Workshops: Wednesday, March 6


12:45 - 2:15 P.m. Sessions

Anxiety in Adolescents and Young Adults: Practical Strategies using CAM (Culture, Apps and Medication)
Paritosh Kaul, MD1; Bethany D. Ashby, Psy D1; Diane Reichmuth, Psy D2; Megan D. Jacobs, MD, MSCS3; Carolyn Lentzsch-Parcells, MD4
1University of Colorado School of Medicine; 2Aurora Mental Health; 3Oregon Health & Sciences University; 4Girls to Women/Young Men's Health and Wellness
Track: Core Clinical Topics

Description: In response to standing room only participation at last year's workshop " Assisting the Anxious Adolescent: Practical Skills for Adolescent and Young Adult Health Clinicians in an Outpatient Setting", participants requested more resources (apps) and information on medications. Our interdisciplinary group presents next steps in taking care of AYA with anxiety with a focus on transcultural awareness. Description of significance: Anxiety symptoms in AYA may present differently across cultures. It is important for AYA healthcare providers to have the knowledge and skills to understand these cultural influences and factors. This practical workshop will share information on how to consider culture when assessing mental health symptoms. The session will explore therapeutic and psychopharmalogic management and treatment options, utilizing an integrated care model. Relevance to conference theme: Psychological Well-Being: International Transcultural Perspectives is the conference theme and anxiety, with a transcultural lens, speaks directly to the conference theme. It is important to understand adolescents in regards to their culture, and cultural expectations, and how these issues can impact the presentation of anxiety symptoms as well as the utility of treatment interventions. 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 cultural knowledge and skills in helping adolescents manage anxiety. This workshop will provide specific practical resources (apps and medications) to utilize with the adolescents whom attendees serve.

Educational Objectives:
  1. Recognize cultural considerations in assessing anxiety symptoms among AYA
  2. Identify symptoms of anxiety among the refugee AYA population
  3. Describe the use of different medications used for AYA with anxiety
  4. Utilize apps that would assist AYA in coping with anxiety
Faculty Expertise: Dr. Paritosh Kaul is Professor of Pediatrics at Children’s Hospital Colorado (CHCO), University of Colorado School of Medicine (UC SOM). He brings expertise in the areas, mental health, cultural competency and medical education. He has served as Director of Publications and on the Board of Directors for SAHM. Dr Ashby is Assistant Professor of Psychiatry at UCSOM. Currently, she is Clinical Program Director of Healthy Expectations Adolescent Response Team and Perinatal Resource Offering Mood Integrated Services and Evaluation) at CHCO. Dr Reichmuth is a Psychologist at CHCO where she works in Adolescent Medicine. In addition, she works at Aurora Mental Health in their Integrated Behavioral Health Program. Dr. Jacobs is a board certified pediatrician and has completed her adolescent medicine fellowship. She has special interest in mental health and well-being of AYA. She completed additional training in mental health and substance abuse dual-diagnosis Substance abuse Treatment, Education and Prevention Program. Dr Carolyn Lentzsch-Parcells, is President and Medical Director of Girls to Women/Young Men's Health and Wellness. She is board certified in pediatrics and is Adjunct Assistant Professor of Pediatrics. She brings expertise in utilizing app for her patient to promote their health and well being.

Sex-Positivity – Changing the Way Health Centers Address Adolescent Sexuality
Maggie Riley, MD, FAAFP; Lauren Ranalli, MPH; Jenni Lane, MA
Adolescent Health Initiative, University of Michigan
Track: Core Clinical Topics

Description: Adolescent patients can be difficult to effectively engage in health care, particularly in relation to sensitive issues such as sexual health. Efforts to improve the health of adolescent populations hinge on the ability of health care providers and staff to create a space in which adolescents are willing to communicate openly and engage as full partners in their care. All health center staff and providers play a role in creating a safe setting for adolescents to access accurate and nonjudgmental sexual health services. By applying a culturally responsive, sex-positive approach, staff and providers can foster a climate of trust and open-dialogue about sexual health and sexual relationships, both with their adolescent patients and parents. This workshop will include an introduction to sex-positivity and strategies to adopt a sex-positive approach when providing health services to adolescents. This workshop will also include a demonstration of a replicable 15-minute mini-training on sex-positive practices to deliver at participants’ own clinical sites. This mini-training includes customizable, engaging, ready-to-use content that highlights key issues in providing a sex-affirming approach to providing health services for adolescents. This model teaches a multidisciplinary training approach and provides a framework for staff education and practice improvement that providers can use to implement changes in their own practice.

