Workshop Sessions - Wednesday, March 18

Workshop Sessions I

9:30-11:00 a.m.

Moving Beyond Health Care Access: Evidence-Based Practices for Young Adults
Charles E. Irwin, Jr., M.D., Chair of Session
Josephine Lau, M.D. Assistant Professor of Pediatrics, UCSF
Elizabeth Ozer, PhD, Professor of Pediatrics, UCSF
Claire Brindis, DrPH, Professor of Pediatrics & Health Policy, UCSF
Member of the Young Invincibles Leadership

Educational Objectives:
  • Describe young adults health status and health care needs
  • Describe health care access and utilization for young adults before and after ACA implementation
  • Identify recommended services and tools to provide those services
  • Identify challenges to maintaining confidentiality and possible solutions
  • Identify tools to increase access and improve quality of care
  • Identify progress, challenges and areas needing further research, with a focus on vulnerable populations.
Description: Through didactic updates, group discussion and small group activities, this Workshop aims to update participants on key issues in young adult health care. The session will examine: trends in access to care in the first few years of ACA implementation; recommendations for preventive care; and challenges in delivering services to this population. Issues to be addressed include preventive benefits and confidentiality. Tools and strategies to improve policy, clinic organization and service delivery will be presented. The session will involve both didactic presentation of information, group discussion and small group activities.

This session is sponsored by the MCHB/HRSA Adolescent and Young Adult Health National Resource Center.

2:15-3:45 p.m.

Management of Substance Use, Misuse, and Problem Use as Adolescents Transition to Young Adulthood
Lydia A. Shrier, MD, MPH1; Sharon Levy, MD, MPH1; Geetha Subramaniam, MBBS2
1Boston Children's Hospital and Harvard Medical School, 2National Institute on Drug Abuse

Track: Clinical Advances

Description: Substance use typically begins in adolescence and peaks in young adulthood. Problems associated with substance use evolve as adolescents become young adults and their substance use patterns and settings change. To be salient, prevention messages and intervention strategies need to be tailored to take into account age, developmental stage, and context. This workshop will begin with a brief overview of substance use-related issues in older adolescents and young adults. We will discuss the prevalence of use of different substances and their consequences by age group; compare and contrast presentations between the age groups, highlighting differences between college students and young adults not attending college; and review prevention strategies specific to each age group. The majority of the workshop will consist of presentation and discussion of cases of youth transitioning to young adulthood. Through guided small group discussion, participants will tackle issues of screening, prevention, brief intervention and treatment planning, confidentiality, treatment engagement, and decisions regarding involvement of and collaboration with parents, college health, and school administration.

Educational Objectives:
  1. Conduct screening and anticipatory guidance appropriate for both adolescents and young adults.
  2. Identify problem substance use in young adults and perform brief interventions.
  3. Provide appropriate guidance and support for parents of young adults with substance use problems, balancing parental involvement with young adult autonomy and right to privacy.
Everything You Wanted to Know About ARFID…But Were Afraid to Ask!
Debra K. Katzman, MD, FSAHM1; Rollyn M Ornstein, MD, FSAHM2; Richard E Kreipe, MD, FSAHM3
1The Hospital for Sick Children and University of Toronto, 2Penn State Hershey Children’s Hospital, 3Golisano Children’s Hospital, University of Rochester Medical Center

Track: Clinical Advances

Description: What is ARFID?  Who develops ARFID? How do I know if an adolescent or young adult has ARFID?  Can you treat ARFID? With the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) there has been the creation of “new” eating disorder called Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is a persistent disturbance in eating that leads to significant clinical consequences, such as weight loss or inadequate growth, a significant nutritional deficiency, dependence on tube feeding or nutritional supplements to sustain adequate intake, and/or impaired psychosocial functioning. The creation of a more inclusive diagnostic category like ARFID is thought to allow for a more specific diagnosis to be given to clinically significant symptoms that develop in adolescents and young adults that could otherwise go unidentified or untreated. Because this is a relatively new diagnosis, this workshop is designed to highlight new applications of recent research advances on this new diagnostic category.  As such, the target audience for this presentation includes interdisciplinary trainees, clinical healthcare providers and experienced adolescent health providers. The session will be interactive and include a combination of didactic and case-based discussions.

Educational Objectives:
  1. Understand the reasons behind the changes in the DSM-5, with a focus on ARFID.
  2. Identify adolescents and young adults with clinically significant eating problems that meet the DSM-5 criteria for ARFID.
  3. Understand the development, course, and clinical expression of ARFID and be able to distinguish ARFID from other medical and psychiatric disorders.

Staying Young at Heart: Achieving Life-long Cardiovascular Health Through Heart-healthy Transitions
Holly C. Gooding, MD1; Richard J. Chung, MD2
1Harvard Medical School, Children's Hospital Boston, 2Duke University Medical Center

Track: Clinical Advances

Description: The American Heart Association 2020 Strategic Impact Goals defined the new concept of ideal cardiovascular health (iCVH).  Individuals who reach middle age with the 7 physiologic and behavioral factors that comprise the iCVH metric can expect to live 40 years or more free of significant cardiovascular morbidity and with excellent quality of life.  Unfortunately, less than 5% of adults reach middle age with iCVH.  Epidemiologic research suggests that the transition from adolescence to young adulthood is a critical period for maintenance or loss of iCVH.  

