Workshops: Friday, March 16




11:00 a.m. - 12:30 p.m. Sessions


Immigrant Youth: Adolescent Milestones and Resources for Healthy Youth Development
Chinwe Efuribe, MD, MPH, Chun Yin Kitty Ho, BS
People's Community Clinic

Track: Clinical Foundation

Description: The process of adolescent development can be challenging for most youth. Immigrant youth face additional challenges when navigating that process in a new cultural environment. In the U.S., research shows that ethnic identification affects adolescent development. For some youth, conforming to some American youth culture norms may increase their health risks while others may be protected from those risks by retaining some of their ethnic values. As immigrant youth, like all adolescents and young adults, adjust to biological developmental needs, they also have a need to balance issues of multiculturalism. This balancing act demands proactive support from their families and communities that care for them, including their medical home. There is research to support that certain protective factors against youth high risk behaviors are particularly more challenging for immigrant youth. For example, the protective factor of school connectedness can be hard for a new immigrant student who must adjust to American cultural norms surrounding interactions with peers, student-teacher or parent-teacher relationships. Adolescents could benefit by interacting with primary care providers who are aware of how their immigrant status may affect each stage and domain of adolescent development. As the nation prepares for the projected demographic shifts, it is becoming important for primary care providers to develop skills for communicating with and supporting a more diverse population in the medical setting. When healthcare institutions become more sensitive to the unique developmental needs of immigrant youth, supportive environments can be created to ensure their healthy youth development.

Educational Objectives:
  • IDENTIFY important tasks to transition from childhood to adulthood for immigrant youth
  • Pause to CLASSIFY teen behaviors according to current adolescent stages of growth
  • CLARIFY communications with teens to promote positive youth development and guide them to community resources
Faculty Expertise: Co-presenter at University of Minnesota Duluth Campus Summit on Equity, Diversity and Multiculturalism; Core member of the Maternal Child Health Bureau (MCHB) Diversity Training Peer Collaborative which explored strategies for increasing cultural diversity at MCHB programs; MCHB Trainee representative at the “Prelude to Strategic Planning Meeting” to identify critical issues for the Health Resources and Services Administration (HRSA) programs; Leadership Education in Adolescent Health (LEAH) fellowship which provided skills in providing clinical adolescent services, conducting workshops, public-speaking, and training in positive youth development; Master’s in Public Health degree focused on Community Health Promotion which provided training in community needs assessments, program development and evaluation; 12 years of clinical practice serving diverse populations in Pennsylvania, Minnesota and Texas (i.e. Somali refugees, African and Hispanic immigrants), personal past experiences/observations as an immigrant youth in the United States.
 


 
Therapeutic Alliance: Enhancing The Essential Ingredient for Promoting the Positive Outcome in Adolescent Medicine
Zeynep Tüzün, PhD1, Nuray Kanbur, MD, Adolescent Medicine Sub-Specialist2, Sinem Akgül, MD, PhD2
1Hacettepe University; 2Hacettepe University Faculty of Medicine

Track: Clinical Foundation

Description: A one-on-one meeting between a patient and a health professional, involves a working relationship reciprocally. This relationship is referred to as the therapeutic alliance (TA) in the area of psychotherapy and it is known to make a significant contribution to the total change that patients make in the treatment process, increase engagement in psychotherapy and leads to positive therapy outcome. The most accepted model in attempting to define TA include the combination of three dimensions: bond, goal and task. Goal refers to the agreement on treatment goals, task refers to the agreement of tasks during treatment and bond refers to the rapport between client and therapist/physicians. Alliance is a predictor of youth therapy outcome and may very well be an essential ingredient in the field of adolescent medicine. Studies of different medical conditions have also shown that a good TA leads to improvements in symptoms, chronic disease care, increase adherence and quality of life. Although the importance of forming a strong relationship between clinicians and patients is well known, approaches in forming TA maybe less known amongst physicians. The aim of this workshop is to introduce the TA concept and the techniques/tools which can be used to improve and better prepared the physician for a working relationship with the adolescent population. We think that the acquired knowledge of this workshop may greatly improve adolescents’ engagement into the treatment process and consequently may elicit positive outcomes.

Educational Objectives:
  1. Define and describe the concept of therapeutic alliance with evidence based research outcomes and practice based knowledge
  2. Identify the key components of therapeutic alliance and describe how to use them with a developmental perspective in the adolescent medicine practice with examples.
  3. Describe interventions and strategies for strengthening the alliance and educate the participants concerning the marks of ruptures that inhibit the formation of alliance
Faculty Expertise: The Division at Hacettepe University has provided comprehensive primary and specialty care to adolescents since 1963. With a holistic approach to patients, caring for both physical and psychosocial problems. Zeynep Tüzün is a clinical psychologist of the division. She is interested in adolescent psychopathologies with a developmental perspective and she gives courses on therapeutic alliance to improve the services provided by clinicians. She worked at the Therapuetic Alliance and Suicide Prevention Laboratory at the Psychology Department of University of South Florida. Nuray Kanbur and Sinem Akgül are faculty at Hacettepe University Faculty of Medicine, Division of Adolescent Medicine. Dr. Kanbur is a co-founder and director of the PhD Program Adolescent Health and Medicine at the Child Health Institute of Hacettepe University. All faculty members are working as clinicians and researchers in addition to teaching and training responsibilities. Their research and publications are in a variety of areas of adolescent medicine.
 


