Workshops: Saturday, March 17


8:45 - 10:15 a.m. Sessions

Assisting the Anxious Adolescent: Practical Skills for Adolescent and Young Adult Health Clinicians in an Outpatient Setting
Paritosh Kaul, MD1, Bethany Ashby, Psy D1, Diane Reichmuth, Psy D2
1University of Colorado School of Medicine; 2Childrens Hospital Colorado
Track: Clinical Foundation
Description: The incidence of anxiety among adolescents globally ranges from 6%-25%, depending on the country. Adolescents all over the world experience anxiety due to a number of psychosocial stressors, many of which are specific to the adolescent experience. These include managing conflict with parents and peers, negotiating romantic relationships, identity development, use of social media, increasing academic demands, and substance use. Adolescents also experience anxiety related to broader concerns about poverty, natural disasters, deportation, terrorism, and war. Description of significance: It is important for adolescent health providers to have the knowledge and skills to contribute expertise in diagnosing adolescents with anxiety and manage their symptoms in different settings. This practical workshop will share information on how to manage these mental health concerns in various settings using an integrated model. Relevance to conference theme: Adolescent health equity. By using an integrated care model (mental health and physical health), we will provide an increased opportunity for health equity for this vulnerable population by increasing providers’ awareness of anxiety symptoms and the impact of anxiety on functioning, as well broadening providers’ understanding of frequent adolescent concerns. Due to the bidirectional relationship between mental and physical health, it is important to address both of these concerns when adolescents present in medical clinics. Relevance of the session to the diverse, multicultural attendee’s: Those in attendance are likely those involved in providing direct care to adolescents, and our workshop will focus on specific strategies to increase their knowledge and skills in helping adolescents manage anxiety.
Educational Objectives: 
  1. List the common symptoms of anxiety in adolescent and young adults (AYA)
  2. Select appropriate screening and assessment tools for anxiety in AYA in an outpatient setting
  3. Teach coping strategies to AYA with anxiety in an outpatient setting
Faculty Expertise: Dr. Paritosh Kaul is a Professor of Pediatrics, in the Section of Adolescent Medicine, at the University of Colorado, School of Medicine, at the Children’s Hospital, Colorado (CHCO). He brings expertise in the area of adolescent medicine, mental health and cultural competency. Dr. Bethany Ashby is an Assistant Professor, University of Colorado, School of Medicine. Currently, she is Clinical Program Director of HEART (Healthy Expectations Adolescent Response Team), and Clinical Director of Psychological Services, PROMISE (Perinatal Resource Offering Mood Integrated Services and Evaluation), at CHCO. Dr. Diane Reichmuth is a psychologist at CHCO and Aurora Mental Health’s Integrated Care Team. At CHCO she worked with the Juvenile Firesetters Team and Adolescent Medicine. Her expertise includes working at CHCO, homeless shelter and private practice. All three have provided expertise in the Integrated Care model at CHCO providing standard of care for mental health assessments.

Creating Gender-affirming Medical Services for Transgender and Gender Non-conforming Youth in Rural and Under-resourced Areas
Jamie Mehringer, MD, Erica Gibson, MD
University of Vermont Children's Hospital
Track: Clinical Advances
Description: At SAHM conferences in recent years, the vast majority of presentations about care of trans youth were from multidisciplinary centers in large freestanding children’s hospitals in urban centers. While large multidisciplinary youth gender clinics such as these are an excellent resource, unfortunately many youth lack access to these centers simply due to distance. In our experience, there is a misperception amongst providers that these services cannot be adequately provided outside of these large centers, thus perpetuating the lack of access to services for youth living in more rural or resource-limited areas. We intend to show that these services can indeed be provided safely and effectively on a small scale, outside of quaternary care centers or freestanding children’s hospitals. Through discussion of our own experiences in establishing a small transgender youth clinic in Vermont serving youth in rural areas, we will explore challenges and strategies for overcoming barriers to providing gender affirming care in this setting. 
Educational Objectives: 
  1. Identify concrete steps that can be taken to establish gender-affirming medical services for trans youth in rural or under-resourced areas
  2. Identify barriers to establishing gender-affirming medical services for trans youth in rural or under-resourced areas
  3. Identify resources for establishing gender-affirming medical services for trans youth in rural or under-resourced areas
Faculty Expertise: Dr. Jamie Mehringer is a fellow in adolescent medicine at The Children's Hospital of Philadelphia and an attending physician in pediatrics at the University of Vermont Children’s Hospital where he co-founded the Transgender Youth Program, Vermont’s first clinic offering gender-affirming medical care for transgender youth of all ages.  Dr. Erica Gibson is the Director of Adolescent Medicine at the UVM Children’s Hospital.  Dr. Martina Drawdy is a Pediatric Endocrinologist and co-founder of the UVM Children’s Hospital Transgender Youth Program. 

