Institutes at the SAHM annual meeting are three-hour sessions (with a 15-minute break), typically with multiple presenters. These sessions allow added time for a more in-depth examination of a particular subject in the field of adolescent medicine or health. They are intended for hands-on training, though they may also employ a variety of other educational formats: lecture, case-based presentation, panel discussion, or small group work.

Wednesday, March 14
1:00 - 4:30 p.m. 

“A Journey Through Gender”: Examining Fundamental Concepts and Clinical Decision-Making Strategies Essential to Caring for Transgender and Gender Non-Conforming Youth
Jonathan Warus, MD1, Johanna Olson-Kennedy, MD1, Aydin Olson-Kennedy, MSW, ACSW2
1Children's Hospital Los Angeles; 2Los Angeles Gender Center

Track: Clinical Foundation
Description: Over the past decade, clinics around the world have seen a large increase in the demand for services for transgender and gender non-conforming youth. Many large academic centers have established gender programs in order to address this growing need; however, they quickly experience an overwhelming surge of patients beyond their capacity, leading to long wait lists for patients accessing services. In order to continue to improve care for transyouth, more professionals must begin to provide services both within and outside of large academic programs. Many practitioners through SAHM continue to express interest in learning how to best meet the needs of this population. Using a multidisciplinary approach, this institute will provide a unique look into the fundamental concepts and knowledge necessary to equip new providers in meeting the needs of the transyouth population. The first portion of the session will re-examine the construct of gender and how this impacts models of care for transyouth. We will then move on to describe some nuances of gender dysphoria and ways in which it may manifest in the lives of transgender youth. For the final portion of the session, these background concepts will be applied to different patient scenarios. Within each scenario, there will be discussions about management decision-making and formation of clinical pearls to help practitioners individualize care for transyouth. These pearls will include topics such as mental health recommendations, medication regimen considerations, discussions of surgical interventions, and troubleshooting insurance denials.
Educational Objectives: 
  1. Describe the construct of gender and its impact on the formation of models of care for transgender youth.
  2. Recognize different nuances of gender dysphoria and how it can manifest in the lives of transgender and gender non-conforming youth.
  3. Begin to engage in the process of individualized clinical decision-making in order to synthesize potential medical treatment regimens unique to each patient.
Faculty Expertise: Jonathan Warus has been working with transgender and gender non-conforming youth for the past year under the training of Dr. Olson-Kennedy. As a new provider in this area, he offers unique insight into potential barriers and concerns that other providers may have in initiating care for transgender youth in their practice. Johanna Olson-Kennedy has been the medical director of the transyouth program at CHLA for over 10 years. This is the world’s largest clinic for transyouth with around 900 youth engaged in care. She is known around the world for her expertise and has trained countless other professionals in this area. As a transgender man and mental health provider, Aydin Olson-Kennedy brings a dual perspective into his work. He has spoken around the country for the past two decades about the importance of rights for gender non-conforming and transgender individuals, with an emphasis on identifying and acknowledging domains of privilege.

Supporting our Health Equity Workforce: managing vicarious trauma and leading change effectively
Maria Veronica Svetaz, MD, MPH, FSAHM, FAAFP1, Veenod L. Chulany, MD, MSED, FSAHM, CEDS2, Marissa Raymond-Flesch, MD, MPH3, Raina Voss, MD4, Mylien T. Duong, PhD5,  Dzung X. Vo, MD, FAAP6; Michele Allen, MD, MS7
1Hennepin Family Care Whittier Clinic; 2Phoenix Children's Hospital; 3University of California, San Francisco; 4Seattle's Children; 5University of Washington; 6BC Children's Hospital | University of British Columbia Faculty of Medicine; 7University of Minnesota