Educational Objectives:
  1. Explore the concepts of sex-positivity and how they can be applied when addressing adolescent sexuality.
  2. Explain how health center staff and providers contribute to a culture of sex-positivity and adopt a sex-positive or sex-affirming approach to providing health services to adolescents.
  3. Participate in a mini-training module on sex-positivity and receive materials to replicate it.
Faculty Expertise: Dr. Riley is Medical Director for Michigan Medicine’s Adolescent Health Initiative (AHI), and is immediate past president for the Michigan Chapter of the Society for Adolescent Health and Medicine. She has presented nationally on AHI’s initiatives to help primary care clinics transform into adolescent medical homes. Ms. Ranalli is the Director of the Adolescent Health Initiative. She has a Masters of Public Health and has held leadership positions across federally qualified health centers, school-based health centers, and national organizations. She has presented nationally on AHI’s work to enhance provider practice and improve adolescent health outcomes. Ms. Ranalli previously served as the Vice President for the Michigan Chapter of the Society for Adolescent Health and Medicine. Ms. Lane has worked in the field of adolescent sexual health education and prevention for over twenty years, and is a national presenter on the topic. She has worked directly with adolescents, and she develops and delivers training for the professionals who work with them, including providers and parents. Her expertise in the field of positive youth development is a natural foundation for the work she does to help professionals adopt a sex-positive framework.

"Sex, Sexting, Violent Videogames, and Cyberbullying – National and International Perspectives on Adolescents & the Media"
Victor C. Strasburger, MD1; Ed Donnerstein, PhD.2
1University of New Mexico School of Medicine; 2University of Arizona
Track: Core Clinical Topics

Description: A primer on the current research on new & traditional media -- including media violence, sex, sexting, cyberbullying, and social networking -- incorporating examples of healthy and unhealthy media and new research from both US and international sources. Videos illustrating both positive and negative aspects of media will be shown. European research on pornography and social networking will be highlighted.

Educational Objectives:
  1. Identify the latest research on the impact of new and traditional media on adolescents (to include: social media, sexting, sex, pornography, media violence, video games, cyberbullying).
  2. Analyze how international media frequently are healthier for teens than US media (specific examples will be given).
  3. Identify ways that clinicians can take an appropriate media history, intervene when necessary, and use media constructively to promote positive public health messages (to include a brief media training segment).
Faculty Expertise: Both speakers are known nationally and internationally and have spoken together many times, including at SAHM meetings. Dr. Strasburger has authored or co-authored most of the AAP policy statements on media. His media textbook is used at many Communications courses in major universities. Dr. Donnerstein is an expert on social media, cyberbullying, and media violence and was a member of the original Attorney General's Task Force on Pornography. Both have published more than 200 journal articles and book chapters.  

Healing Immigrant Families to Help Adolescents Thrive
Evelyn Kappeler1; Carolyn Camacho, MS, BS, BA2; Johan Orjuela, MSW, BSW, LCSW-C3; Veronica Stroman, BA2; Tiziana DiFabio, MPH, MSW, LCSW-C2
1Department of Health and Human Services; 2Identity, Inc.; 3EveryMind.
Track: Clinical Advances

Description: There are more than 180,000 Latinos residing in Montgomery County, Maryland. Approximately one-third of the Latino residents are under the age of 18 and Latino youth have surpassed or are quickly approaching 40% of the population in many public schools. The majority of these youth are immigrants themselves or the children of immigrants. Many have fled their homelands due to civil wars, violence, political instability, natural disasters or economic crisis and have experienced family separation, and are now struggling to heal and integrate into American society. In this session, the HHS Office of Adolescent Health (OAH) will share the framework for their Adolescent Health: Think, Act, Grow® initiative, and the growing body of research that supports taking a strengths-based, dual-generation approach to helping vulnerable youth heal and thrive. Identity Inc., a Montgomery County youth-serving organization, will introduce an integrated approach to trauma-informed care with Latino youth who have immigrated to the United States, highlighting the important role that family strengthening and reunification supports play in helping youth heal. Identity will share how the school-based health and wellness center setting and community programs assess youth and their parents for trauma and psycho-social needs; and how referrals to social services and clinical and non-clinical interventions such as medical care, curriculum-based programs, mentoring, case management, individual and group counseling, and techniques of “restorative practices” create the conditions for youth to thrive. Identity will also describe their rigorous evaluation approach and the lasting impact they have on the youth and families they serve.