AA-HA! How to Accelerate Action for the Health of Adolescents Globally
Sophie Leticia Remoue Gonzales, MD1, David A. Ross, MA, MSc, BMBCh, PhD2, Valentina Baltag, MD, MSc, PhD2, Danielle Engel, MA3, Jason Nagata, MD, MSc4
1Baylor College of Medicine/Texas Children's Hospital; 2World Health Organization; 3The United Nations Population Fund; 4University of California, San Francisco

Track: Public Health/Advocacy
Description: With 1.8 billion adolescents in the world, 89% of whom live in LMIC’s, adolescent health has come to the forefront of the global agenda including its addition to the United Nations’ Global Strategy for Women’s, Children’s and Adolescent’s Health 2016-2030. 2017 marked the launch of the Global Accelerated Action for the Health of Adolescents (Global AA-HA!) guidance to support country implementation of this agenda. This workshop will feature WHO’s and UNFPA’s leaders in adolescent health as well as young investigators who contributed to the AA-HA! This forum will highlight recent contributions of United Nations organizations to global adolescent health research and policy. We will provide an overview of the findings of the Global AA-HA! including evidenced-based interventions, planning and implementation of national programs, and priority areas for future research in adolescent health.
Educational Objectives: 
  1. Describe the role of the World Health Organization (WHO) and the United Nations Population Fund (UNFPA) in advancing adolescent health.
  2. Highlight the main recommendations of the Global Accelerated Action for the Health of Adolescents (Global AA-HA!) guidance document.
  3. Identify priority areas for future research in adolescent health, particularly in low- and middle-income countries (LMIC’s).
Faculty Expertise: Dr. David Ross and Dr. Valentina Baltag are both members of the WHO’s Department of Maternal, Newborn, Child & Adolescent Health. Dr. David Ross is a Medical Officer with expertise in adolescent health research and guidelines. Dr. Valentina Baltag is a Scientist with expertise in programming and policies in adolescent health. Danielle Engel, a sociologist by training, is a technical specialist on Adolescent and Youth at the United Nations Population Fund who has worked all across the world. Ross, Baltag, and Engel are co-authors of the Global AA-HA! Dr. Sophie Remoue Gonzales and Dr. Jason Nagata are post-doc clinical fellows at Baylor College of Medicine/Texas Children’s Hospital and at the University of California, San Francisco, respectively, who interned at WHO’s Department of Maternal, Newborn, Child & Adolescent Health as early career professionals under Dr. David Ross’ supervision. They are the co-leaders of SAHM’s Global Adolescent Health Special Interest Group (SIG).