Track: Clinical Advances
Description: The current international and national shift from globalization to nationalism, the global reaction to religious extremism, the softening of protections for gender and sexual minority groups, and recurrent excessive use of police force in communities of color all communicate messages of pervasive structural and systemic bias against members of non-dominant groups. These messages have the potential to negatively impact the health and well-being of youth members of marginalized groups. Youth Providers are in unique position to identify youth who have experienced bias, discrimination, and stereotyping and to intervene as part of an overall strategy to foster youth development and promote health equity. Many providers working with marginalized youth also come from non-dominant religious, racial, ethnic, and/or sexual groups. These providers may have directly experienced discrimination and, along with anyone providing care for vulnerable youth, they are vulnerable to vicarious trauma through their clinical work with marginalized populations. These experiences of discrimination and vicarious trauma create extra burden on a workforce that is already taxed by the challenges of practicing in the face of systemic health inequities (e.g. fewer health care resources and more unmet needs). This workshop addresses: how to prepare providers to identify the effects that vicarious trauma and discrimination have on them, and how that affects their work with youth; how to engage providers to promote resilience, retention and propel system change as they work with communities that need them the most; and how to promote successful leadership skills to prevent provider burnout while advancing Health Equity.
Educational Objectives: 
  1. To identify the risk factors for vicarious trauma and discrimination in clinicians and clinical trainees.
  2. To identify the risk factors for vicarious trauma and discrimination in clinicians and clinical trainees.
  3. To acquire or refresh leadership tips to Advance Health Equity
Faculty Expertise: Dr. Svetaz is an immigrant from Argentina that has been working on MN Safety Net on Adolescent Health and Health Equity since 2001. Dr. Vinny Chulani is a cisgender, queer physician who has been active in clinical program development and health profession education on care of gay, lesbian, bisexual, transgender, and questioning youth. Marissa Raymond-Flesch , MD, MPH is a Mexican-American physician and public health researcher with a focus on the health and health care access of undocumented youth. Dr Voss is a Pediatrician fellow at the Seattle LEAH program who has championed research and leadership around topics like Health Equity, Implicit Bias and LGBTQ rights. Dr. Duong is a child clinical psychologist with expertise in culturally responsive evidence-based interventions mental health interventions of ethnic minority children and adolescents. Dr. Allen has been working applying CBPR to Health Equity issues in MN since 2001, in settings like healthcare and schools.

LARC 202: Intermediate and Advanced LARC Institute
Katherine Blumoff Greenberg, MD1, Mandy Coles, MD, MPH2, Aletha Y. Akers, MD, MPH3
1University of Rochester Medical Center; 2Boston University Medical Center; 3University of Pennsylvania School of Medicine

Track: Clinical Advances
Description: With US adolescent pregnancy, birth, and abortion rates at an all time low, researchers have found that these decreases are driven entirely by improved use of contraception. With long acting reversible contraception (LARC) use among women of all ages on the rise, experts also believe that better use of more effective contraception enables much of this improvement. We know that provider training predicts future LARC provision and that both clinical operations and provider knowledge can serve as barriers or facilitators to adolescent LARC use. Thus, it is not enough merely to offer LARC at our health centers; we must be prepared to use the evidence base in patient counseling, clinical operations, and challenging clinical cases. In this Institute, we plan to build on the knowledge base for beginning, intermediate, and advanced LARC practitioners to discuss both more and less common LARC management quandaries. We will discuss timing of LARC insertion and use of LARC in medically complex patients, as well as management of breakthrough bleeding and difficult contraceptive implant removals. We will also cover use of LARC for non-contraceptive indications, including in those young people with intellectual disabilities. For those attendees in resource poor settings, we will discuss the minimal clinical requirements for LARC insertion and how to problem-solve when and where LARC insertion can be achieved. Finally, for more advanced providers we will discuss advanced IUD placements, including immediate postpartum IUDs and difficult IUD insertions.
Educational Objectives: 
  1. Describe typical management issues that can arise during insertion, removal, and ongoing use of long acting reversible contraception (LARC)
  2. Discuss challenging LARC cases, including the management of less common complications
  3. Demonstrate individualized LARC counseling and management skills in small group formats
Faculty Expertise: Drs. Greenberg and Coles are pediatric adolescent medicine physicians and faculty of the Adolescent Reproductive and Sexual Health Education Program (ARSHEP) for Physicians for Reproductive Health, a doctor-led advocacy organization that works to improve access to comprehensive reproductive health care. Dr. Akers is an obstetrician and gynecologist who is the medical director of the adolescent gynecology program at Children’s Hospital of Pennsylvania. All three are long time LARC providers who serve as medical experts at their respective institutions. Drs. Greenberg and Coles lecture on reproductive health locally and regionally through their primary appointments as well as nationally through the ARSHEP program and other consultative educational roles; Dr. Akers is a nationally recognized expert in adolescent gynecology with prior invited lectures through such organizations as the Society of Family Planning (SFP), and the Association of Reproductive Health Professionals (ARHP), and the North American Society for Pediatric and Adolescent Gynecology.

