Workshop Session: Wednesday, March 8, 2017


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AM Sessions:


PM Sessions:



8:00 - 9:30 a.m.


A Workshop in Trauma-Informed Care for Healthcare Providers

Meredithe Claire McNamara, MD
University of Chicago

Track: Education/Training
 
Description: We will open with a 45-minute discussion of the cycle of violence, the model of a hospital-based violence intervention program, the gun violence crisis in the United States and key developmental capabilities affected by trauma. We will move on to discuss the Five Points of Trauma-Informed Care: (1) Screening for trauma, (2) Ensuring safety of patients affected by violence, (3) Avoiding retraumatization, (4) Contextualizing behaviors of traumatized patients and (5) Discharge planning. Throughout our discussion, we will be joined by a survivor of gun violence who has traveled from Chicago to discuss his experiences with injury and healing. Questions and dialogue is encouraged along the way. We will close the session by discussing self-care for providers who incur trauma themselves in the care of these patients.
 
Educational Objectives
1.  Emphasize Safety -  a. Participants will be able to describe how they can give patients the message that they are safe. b. Participants will be able to identify a barrier to giving a message of safety in the course of their work.
2.  Understand Context - a. Participants will be able to describe one way in which a trauma-informed lens explains seemingly irrational or frustrating patient and family behavior. b. Participants will be able to identify a barrier to understanding context in the course of their work.
3. Avoid Re-traumatization -
a. Participants will be able to describe how they can minimize triggers that may cause patients and families to re-experience trauma.
b. Participants will be able to identify a barrier to avoiding re-traumatization in the course of their work.
 

Faculty Expertise:  As a new member of the Department of Pediatrics in the Section of Academic Pediatrics at Comer Children's Hospital (University of Chicago), I have been expanding upon my work in residency in developing a curriculum of Trauma-Informed Care for healthcare providers who often interface with pediatric victims of violence. This curriculum has been developed in conjunction with Bradley Stolbach, Ph.D., the Clinical Director of Healing Hurt People-Chicago (HHP-C). HHP-C is a violence intervention organization that serves children, teens and families affected by violence in the South Side of Chicago with intensive case management services and trauma-focused therapy. In integrating HHP-C with Comer Children's and John H. Stroger Hospitals, it is imperative that healthcare workers are trauma-informed and foster sensitive, healing interactions with patients affected by violence. Our curriculum is modeled off of those employed by successful trauma-informed care modules used by thriving hospital-based violence intervention programs across the country.
 
Deamonte Lee is a high school senior from Chicago, IL. He suffered multiple gunshot wounds in October 2014 and has since been a client of Healing Hurt People-Chicago. He has participated in and now leads SELF (Safety/Emotions/Loss/Future) Group sessions, a psycho-educational support group for teenagers affected by violence. He enjoys spending time with his family, connecting with friends and playing basketball. He is passionate about sharing his experiences with PTSD in the hopes of helping others affected by violence. He plans on attending college.
 



9:45-11:15 a.m.


Engaging in the Moment: Meeting the Behavioral Health Needs of High Risk Adolescents in the Primary Care Medical Setting

Matthew Oransky, PhD, Caroline Barangan, MD 
Icahn School of Medicine at Mount Sinai       

Track: Clinical Foundations

Description: Approximately 50% of young people will experience a diagnosable mental illness by the time they are eighteen and 75% of mental health problems begin by young adulthood.  However, only 20-30% of adolescents who experience mental health problems receive mental health care.  This lack of mental health care has a significant deleterious impact on adolescents’ physical well-being, their educational and vocational productivity, and on society as a whole.  The integration of behavioral health services into the primary care/ medical clinic setting may greatly improve adolescents’ engagement into behavioral health services. This presentation describes a primary care-behavioral health integration model that has been developed to engage traditionally underserved, high-risk adolescents at an adolescent health center serving primarily low income and minority youth.  In particular, we will describe how our integrated and highly collaborative model is based on the formation of strong relationships, both among interdisciplinary professionals (e.g. physicians, psychologists, social workers and health educators) and between providers and the adolescent patients themselves. The knowledge and tools provided at this workshop will assist participants in developing strategies to improve adolescents’ engagement in mental health service in their individual healthcare settings.