Powerful Presentations: The art and science of communicating information, ideas, and concepts in adolescent health
Richard J. Chung, MD1, Joshua Borus, MD, MPH2
1Duke University School of Medicine; 2Harvard Medical School
Track: Training/Education
Description: In follow-up to our successful workshop at the 2015 SAHM annual meeting, we propose an update on the rapidly evolving art and science of presentation design and delivery. At core, adolescent health professionals are communicators. Whether in a lecture hall, at a research symposium, before a school board, or on the evening news, adolescent health advocates are often positioned to influence minds and attitudes in ways that can powerfully affect the well-being of adolescents. Communicating well is just as important as having something to say. This is particularly true in the domain of global adolescent health equity in which skillfully interweaving stories and data is crucial to convey the lived experiences of adolescents in faraway settings to key stakeholders in order to improve health and mitigate disparities. 350 PowerPoint presentations are given every second around the world, yet many are ineffectual or even detrimental to communicating content effectively. Unfortunately, the adolescent health community is not immune to these challenges. Whether hiding behind soporific slides, failing to engage an audience or rambling through a bloated research presentation, our imperfections and inefficiencies as communicators detract from the value of our efforts and our collective impact as a Society. Given the crucial importance of conveying ideas and shaping attitudes in advocating on behalf of adolescents, it is fortunate that these errors are remediable. Borrowing concepts from the business, psychology, design, and performing arts worlds, adolescent health advocates can maximize the impact of their ideas, opinions, and research findings and create truly powerful presentations.
Educational Objectives: 
  1. Describe core concepts in formulating a presentation and key vehicles for effective communication including storytelling.
  2. Summarize the evidence available to guide presentation design and delivery.
  3. Synergize the art and science of powerful presentations and create a personal action plan to strengthen one’s delivery of content across contexts.
Faculty Expertise: Dr. Richard Chung is the Director of Adolescent Medicine at Duke University and is an Associate Professor of Pediatrics and Medicine. Dr. Josh Borus is Director of Resident and Medical Student Training for the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital and Instructor in Medicine at Harvard Medical School. He and Dr. Chung have given multiple seminars on the topic of presentation and slide design including at the 2015 SAHM annual meeting and the 2016 Pediatric Academic Societies meeting. In addition, Dr. Chung has mentored several trainees and faculty members in creating and delivering effective presentations and is an active member of the Duke AHEAD Health Education Academy in which he has lectured on this topic area. Dr. Borus has also worked with residents, colleagues and trainees on effective communication strategies in teaching settings and is a member of the Boston Children’s Hospital Academy.


Working with Your IRB to Facilitate Research with Adolescents
Judith L. Navratil, MA, CIP1, Elizabeth Miller, MD, PhD2, Heather L. McCauley, ScD, MS3, Michael P. Marshall, PhD1
1University of Pittsburgh; 2Children's Hospital of Pittsburgh; 3Michigan State University
Track: Research
Description: Human subjects review committees (or Institutional Review Boards, IRB) generally require parental permission for individuals under the age of 18 to participate in research. Both the Institute of Medicine (IOM) and Society for Adolescent Health and Medicine have asserted that requiring parental consent ignores adolescents’ decision-making capacities and seriously impedes vital research that could benefit individual adolescent participants as well as promote the health and wellbeing of all adolescents. Yet, IRBs continue to base their review of adolescent research on the supposition that all children are incapable of providing consent, even though the regulations specify that for some research, parental permission may not be a “reasonable requirement” to protect child subjects, allowing IRBs to waive parental permission “provided an appropriate mechanism for protecting the children who will participate as subjects in the research is substituted, and provided further that the waiver is not inconsistent with federal, state, or local law.” We will explore the notion that parental permission should not be required for adolescents’ participation in many types of minimal risk research for two different sets of reasons. The first concerns adolescents’ autonomy and well-being. The second concerns the potentially negative repercussions the requirement for parental permission has on the quality of science, including generalizability of research results.
Educational Objectives: 
  1. Identify how the requirement for parental permission for studies about behaviors that impact adolescent health adversely affects research with adolescents, and in particular, at risk and marginalized adolescents, including LGBTQ youth and adolescents
  2. Recognize opportunities that exist for asking that IRBs waive parental permission for research with adolescents and develop strategies that emphasize adolescents’ strengths and that focus on the adolescents’ best interests, not parental rights.
  3. Develop a ‘toolkit’ to use when working with the IRB to justify waivers of parental permission for research.
Faculty Expertise: Prior to joining the University of Pittsburgh Human Research Protection Office, Judith Navratil spent 20 years running longitudinal research on adolescent mental health. Her Master’s Degree in Bioethics focused on research with vulnerable populations and she has given national presentations on this topic. Elizabeth Miller, MD, PhD, has extensive experience in community-partnered intervention research on interpersonal violence prevention and sexual health promotion for adolescents and young adults. Her research includes work in low-resource, marginalized communities and with youth in the juvenile justice and child welfare systems. Michael Marshal, PhD has an NIH-funded program of research on mental health and substance use disparities among LGBT youth, with a special focus on identifying trajectories, mediators, and moderators of the disparities in order to develop prevention and intervention programs. Dr. Heather L. McCauley’s research focuses on victimization among marginalized communities including sexual minority youth and youth in foster care.