Novel Strategies to prevent gender based violence among adolescents: Case studies from Kenya, Pakistan, Afghanistan, and the United States
Clea Sarnquist, DrPH, MPH1, Michael T. Baiocchi, PhD1, Judith McFarlane, PhD2, Jennifer Keller, PhD1, Cynthia Kapphahn, MD, MPH1
1Stanford University; 2Texas Women's University

Track: Public Health/Advocacy
Description: Gender-based violence exacts a high price on the health and well-being of adolescents worldwide. It frequently causes physical and emotional injury, severe stigma, and reduced life-long education attainment and economic potential. It can also result in unplanned pregnancy and sexually transmitted infections, including HIV. The conference theme, “Global Adolescent Health Equity”, is directly aligned with this institute, focusing on the human rights and well-being of adolescents in diverse global settings. In order to achieve global adolescent health equity, we must also recognize the role of gender equity. The need for such equity is supported by the global community in Sustainable Development Goal #5, Gender Equality, and will likely be of significant interest to the diverse and global population of attendees at the SAHM annual meeting. Increasingly, there is recognition that equity is not possible without addressing GBV explicitly, as it is an important factor in many other negative physical and mental health outcomes. In this institute, participants will first learn about the “big picture” of GBV prevention, then will move into case-based discussions of adolescent GBV prevention programs in four unique environments. We will then synthesize all of the learning into a larger discussion of best practices and directions for future practice and research.
Educational Objectives: 
  1. Describe the adverse effects of gender-based violence on the physical and mental health of adolescents, especially in global settings, including the impact on life-course.
  2. Understand leading methods of preventing and researching GBV, both in the US and globally.
  3. Compare and contrast GBV prevention interventions and rigorous research approaches across four diverse adolescent populations and nationalities in Nairobi, Kenya, Karachi, Pakistan, Kabul, Afghanistan, and San Jose, California.
Faculty Expertise: Dr. Sarnquist co-leads the gender-based violence (GBV) prevention research with adolescents in Kenya, with Dr. Baiocchi. She is an expert in evaluation of prevention programs. She teaches in global health. She and Dr. Baiocchi work closely with the teams in Afghanistan and Pakistan in a research consortium. Dr. Baiocchi co-leads the RCT in Kenya. He is a statistician specializing in creating solutions for rigorous analysis of complicated data. He teaches in statistics and has won several teaching awards. Dr. McFarlane co-leads with Dr. Rozina Karmaliani the RCT of an intervention to interrupt violence in schools in Pakistan and is an expert in intergenerational impact of GBV. Dr. Keller has developed and researched empowerment based GBV prevention programs for adolescents in the US. She teaches research methods. Dr. Kapphahn specializes in adolescent medicine and was a pediatric sexual assault Emergency Response Physician. Co-authored GBV prevention evaluations in Kenya.