Educational Objectives
  1. Describe the theory, research evidence, and practice-based knowledge supporting the integration of behavioral health care into the medical primary care setting.
  2. Identify the key components of a collaborative and interdisciplinary primary care-behavioral health model that can be used in the participant’s healthcare setting.
  3. Utilize practical, research-based techniques to creatively engage high-risk and traditionally underserved adolescents in need of mental health services.
Faculty Expertise: Matthew Oransky, PhD: active clinical practice as a clinical psychologist in an adolescent medicine setting; oversees and has developed a model of integrating behavioral health into a primary care, adolescent medical setting; Co-directs an APA Accredited Clinical Psychology Internship at the Mount Sinai Adolescent Health Center; has developed and taught training curricula for mental health providers working in medical settings; has presented at conferences on integrating mental health care into medical settings. Caroline Barangan, MD: Deputy Medical Director at the Mount Sinai Adolescent Health Center, specifically involved in overseeing mental health services; Clinician, Active Adolescent Medicine practice, in-patient and out-patient; Active participation in facilitating educational workshops at SAHM; Curriculum development for faculty development; Curriculum development for health education experiences.





2:45-4:15 p.m.


WHY AREN’T AYAS GOING TO WELL-CARE? CHALLENGES AND OPPORTUNITIES IN IMPROVING RECEIPT OF PREVENTIVE SERVICES

Charles Irwin, MD, FSAHM1Elizabeth Ozer, Phd1, Erin Hemlin2, Charlene Wong, MD3
1University of California, San Francisco; 2Young Invincibles;  3The Children's Hospital of Philadelphia

Track: Research

Description: The ACA has removed significant financial barriers to utilizing preventive care, through major insurance expansions and removal of co-pays for critical preventive services. However, rates of receipt of well visits and preventive services among adolescents and young adults have increased modestly, at best, since the ACA’s passage. Through didactic presentation of information and group discussion, the workshop will examine:

  1. Trend data on receipt of well visits and receipt of preventive services
  2. Research on factors associated with receipt of the well visit and preventive services
  3. Tools, resources and initiatives to increase receipt of the well visit and preventive services

Discussion of strategies to improve receipt of these services will address both improving the capacity of service delivery systems to provide preventive services and increasing awareness of the importance of the well visit and preventive care.
 
Educational Objectives:

  1. Understand ACA provisions relevant to insurance, preventive services and well visits
  2. Understand research and trends relevant to increasing receipt of well visits and preventive services for AYAs
  3. Identify clinical, public health and policy strategies to improve receipt of preventive care
This session is sponsored by the Adolescent and Young Adult Health National Resource Center, Division of Adolescent and Young Adult Medicine, UCSF Benioff Children’s Hospital, UCSF, San Francisco, CA.


Recovery from Restrictive Eating Disorders of Adolescence
                Damian Wood, MBBS1, Claire Knight, MSc2   
                1Nottingham University Hospitals NHS Trust; 2Nottinghamshire Healthcare   

Track: Clinical Foundations

Description: A multi-disciplinary workshop which draws on peer-reviewed research and experiences of providers and children, young people and families to establish how professionals caring for young people with restrictive eating disorders should conceptualise recovery. The workshop will focus on the connections between physical, psychological and social aspects of recovery at the different stages of a young person's journey to recovery. Participants will consider the differing perspectives of providers, young people and families and the connections between these stakeholders in promoting recovery. The facilitators will assist participants to examine the available evidence on interventions and outcomes and relate these to the concepts of recovery.

Educational Objectives
  1. Analyse current concepts of recovery from restrictive eating disorders in young people including physical, psychological and social dimensions and the connections between these domains
  2. Identify the varied perspectives of providers, young people and families on what constitutes recovery and the connections and connectedness between stakeholders at different stages of recovery
  3. Describe therapeutic interventions which promote or inhibit recovery and factors which may contribute to outcomes for young people
Faculty Expertise: Dr Damian Wood is a paediatrician working with young people and families affected by eating disorders in acute hospital, specialist eating disorder unit and community settings. Damian is an author of the Royal College of Psychiatrists (UK) Junior MARSIPAN guidance which outlines the recognition and management of eating disorders in children and young people. Damian is a trained educator and Honorary Clinical Teacher at Nottingham University. Claire Knight is a clinical lead dietitian with extensive experience of managing eating disorders in young people across a variety of setting. Claire leads the UK CAMHS Dietician group of the British Dietetic Association and is an honorary clinical lecturer at Nottingham University. Damian and Claire are trained in Family Based Therapy for eating disorders and have published review articles and lectured on management of eating disorders in young people to a variety of audiences including a previous workshop at SAHM in 2015.