10:30 a.m. - 12:00 p.m. Sessions

Surviving Shark Week: A Multidisciplinary Case Discussion of Evaluation and Management of Adolescents with Abnormal Uterine Bleeding
Tanya L. Kowalczyk Mullins, MD, MS1, Rachel J. Miller, M.D.2, Eric S. Mullins, M.D.3
1Cincinnati Children's Hospital Medical Center; 2Children’s Hospitals and Clinics of Minnesota; 3Cincinnati Children’s Hospital Medical Center
Track: Clinical Foundation
Description: Complaints about heavy or otherwise abnormal menstrual bleeding are among the most common clinical issues confronted by primary and subspecialty providers caring for adolescents domestically and globally. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) introduced a refined system of nomenclature to standardize the description of abnormal uterine bleeding in women: PALM-COEIN. The American College of Obstetricians and Gynecologists (ACOG) subsequently endorsed the adoption of this naming system. The overall intent of this workshop is to review the PALM-COEIN nomenclature system and management of abnormal uterine bleeding from a multidisciplinary perspective. Because the FIGO nomenclature system was designed to be used by providers internationally, this topic is relevant to all SAHM attendees who provide medical care to adolescent women. In addition, by understanding the current recommendations for evaluation and treatment of abnormal uterine bleeding, health care providers in all settings will be able to implement evidence-based care for their patients, thereby enhancing global equity of health care services for young women. The session faculty represent three different subspecialties that treat adolescents with abnormal uterine bleeding (AUB): adolescent medicine, adolescent gynecology, and pediatric hematology. This multidisciplinary format will allow for a unique interaction and discussion between faculty and participants.
Educational Objectives: 
  1. Describe the classification system and terminology related to abnormal uterine bleeding.
  2. Determine which adolescents presenting with abnormal uterine bleeding warrant further evaluation.
  3. Formulate a plan for clinical and laboratory evaluation of adolescents with abnormal uterine bleeding and discuss the management options.
Faculty Expertise: Dr. T. Mullins is a board certified adolescent medicine subspecialist with a clinical interest in women’s reproductive health. She provides consultative medical care to adolescents with menstrual disorders and teaches local trainees on this topic regularly. Dr. Miller is a board certified obstetrician/gynecologist who co-originated the combined hematology/gynecology clinic at Cincinnati Children’s in 2007 when she was a fellow in pediatric and adolescent gynecology and has continued her clinical interest with a similar clinic at Children’s Minnesota. She has spoken at the National Hemophilia Foundation annual meeting as well as local “Women’s Weekend” and summer camp events. Dr. E. Mullins is a board certified pediatric hematologist with a clinical and research focus on hemostasis. With Dr. Miller, he cofounded the combined hematology/gynecology clinic in Cincinnati and has continued this multidisciplinary clinic for the last 8 years. His practice focuses around children and young adults with bleeding and thrombotic disorders.


