportunities within the community.  Using six case-based discussions, participants will explore issues related to adolescent development in males and females with intellectual disabilities including: a) hygiene, menstruation and sexual expression, b) relationship building, boundaries and consent, and c) safety, bullying, victimization, and assault prevention. Each case will be presented to the audience, followed by small group discussions in which each table will identify key issues in the case  and consider options for the clinical approach.  Each small group will then develop and practice a key communication script to enhance future clinical conversations with youth and with parents or caregivers around one of the scenarios. Small groups will share their work in a larger group debrief.  Topics for discussion will include teaching about private/public behaviors and settings, stranger/acquaintance/friend/family identification, good/bad/necessary touch, manipulative/conditional/exploitive relationships, community and internet safety, and methods for the balancing of self-autonomy versus caregiver supervision of activities.   Using examples of existing resources and programs, participants will plan how to better collaborate with community agencies such as schools, reproductive health programs, or therapeutic recreation programs and use internet resources to improve options locally for adaptive sexual health education.  Each participant will brainstorm ideas and create a commitment to change for the improvement of adaptive sexual health training for youth with intellectual disabilities back in their own home communities. Audience members will be invited to share new ideas with the group.

Educational Objectives:
  1. Address unique challenges in physical health, behavior and parental concerns associated with puberty and sexuality in youth with intellectual disabilities.
  2. Promote chronological and developmentally-appropriate relationship development for youth with intellectual disabilities.
  3. Facilitate skill acquisition for maintaining personal safety in home and community settings for both youth with intellectual disabilities and their parents or caregivers.


The Immigrant Experience: Transitions Across Cultures
Estherann Grace, MD, FSAHM1; Dana S. Ostberg, RN2
1Harvard Medical School, 2Boston Children's Primary Care at Martha Eliot

Track: Clinical Foundations

Description: Members of the most rapidly increasing population in the United States are of Hispanic descent. They come from multiple Latin countries and bring a rich cultural heritage with them. Their move to North America is a challenging transition. This workshop aims to address a broad scope of issues facing both the adolescent and their families including physical and mental health and acculturation into North American society.  Two glaring problems are the high rates of suicidal ideation among Latina teens and the incidence of obesity among males and females.  The ease of the cultural transition is facilitated by the acquisition of the English language.  Parental delay in mastering English increases the adolescent's transition burden.  This workshop will highlight this, and the many other acculturation challenges facing adolescents and their parents.  Video interviews will demonstrate the skills and techniques to achieve a successful transition.  It is the goal of the workshop to provide a broad and inclusive scope of information for all disciplines.

Educational Objectives:
  1. Identify the acculturation challenges faced by adolescents and their families as they navigate a health care system in a new country.
  2. Navigate the medical, social and mental health issues faced by adolescent and their families within the context of cultural divergence.
  3. Provide support of the adolescent while maintaining an alliance with a parent who may be struggling with a language barrier and lack of financial resources.
 

Aardvarks to Zebras X: Case Studies in Adolescent Medicine
John  Kulig, MD, MPH, FSAHM
Tufts Medical Center

Track: Clinical Foundations

Description: This workshop is the tenth in a case series drawn from the presenter’s clinical practice. Ten new cases will be presented for interactive participant discussion. Workshop materials will include written case studies describing the initial clinical presentation. Discussion materials and references for further study will be available to participants after the workshop concludes.

Educational Objectives:
  1. Recognize uncommon presentations of certain common medical disorders in adolescence.
  2. Recognize common presentations of certain uncommon medical disorders in adolescence.
  3. Plan a diagnostic approach for adolescents presenting with unusual clinical signs or symptoms.

 
Accreditation, Milestones, EPAs and More
Patricia K. Kokotailo, MD, MPH1; Sarah A.B. Pitts, MD2; Sheryl Ryan, MD3;  Karen Soren, MD, MPH, PhD, FSAHM4
1University of Wisconsin School of Medicine and Public Health, 2Harvard Medical School, 3Yale University School of Medicine, 4Columbia University Medical Center

Track: Professional Development

Description: With the Next Accreditation System (NAS) in effect, there are many questions with respect to what is required for subspecialty training, particularly concerning the use of Entrustable Professional Activities (EPAs), competencies and milestones. In this session, a continuation of the successful 2014 SAHM workshop focused on mapping of Entrustable Professional Activities (EPAs), learners will participate in large and small group activities to be better able to practically use competencies, milestones, and EPAs.  Teaching and developmental materials developed by the American Board of Pediatrics and ACGME will be reviewed.  Participants will work in small groups to review the mapped EPA’s developed for adolescent medicine subspecialty training and provide input regarding review and documentation of fellows’ progress.  Experiences to date from the “EPA Subspecialty Research Study” sponsored by Council of Pediatric Subspecialties (CoPS) and Association of Pediatric Program Directors (APPD) will be shared. The group will work together to describe and delineate curricular needs to develop the knowledge, attitudes and skills to support competency-based teaching of adolescent medicine in fellowship and residency.  Faculty development needed for further educational progress will be discussed.  Ideas and products from the group will aid in the ongoing development of competency-based education in adolescent medicine.