What’s New in Clinical Preventive Services? New Evidence, Guidelines, Policies – Challenges and Opportunities
Charles E. Irwin, Jr., MD1, Claire D. Brindis, DrPH1, Elizabeth Ozer, PhD1, Judith Shaw, EdD, MPH, RN, FAAP2, Erin Hemlin, MA3, Judy Klein, MBA4
1University of California, San Francisco (UCSF); 2University of Vermont College of Medicine; 3Young Invincibles; 4Unity Consoritum 
 
Track: Clinical Foundation

Description: Clinical preventive service recommendations for adolescents were first issued in the early 1990s, when the AMA published GAPS. Over the past 20+ years, the CPS field has evolved considerably, shaped by new guidelines, innovative training and clinical systems, research, policy changes and an expanded focus on young adults.  Through didactic presentation and discussion, the workshop will examine new guidelines (including the 4th edition of Bright Futures and USPSTF updates), policies, and new research on the value of a well visit and perspectives of adolescents, young adults and parents on the well visit. Discussion will focus on implications of these developments for clinical encounters and service delivery systems.

Educational Objectives:
  1. Participants will be able to describe updates to CPS guidelines and recommendations.
  2. Participants will understand youths and their families’ perspectives on preventive services and well care. 
  3. Participants will be aware of the implications of policy developments for CPS delivery.
Faculty Expertise: Dr. Irwin is the Director of the Adolescent and Young Adult Health National Resource Center (AYAH-NRC) and the Editor-in-Chief of the Journal of Adolescent Health (JAH). Dr. Brindis is a co-director of the AYAH-NRC and Director of the PRL-IHPS. Dr. Ozer is PI of the Adolescent and Young Adult Health Research Network and co-author of the Network’s review article published in the March 2017 JAH issue. Dr. Shaw is a Co-Editor of the Bright Futures Guidelines and Professor of Nursing that the University of Vermont. Ms. Hemlin is the Director of Training at Young Invincibles and directs qualitative research on engaging young adults in health care. Ms. Klein directs the Unity Consoritum, a non profit organization focused on improving adolescent and young adult health through prevention and immunization.  

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.
 

 

Beyond Rainbow Stickers: A Replicable Model to Create Affirming Spaces for Transgender Adolescents
Margaret Riley, MD, FAAFP1, Jenni Lane, Master of Arts2, Ellen Selkie, MD, MPH3, Elizabeth Shih, MD3
1Michigan Medicine; 2Michigan Medicine; 3University of Michigan Medical School

Track: Clinical Advances

Description: Transgender and gender non-conforming adolescents deserve to have affirming, respectful experiences in all health centers. Transgender individuals report avoiding medical care due to perceived and actual negative experiences in health care settings. Conversely, when transgender adolescents have positive experiences seeking and receiving health care, this can set a tone for a lifetime of engagement as a health care consumer. Creating a positive health care experience where transgender adolescents feel respected and receive high quality care requires training for providers and staff alike. As a simple way to spark the conversation within a health center and begin a commitment to practice change, Michigan Medicine’s Adolescent Health Initiative (AHI) developed an innovative mini-training, He, She, They, and Zie: Patient-Centered Care for Transgender Adolescents. This pre-packaged 30-minute mini-training is designed for use in primary, specialty, or school-based health centers; the module includes slides, scripts, a video, and follow-up activities. Staff and providers report that this mini-training is easy to replicate in a busy clinic setting, and that it improves the climate of the clinic, as people accommodate the needs of trans adolescents, identify their own biases, and strive to be welcoming and compassionate with all adolescent patients. In this workshop, participants will participate in the mini-training, address challenges to its delivery, and receive the materials needed to replicate it in their home setting.

Educational Objectives:
  1. Identify primary aspects of patient-centered care for transgender adolescents
  2. Outline components of a mini-training to replicate at their own health center meetings
  3. Plan for challenges and develop strategies related to ongoing clinic-wide practice improvement towards affirming care of transgender adolescents
Faculty Expertise: Dr. Selkie is an Adolescent Medicine physician and Research Director of the Child and Adolescent Gender Services clinic at Michigan Medicine C.S. Mott Children’s Hospital, where she works closely with transgender youth in both clinical and research capacities. She has personally administered this presentation’s mini-training to staff from clinic support staff to work toward creation of a gender affirming environment in the hospital’s subspecialty clinics. Ms. Lane has worked in the field of adolescent sexual health education and prevention for eighteen years, and is a national presenter on the topic. She has worked directly with transgender adolescents, and she develops and delivers training for the professionals who work with them. As a parent of a gender non-binary adolescent herself, she has been a tireless advocate for trans-affirming policies and practices at varied levels, including state Board of Education, district Board of Education, schools and classrooms, health systems, and health centers.
 