Educational Objectives:
  1. Describe key elements of a model that uses strengths-based and dual-generation approaches and integrates adolescent health, social, emotional and academic development goals.
  2. Identify individual, group and dual-generation interventions that effectively help first and second-generation Latino immigrant youth heal from trauma and thrive.
  3. Describe trauma-informed tools for implementing an integrated program model that supports the psychological wellbeing of immigrant youth.
Faculty Expertise:  Evelyn M. Kappeler is the Director of the HHS Office of Adolescent Health. She oversees the implementation of two grant programs, the Teen Pregnancy Prevention (TPP) Program and the Pregnancy Assistance Fund (PAF). The national evidence-based TPP program is a competitive grant program that works to prevent teen pregnancy through the implementation and evaluation of evidence-based TPP programs. The Pregnancy Assistance Fund is a competitive grant program for states and Tribal entities to support expectant and parenting teens, women, fathers, and their families. She also oversees Adolescent Health: Think, Act, Grow® (TAG), a national call to action to promote adolescent health. Ms. Kappeler began her career in Washington, DC, as a legislative assistant in the Office of the Governor of the State of Illinois. A graduate of the State University of New York at Brockport, she has been awarded numerous commendations and awards for outstanding government service.

Behavioral Health Home Services “A bridge on Health Equity in primary care”
Maria Veronica Svetaz, MD, MA in Public Health1; Ursula Reynoso, MA in Organizational Leadership1; Dora Palma, RN1; Isabel Duran-Graybow, BA in Communication1; Diego  Garcia-Huidobro, MD, PhD1; Vimbai Madzura, MA, LGSW2
1Hennepin Healthcare - Aqui para Ti; 2Minnesota Department of Human Services
Track: Clinical Advances

Description: This session will describe a Behavioral Health Home model, how services are reimbursed, and outline benefits and challenges of these two models of care. This session is very significant because it will describe how mental health services can be imbedded into the usual clinical care, from the perspective of the funding organization (Minnesota’s Department of Human Services), providers (medical director, therapist, parent educator, youth mentor, and program coordinator), and patients. Innovative aspects of this workshop include showcasing a very innovative model of care for adolescents and young adults in primary care, from multiple perspectives, providing attendees the opportunity to reflect on how this model of care could be implemented in their local practice (clinic, State, country). Aqui Para Ti (APT) is a clinic for Latino youth and their families at Hennepin Health Services. It aims to reduce health disparities by delivering comprehensive care for low-income Latino families. APT integrates services of a Patient-Centered Medical Home (PCMH) and a Behavioral Health Home (BHH) since September of 2017. This transition allowed including mental health counseling, parent education, and mentoring to patients and their families in addition to the traditional clinical services. Up to June of 2018, the BHH has enrolled 64 patients. Becoming a BHH has allowed APT to expand its clinical services to Latino families.

Educational Objectives:
  1. Identify the characteristics of Aqui Para Ti as a primary care patient-centered medical home and a behavioral health home.
  2. Identify characteristics of the financial systems to sustain the healthcare and behavioral health services in primary care.
  3. Summarize benefits and challenges of transitioning from a patient-centered medical home to a behavioral health home.
Faculty Expertise: Dr. Svetaz is an Adolescent Health expert working with minority families. She has been working on expanding the family center adolescent driven care for youth and their families for the last 20 years ion the twin cities. Also, she has been functioning as Chair of the SAHM’s diversity committee. Mrs. Reynoso has more than 15 years of experience working with Latino youth and their families. Her areas of expertise are around health disparities issues and system change initiatives. She is also the leader of the Behavioral Health Home (BHH) implementation stage. Ms. Palma has been working as a Parent Coach for the last seven years; she is an expert on promoting healthy families interaction and supporting immigrant families on how to navigate a new culture. She also educates Latino families about mental health issues. Ms. Duran-Graybow functions as a College Connector; her role is to engage and support immigrant youth on their educational journey. She also is the liaison between the school system and Latino youth with mental health diagnosis. Ms. Madzura serves as the policy lead and works to review and revise BHH services standards, BHH services policy and internal workflow processes.