CDC’s 2016 U.S. Medical Eligibility Criteria (MEC) for Contraceptive Use and 2016 U.S. Selected Practice Recommendations (SPR): Evidence-Based Contraceptive Care In Action

Loris Y. Hwang, MD1, David A. Klein MD2, MPH, Emily M. Godfrey MD, MPH3, Kathleen P. Tebb, PhD4, Andrea J. Hoopes MD, MPH5, May Lau, MD, MPH6
1University of California, Los Angeles; 2Uniformed Services University of the Health Sciences; 3University of Washington; 4University of California, San Francisco; 5University of Colorado School of Medicine; 6University of Texas Southwestern
    
Track: Clinical Advances

Description: The Centers for Disease Control and Prevention (CDC) released updates to national contraceptive guidelines in July 2016.  These guidelines include the U.S. Medical Eligibility Criteria (USMEC) and U.S. Selective Practice Recommendations  (USSPR) for Contraceptive Use. The purpose of this workshop is to introduce participants to the national contraceptive guidance updates and to USMEC and USSPR point-of-care clinical resources. This workshop will review evidence-based contraceptive care for common medical conditions (e.g. dysmenorrhea) and characteristics (e.g. postpartum) in adolescents. This workshop will introduce participants to new 2016 USMEC updates of less common, but complex medical conditions (e.g. cystic fibrosis and rheumatoid arthritis).  This session will also review USSPR updates to common, yet complex contraceptive management issues related to initiation and use of contraception in adolescents.  Participants will also be introduced to point-of-care tools (Smartphone app) and web-based resources. Patient friendly CDC-generated tools will be introduced. Upon the completion of this workshop, attendees will be able to facilitate similar discussions regarding CDC guidance with their local clinical teams and departments. This workshop is relevant to international attendees as the CDC’s guidelines are closely adapted from World Health Organization recommendations. From the perspective of the conference theme of Cultivating Connections, a comfortable and effective clinician-patient relationship can positively support a patient’s contraceptive decision-making.

Educational Objectives
  1. Be able to explain the content of the CDC’s 2016 updates to the U.S. Medical Eligibility Criteria (MEC) for Contraceptive Use, and the U.S. Selected Practice Recommendations (SPR) for Contraceptive Use
  2. Apply the MEC and SPR guidelines in clinical settings when offering contraceptive options and managing side effects
  3. Use the MEC and SPR point of care tools during clinician patient care sessions 


Narrative Medicine: Stories and Writing on the Importance of Relationships in Adolescent and Young Adult Health

            Sheila M. Quinn, DO1, Tomas J. Silber, MD, FSAHM2
1Children's Hospital of Philadelphia; 2Children's National Medical Center & George Washington University
    
Track: Education/Training

Description: Adolescent health and medicine runs deep with stories of triumph, humor, tragedy, and love.  Unfortunately, without the mindfulness to process the stories that we bear witness to, these narratives are lost.  One method of processing the rich medical and psychosocial content that we are exposed to as providers, is to understand each patient in the context of a narrative—his or her individual story, and how we have come to fit into it, if only as a witnessing provider.  Writing a narrative of a patient, colleague, or oneself requires the ability to listen, observe, interpret and tell a story—these skills are what constitutes “ the Art of Medicine” and will be the focus of this workshop.  Participants will be given an overview of the background of narrative medicine and the role it can play in clinical practice and medical education.  This will be followed by an experiential activity: observing, interpreting, and responding to prompts provided by workshop facilitators.  For example, a story, a painting or poem will be shared with the group, and participants will be asked to discuss the possible meanings behind it. For example, a poem alluding to themes of deeply connecting with a stranger may lead to a prompt of “Write about a time when you felt deeply connected to a patient”. The workshop will end with a group reflection on a participant’s piece.   A list of places to publish narrative medicine pieces will be provided at the conclusion of the workshop.