Global Advances Informing Clinical Practice and Service Systems for Adolescents and Young Adults in Primary Care
Lena Amanda Sanci, MBBS., PhD., FRACGP1, Dagmar Martina Haller, MD., PhD2, Melissa Shi-Ling Kang, MBBS., PhD., Master Community Health3, Elizabeth  Ozer, PhD., MA (Psych)., BA (Psych)4, Anne  Meynard-Colomb, MD., FMH, IUD2
1University of Melbourne; 2University of Geneva & Geneva University Hospitals; 3University of Technology Sydney; 4University of California, San Francisco (UCSF)
Track: Clinical Advances
Description: This session will present recent research evidence from around the globe including the US, Australia, Switzerland and selected low and middle income countries that will allow a contemporary understanding of both the service system factors and clinical consultation factors that impact on achieving quality youth focused adolescent primary care, including the ability for young people to navigate the system, see appropriate health providers, engage with care and have health risks detected. Service navigation barriers will be examined particularly for vulnerable groups such as the chronically ill, Indigenous, gender diverse, rural, and culturally diverse with implications for clinical practice. Findings from recent research and evidence reviews testing long held best practice frameworks on adolescent risk assessment and intervention will be presented with their implications for clinical practice. Recent evidence testing innovations, including technology, in service design and clinical approaches to health issues will be examined and applications discussed. Participants will consider their own contexts, disciplines and settings and local solutions in light of evidence. With the growth of non-communicable diseases even in low and middle-income countries, the need for effective systems and clinical approaches to engage adolescents, particularly the most vulnerable, in preventive and ongoing care and early intervention is important to achieve better health outcomes for youth and the future adults and parents they will become and to have more efficient health systems. The content of this sessions thus aligns with the theme of the conference on global adolescent health equity.
Educational Objectives: 
  1. Relate recent research on standard and innovative approaches to quality youth focused primary care to implications for clinical practice, service design and for clinical teaching
  2. Relate recent research findings on barriers and enablers of an accessible quality primary care system for vulnerable adolescents to how these impact on clinical care
  3. Appraise context and settings of primary care for adolescents around the globe and the innovations in place, or required, for effective service navigation and clinical approaches to improve health outcomes.
Faculty Expertise: Collectively, the leaders of this workshop have vast experience in the field of youth health research, and as clinicians dedicated to improving adolescent primary care. In addition to their considerable clinical experience, all leaders bring specific research expertise to guide the workshop. This includes system based interventions in primary care (LS, DH, EO), models of youth friendly health care and health system navigation (LS, MK), addressing access barriers to health care for young people (All), evaluating risk and protective factors in providing youth-friendly care (LS, DH, EO), improving clinical education to deliver better health care for adolescents (All), improving screening and counselling for health risks (LS, EO), and the use of technology to facilitate preventive health care in young people (LS, EO). The leaders have applied their knowledge to the study of adolescent primary care in Western and Eastern Europe, Australia, North America and Asia.

No Limitation as Limitation: Embracing creative spaces and diverse teams to generate, frame and implement fearless ideas to meet every youth’s potential
Brandi Shah, MD, MPH1, Andrea Hoopes, MD, MPH2, Casey Magee, MA3
1Pacific Medical Centers; 2Kaiser Permanente Washington; 3Greater Seattle Bureau of Fearless Ideas
Track: Public Health/Advocacy
Description: This session encourages people to come with their most fearless and persistent ideas about improving the lives of youth. These ideas are unfailingly those that would uplift the lives of the most underserved youth and their communities, but instead remain unactualized due to a fatalistic sense of structural realities, expertise silos and fear of inadequate impact. We will bring together the diverse SAHM community, Bureau of Fearless Ideas (BFI)--a youth-centered writing nonprofit in Seattle, and youth to nurture an environment of creative possibility that teaches modern principles and methods for engaging in group processes that “[have] no limitation as limitation” (Bruce Lee). BFI is a corps of youth and adult allies who believe the power of words can open doors to important opportunities. Tutoring, writing, and publishing programs prepare youth for the future by developing strong writing skills, championing diverse communication styles, and motivating personal story-telling. Along with BFI's example, we will teach attendees how to leverage practices of two frameworks borrowed from non-health sectors—transdisciplinary collaboration and human-centered design—in order to cultivate creative spaces in their own settings, prioritizing open flow of ideas, responsive team participation, and equitable engagement. Though modern technology allows us to do most anything virtually, human connection remains integral to how we work together for good. We invite participants to engage in creative, youth-centered, problem-solving spaces for 90 minutes. They will leave with a renewed sense for shaping inclusive teams with multifaceted expertise, redefining measures of success, and positively engaging youth along the way.
Educational Objectives: 
  1. Leverage principles of collaborative and design frameworks that can be applied to their own creative processes and equitable team participation as they follow youth-centered ideas from conception to execution
  2. Demonstrate group process methods presented in the session by participating in real-time equitable, creative spaces that offer practice in building on concepts and implementation strategies for pressing youth health and development challenges
  3. Differentiate the roles and expertise of community and academic colleagues, including youth, who represent diverse disciplines, sectors and lived experience that can complement open, creative, and equitable teams
Faculty Expertise: Dr. Shah practices family and adolescent medicine. She operates at the intersections of rights-based sexual and reproductive health service delivery, community engagement and positive youth development. As a clinician and transdisciplinary collaborator, she has worked in many settings domestically and internationally. She believes in empowering marginalized youth and women to center their voices and agendas in the discourse about healthcare innovation. Dr. Hoopes is an adolescent medicine physician whose work focuses on improving the sexual and reproductive health of adolescents in low-resource settings and marginalized communities. She is currently building an innovative tool designed to improve teen sexual health outcomes by engaging parents, guardians and supportive adults as primary sexual health educators for young people.Mr. Magee is a youth development professional with a Masters in Non-Profit Management and 5+ years of experience in managing non-profit projects, programs and operations that leverage community support to help youth reach their full potential