Educational Objectives:
  1. Review progress made in utilizing competencies, milestones and Entrustable Professional Activities (EPAs) in adolescent medicine fellowship programs and describe evaluation processes for fellows, including use of Clinical Competency Committees
  2. Describe elements of curricula to be used to support the knowledge, skills and attitudes to perform the functions needed to be entrusted with a professional activity.
  3. Discuss faculty development needed for future work in subspecialty training
 
Adolescent Health Professionals-In-Training (#SAHMateurs) Development Workshop: Choose Your Own Adventure
Andrea (Annie) J. Hoopes, MD1; Casey  Cottrill, MD2; Tracy  Exley, MD, MPH3;  Oriaku  Kas-Osoka, MD4; Erin  McKnight, MD2; Gerald  Montano, DO5; Ellen  Selkie, MD, MPH6; Fareeda W. Haamid, DO7
1University of Washington, 2Nationwide Children's Hospital, 3Stanford Children's Health, 4Cincinnati Children's Hospital & Medical Center, 5Children's Hospital of Pittsburgh of UPMC, 6University of Washington, 7The Ohio State University College of Medicine/Nationwide Children's Hospital

Track: Professional Development

Description: The annual SAHM Adolescent-Health Professionals-in-Training Development Luncheon has traditionally offered an opportunity for future adolescent health professionals to gather and identify a peer network of adolescent health colleagues outside of their training program.  We propose adapting the luncheon format into a workshop.  In order to suit diverse trainee needs, the workshop will offer two concurrent programming options.  Having a choice of programming will allow trainees to choose which option best fits their own individual goals and allow for a smaller, more intimate learning and networking environment.  After a brief introduction, we will invite trainees to choose between two topics presented in parallel: (A) Get a Job! [Entering the adolescent health workforce] or (B) Teach them a Lesson! [Improving your skills as an educator].  Workshop programming will differ for each track. For (A) Entering the adolescent health workforce, activities will include a brief didactic presentation highlighting various career trajectories in adolescent health and different types of recruitment activities (eg the interview, the recruitment presentation or “job talk,” the group dinner), a panel of fellowship graduates who have recently navigated the job search process as well as division directors with recent experience in recruitment of trainees, and a hands-on session practicing your self-introduction (aka “elevator talk”).  For (B) Improving your skills as an educator, activities will include a brief didactic presentation by a SAHM member with previous teaching experience to focus on adult learning theory and appropriate application of goals and objectives.  Participants will actively engage in teaching strategy development and learn various skills to make instruction engaging and efficacious.  Additionally this workshop session will address the topic of using evaluation to improve instructional quality and the learning experience for both the learner and the educator.  Finally, participants will use new skills in order to develop an educational action plan to be implemented in future teaching settings.

The session will conclude by bringing the two groups together for (C) a networking activity and a discussion of options for communicating with other SAHM trainees during and after the conference.  For this portion of the session, attendees are encouraged to bring a number of business cards to share if possible.

Educational Objectives:
  1. Identify common career trajectories in adolescent health, become skilled at delivering a brief self-introduction describing your current activities and future career interests, develop resources to aid in post-training adolescent health job search.
  2. Recognize and learn effective strategies for teaching as an adolescent health trainee, learn how to integrate evaluation to improve the teaching and learning experience, develop an education action plan for application of new instructional skills.
  3. Engage with  professionals in other adolescent health training programs Identify various mechanisms for communicating with SAHM trainees, including the trainee lounge, social events, and social media, participate in a networking activity.




4:30-6:30 p.m.

Integration of Behavioral Health Services for Adolescents and Young Adults in Primary Medical Settings: Developing a Research Agenda for the Future
Laura Richardson, MD, MPH; Joan Asarnow, PhD; Tumaini Coker, MD, MBA; Sheryl Kataoka, MD, MSHS; Elizabeth McCauley, PhD; Ana Radovic, MD, MSc

Moderators: Cari McCarty, PhD and Peter Scal, MD, MPH

Description: Behavioral health disorders are a leading cause of morbidity and mortality during adolescence but few adolescents with mental health conditions receive the care that they need. Integration of behavioral health services into primary care, school based health clinics, and other medical settings may increase adolescent engagement in mental health services and improve youth outcomes. However, research on the integration of services for adolescents remains limited. The goal of this workshop, sponsored by the Maternal Child Health Bureau-Funded Adolescent and Young Adult Health Research Network, is to review the current state of research and to discuss needed evidence to inform the development of a white paper to guide future research work in this area.

The session will include a brief introduction to current integrated care models, a summary of existing literature, and brief presentations by leading researchers in the field highlighting current work and lessons learned. During the second half of the session, we will have a moderated discussion focusing on perceived gaps in the literature and research priorities in order to advance the field and improve care.




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