Hot Topics

The Hot Topics sessions is one of the most popular components of SAHM annual meetings. There are two sessions, each consisting of four fifteen minute presentations on today's hottest topics in adolescent health.  

 



Hot Topics I: Wednesday, March 6 - 10:15 - 11:30 a.m.

Moderator: Matthew Aalsma, BA, MA, PhD, HSPP

Caught in the Middle: Public Charge Proposals, Mandatory Reporting and U.S. Immigrant Youth
 Lisa Klee Mihaly, RN, MS, FNP; Naomi Schapiro, RN, PhD, CPNP
University of California San Francisco
 
Description:
In October 2018, the Trump administration proposed a dramatically expanded definition of “public charge” for families seeking admission or permanent residence. If adopted, the use of health care, including Medicaid and possibly CHIP, food assistance (SNAP) and housing vouchers, could be used against families in the immigration process. Immigrant families may disenroll their youth from insurance, suffer greater food and housing insecurity, all with detrimental impacts on physical and emotional health. We will update participants on these changes, and strategies for mitigating impact.

All 50 states and the District of Columbia have mandatory child abuse reporting laws. Many states have since added mandatory reporting requirements for trafficking and domestic violence cases. Reporting can bring immigrant families into view of child protective service agencies and/or the police, but has also aided some families in establishing residency or gaining asylum. However, there are increasing reports of family separation and deportation, including arrests of IPV victims arriving at court to testify against their abusers. Approaches to ethical decision-making and protecting the rights of youth and families will be explored.

Providers and staff in clinics serving immigrant youth face increased stress, vicarious trauma and potential burnout as our traditional approaches toward both legal professional responsibilities and enrollment in health care, housing and food assistance may have greater risks and fewer benefits in the current climate. We will review approaches to decision-making and addressing the rights of youth and families as outlined in UN Convention on the Rights of the Child.

Learning Objectives:
 
  1. Discuss the status of proposals to expand criteria for public charge and expected impact on immigrant youth and families
  2. Identify benefits and potential risks to immigrant patients and families related to mandatory reporting of child abuse, trafficking, and intimate partner violence 
  3. Discuss the legal and ethical challenges for providers, staff, and organizations working with immigrant youth in the current political climate
  
The Creation and International Impact of the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents

Michelle M. Telfer, MBBS (Hons.) FRACP; Michelle Tollit, Bach. Psychology, Masters Psychology, PhD;
Carmen Pace, Bach. Psychology (Hons.) Masters Psychology, PhD; Ken Pang
The Royal Children's Hospital Melbourne
 
Description:
Clinical standards of care and treatment guidelines for the transgender population have been available since the first publication of the World Professional Association for Transgender Health (WPATH) SOC in 1979. WPATH have now published seven versions of this guideline, most recently in 2011. Creation of the WPATH SOC version8 has commenced but is in the early stages of production and is not expected to be published until after 2020. Initiated to advocate for legal reform in Australia in the absence of international guidelines that reflected best practice for affirming care for transgender adolescents, the guideline was created using empirical evidence, clinical consensus and results of non-randomised and observational studies. They were developed in consultation with multidisciplinary experts from across Australia, peer and parent support groups, trans children, adolescents and their families. The Australian guidelines differ from previous international guidelines by moving away from arbitrary treatment recommendations based on chronological age, with recommended timing of medical transition and surgical interventions dependent on the adolescent’s capacity and competence to make informed decisions, duration of time on puberty suppression, coexisting mental health and medical issues, and existing family support. They also stand apart from previous recommendations by suggesting that social transition should be led by the child. The significance of this guideline in promoting current best practice has been recognised by The Lancet who provided editorial comment recommending their use (Vol 391 June 2018). This followed their publication in the Medical Journal of Australia (Med J Aust doi: 10.5694/mja17.01044 18 June 18)

Learning Objectives:
 
  1. Identify the current medical and psychosocial issues facing trans and gender diverse adolescents internationally 
  2. Identify and understand the latest and most progressive clinical recommendations for gender affirming care and treatment for trans and gender diverse adolescents  
  3. Identify the reasons for creation of this guideline and their impact internationally following publication in the Medical Journal of Australia and subsequent editorial comment provided in The Lancet encouraging their implementation internationally
 
Suicide, Mass Shootings, and the Media: Improving Adolescent Psychological Well-being in an Age of News Oversaturation
Nicholas J. Westers, Psy.D.
Children's Medical Center Dallas & UT Southwestern Medical Center
 
Description:
With instant access to news online and through social media, today’s youth are inundated with news headlines from all over the world more than ever before. With recent top stories including suicide (Kate Spade, Anthony Bourdain) and mass shootings (Orlando nightclub, Parkland and Santa Fe high schools), mental health and well-being have jumped to the forefront of today’s hot topics. One in 4 U.S. teens reports feeling very worried that a shooting could happen at their school, while suicide has become the 2nd leading cause of death among adolescents worldwide. These rates are even higher among sexual minority youth, a vulnerable group in which a quarter report having attempted suicide within the past year.