Mobilizing the Adolescent Health Community to Address the Health Needs of Commercially Sexually Exploited Youth
Aisha Mays, MD1, Tonya Chaffee, MD, MPH2, Veenod Chulani, MD, MSED, FSAHM, CEDS3, Taylor Rose Ellsworth, MPH4
1UC Berkeley School of Public Health; 2University of California San Francisco; 3University of Arizona College of Medicine; 4Physicians for Reproductive Health

Track: Clinical Advances

Description: Commercial sexual exploitation of children (CSEC) is a serious and urgent global adolescent health issue. It has been estimated that at least 26 million persons worldwide are victims of human trafficking and approximately 27% of those victims are children. In 2013 The Institute of Medicine Committee on Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States recommended that health care professionals recognize and treat the myriad medical and mental health needs of minors who are victims or survivors of commercial sexual exploitation and sex trafficking. Although several non-validated tools exist to assist medical professionals working with CSEC, to date, there are none that focus on adolescent health providers. Physicians for Reproductive Health developed an interactive curriculum to teach adolescent health providers, including trainees, about the social, structural and health implications for youth who are affected by CSEC. Presenters will introduce this curriculum and lead a train-the-trainer session that will provide workshop participants with tools to teach about the complex healthcare needs of CSEC within their home institution.

Educational Objectives:
  1. Discuss the individual, social, and structural risk factors associated with international and domestic commercial sexual exploitation of minor children and youth (CSEC).
  2. Describe Physicians for Reproductive Health Adolescent Reproductive and Sexual Health Education Program (ARSHEP) curriculum developed to support youth-serving health care providers respond to the needs of CESEC youth.
  3. Practice key teaching and learning components of the ARSHEP CSEC Module to optimize CSEC training for adolescent health providers.
Faculty Expertise: My current clinical practice and research centers on addressing the health needs of commercially sexually exploited youth. I have trained medical professionals throughout the country on the health impacts of CSEC and am currently training hospital systems with HEAL network. I am the PI of a study to create peer led CSEC sexual health curricula and am a co-author of the PRH/ARSHEP CSEC curriculum. I teach a lecture on CSEC and health in the UCSF/Joint Medical Program, where I am faculty, and have given CSEC and health oral and poster presentations both APHA and the National School Based Health Alliance. I published an article, CSEC and the Medical Community, in Current Problems in Pediatric and Adolescent Health Care in 2014.



Don’t Say the A-Word: How the Global Gag Rule Translates Into Reproductive Health Restrictions Internationally and Locally
Tracey A. Wilkinson, MD, MPH1, Katherine Blumoff Greenberg, MD2, Angel M. Foster, DPhil, MD, AM3
1Indiana University School of Medicine; 2University of Rochester Medical Center; 3School of Interdisciplinary Health Sciences

Track: Public Health/Advocacy

Description: Within a week of his tenure, President Trump reinstated the Global Gag Rule (GGR). First introduced by President Regan in 1984 and promulgated by every Republican administration since, the GGR stipulates that any organization receiving US family planning funding cannot discuss, refer for, or provide abortion services. The 2017 Executive Order further broadened this policy to include global health assistance provided by any part of the US federal government. Globally, the US supports billions of dollars of health care programs in dozens of countries, and organizations that violate the GGR risk losing their funding for other areas of health care including maternal-child health, HIV prevention, and nutrition. Analysis of the GGR’s impact has shown that it increases the risk of unintended pregnancy and unsafe abortion, which is a major cause of morbidity and mortality for women in the developing world. This policy has additional implications for US-based family planning providers; the same arguments made by anti-abortion activists in favor of the GGR are also used to attack domestic programs providing abortion care using non governmental funds. This workshop will describe the international scope and impact of the US Global Gag Rule, as well as its impact for US-based comprehensive reproductive health services. We will create regional small groups in order to facilitate sharing of advocacy and patient care resources. We hope to enable our SAHM network to discuss the impact of these laws, foster connections, and improve relationships with adolescent patients by helping them navigate restrictive barriers to abortion care.

Educational Objectives:
  1. Describe the scope, impact, and relevance of the Global Gag rule as it relates to international reproductive health services
  2. Discuss how the Global Gag rule has implications within the US in terms of reproductive health policies
  3. Cultivate connections among regional providers across all specialties and share resources to support and advocate for comprehensive reproductive health access
Faculty Expertise: Drs. Greenberg and Wilkinson are members of Physicians for Reproductive Health, a doctor-led advocacy organization that works to improve access to comprehensive reproductive health care, graduates of the Physicians Leadership Training Academy, and faculty of the Adolescent Reproductive and Sexual Health Education Program (ARSHEP), where they received additional training in advocacy skills and physician education. Dr. Foster is a well-known leader in global reproductive health research and advocacy and serves on the Board of Directors of the National Abortion Federation. Dr. Greenberg lectures widely on reproductive health through the Greater Rochester LARC Initiative, and as a consultant for Cicatelli Associates. Dr. Wilkinson’s research on emergency contraception availability and access has brought national attention to barriers and been cited in legal decisions changing dispensing regulations. Dr. Foster has published more than 50 peer-reviewed articles and two edited books on abortion, emergency contraception, and sexual and reproductive health in refugee settings.



