Workshops and Institutes

Call for Workshops and Institutes: Workshop and Institute submissions for the 2011 Annual Meeting in Toronto, Ontario, Canada ended on Friday, May 1, 2009. Please visit this site in May 2010 for the 2011 Call for Workshops and Institutes. The 2011 annual meeting of the Society for Adolescent Medicine will be in Seattle, Washington.

2010 Institutes, Wednesday, April 7, 8:15 - 11:45 a.m.

Institute 1. Don’t Go Breaking My Heart: Primary Care Cardiac Evaluation in the Adolescent Patient

Speakers: Mark E. Alexander, MD, Amy D. DiVasta, MD, MMSc, Sarah de Ferranti, MD, MPH

Cardiac complaints of fainting, dizziness, palpitations, and chest pain are extremely common. Although these symptoms rarely signify serious disease, concerns about the possibility of an underlying cardiac condition often cause alarm in adolescents, in their families, and in their medical providers. Using clinical cases, this institute will discuss the challenge of the diagnostic evaluation and therapeutic options of such often vague cardiac complaints. The leaders — from both adolescent medicine and cardiac electrophysiology and preventative pediatric cardiology and will view each of the problems from the patient, primary provider and specialty provider perspective to help facilitate local referrals.

We will start with focus on the common, benign diagnoses such as neurocardiogenic syncope, substance abuse, and orthostatic intolerance. Additionally, we will discuss the cardiac manifestations of chronic diseases such as eating disorders, chronic fatigue syndrome and psychiatric illnesses. Despite the relative rarity of significant, life threatening cardiac disease there are increasing efforts to screen either all adolescents or selected groups (ADHD patients, athletes). The logic and data surrounding those choices will be reviewed to help permit local care patterns to evolve while national consensus is developed.

We will also review the relative rarity of significant, life-threatening cardiac disease in the adolescent patient, common presentations of such disorders, and the role of the primary care physician in the identification of these patients.

As children move into adolescence they are increasingly coping with more traditional cardiovascular risks: hypertension, hyperlipidemia and metabolic syndrome. These topics will be addressed from both the perspective of a cardiologist who manages a referral preventative cardiology program and the office based adolescent physician.

The institute is specifically designed to foster an interactive exchange, and to facilitate general and primary health care of these patients.

If you have specific case scenarios for discussion may be sent to mark.alexander@cardio.chboston.org prior to the meeting.

Upon completion of this session, the learner will be able to:

Review the fundamental details and “precision” of the initial cardiovascular examination
To discuss practical, office-based approaches to the evaluation of cardiac signs and symptoms in the adolescent patient, and the clinical management of such patients
Outline the longitudinal data regarding traditional cardiac risk factors, including hypertension, hypercholesterolemia and metabolic syndrome.

Institute 2. Putting the Cart Before the Horse: A Re-Evaluation of Short-Term and Long-Term Refeeding in Anorexia Nervosa

Speakers: Simon D. Clarke, MD, Michael R. Kohn, MD, Neville H. Golden, MD, Andrea K. Garber, PhD

Achieving adequate weight gain and restoring menses are central to recovery in anorexia nervosa but difficult to achieve. The metabolic changes that occur during starvation and refeeding have been demonstrated, but little is known about optimal feeding strategies to safely maximize weight gain. These challenges have assumed even more significance as we learn of the changes in cognition and emotion both in the starving state and after refeeding. Treatment programs are currently using a wide variety of refeeding protocols with various measurement tools. Refeeding has traditionally been conservative, with low calorie diets that advance slowly. Newer evidence is now emerging to demonstrate the success of more aggressive feeding protocols. In addition, recent studies have highlighted the role of cognition and emotion in refeeding and underscore the need for better assessment techniques in this area. Thus, we will use our combined experience and data from refeeding of over 4,000 patients as an evidence base to reevaluate refeeding strategies in relation to overall recovery.

We will present body composition studies, energy expenditure, MRI changes as well as cognitive and emotional changes that occur during the refeeding process. Participants will learn new refeeding techniques and revisit previous practices. Long-term refeeding will also be discussed in light of recent findings. The session will be suitable for both junior and senior clinicians. The institute will consist of some presentation of data, but will mostly be interactive with the clinicians presenting their experience and inviting further comment from the floor. The expected result of this session is to move the group toward consensus on optimal refeeding strategies to safely maximize recovery in anorexia nervosa.