Negotiating with your chair: Essential advice for adolescent faculty
Mary A. Ott, MD MA1, Susan L. Rosenthal, PhD2, Keith J. Loud, MD, MMSc3, Leslie R. Walker-Harding, MD4, Renee Jenkins, MD5, Elizabeth McAnarney, MD6, Marianne Felice, MD7
1Indiana University School of Medicine; 2Columbia University College of Physicians and Surgeons; 3The Geisel School of Medicine at Dartmouth; 4Penn State University Hershey Medical Center; 5Howard University; 6University of Rochester; 7University of Massachusetts Medical School
Track: Training/Education
Description: One of the most difficult things for adolescent faculty is negotiating with their chair. While adolescent providers tend to be fierce advocates for youth, we often fall short in advocating for ourselves. Because adolescent medicine is not a big revenue generating subspecialty, we often do not have the financial clout within the university. A vice-chair for faculty development and several department chairs (all SAHM members!) will participate in a panel discussion about effective approaches to working with one’s chair. Topics will include building a relationship with your chair, preparing for meetings with one’s chair, and strategies for negotiation with a chair. We will address common “asks”, including time and support for salary, new programs and fellows. We will provide common scenarios as well as take questions from the audience . Adolescent medicine is a diverse, multidisciplinary field. Coaching adolescent providers to advocate for themselves helps address workplace inequities and builds a vibrant, diverse adolescent health workforce.
Educational Objectives: 
  1. Identify approaches to build a relationship with one's chair.
  2. Identify strategies for negotiating with a chair.
  3. Identify preparations and approaches needed for an "ask" from a chair.
Faculty Expertise: Dr. Rosenthal is a vice chair for faculty development who has extensive experience in coaching adolescent health faculty to advocate for themselves. She has given talks and has publications on faculty development. Dr. Ott is a mid-level faculty member committed to professional mentorship with experience running panel discussions. The panel will consist of SAHM members who are current or former department chairs to provide a chair's perspective on negotiation.

Bringing Youth Voice into Research – Youth Participatory Action Research
Michele Allen, MD, MS1, Luis Ortega, MEd2, Mikow Hang, BA2, Shannon Pergament, MPH2, April Wilhelm, MD1
1University of Minnesota; 2SoLaHmo Partnership for Health and Wellness
Track: Research
Description: Objective: Adolescent health research may benefit from including youth voice in the planning and implementation of research projects through youth participatory action research (YPAR), where youth conduct their own research to address institutional structures and contexts that impact their health. The objective of this workshop is to prepare adolescent health researchers to involve youth in all stages of research processes, and particularly to conduct and apply YPAR. Content of the session: Using examples from the NIH-funded YPAR study, Project TRUST (Training for Resiliency in Urban Students and Teachers) and their own research experiences, participants will learn and share: a) the tenets of YPAR and benefits of bringing youth voice into decision making; b) resources, tools, and processes for supporting and conducting YPAR; c) benefits and challenges of bringing youth into larger research projects (e.g. assuring youth voice within adult-dominated groups); and d) explore applications within adolescent health research.
Educational Objectives: 
  1. Learners will identify and describe at least two resources for conducting youth participatory action research.
  2. Learners will describe common challenges and approaches to addressing challenges to the process of youth participatory action research.
  3. Learners will develop strategies to incorporate youth participatory action research in their current research activities
Faculty Expertise: Presenters at this workshop are participating on a NIH funded research project using youth participatory action research. The primary presenter with the community co-presenters have published and presented widely on the topic of participatory research, and youth participatory action research.