SAHM Research and Mentoring Forum: Developing and Using Emotional Intelligence for Effective Research Management and Productivity
Maria Trent, MD, MPH1, S. Jean Jean Emans, MD2, Elizabeth Miller, MD, PhD3
1Johns Hopkins Medicine; 2Harvard Medicine School/Boston Children's Hospital; 3Univ of Pittsburgh School of Medicine/Children's Hospital of Pittsburgh
Track: Research
Description: The SAHM Research Committee leaders and LEAH program directors developed an initiative at SAHM in 2011 to strengthen research careers in adolescent health through a Research and Mentoring Forum. The program continues to build upon the recommendations from the November 2008 William T. Grant Foundation Conference, the IOM report on “Missing Opportunities”, the mission of the interdisciplinary LEAH program, the longstanding collaborative relationship of the Maternal Child Health Bureau and SAHM, and SAHM's strategic plan for the development of a new generation of adolescent health researchers who have the capacity to conduct research that addresses health disparities in health care delivery and health outcomes among adolescents in national and international settings. Through this collaborative effort, selected fellows and junior faculty have participated in a mentoring seminar and carefully paired with senior investigators to augment their research and professional development. This year we will select new mentoring participants and in addition invite the current cohort of forum mentees to present their research in progress with lessons learned and to receive additional feedback from colleagues and mentors regarding their work. New participants will be selected through an application process and also matched with experienced SAHM researchers for at least one year. Successful interdisciplinary team-based science requires effective communication and the capacity to manage emotions. The focus of this year's interactive training component will be focused on using emotional intelligence to cultivate collaborative and productive professional relationships that lead to enhanced research productivity.
Educational Objectives: 
  1. Execute a successful mentorship relationship with a senior investigator in adolescent health
  2. Pre-identify strategies to avoid and overcome common pitfalls faced by junior researchers while developing a research program
  3. Develop a plan for effectively building and/or working with an interdisciplinary research team to produce high quality science in adolescent health using emotional intelligence.
Faculty Expertise: Our team has been working with trainees through the mentoring forum since 2011. We are all independent investigators and training directors in Adolescent/Young Adult Health. Our expertise in topical areas is broad, but complementary and builds on our collaborative relationships with each other and senior researchers in SAHM to pair trainees and to bolster the in-session experience for learners. Past sessions have been well received and trainees have had positive outcomes as a result of their participation. Blood EA1, Trent M, Gordon CM, Goncalves A, Resnick M, Fortenberry JD, Boyer CB, Richardson L, Emans SJ.Leadership in adolescent health: developing the next generation of maternal child health leaders through mentorship. Matern Child Health J. 2015 Feb;19(2):308-13.

Saturday, March 17

8:45 a.m. - 12:00 p.m.

Intrauterine Contraception Placement for Medical Providers

Elise Berlan, MD, MPH1, Aletha  Akers, MD, MPH2, Mandy Coles, MD3, Melanie Gold, DO4, Katherine  Greenberg, MD5, Jennifer Hillman, MD5, Rachel J. Miller, MD6
1Nationwide Children's Hospital; 2Children's Hospital of Philadelphia; 3Boston University Medical Center; 4Columbia University; 5University of Rochester Medical Center; 6Children’s Hospitals and Clinics of Minnesota