This workshop will review the iCVH construct and its 7 individual metrics during a 20-minute introductory session.  After discussion of the individual metrics, learners will calculate their own iCVH score to practically apply and personalize the concept.   After participants have been actively engaged, they will then be divided into small groups of up to 5 participants to collaboratively apply multiple available risk calculators (PDAY, QRISK, AHA/ACC, Framingham) to estimate the lifetime risk of cardiovascular disease for hypothetical adolescent and young adult cases.  This 20-minute segment will introduce participants to these tools and encourage examination of the differential impact of individual risk factors as people age.  

In the next 20 minutes, the presenters will review key discrepancies between pediatric and adult guidelines for screening and treatment for hypertension, dyslipidemia, and obesity. Practical application of each set of guidelines to hypothetical patients 15-25 years of age will be discussed. A printed summary of cardiovascular risk management guidelines in adolescence and young adulthood will also be provided to audience members for their reference. During the final 30 minutes, motivational interviewing principles and other strength-based approaches that target positive development will be reviewed and the different approaches to counseling and supporting the transition of a series of hypothetical adolescent and young adult patients will be discussed. Participants will be invited to share their own personal experiences with different approaches. Video vignettes of staged patient encounters will be incorporated to concretely convey key techniques.

Educational Objectives:
  1. Describe the American Heart Association 2020 Strategic Impact Goals from the developmental perspective of teens within a family context transitioning to independent adulthood.
  2. Utilize multiple available risk calculators to estimate lifetime risk for cardiovascular disease for emerging adults.
  3. Compare and contrast pediatric and adult guidelines for the screening and treatment of cardiovascular risk factors.

Taking the Core Elements of Health Care Transition Back to your Practice
Patience H. White, MD1; Brett Robbins, MD2; Margaret A. McManus1
1The National Alliance to Advance Adolescent Health, 2University of Rochester Medical Center

Track: Clinical Foundations

Description: There are an estimated 18 million adolescents, ages 18-21, about ¼ of whom have chronic conditions; and many more if youth between ages 12-26 are counted. Most will need to move from pediatric to an adult health care system. The majority of youth and especially those with special health care needs are ill prepared for this change and often have worse health outcomes during this vulnerable time. Surveys of health care providers consistently show they lack and are interested in a systematic way to provide transition support from pediatric to adult health care.

The session will be a panel discussion using didactic case based presentations and an interactive component where participants will rate their practice/clinic on a new transition measurement tool and plan their next HCT quality improvement step for their practice. The didactic component will discuss the new 6 health care transition (HCT) core elements that are aligned with the AAP/ACP/AAFP Health Care Transition report that emphasize the development of a practice-wide transition policy, systematic identification of transitioning youth, assessment of transition readiness, development of a transition plan, and organized process for transfer to adult practice. The participants will discuss how transition quality improvement strategies and tools can be implemented in their practice with examples of successful incorporation of the core elements into 3 types of practices: academic primary care practices, a Medicaid managed Care Company and 2 academic subspecialty clinics.

Educational Objectives:

  1. Review the core elements for implementing the new health care transition clinical report and algorithm developed jointly by the AAP/AAFP/ACP to improve health care transition for youth and families.
  2. Discuss three examples of quality improvement strategies to incorporate the core elements into 3 types of practices: Academic primary care, a Medicaid managed Care Company and an academic subspecialty clinics.
  3. Rate their practice on the new transition improvement scale and discuss the next transition quality improvement steps for their practice.

Change Points: Navigating ADHD through Adolescence into Young Adulthood
Mark H. Thomas, MD, FSAHM1; Earl John Soileau, Jr., MD, FSAHM2
1Tuscaloosa Focus MD, 2LSUMC-S Family Practice Residency  Program Lake Charles Memorial Hospital

Track: Clinical Foundations

Description: Delays in the maturation processes of the brains of young persons with ADHD complicates the treatment of ADHD during the transition periods from childhood to adolescence and from adolescence into young adulthood. Young adults with chronic illnesses such as ADHD often require assistance upon encountering issues such as  transitioning to a new provider of care, transferring medical records, making and keeping appointments, dealing with insurance providers for reimbursement of care, and managing prescriptions / pharmacy issues. Didactic presentations, case studies, and group discussions will be utilize to engage participants in this institute designed to motivate, inform and update practitioners who encounter adolescents and young adults with ADHD in their practices. We will also emphasize the urgent need for greater integration of ADHD into research pertaining to health-risk behaviors and health-related outcomes in adolescents and young adults.