Upon completion of this session, the learner will be able to:

Identify the metabolic changes that occur during starvation and refeeding
Discuss findings relating to cognition and emotion following refeeding and the implications for ongoing treatment in relation to neurophysiology and neuroanatomy
Evaluate refeeding strategies and the implications for future clinical management

Institute 3. Helping Homeless and Disadvantaged Youth Successfully Access Health Care, Housing, and Happiness: Perspectives from the United States and Canada: Models That Work

Speakers: Seth Ammerman, MD, April Elliott, MD, Deb Welliver, RSW

The homeless youth populations are substantial and growing, as are the numbers of uninsured youth. Underserved and homeless youth often present with complex medical, psychosocial, mental health and nutrition-related problems. The first part of the institute will review the current literature and issues concerning pathways into homelessness, health risks of homeless and disadvantaged youth, and barriers to getting out of homelessness. The second part of the institute will describe two distinct programs targeting disadvantaged and homeless youth: 1) Lucile Packard Children’s Hospital mobile clinic program, which provides an enhanced medical home model of care for homeless and uninsured youth in the San Francisco Bay Area; and 2) the Canadian Calgary Homeless Foundation, in conjunction with the Calgary Adolescent Treatment Services (CATS), which in collaboration with other systems, including health, justice, education and social services, provides a holistic approach to helping homeless youth, with a longer-term goal of eliminating youth homelessness in Calgary. The "art and science" of developing and sustaining these programs will be discussed in detail. The last part of the workshop will be interactive, so attendees are encouraged to bring their own specific program ideas, challenges, and solutions to the workshop for brainstorming after the main presentation. The workshop will be of benefit to youth health practitioners who are interested in learning more about innovative ways to tackle youth homelessness and care for disadvantaged youth in a holistic manner. Faculty with experience working with homeless youth are also invited to join the institute to share their ideas and build existing knowledge. This institute will also be of benefit to those who want to develop new programs for unmet health care needs, as the processes discussed will have broad applicability to the development and sustainability of any new program.

Upon completion of this session, the learner will be able to:

Compare and contrast pathways into youth homelessness and barriers to exiting homelessness in the United States and Canada
Describe specific components of two different comprehensive programmatic approaches targeting homeless and disadvantaged youth
Identify steps necessary to support and sustain the development of a new program targeting an unmet health care need, using the two approaches discussed as effective examples of models that work

Institute 4. Resilience in Action: A Strength-Based Approach to Reaching Adolescents in a Clinical Setting

Speakers: Ken Ginsburg, MD, MS Ed

The major goal of "Resilience in Action" is to present resilience theory and youth development philosophy in a manner that will help participants move from a theoretical understanding to a practical clinical strength-based approach. The presentation style will be didactic and interactive using real-life examples that detail how the philosophical shift from a risk-based to a strength-based approach can change the experience of young people in one-on-one interactions with health and wellness professionals. A major tenet of the youth development model is that young people live up to — or down to — our expectations of them. A major question, therefore, is how to authentically hold youth to high expectations despite a great deal of evidence that their current behaviors and choices are negative. Part of the answer is to help the young person gain the confidence to change after a realization of his/her inherent competence. An adult's role is to help them find and build upon this area of competence. The presentation will offer facilitation techniques adults can use to guide youth to realize, own and build upon their own strengths. It will also offer communication strategies on how to convey information to youth that allows youth to gain ownership over behavioral change. A large focus will be on helping youth to develop a wide repertoire of positive coping strategies to stressful situations as a preventive measure that will guide them away from turning to the easier, but dangerous, coping strategies we fear they will choose (e.g. drug use, gang affiliation and cutting). This presentation may be useful to any health professional, but will be targeted to trainees at all levels and to seasoned clinicians who wish to increase their comfort level or clinical repertoire working with adolescents.

Upon completion of this session, the learner will be able to:

Create the zone of safety that communicates to youth that they are in a trustworthy setting
Build youth confidence by focusing on existing competencies
Facilitate adolescents' ability to make wise choices through a communication style that avoids lectures and encourages decision making

Institute 5. The Adherence Maze: Helping Adolescents Get the Best From Their Medications

Speakers: Nicola J. Gray, PhD, RPh, Rachel A. Elliott, PhD, RPh, Cristine Glazebrook, PhD, Cpsychol, Sarah Clifford, PhD, Cpsychol