Since the 1970’s, social psychology research has shown that when a suicide is publicized, rates of suicide among similar individuals acutely increase within the next 10 days (“Werther Effect”), but responsible media reporting may have protective effects (“Papageno Effect”). As a result, media guidelines for reporting responsibly on suicide in the news and on television have been published.

This Hot Topic presentation will briefly review the history and research of the Werther and Papageno effects as related to both suicide and murder-suicide, use screenshots of recent news headlines to illustrate and highlight key media recommendations for responsibly reporting such tragedies, briefly dispel common mental health myths, and offer strategies that all healthcare professionals (physicians, nurses, social workers, psychologists, advanced practice providers, other health professionals) can integrate into their work with adolescents, parents, and the public.

Learning Objectives:
 
  1. Define the Werther Effect & Papageno Effect and their relation to research on suicide and murder-suicide contagion 
  2. Explain at least 3 ways suicide and mass shootings should be responsibly reported or depicted in the media 
  3. Describe practical strategies for how adolescent healthcare providers can raise mental health awareness and help-seeking behavior among youth

Opportunities to Increase Health Equity and Well-Being of Adolescents and Young Adults Through Worldwide Access to Pre-Exposure Prophylaxis (PrEP)
Renata Sanders, MD, MPH, ScM1; Adam Leonard, NP, MPH, MS, AAHM2; Jack Rusley, MD, MHS3
1Johns Hopkins University School of Medicine, 2San Fransisco Department of Health
Hasbro Children's Hospital, 3Alpert Medical School of Brown University
 
Description: 
Adolescents (10-19) and young adults (20-24) (AYA), especially young women and key populations are disproportionately burdened by immunodeficiency virus (HIV) infections worldwide.

Pre-exposure prophylaxis (PrEP) co-formulated as tenofovir (TFV) disoproxil fumarate (TDF) and emtricitabine (FTC), is a biomedical intervention when taken can protect against HIV transmission in as much as 75% in heterosexual serodiscordant partnerships and 92% in men having sex with men (MSM) and transgender women when taken daily. PrEP uptake in AYAs in the U.S. and worldwide has been limited due to provider, system and individual barriers to access the drug. PrEP interventions require an interdisciplinary, multi-team, community approach that incorporates PrEP into a comprehensive framework that addresses the social context, developmental and sexual health needs of AYAs.

With FDA approval in May 2018 of PrEP for adolescents age 12-17 weighing 35 kg or more and the World Health Organization recommending PrEP since September 2015 for anyone at substantial risk of HIV infection as part of combination HIV prevention approaches, youth-serving clinicians in all parts of the world will need to armed with the skills to be able to use this HIV prevention tool in their practice. This hot topic will review the: 1) evidence regarding use of PrEP in AYAs; 2) key barriers that need to be addressed in order to increase access to PrEP; 3) steps as outlined in the recent Society for Adolescent Health and Medicine Position paper; and 4) examples of strategies to improve PrEP access and health equity in AYAs.

Learning Objectives:
 
  1. Understand the state of science on pre-exposure prophylaxis (PrEP) in preventing HIV among adolescents
  2. Identify barriers and facilitators to adolescents and uptake of PrEP
  3. Discuss the role of youth-serving clinicians and practical approaches to increase PrEP uptake among adolescents and improve health equity



Hot Topics II: Thursday, March 7 - 9:15 - 10:30 a.m.

Moderator: Christina Akre, PhD

Helping Adolescents Thrive (HAT): A New Intervention Package for the Promotion of Adolescent Mental Health and Prevention of Mental Disorders, Risk Behaviours and Self-Harm
David Anthony Ross, MA, MSc, BMBCh, PhD
World Health Organization

Description:
We will present the Helping Adolescents Thrive (HAT) intervention package for the promotion of adolescent mental health and prevention of mental disorders, risk behaviours and self-harm which has been developed by the Universities of Cape Town and Stellenbosch in collaboration with WHO and UNICEF based on an extensive review of the global literature and expert consultations and based on WHO/UNICEF guidelines that are in currently under development. The interventions will use psychosocial approaches. The intervention package will include a manual for facilitators, an adaptation manual (for adaptation to the local context), a training and supervision manual and a monitoring and evaluation manual. The aim will be to generate interest in the new materials and discussion of their content and approach.
 
Learning Objectives:

 
  1. Analyze the global incidence, prevalence and causes of adolescent mental health disorders.
  2. Analyze the effectiveness of interventions to promote adolescent mental health and prevent mental disorders, risk behaviours and self-harm, and the components of psychosocial interventions that increase the effectiveness of these interventions.
  3. Understand the content and instructional components of the new WHO/UNICEF intervention package for the promotion of adolescent mental health and prevention of mental disorders, risk behaviours and self-harm.
 