Stories and Writing on Diversity in Healthcare: A Workshop in Narrative Medicine
Sheila M. Quinn, DO1, Tomas J. Silber, MD2
1Children's Hospital of Philadelphia; 2Children's National Medical Center

Track: Training/Education

Description: The field of medicine runs deep with stories of triumph, humor, tragedy, and love. Without the mindfulness to process the stories that we bear witness to, these narratives, and the opportunities for reflection, advocacy, and empathy, are lost. An increasingly popular and professionally recommended 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 the narrative of a patient, colleague, or oneself requires the ability to listen, observe, interpret and tell a story—the essential skills that constitute “The Art of Medicine”, and those which 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. The group will read and discuss a poem together. Workshop facilitators will provide 2-3 prompts based on the poem, and the participants will subsequently be given a short time to write a narrative response. Participants are invited to share their work, benefiting from group reflection and feedback. This year, the workshop focuses on “Global Adolescent Health Equity” by using a feature poem about diversity, bias, or identity, and how it affects the experience of our patients, our colleagues, and ourselves. 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 formed within the healthcare team
  2. Realize the technique of narrative medicine as a way of understanding these connections
  3. Recognize how narrative medicine can contribute a method for a deeper understanding in medical education and training
Faculty Expertise: Dr. Quinn is an internist and adolescent medicine provider, whose true passion and expertise lies in the area of Medical Humanities. She co-facilitates the Narrative Medicine group at Children's Hospital of Philadelphia, and has led workshops locally and nationally on this topic. She served as a plenary panelist at the Hippocrates Symposium for Poetry and Medicine at Harvard last spring. Her own writing can be found in Annals of Internal Medicine, and Journal of General Internal Medicine, as well as Capsules, a publication of the Yale Internal Medicine Writer's Workshop.
 



Reaching and Engaging Adolescents in Nation-wide Digital Focus Groups: Opportunities, Potential Pit Falls, and Ways Forward
Elizabeth Saewyc, PhD, RN, FSAHM, FAAN1, Michele Ybarra, PhD2, Jennifer Wolowic, PhD1, Tonya Prescott, BA2
1Stigma and Resilience Among Vulnerable Youth Centre; 2Center for Innovative Public Health Research

Track: Research

Description: In the United States, 92% of teenagers go online daily according to a 2015 report by the Pew institute, with 24% reporting they are online “almost constantly.” With so many youth already online, the internet poses an advantageous ‘place’ for researchers to engage adolescents. This workshop informs attendees about the methodology of designing and conducting online asynchronous focus groups. Strengths and challenges will be discussed. For example, online focus groups support larger sample sizes (e.g., groups of 18-22 instead of 8-10 in face-to-face groups) and participants from a wider geographic area (e.g., national versus one city). Creating a group dynamic, where participants talk to each other, can be more difficult however. Working with sexual minority youth as the primary case example, the workshop will walk participants through the stages of recruiting, enrolling, and conducting online asynchronous focus groups with youth nationally. Many sexual minority youth face stigma, feel marginalized and isolated. An online environment where they can connect with similar teens can create a unique dynamic that supports disclosure about sensitive topics as well as a sense of group belonging. Digital environments also have the benefit of engaging youth across wide geographic areas.

Educational Objectives:
  1. Identify pros and cons of online asynchronous focus groups for research, including considerations for recruitment, scheduling and the retention of participants in digital environments.
  2. Gain knowledge of best practices for posing questions, encouraging interaction between participants and following up or probing particular participant responses
  3. Understanding of the limits and opportunities of data gained during asynchronous focus group to decide if the methodology is appropriate for attendees research areas.
Faculty Expertise: Dr. Saewyc is recognized as a world leader in research on health disparities of lesbian, gay, bisexual, transgender & queer (LGBTQ) youth, conducting mixed method studies in the field, including research identifying policies, programs and practices that help reduce those disparities and foster resilience. Dr. Ybarra and her staff at the Center for Innovative Public Health, including Tonya Prescott, engage LGBTQ youth in online research platforms and text message based interventions in the US and internationally. Dr. Wolowic is an anthropologist and ethnographer whose work at the Stigma and Resilience Among Vulnerable Youth Centre identifies meaning making and community considerations that are important to LGBTQ youth.