It is estimated that only 50-75% of medications are taken as originally intended. Non-adherence to medications is worse in adolescence (11-20 years) than for children or adults, ranging from 10% to 96% (rates vary depending on the condition and how adherence is measured). Poor childhood adherence to medications can result in poor health outcomes, e.g. increased restricted activity days, hospitalizations and deaths in asthma; relapse in leukemia; seizure rates in epilepsy; and complications in diabetes. Moreover, establishing good medication-taking behaviors in adolescence may help sustain these behaviors through into adulthood. Gender, race and socioeconomic status do not reliably predict adherence in children, but urban living, language barriers and age (adolescence) increase non-adherence. Non-adherence may be intentional (e.g. caused by beliefs about medications) or non-intentional (e.g. caused by skills deficits), and different approaches are needed to explore and address such barriers. Thus negotiating adherence to medications for good health outcomes is an example of integrating the art and science of adolescent clinical medicine. This workshop is designed for adolescent health providers, researchers and policymakers who wish to explore ways to identify young people and families at greater risk of non-adherence, and to practice strategies for communicating with adolescents and their families about difficult medication issues. The emphasis will be on opportunities during office visits to explore and address barriers to adherence. There will also be discussion of system barriers to optimum adherence, such as medicines storage and supply policies in schools. Case studies of non-adherence for discussion will be drawn from the ongoing TABS (Talking ABout medicineS) study in Nottingham (http://www.nottingham.ac.uk/pharmacy/TABS/), and cross-national work about the home/school interface for adolescent diabetes care.

Upon completion of this session, the learner will be able to:

Explain, and reflect upon, the barriers to adherence with medications for adolescents
Proactively identify adolescent patients and families within their practice who are at greater risk of sub-optimal adherence to medications
Use strategies within the consultation to explore and address challenges to adherence

Institute 6. Common Overuse Injuries of the Lower Extremities

Speakers: Barbara J. Long, MD, MPH, Albert C. Hergenroeder, MD

This institute will address the common problem of anterior knee pain and lower extremity pain in active adolescents. The histories, physical examinations and diagnostic tests that are helpful in developing a diagnosis and treatment plan will be reviewed. Common problems including, patello-femoral syndrome, iliotibial band syndrome, Osgood Schlatter syndrome, shin splints, stress fractures and plantar fasciitis will be discussed in detail. There will be a PowerPoint presentation and hands on demonstration of the physical exam by institute leaders. Time will be allowed for participants to discuss challenging cases.

Upon completion of this session, the learner will be able to:

Identify the key histories, physical examination findings and diagnostic tests for evaluating overuse injuries of the lower extremities
Discuss the differential diagnosis of chronic lower extremity pain in active adolescents
Utilize an approach to treating overuse injuries within a primary care setting

Institute 7. Families Matter: Rethinking Approaches to Reduce Risk and Promote Well-Being for Lesbian, Gay, Bi-Sexual and Transgender Youth

Speakers: Erica Monasterio, RNC, MN, FNP, Tonya Chaffee, MD, MPH, Caitlin Ryan, PhD, ACSW, San Francisco State University

LGBT adolescents have consistently been reported as being at high risk for a range of health and mental health concerns, but little has been known about the role of families and caregivers in contributing to risk and promoting well-being. New research from the Family Acceptance Project (FAP) shows how family acceptance and rejection affects their health and mental health. Through an interactive presentation and case-based discussion format, this session will share FAP's findings, discuss the conceptual framework of new family-based strategies to decrease risk and promote well-being among LBGT youth and provide guidance on working with diverse families. Presenters will demonstrate the use of the FAP risk assessment tool, a rapid risk screener to identify family rejection of LGBT youth, and will offer approaches for participants to use in talking with LGBT youth about family reactions.

This institute will provide an overview of the work and application with clients and families from the perspective of community-based researchers, mental health clinicians and primary care providers. Print and online resources for providers, youth and parents will be included.

Upon completion of this session, the learner will be able to:

Identify the impact of family response to an adolescent's LGBT identity on their health status
Integrate an assessment of family relationships into the health care interaction with LGBT clients through use of an evidence-based rapid risk assessment tool
Describe an effective family-related approach to helping families decrease rejection and increase support of their LGBT children to reduce health risks and improve well-being

Institute 8. Integrating Behavioral Health in Adolescent Primary Care: Making It Work in Your Practice

Speakers: Celia Neavel, MD, Robin Rosell, LCSW/LMFT, Lynda Frost, JD, PhD

Medical providers increasingly feel pressured to address complex behavioral and mental health issues in their adolescent patients. Access to mental health specialists in many communities is limited by availability, narrow eligibility criteria or cost. Patients also may be reluctant to follow-up somewhere else for a "psych" problem. An emerging solution is integrating services at the primary medical site. This institute will review successful Integrative Behavioral Health (IBH) models and discuss how to apply lessons learned to your practice, whether you are a clinic director, a medical clinician in public or private practice, teaching adolescent medicine or a behavioral health provider. If fully adopting a comprehensive program is not feasible, we also will review and make available tools and resources that are helpful in your daily practice. Information will be presented from the perspectives of various disciplines and will include research data, behavioral/mental health care algorithms and case discussions. The Program Officer from the Hoff Foundation for Mental Health, a nonprofit that has funded IBH demonstration projects, will share her experience and lessons learned. As time allows, other providers will participate in discussion of their experiences and models of integrating behavioral health services.