Understanding the Emotional and Physical Health Needs of Muslim Youth in Today's Political and Cultural Climate
Khadija Khan, BA; Sonia A; Rafay Qureshi; Noor Pervez
Advocates for Youth
Track: Public Health/Advocacy

Description: Anti-Muslim stigma, cultural barriers, and post-9/11 political, social, and cultural discrimination present Muslim youth with myriad challenges that can lead to negative health outcomes. The Muslim Youth Leadership Council (MyLC), a project of Advocates for Youth, works to address these challenges through cultural and political advocacy. MyLC is comprised of 20 young Muslim leaders, ages 16-24, from across the U.S. The Council focuses on four main areas of work: countering Islamophobia and anti-Muslim hate; advocating for the sexual health and reproductive health and rights of young Muslim, promoting LGBTQ rights for young queer Muslims, and working towards racial justice. Workshop attendees will hear from a panel of three members of the Muslim Youth Leadership Council who are working at the intersections of queer and transgender rights, disability rights, sexual health, and Islamophobia. Panelists will provide insight into the real life experiences of young Muslims by sharing the cultural, political and economic barriers they face when seeking sexual health education and services; discussing the impact of Islamophobia and homophobia on their emotional and physical wellbeing; and assisting workshop participants to explore innovative and culturally responsive ways to reach this marginalized group with health education and services.

Educational Objectives:
  1. Identify at least three cultural/political factors affecting the mental health, sexual health, and community health needs of Muslim young people.
  2. Explore individual experiences of three Muslim youth in order to gain context for the provision of more effective care – including specific content regarding Muslim youth who are LGBT and/or disabled.
  3. Identify at least three skills or resources to can assist health care providers to better meet the emotional and physical health care needs of Muslim youth.
Faculty Expertise: Khadija Khan coordinates Advocates for Youth’s Muslim Youth Leadership Council (MyLC) and works with Muslim youth from across the US to help them raise awareness, create networks, and speak out on the intersections of Islamophobia, LGBTQ rights, racial justice, and reproductive health and rights. Sonia A. is a MyLC member, student at Georgetown University, Trip Co-Leader of Magis: Deconstructing Islamophobia, and Advocacy Chair of Georgetown Queer People of Color. Rafay Q. is a graduate student at Johns Hopkins, and a member MyLC and Muslims for Progressive Values. She is one of seven Lead Residential Advisors on campus organizing events on racial justice, sexual/reproductive rights, and more. Noor P. is a MyLC member, a disability rights activist, and the Community Engagement Coordinator for the Autistic Self Advocacy Network. Noor consults on accessibility issues with Genderqueer DC, Khush DC, Trans DC, MASGD, NQAPIA and the Asian/Pacific Islander DC Support Group.

Too Vulnerable to Participate? Using Innovation, Technology, Community-based Team Science, and Health Economics Research to Improve Clinical Outcomes and Psychological Well-being for Adolescents and Young Adults
Allison Agwu, MD, ScM1; Maunank Shah, MD, PhD1; Pamela Matson, PhD, MPH1; Maria  Trent, MD, MPH1; Connie Trexler, BSN2
1Johns Hopkins University School of Medicine, 2Children's National Medical Center

Track: Research

Description: Adolescents and young adults (AYA) face significant health disparities and there is a need for innovative, high-quality, interdisciplinary research to better understand and improve health outcomes. While AYA who are often most affected by health disparities are often perceived as too vulnerable to participate in research, access to clinical trials and other research protocols, if designed well, may demonstrate novel strategies to approach difficult clinical and public health issues, while also resulting in substantial improvements in health for the enrolled individual. However, vulnerable youth (e.g., drug using, sexual and gender minorities) are often excluded from research because of pre-identified barriers to successful completion of study procedures rather than investigators opting for creative solutions to facilitate their participation and that work with their lifestyle. A number of research studies have successfully used community-based research strategies that incorporate technology to address critical issues in AYA health and have been shown to provide clinical and psychosocial support. A key component to this work is addressing both efficacy and cost-effectiveness for relatability, scalability, and sustainability. The objective of this workshop is to utilize several research projects to demonstrate how research and clinical health are intrinsically intertwined and may push the envelope towards designing, testing, and implementing new standards for health care practice with vulnerable AYA.

Educational Objectives:
  1. Identify key questions and planning behaviors necessary in the conduct of clinical research with at-risk adolescents and young adults and discuss development of creative study designs for effective recruitment and retention in longitudinal research.
  2. Determine key clinical outcomes including health status, cost, and patient retention and satisfaction.
  3. Discuss and analyze the field-level engagement for effective outreach with patients once enrolled in longitudinal research, from the perspective of the research team and the participants from the target population.
Faculty Expertise: The multi-faceted Johns Hopkins faculty bring clinical, research, and teaching expertise. Allison Agwu, Associate Professor of Pediatric and Adult Infectious Diseases, focuses on health disparities for HIV-positive adolescents and young adults. She designs clinical trials, cohort studies, clinical and community-based interventions, including an NIH-funded care model utilizing technology and community-based care, aimed at optimizing outcomes for youth. Maunank Shah, Associate Professor of Adult Infectious Diseases, evaluates and implements novel HIV and TB intervention strategies, globally. He leads efforts in multiple funded studies to develop mathematical models, including the Johns Hopkins HIV Epidemiologic-Economic Model, to examine the economic and epidemiological impact of the HIV continuum of care in the U.S. Pamela Matson, epidemiologist and Director of Research for Hopkin’s Adolescent Medicine Fellowship Program, uses daily electronic data collection and mobile recruitment methods to study the relationship context of intimate partner violence, substance use, and STIs. Maria Trent, Professor of Pediatrics and Adolescent Medicine and president-elect of SAHM, focuses on prevention of sexual and reproductive health disparities and is responsible for training individuals across disciplines in this area. Her multiple NIH-funded projects use technology, community health nursing, STI diagnostics, and other evidence-based interventions to reduce health disparities in adolescents and young adults.