2:00 - 3:30 p.m. Sessions



Providing Coordinated Primary Care for Refugee and Immigrant Adolescents
Jill D. Tallman, PA-C, Lisa M. Lowery, MD, MPH, CPE
Spectrum Health-Helen DeVos Children's Hospital

Track: Clinical Foundation

Description: Thousands of adolescents enter the United States as refugees or immigrants each year. Where do they obtain primary care? How do they assimilate into the U.S. Health System? What special considerations need to be taken to adequately care for these adolescents? The Adolescent and Young Adult Clinic at Helen DeVos Children's Hospital in Grand Rapids, MI partners with Bethany Christian Services in Grand Rapids, MI to provide coordinated care for refugees and immigrants from many countries and cultures. We will discuss the process of assimilating the patients into the health system, coordinating care with the agency and the special challenges we have encountered during this journey.

Educational Objectives:
  1. Differentiate between classifications of refugees and immigrants in the United States.
  2. Complete a comprehensive history and physical tailored to the refugee/immigrant adolescent patient.
  3. Develop a collaborative relationship with local agencies caring for refugee/immigrant adolescents.
Faculty Expertise: Our clinic has been providing primary care to refugees and immigrants in Grand Rapids, Michigan for more than 15 years. We currently partner with Bethany Christian Services, which provides housing, education, legal assistance, mental, physical and dental health care services for their clients. We serve as the primary care providers for these youth.



Global Reproductive Health Equity for Adolescents: Increasing Access to Contraception Through Evidence-based Guidelines
Jamie W. Krashin, MD, MSCR1, Mary Lyn Gaffield, PhD2, Emily M. Godfrey, MD, MPH3, Nora E. Rosenberg, PhD, MSPH4, Arturo Martinez-Guijosa, BS5
1Centers for Disease Control and Prevention; UNC School of Medicine; 2World Health Organization; 3University of Washington School of Medicine; 4University of North Carolina at Chapel Hill; 5Seattle World School Based-Health Center

Track: Clinical Foundation

Description: Unintended pregnancy among adolescents is a global public health issue. Many of the 17 million annual births to adolescents are from unintended pregnancies.1 Adolescent pregnancy is associated with higher risk of maternal death, stillbirth and neonatal death, and income insecurity than pregnancy in women past adolescence.1 While adolescent females in low- and middle-income countries disproportionately face unintended pregnancy and its associated risks, teens everywhere are affected. Contraception reduces the risk of unintended pregnancy. However, medical barriers may exist to providing adolescents the full range of contraception, especially the most effective and convenient contraceptive methods. In order to remove unnecessary medical barriers to accessing contraception and thus decrease unintended pregnancy, the World Health Organization (WHO) and United States Centers for Disease Control and Prevention (CDC) produce two sets of evidence-based guidance for contraceptive provision at the global and U.S levels, respectively. The Medical Eligibility Criteria for Contraceptive Use (MEC) provides recommendations regarding contraceptive safety for women with certain characteristics or medical conditions.2,3 The Selected Practice Recommendations for Contraceptive Use (SPR) provide guidance on common contraceptive management issues.4,5 These guidelines include recommendations pertinent to adolescents, and WHO provides additional guidance on provision of equitable youth-friendly services as a human right.2-10 WHO and CDC work with governmental, non-governmental, and clinical organizations to implement these guidelines into protocols and practice. This session will address strategies for using WHO and US evidence-based contraceptive guidance in clinical and policy settings to improve adolescent health equity.

Educational Objectives:
  1. Apply WHO and US evidence-based contraceptive guidance to clinical scenarios relevant to adolescents
  2. Identify strategies to implement evidence-based contraceptive guidance in different resource settings
  3. Discuss strategies to implement these recommendations in different practice settings
Faculty Expertise: Dr. Krashin is a family planning-trained obstetrician-gynecologist whose research focuses on CDC’s contraceptive guidance. Dr. Gaffield is an epidemiologist who leads the development and implementation of WHO’s global family planning guidelines. Dr. Godfrey is a family planning-trained family medicine physician with clinical interest in adolescent health and extensive research background in dissemination and implementation of evidence-based guidelines and adolescent pregnancy prevention. Dr. Rosenberg is an epidemiologist and the principal investigator of a multi-site trial that addresses pregnancy prevention and other reproductive health outcomes among adolescents in Malawi and South Africa. Mr. Martinez-Guijosa is the Patient Navigator Supervisor at Seattle World School-Based-Health Center and former HealthCorps Volunteer whose work focuses on helping a diverse population of adolescents access reproductive health care in school-based and community health centers.



Does One Size Fit All? How School-based Clinics in an Urban School District are Screening for Trauma and Providing Culturally Appropriate Interventions
Naomi Ann Schapiro, RN, PhD, CPNP1, Kristine Carter, RN, MS, CPNP2, B. Ruth Campbell, LCSW3
1University of California, San Francisco; 2Lifelong Medical Care; 3La Clinica de la Raza