Track: Clinical Foundation
Description: Although long acting reversible contraceptive (LARC) methods, such as contraceptive implants and intrauterine contraception (IUC), are safe and more effective than combined hormonal contraceptives and injectable contraception, few American teens use these methods. IUC [levonorgestrel and copper containing IUCs (e.g., Mirena, Liletta, Kyleena, Skyla, and Paragard)] is recommended as a first line contraceptive option for adolescents. However, a paucity of training opportunities for non-obstetrician/gynecologists has limited many providers’ ability to provide this valuable service to their adolescent patients. The goal of this institute is to reduce barriers to IUC provision among Adolescent Medicine clinicians. During the didactic component of the Institute, participants will: a. Learn about indications and contraindications for IUC use among adolescent and young adult women b. Review female reproductive anatomy c. Review the instruments used for IUC insertion and removal d. Receive instruction on the foundations of placing both the levonorgestrel and copper containing IUCs (Mirena, Liletta, Kyleena, Skyla, and Paragard) and managing potential complications.
Educational Objectives: 
  1. Verbalize indications for intrauterine contraception use in adolescents.
  2. Demonstrate skills in intrauterine contraception placement on a pelvic model.
  3. Identify strategies to improve collaboration with obstetrician-gynecologists and next steps to incorporate intrauterine contraception in their practice.
Faculty Expertise: Our teaching faculty are innovators in advancing contraception placement skills and represent diverse professional backgrounds: Pediatric and Adolescent Gynecology, Adolescent Medicine Pediatrics, and Student health services. We have presented this well-received training at SAHM Meetings four times over the last four years. All faculty are experienced intrauterine contraception providers and medical educators.

The Global University: providing culturally aware healthcare in U.S. higher education institutions to international students and U.S. students studying globally
Thomas A. Eccles, M.D.1, Stanford Shen Yu Ho, MD2, Michael D. Crandall, M.Ed.3, Bong Joo Hwang, PhD4
1Arizona State University Health Services; 2ASU Health Services; 3Arizona State University; 4ASU Counseling Services, Arizona State University
Track: Clinical Advances
Description: Higher education institutions throughout the United States enroll what has been until recently an increasing numbers of International Students. US students study abroad frequently. Successfully providing healthcare to international students studying in the US involves using a carefully-crafted mélange of medical, cultural, language and social knowledge in order to address the needs and expectations of these students. Preparing US students for travel abroad is differently complex, involving preventive healthcare and sociological preparation. It is not clear what impact global political and social unrest may have on numbers and countries of origin of students studying outside their home countries, but students see education as a global endeavor and numbers will likely remain high. Language differences, financial concerns, family expectations, and student worries about the impact of global change on their studies and careers play significant roles in defining healthcare needs in this arena. Providing healthcare to International Students requires a willingness to explore students’ prior healthcare experiences, differences in the cultural understandings of disease processes and treatments, and culturally-defined expectations students have of providers and systems. These elements will impact a patients’ willingness to accept recommended interventions and treatments. Providing anticipatory care to US students traveling abroad also requires a nuanced understanding of disease, risk and social expectations that may impact the student experience. This workshop is designed to provide information as to the many disciplines, processes and collaborations needed to provide culturally sensitive and medically appropriate care in the Global University, and to promote participant discussion concerning this ever-changing topic.
Educational Objectives: 
  1. Identify challenges facing international students studying in US Higher Education Institutions, and analyze how those challenges impact the physical and mental health of students and what interventions can be developed to mitigate those challenges.
  2. Describe some of the challenges facing students who are traveling abroad from the US, and describe ways in which healthcare and mental healthcare providers may provide interventions that might mitigate the risks these student may encounter.
  3. Describe how ongoing geopolitical changes may impact both international students and US students studying abroad, and describe ways in which institutions and providers may support and advise the global student so as to enhance their resilience.
Faculty Expertise: Dr. Thomas Eccles has worked in College Health intermittently since 2005, exclusively since 2015 when he joined Health Services at Arizona State University (ASU). As Lead for Education at ASU Health Services, he has programmed CME presentations that bring to Health Services international students and international health experts to discuss culturally-based healthcare needs for international students and domestic students traveling abroad. In his role in directing the Mayo Internal Residency Young Adult Medicine Rotation, he has expanded educational goals and objectives in International Health and Travel Medicine. He has extensive experience in interviewing and video presentations that will make up a portion of this Institute, as well as extensive experience leading workshops and institutes for ASU and other institutions. For this presentation, other faculty and administrators at ASU will collaborate via embedded video interviews offering additional insights into this topic. They will not attend in person.