Upon completion of this session, the learner will be able to:

Discuss recent research supporting the efficacy of various Integrative Behavioral Health programs, as well as the barriers medical clinics have encountered in implementation
Evaluate working models, funding and tools for clinicians and faculty
Discuss specific, challenging cases, such as adolescents with chronic medical and psychiatric illnesses, that benefit from an integrative behavioral health approach

Institute 9. Transgender Youth — Old Myths and New Guidelines for Treatment

Speakers: Michele Angello, PhD, Marvin Belzer, MD, Richard Levine, MD, Johanna Olson, MD

Transgender youth are a very interesting and complicated patient population who require a multidisciplinary approach to meet their medical and psychological needs. Transgender youth are also generally poorly understood and significantly underserved population at high risk for considerable morbidity and mortality related to drug use, suicide, depression and violence. The purpose of this workshop is to explore medical and psychological issues involved in the evaluation and care of trans youth. The leaders will discuss current diagnostic criteria of gender identity disorder in children and teens, including the benefits and significant limitations of these criteria. The etiology of gender identity will be explored and discussed. The presenters will review the new standards of care from Holland and the United States, as well as the use of hormone blockers to suspend puberty in early adolescents. They will discuss the use and physiologic response to cross sex hormone therapy and the issues involved in the medical evaluation prior to beginning hormone treatment. The presenters will also review high risk male to female transgender patients and the challenges providers face in their treatment, as well as, the anticipated psychological issues that arise when treating complex patients and families. This will be a didactic presentation that incorporates numerous case examples to illustrate treatment protocols and considerations. Cases will include young trans youth with intact supportive families, older youth with less supportive families, youth with Asperger’s, youth with atypical/late onset of gender confusion and youth with high risk behaviors/HIV risk. Participation in this workshop will provide attendees with an understanding of how to appropriately evaluate youth with gender identity issues in collaboration with mental health providers. Attendees will also learn the principles for assessing the risk/benefit ratios of early versus delayed treatment and how to implement recent treatment guidelines. This workshop is targeted toward professionals who work with, or are interested in working with and/or advocating for the trans youth population.

Upon completion of this session, the learner will be able to:

Understand the medical and psychosocial needs of the transyouth population
Outline a clinical approach to the transgendered adolescent patient
Understand the principles for assessing the risk/benefit ratios of early versus delayed treatment

Institute 10. Leadership is a Verb: Becoming an Agent of Change in Adolescent Health

Speakers: Laura P. Shone, DrPH, MSW, Lydia A. Shrier, MD, MPH

Leadership is both the focus of SAM's vision as well as one of its four core values. Adolescent health professionals who are interested in being an agent of change for the benefit of adolescents, their own career, or SAM, require leadership skills to be effective in their efforts to positively influence people towards a common goal. This institute will provide participants with the knowledge that they need to be able to work with others to achieve success in improving the health of adolescents. Based on the highly-regarded Five Leadership Practices^TM of Kouzes and Posner (modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart) and adapted to adolescent health issues, the session will focus on the competencies of leaders. By engaging in proved didactic and interactive learning experiences in a modular format, participants will appreciate elements of the art and science of leadership. The institute will be facilitated by two SAM members with both experience and training in leadership; in addition, lively interaction among participants will be encouraged so that all can learn from one another.

Adolescent health professionals across the career spectrum who are faced with challenges to both "do things right" (manage) and "do the right things" (lead and who are interested in developing or enhancing their leadership competencies are encouraged to register. Participants will complete a brief application describing a problem related to adolescent health that they would like to address effectively. Participants will commit to complete preparatory work (instruments, readings, written preparation) prior to the institute to ensure that they can focus on applying the knowledge gained about leadership competencies in a meaningful way.

Upon completion of this session, the learner will be able to:

Understand how your core values influence your leadership style and decisions
Incorporate five leadership practices into your work in adolescent health
Apply these practices to specific problems requiring leadership skills