Track: Clinical Advances

Description: Trauma is an international issue, as evidenced by a record number of 65.6 million forcibly displaced people worldwide. Of these, 22.5 million are officially recognized refugees, over half of them under the age of 18. Across the US, adolescent providers are increasingly seeing youth impacted by trauma, locally or from their country of origin. Trauma exposure is highly prevalent among adolescents seeking care in community settings, with over 90% of adolescents in one diverse urban school district endorsing trauma exposure. There is a need for developmentally and culturally appropriate screening for trauma exposure and trauma-related symptoms. Although there are national recommendations for screening all youth for depression and substance youth, there are currently no national guidelines for trauma screening, nor are there recommended algorithms for follow-up. Alameda County, one of the most diverse counties in the US with 29 school-based health centers, has been the site of a learning collaborative for trauma screening and care in schools and school-based health centers, particularly in an urban school district with 72% eligible for free and reduced lunch, 30% English language learners, and over 2000 newcomers from other counties in the 2016-17 academic year. Workshop presenters will lead a discussions of the pros and cons of a variety of screening tools currently in use in these settings, the logistics of school-wide screening for trauma, current efforts to validate adult tools in this population, and multi-level interventions that comprise trauma-informed care in this setting.

Educational Objectives:
  1. Analyze the advantages and disadvantages among brief trauma and ACE related screening tools currently in use in adolescent primary care
  2. Discuss benefits, logistics and follow-up for population-level screening in schools versus. traditional screening during medical appointments.
  3. Differentiate the levels of follow-up services needed after trauma screening, including coping skills, intensity of services, and advantages of group vs. individual follow-up
Faculty Expertise: Dr. Schapiro has extensive experience with children who are survivors of physical and sexual abuse, adolescents in school-based settings, and has practiced with, researched, presented and published on experiences of immigrant youth. She recently finished a pilot validation study of brief adult primary care PTSD screens in middle schools. Ms. Campbell has 19 years of clinical experience with immigrants, survivors of torture and humanitarian aid workers, and has implemented a comprehensive trauma screening and response program at La Clinica de la Raza SBHC. Ms. Carter has extensive adolescent experience and developed school wide screening and intervention protocols at two Oakland middle schools with high levels of trauma. exposure.



Addicted to the Internet? Recognizing and Treating Problematic Interactive Media Use (PIMU)
Michael Rich, MD, MPH, FAAP, FSAHM1, David Bickham, PhD2, Michael Tsappis, MD3
1Center on Media and Child Health, Boston Children's Hospital; 2Boston Childrens Hospital; 3Harvard Medical School, Boston Children's Hospital

Track: Clinical Advances

Description: From smartphones to television, today’s children and youth of all over the world spend more time communicating, educating, and entertaining themselves with screens than they do in school, with parents, pursuing physical activity and, for some, sleeping. Research has shown that media use has powerful effects on their physical, mental, and social health, increasing the risk of obesity, anxiety, depressions, sleep disturbances, learning difficulties, and, in some cases, excessive or compulsive screen media use that harms their health and disrupts development. Ongoing research shows that when media are overused or used compulsively, they can interfere with a child’s daily life and lead to sleep disturbance, poor school performance, family and relationship conflicts, emotional and psychological problems. While these problems have been called “Internet Addiction”, “Internet Gaming Disorder” or “Video Game Addiction”, they are more accurately characterized as Problematic Interactive Media Use (PIMU). Today’s clinicians need a systematic diagnostic and therapeutic approach to PIMU in order to alleviate significant dysfunction, developmental distortion, and familial disruption. Effective diagnosis and treatment requires a base of research evidence to recognize and describe what we are seeing to each other and to patients and clinical therapeutic trials with rigorous evaluation. As our societies have evolved, connectivity and facility with interactive screen media are necessary to function in school, work, and social situations. Abstinence is not an option, s treatment must include thoughtful, realistic and clinically monitored re-establishment of interactive media use.

Educational Objectives:
  1. Recognizing adolescents' motivations to use digital technology, problems and potentials of that use, and recognition of interactive media-related physical, psychological, social, and academic problems
  2. Understanding of Problematic Interactive Media Use (PIMU) (aka internet or video game addiction), diagnostic, therapeutic,and educational strategies for PIMU and other media-related physical, psychological, and developmental issues
  3. Strategies for incorporating awareness of PIMU and other media-related problems in medical history-taking, treatment, and anticipatory guidance
Faculty Expertise: Founder and Director of the Center on Media and Child Health (CMCH), Dr. Rich combines 12 years of experience creating media experience with rigorous scientific evidence about the powerful positive and negative effects of its use to treat youth struggling with media-related health issues and advise clinicians, parents, and youth to use media to optimize development. Dr. Bickham, CMCH Research Scientist, investigates pathways by which media use may contribute to mental health problems and evaluates outcomes of clinical interventions. Dr. Tsappis, board certified in psychiatry and child and adolescent psychiatry, provides psychiatric care at Boston Children’s Hospital and serves on the Adolescent Psychiatry Committee of the American Academy of Child and Adolescent Psychiatry. Many of Dr. Tsappis’ current clinical and academic projects focus on recognition and treatment of Problematic Interactive Media Use (PIMU); he has been invited to present this work to local, regional, national and international audiences.