Entry into Human Trafficking: It’s Often the Ones Closest To Us
 Diane Santa Maria, DrPH, MSN, BSN1; Salina Mostajabian, MD2; Constance Wiemann, PhD; Elizabeth Newlin, MD3
1University of Texas Health Science Center at Houston; 2People's Clinic; 3Baylor College of Medicine

Description:
Various data sources of human trafficking (HT) suggest many youth are affected. School-based surveys in the U.S. and Canada estimate that 3% of students are sexually exploited and is substantially higher for youth experiencing homelessness (YEH).

For Aim 1, we will review various data sources to describe the current state of human trafficking among youth, particularly among high-risk groups, in the U.S. and across the globe including psychological needs.

For Aim 2, we will present data from a qualitative study we conducted to assess the entry experience of human trafficking (HT) among 42 youth 18-21 years old residing at a homeless shelter in one of the HT hubs in the U.S. Three main themes emerged related to how youth get exposed or enter into HT. 1) It’s a Family Affair, 2) Stranger Danger, and 3) Social Networks Matter. Youth described how family forced or convinced youth to get involved in trafficking. Other youth described circumstances that led them to be in contact with strangers who solicited them. Finally, youth described how friends and acquaintances exposed them to HT.

For Aim 3, we will describe various methods used by adolescent providers to identify youth affected for human trafficking and their psychological needs. Significance: This Hot Topic is significant because there are several points of vulnerability among YEH that provide entry into HT. Providers must consider that family members may be the entry point into HT which should be considered with safety assessments and family reunification programs.
 
Learning Objectives:
 
  1. Analyze the current landscape of Human Trafficking among youth and young adults.
  2. Describe entries into trafficking for youth experiencing homelessness.
  3. State strategies to effectively identify youth affected for human trafficking and their psychological needs.

 
Maltreatment of Asylum Seeking and Refugee Youth – What can we do?
 Diana M.L. Birch, MBBS: DCH: MSC; MD; FRCP; FRCPCH
Youth Support
 
Description: 
We are currently facing a global crisis in the movement of refugee youth. There are more children being held in camps at border crossings than ever before. underage children are often detained in adult prisons and children are separated from their parents and families. How can we intervene to stop these practices and protect youth from these traumatic experiences? The health and welfare of refugee youth is being neglected. Detained children are caught in political conflicts not of their making and often lack the basics of nutrition and care as well as educational opportunities. Young immigrants are being discriminated against and branded as troublemakers and criminals. We need to challenge racist and discriminatory practices which often extend to those professionals attempting to help refugees.

Learning Objectives:
 
  1. Participants will have an overview of the level of the problem facing immigrant and refugee children and youth internationally with particular emphasis on the crisis affecting USA and Europe
  2. Appreciate hazards faced by refugee youth fleeing from their country of origin, and the additional traumas and deprivations suffered when reaching countries of 'refuge' including Health and safety within camps, detention and 'internal' camps
  3. Assess the need for interventions and how best to confront prejudice and isolation of the refugee community. We will also address the need for professionals to 'keep safe' and protect themselves whilst undertaking this often very challenging work.
 
Crisis Pregnancy Centers: Public Health Risks, Responses, and Resources
Andrea Swartzendruber, PhD, MPH; Danielle Lambert, MPH
University of Georgia College of Public Health

Description:
Crisis pregnancy centers (CPCs) aim to dissuade pregnant women from seeking abortion, often using disinformation and deceptive tactics. CPCs are expanding globally and gaining substantial U.S. government support. Many CPCs receive federal funding for school-based abstinence education, and states increasingly directly fund the centers through dedicated grant programs. In 2018, the U.S. Supreme Court supported the centers’ First Amendment rights and overturned a California law mandating CPCs provide notice about the limitations of their services and the availability of public reproductive health programs. Additionally, newly proposed Title X changes appear to make CPCs eligible for funding. CPCs are becoming more medicalized but do not adhere to medical practice or ethical standards. The centers target young people and pose risk to health and wellbeing through misinformation, delayed care, and stigmatizing practices. SAHM and NASPAG are currently drafting a joint position paper on CPCs (led by the first author).

Given CPCs’ lack of transparency and growing prominence, we created a national online geolocated CPC database to aid individuals seeking care know which centers are CPCs and facilitate academic research.

Faculty will present an overview of CPCs globally and recent research findings. Emphasis will be on U.S. experiences and resources and translation opportunities. We will use multiple innovative and engaging presentation methods, including a simulated experience searching for health services online, narratives from young people who sought CPC services, and brief demonstration of resources for increasing public awareness, advocacy, and aiding young people in different contexts find quality sources of information and services.
 
Learning Objectives:
 
  1. Describe crisis pregnancy centers, including their mission, services, common tactics, global prevalence, risks to young people, and relevance in the current policy environment
  2. Summarize the purpose, methods, and findings from a new online geolocated directory of crisis pregnancy centers in the United States (CPC Map: crisispregnancycentermap.com)
  3. Discuss how public health practitioners and clinicians can support social awareness and advocacy/policy efforts and aid individuals seeking unbiased, medically-accurate health information and safe sexual and reproductive health services