Educational Objectives
  1. Reflect, narrate and write about the complex connections we form with our adolescent patients. This will be based on stories you may share, or based on a prompt from a non-medical source of art or literature.
  2. Realize the technique of narrative medicine as a way of understanding our connections with teenagers and young adults in our clinics, hospitals, and communities.
  3. Recognize how narrative medicine can contribute a method for a deeper understanding in medical education and training.
Faculty Expertise: Quinn, SM: Relevant Training: Yale School of Medicine Writer's Workshop 2013, 2015; CHOP Narrative Medicine Program 2015-present;  CHOP Narrative Medicine Writer's Workshop 2016 Relevant Publications:  Quinn, SM. What’s Left Inside.  Journal of General Internal Medicine. 2014 Sep;29(9):1315-6.  Quinn, SM.  Etymology. Annals of Internal Medicine. 2014 Jun 17;160(12):874-5 Silber, TJ: Relevant Experience, Training, and Speaking: He has a long standing interest in narrative medicine and has used stories in medical training and education in his 42 years as Adolescent Medicine Fellowship Director at DC Children's. He also participated in narrative ethics as the Director of the Pediatric Ethics Program for the past 20 years.  His current area of interest is in helping families and patients with eating disorders, and his classic “Stories that I tell my patients” can be seen at You-tube.



4:30-6:00 p.m.


Here’s the Point: Rapid, Point-of-Care Testing for Sexually Transmitted Infections

            Lea E. Widdice, MD1, Charlotte Gaydos, DPhil2, Anne Rompalo, MD2    
1Cincinnati Children's Hospital Medical Center; 2Johns Hopkins University   
 
Track: Clinical Advances

Description: Point-of-care (POC) tests are diagnostic devices used to test specimens at or near the point of patient care. POC testing for STIs is an important strategy to improve patient outcomes and to address the worldwide epidemic of STIs among adolescents. POC tests are used in both high- and low-resource settings in clinics, homes, and community settings. Multiple POC tests for STIs, including chlamydia, gonorrhea, trichomonas vaginalis, HIV, herpes simplex, and syphilis, are newly available in the United States and internationally, and more are in the development pipeline. Benefits of POC testing for STIs include rapidly available results that can inform treatment decisions and patient counseling, leading to improved accuracy of treatment, antibiotic stewardship, and patient understanding of STI diagnosis.  However, barriers exist to realizing the full potential of these devices, including awareness of their availability and characteristics and their potential impact on clinic processes and flow. The World Health Organization developed criteria the “ASSURRED” criteria (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, Delivered) for guiding development of POC tests. Clinicians and other providers who evaluate, treat, and refer adolescents at risk for STIs can use a scoring system based on the ASSURRED criteria to help determine the usability of POC tests for STIs in their practice settings.

Educational Objectives
  1. Describe and differentiate point-of-care (POC) tests to detect sexually transmitted infections (STI) that are available on the market internationally and in the United States that can be used in their clinical setting.
  2. Discuss the benefits and barriers of POC STI tests.
  3. Critique features of POC STI tests for usability in clinical settings.
Faculty Expertise: Dr. Charlotte Gaydos, Professor in Infectious Diseases at Johns Hopkins University (JHU), has 45 years of laboratory expertise in microbiology and has authored 430 papers.  Her MPH and DrPH in immunology and infectious diseases were received from the JHU School of Public Health. She has conducted FDA clinical trials for new STI diagnostics. She has expertise in epidemiology and experience in development and evaluation of molecular amplification tests. She is the Director of the JHU International STI Research Laboratory and P.I. of an NIH Center to develop point-of-care (POC) tests for STIs.  Dr. Anne Rompalo has over 35 years’ experience as Medical Director of the JHU STD/HIV Prevention Training Center.  She conducts national and international needs assessments and training for POC STI devices. Dr. Lea Widdice has worked in biotechnology on POC devices and currently conducts alpha and beta testing on POC STI devices, assisting developers with design and usability.


How Much Does Media Violence Contribute to Real Life Violence?

Victor C. Strasburger, MD, FSAHM1, Ed Donnerstein, PhD2
1University of New Mexico School of Medicine; 2University of Arizona

Track: Public Health/Advocacy

Description: American children and teens are now inundated with images of violence in the media -- whether it's the evening news or the most popular movies or first-person shooter video games.  In 2011, the U.S. Supreme Court even took up the issue of violent video games (and both of us were there!).  It is crucial for health professionals to understand how the media violence research is done, what exactly it says, and how to explain it to the general public.  Media violence is not the leading cause of violence in society, but it is something that contributes substantially, particularly in vulnerable individuals. This workshop will give health professionals the tools to discuss the issue in their communities and begin to identify susceptible individuals.