Challenges of Using Technology to Extend the Reach of Clinicians for Adolescent and Young Adult Clinical Preventive Services
Charlene Wong, MD MSHP1, Elissa Weitzman, ScD2, Sion Harris, PhD2, Elizabeth Ozer, PhD3, Megan Moreno, MD, MSED, MPH4
1Duke University; 2Boston Children's Hospital; 3University of California, San Francisco; 4Seattle Children's Research Institute

Track: Clinical Advances

Description: Through didactic presentation of information and interactive case-based discussion, this workshop aims to update participants on the key challenges of using technology to promote preventive care in adolescents and young adults (AYA). eHealth, which includes social media, mobile health apps, wearable/digital devices & gamification, has become ever prevalent in the lives of AYA around the world with the spread of the internet & mobile devices to even the most impoverished areas. eHealth democratizes healthcare experiences through ubiquitous access to health information and self-monitoring, with the potential to narrow health inequalities. Although there is increasing enthusiasm for eHealth integration in AYA preventive services, new challenges have emerged as a result of these seemingly panacea websites, applications, and digital devices. AYA providers need to be well-versed in the challenges their patients face as they explore the growing world of eHealth platforms.

Educational Objectives:
  1. Describe the challenges of maintaining privacy, security, and identity among adolescents and young adults using eHealth for clinical preventive services.
  2. Describe strategies for assessing the reliability and accuracy of health information presented on eHealth platforms related to adolescent and young adult clinical preventive services.
  3. Identify challenges and opportunities related to eHealth connectedness to adolescent and young adult clinical preventive services
Faculty Expertise: Drs. Wong, Weitzman, Ozer and Harris are part of the Adolescent and Young Adult Health Research Network; their contributions have focused on clinical preventive services for adolescents and young adults, with a first paper in 2017 led by Drs. Harris & Ozer (doi.org/10.1016/j.jadohealth.2016.10.005). Drs. Wong & Weitzman led the “Using technology to extend clinician’s reach” section of this paper, which was a SAHM 2017 Workshop. The content being proposed in the SAHM 2018 workshop is from a second review paper that is in development. Research mentees (Master, Madanay, Moore) are working on this second review paper and will be co-presenting, including representation of the youth view on issues around the challenges. Dr. Moreno is an internationally-recognized expert on how technology can be used to improve adolescent health and PI of the Social Media and Adolescent Health Research Team (SMAHRT).

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



Global Health Equity in the Current Climate: How Laws & Policies Affect Health, Well-Being, and Access to Health Care for Adolescents & Young Adults
Abigail English, JD1, Krishna K. Upadhya, MD, MPH2
1Center for Adolescent Health & the Law; 2The Johns Hopkins University School of Medicine

Track: Public Health/Advocacy

Description: Laws and policies affect the health, well-being, and access to health care of adolescents and young adults worldwide. These laws and policies often have a dramatic impact on health equity, frequently resulting in adolescents and young adults suffering worse health and more limited access to health care based on their income, nationality, gender, sexual orientation, gender identity, race, or ethnic group. Recent political, social, economic, and environmental developments in both the U.S. and globally are contributing to major shifts in laws and policies, many of which can have adverse effects on adolescents and young adults. The workshop will explore this phenomenon by examining legal and policy developments in three specific arenas to illustrate the critical importance of laws and policies for the health, well-being, and adolescents: (1) financial access to health care via health insurance and other funding: (2) sexual and reproductive health care; and (3) young people who are immigrants, migrants, and refugees. In each of these three areas, the workshop will highlight current political, social, economic, and environmental factors and key legal and policy developments that are significant for the health, well-being, and health care access of adolescents and young adults. Examples will be included from the U.S. and other countries. After setting the stage, the workshop will identify ways in which health care professionals can advocate to resist policy changes that adversely affect the health, well-being, and health care access of adolescents and young adults and promote policies that improve health equity.

Educational Objectives:
  1. Explore the ways in which current shifts in laws and policies can adversely affect the health, well-being, and access to health care of adolescents and young adults or promote health equity.
  2. Compare and contrast the potential effectiveness and limitations of alternative strategy approaches for resisting adverse policies or promoting health equity.
  3. Identify promising strategies to advocate for policies that support the health, well-being, and health care access of adolescents & young adults related to health care financing, sexual & reproductive health, & young migrants, immigrants, & refugees.
Faculty Expertise: Abigail English is a lawyer, researcher, and advocate for the rights of vulnerable young people. She directs the Center for Adolescent Health & the Law. Her research and advocacy have focused on health insurance and public financing of care for adolescents and young adults, consent and confidentiality protections, sexual and reproductive health care, and human trafficking. She is a past president of SAHM and former chair of the SAHM Advocacy Committee. Krishna Upadhya is Assistant Professor in the Division of General Pediatrics and Adolescent Medicine at Johns Hopkins. Dr. Upadhya is actively involved in clinical care, teaching, research and advocacy in the areas of adolescent and reproductive health. She serves as Chair of the Advocacy Committee of the SAHM and the Adolescent Health Working Group for the DC Chapter of the American Academy of Pediatrics and is also a member of the national AAP’s Committee on Adolescence.