Educational Objectives:

  1. Analyze issues surrounding transition of ADHD treatment from a pediatric model to an adolescent medicine model where patients are enlisted more fully into the treatment team and are gradually given a greater role in exchange of information and treatment p
  2. Recognize issues surrounding transition from adolescent medicine model to adult medical model in which patient become independent in their interactions with the medical community and making treatment decisions thereby needing to be more fully educated abo
  3. Integrate new revelations from neuroimaging studies pertaining to the delay in maturation of the brains in adolescents and young adults with ADHD, the emergence of substance abuse and diversion of medication as treatment issues and how these impact treatment

Stories Stick, Facts are Forgotten: Advocating for Adolescent Sexual Health Beyond the Exam Room

Tracey Wilkinson, MD, MPH1; Anita Brakman, MS2
1Children's Hospital of Los Angeles, 2Physicians for Reproductive Health

Track: Professional Development

Description: Adolescent health professionals know that providing preventive services and other essential health care for young people translates into positive health outcomes throughout adulthood. High-quality, affordable, and confidential reproductive and sexual health services are especially crucial for young people to make transitions into healthy adulthood. Unfortunately, those that work with adolescents and young adults see firsthand sizable barriers that young people face in trying to access health services. The essential role of sexual health services, and the significant access barriers that exist, are not always understood by legislators, media outlets and policy makers at institutions like schools and hospitals.  For this reason, it is important for professionals who work with this unique population to share their specific knowledge and unique perspectives in public discussions and debates around public health and medical care. Most health professionals recognize an ethical obligation to advocate for individual patient or client needs, and this obligation can and should extend to advocacy in the public sphere. Unfortunately, training in advocacy is not something that is typically a part of medical or public health education.

This session will introduce participants to the concept of health professional advocacy and provide examples of how to integrate advocacy efforts within the scope of one’s busy worklife as a clinician, researcher or health educator. After a brief introduction to the topic and the unique role health professionals can play in advocating for adolescent reproductive health, leaders will present two practical approaches to advocating for essential services provided to young people as they move from childhood to adulthood. First, Dr. Katherine Greenberg will discuss using patient stories in advocacy as an effective way to humanize controversial topics including adolescents’ access to family planning services or gender affirming hormones and treatments. Next, Dr. Tracey Wilkinson will discuss how professionals primarily involved in research or education, outside of patient care, can utilize their experiences to advocate in ways that are accessible to the public and those outside of academia. Dr. Wilkinson’s research on adolescents’ access to emergency contraception was first published in JAMA and Pediatrics in 2012. Over the last 2 years, Dr. Wilkinson discussed her research extensively with online and print media sources, ensuring that stories reported in major news outlets would be based on science rather than politics and rhetoric. Participants will also have the opportunity to work in small groups and write down patient or client stories and receive feedback from session leaders on how these stories might be utilized for advocacy efforts.  

Finally, leaders will discuss several advocacy training resources for health professionals and students including Physicians for Reproductive Health’s Leadership Training Academy (the Academy).  The Academy is a CME accredited, 9-month intensive advocacy training program for physicians of which Dr. Wilkinson and Dr. Greenberg are alumni and Ms. Brakman is on staff.  The goal of the Academy is to create lifelong leaders and physician advocates within the realms of policy, media, and medical education. Nearly 200 physicians have completed this program since its inception in 2003.

Educational Objectives:
  1. Recognize the unique role health professionals can play in shaping policy decisions and media discussions about adolescent reproductive and sexual health.
  2. Develop and adapt a patient story appropriate for use in an advocacy venue including: meeting with a state or federal legislator, a letter-to-the-editor of a newspaper, or speaking in support of policy change in a professional medical or public health organization.
  3. Identify resources for additional training and technical assistance with advocacy efforts to promote positive outcomes for adolescents and young adults.

Developing Adolescent Health in Global Settings
Fadia S. AlBuhairan, MBBS1; Rosawan Areemit, MD2; Lana Lee, MD3;  Asha Pemberton-Gaskin, MBBS4
1King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, 2Khon Kaen University, 3Johns Hopkins School of Medicine, 4The Queen Elizabeth Hospital and the University of the West Indies

Track: Professional Development

Description: Out of the 1.2 billion adolescents in the world, nearly 90% currently live in countries other than the industrialized countries.  For many of these countries, young people represent a significant proportion of the population. In fact, young individuals less than 30 years of age may comprise over 70% of the population in some countries. Despite these demographics, addressing adolescent health needs in these countries have often lagged behind, until recently. Using country-specific case examples, workshop participants will examine the similarities and contrasts of emerging adolescent health issues in countries from four distinct global regions: the Middle East, Africa, Asia, and the Caribbean.  Adolescent health professionals will share their experiences in setting up the necessary services and programs to address local adolescent health needs in various settings. Using interactive small and large-group discussions, participants will discuss lessons learned and effective strategies to address relevant emerging adolescent health issues in global settings. The educational formats that will be used during this workshop include brief didactic case-based presentations, panel discussion, and interactive group discussions.

Educational Objectives:

  1. Identify and compare global adolescent demographics in the context of the disparities between existing needs and available services
  2. Identify unmet needs and challenges in setting up adolescent health services/programs in countries where adolescent health is developing.
  3. Identify successful approaches for setting up adolescent health services/programs in countries where adolescent health is developing.

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