Educational Objectives
  1. Identify and analyze the current state of American media with regard to media violence -- including TV, movies, Internet, social networking sites.
  2. Analyze the impact of viewing media violence on teenagers.
  3. Identify how to mediate against harmful media violence effects through (1) office counseling (2) teen and parental education (3) school-based media education programs.
Faculty Expertise: Drs. Strasburger & Donnerstein have presented together all over the world and at several SAHM and AAP meetings.  Most recently, they did a 7 hour invited seminar together at the annual American Psychological Association meeting in Toronto, Canada in August, 2015.



USING TECHNOLOGY TO EXTEND CLINICIANS’ PREVENTIVE REACH

Sion Harris, PhD1, Elissa Weitzman, ScD, MSc1, Charlene Wong, MD2, Elizabeth Ozer, PhD3
1Boston Children's Hospital; 2The Children's Hospital of Philadelphia; 3University of California, San Francisco

Track: Clinical Advances

Description: A rapidly growing area of research examines technological strategies to enhance the efficiency and effectiveness of the clinical encounter, or extend clinical preventive interventions beyond the face-to-face visit to motivate behavior change among AYAs between clinical visits.  Clinicians’ efforts can be augmented by digital tools, such as self-guided online-based disease prevention and treatment modules that are assigned to patients and/or their families in addition to provider interactions. AYAs’ nearly universal access to, and facility with, computers, mobile technology and the Internet coupled with a burgeoning of information technologies—encompassing social networking tools, mobile and wearable devices—offer numerous options for extending clinical preventive services delivery and access beyond the clinical setting. 


This workshop will frame this technology landscape and describe the state of the art, as well as allow participants to view and interact with examples of technologies in these areas, share their own experiences, and engage in steering the direction of a research agenda.


This session is sponsored by the MCHB/HRSA Adolescent and Young Adult Health Research Network.



Interprofessional Education to Improve Adolescent Patient Care: Building Community in Health Centers across Disciplines Using the Adolescent Health Initiative’s Innovative Spark Training
Margaret Riley, MD1, Jenni Lane, MA2, Lisa Lowery, MD, MPH3, Karen Alton, MD4, Lauren Ranalli, MPH2
1University of Michigan Medical School; 2University of Michigan Health System, 3Helen DeVos Children’s Hospital-Spectrum Health Medical Group, 4St. John Providence Children’s Hospital

Track: Clinical Advances

Description: The University of Michigan Health System Adolescent Health Initiative (AHI) developed the innovative, evidence-based Spark training model to advance adolescent-centered healthcare in primary care and school-based health practices.  Multidisciplinary champion teams deliver pre-packaged 15-minute mini-trainings, known as “Sparks,” to the entire health center. Sparks include slides, scripts, case scenarios and follow-up activities, and are intended to spark discussion and reflection on adolescents’ needs in a clinical setting. Sparks address issues such as adolescent-centered care, confidentiality laws, and adolescent brain development.  The model not only enhances culture by creating a more adolescent-centered environment, but also by reducing hierarchies between frontline staff, providers, and management, creating a more collaborative climate.  Staff and providers report that Sparks are easy to replicate in a busy clinic setting, and that they improve the climate of the clinic, as people accommodate the needs of adolescents, identify their own biases, and strive to be welcoming and compassionate with adolescent patients.  When all staff and providers are invested in the care of adolescents, adolescents have true continuity of care within a medical home.  This workshop will outline the Spark model for replication, provide the materials for an introductory sample Spark, and allow time for participants to collaborate to build their own Sparks.

Educational Objectives
  1. Explain the benefits of interprofessional development and education as a means to build support for and enhance the quality of adolescent care across a clinical practice
  2. Identify components of AHI’s innovative Spark training model for replication at their own health center meetings
  3. Develop new Spark topics that each participant will have the opportunity to workshop and practice among the group
Faculty Expertise: Dr. Riley is the Medical Director for the University of Michigan’s Adolescent Health Initiative (AHI), and has presented nationally on AHI’s initiatives to help primary care clinics transform into adolescent medical homes.
 
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