Exercising Cultural Humility and Respect for Diversity: Training Strategies for the Next Generation of Health Care Providers
Sara Sherer, PhD1, Mari  Radzik, PhD1, Sophie  De Figueiredo, Psy.D.2
1Children's Hospital Los Angeles, USC Keck School of Medicine; 2Children's Hospital Los Angeles

Track: Training/Education

Description: The overarching focus of this workshop will be on making meaning of different facets of cultural diversity as these relate to one's individual, clinical, and professional development. The workshop will introduce curriculums emphasizing developing competencies regarding cultural and individual diversity with specific focus on cognitive, social, cultural, and affective development. One main goal of this workshop is to further the developmental progression of clinicians’ professional skills in multiculturalism as it relates to both self-awareness and health care provision. Another main goal is to foster an attitude of curiosity and culturally humility towards holistic treatment of diverse adolescent and young adult populations. The importance of developing cultural self-knowledge is vital to culturally sensitive practice and professional development. The workshop will review how one’s self, biases, stereotypes, and cultural backgrounds play a role in clinical and professional spheres. A clinician’s own self-awareness of and competence around issues of diversity, including power, privilege, biases, and worldviews, are essential to effective clinical practice with diverse populations.

Educational Objectives:
  1. Further the developmental progression of clinicians’ professional skills in multiculturalism as it relates to both self-awareness and health care provision.
  2. Develop an attitude of curiosity and culturally humility towards holistic treatment of diverse populations.
  3. Introduce strategies and effective culturally sensitive trauma informed practices that can be implemented in the health care work place.
Faculty Expertise: All the presenters are psychologists, have extensive clinical experiences, and are actively involved in training medical, psychology and other interdisciplinary trainees. Drs. Sherer and Radzik are faculty at the USC Keck School of Medicine and direct the Behavioral Services at the Division of Adolescent and Young Adult Medicine (DAYAM) at CHLA. Dr. Sherer is the PI on the new CHLA LEAH grant. Dr. Radzik coordinates the EBPs Motivational Interviewing and Seeking Safety trainings. Dr. DeFigueiredo specializes in trauma informed care, and teaches diversity seminars.




Recruiting Sexual and Gender Minority Youth into Research Studies: Challenges and Potential Solutions
Gerald T. Montano, D.O., M.S.1, Holly B. Fontenot, Ph.D., R.N./N.P.2, Richard Dunville, M.P.H.3, Kathryn Macapagal, Ph.D.4, Michael P. Marshal, Ph.D.1
1University of Pittsburgh School of Medicine; 2Boston College; 3Centers for Disease Control and Prevention; 4Northwestern University Feinberg School of Medicine

Track: Research

Description: Sexual and gender minority youth around the world are at an elevated risk for adverse health outcomes such as anxiety, depression, and substance use due, in part, to stigma and discrimination related to sexual and gender identities or behaviors. Moreover, sexual and gender identity formation is an integral part of adolescent health development; however, because of the anti-gay and anti-trans stress they experience, achieving optimal health and well-being for this vulnerable population is difficult. Research may identify ways to improve health and well-being for this population, but sexual and gender minority youth face many obstacles in participating in research studies. Apprehension from Institutional Review Boards to approve studies involving sexual and gender minority youth, safety involving sexual and gender minority youth who are not out to their parents, and requiring parental permission to participate in studies are just many of the barriers to recruiting this vulnerable population. The principles and techniques outlined in this workshop will be relevant to clinicians who must handle confidentiality among their sexual and gender minority patients, and researchers, epidemiologists, and public health professionals who are finding ways to achieve health and prevent disease in this vulnerable population. Although these techniques have been used in the United States, they may serve as a template to conduct research on sexual and gender minority youth around the world.

Educational Objectives:
  1. Explain the difference between consent, assent, and parental permission and how these concepts affect sexual and gender minority recruitment in to research studies.
  2. Describe various recruitment methods relevant to sexual and gender minority youth, their advantages and disadvantages, and their external and internal validity.
  3. Apply strategies to working successfully with Institutional Review Boards to create an ethical and safe recruitment strategy for sexual and gender minority youth.
Faculty Expertise: Dr. Montano is an adolescent medicine-trained physician who has published research describing the relationship between parenting behaviors and adverse health outcomes among sexual minority youth. CDR Dunville focuses on providing tools and scalable interventions for sexually transmitted disease (STD) prevention, including the development of tools for adults who serve adolescent sexual minority males and trans youth and tools for evaluating school-based STD screening programs. Dr. Fontenot has experience employing various online and app-based approaches for recruitment, engagement, and data collection among men who have sex with men (MSM) and transgender youth, including online focus group methods. Dr. Macapagal has published research using qualitative and quantitative methods to understand sexual and relationship health needs of sexual and gender minority persons. Dr. Marshal has published research examining longitudinal substance use disparities among sexual and gender minority youth, with a special focus on identifying trajectories, mediators, and moderators of these disparities.