 2:30 - 4:00 p.m. Sessions

Breaking Barriers: Improving Access to Mental Health Care for a Multicultural Adolescent Population in a Primary Care Setting
Julie Nagpal, MD1; Monique Collier-Nickles, MD1; Emma Schubert, LMSW2; Diane McLean, MD, PhD, MPH1
1Lincoln Medical and Mental Health Center; 2Mental Health Service Corps
Track: Core Clinical Topics

Description: Approximately 1 in 5 adolescents will experience an episode of depression by age 18 and up to 8% of youth who develop depression complete suicide by young adulthood. Adolescent depression can adversely impact school and work performance, impair interpersonal relationships, and exacerbate other health conditions. Youth who have had a Major Depressive episode in the past year are at greater risk for suicide and are more likely than peers to engage in substance use. For many adolescents, their primary care provider (PCP) is the only healthcare professional they see regularly. Additionally, many adolescents from immigrant families face cultural and social barriers to receiving mental health treatment. In 2016, approximately 60% of adolescents with a Major Depressive episode did not receive treatment. Collaborative Care to treat depression among adolescents in primary care is a vital, evidence based model to serve the growing number of adolescents experiencing the early stages of depression. The Collaborative Care model includes universal screening for depression for adolescents ages 12-21. Beginning with universal depression screening and clinical interviews by PCPs, adolescents are then referred to a social worker who assesses for depression and other mental health concerns. If mild/moderate depression is identified, the patient is treated with therapy and medication in their primary care setting. Cases are discussed weekly by integrated care team of PCP, social worker, and consulting child psychiatrist. This model allows barriers to be broken down, specifically in a multi-cultural patient population where stigma prevents timely access to mental health care.

Educational Objectives:
  1. Identify the unique stressors and challenges facing adolescents from different cultures as it relates to depression
  2. State the benefits and role of Collaborative Care for identifying and treating depression primary care settings
  3. Describe several implementation strategies and challenges to Collaborative Care Programs for adolescents and the principles of providing culturally informed medical and mental health care services
Faculty Expertise: The faculty members for this workshop have clinical expertise in the clinic wide implementation of screening, diagnosis, treatment and management of adolescent depression using a Collaborative Care model in the primary care setting. They each recognize that depressed adolescents often present with physical complaints and primary care doctors are in a key position to screen, identify and treat depression. This is critically important in under-resourced multicultural urban settings such as the South Bronx because the impacts of depression are compounded by a lack of access to medical and mental health treatment. In addition, adolescent patients we serve face potential stressors such as cultural stigma, poverty, complex trauma histories, community violence, and systemic oppression associated with racial minority status. Furthermore, caregiver-child disparities in expectations for peer social involvement, career goals, and gender roles are common stressors we see impacting adolescents and their families.

What's Up with What We See Down There? PAG Dermatology, a NASPAG-sponsored workshop
Ellen S. Rome, MD, MPH1; Veronica Gomez-Lobo, MD2
1Cleveland Clinic; 2Children's National Health System
Track: Core Clinical Topics

Description: In a show and discuss, case-based format, this interactive workshop will help participants discriminate between normal and abnormal vulvar pathology in the pediatric patients, as well as identify strategies for diagnosis and treatment. The North American Society for Pediatric and Adolescent Gynecology values its relationship with SAHM and wishes to cosponsor a PAG-related topic at each annual meeting. Offerings such as this workshop represent a sharing of PAG expertise, accessible and usable by the SAHM clinician/practitioner.

Educational Objectives:
  1. To recognize normal and abnormal vulvar rashes
  2. To identify best practice and whenever possible, evidence-based strategies to manage symptoms for these patients
  3. To recognize vulvar dermatologic lesions that are NOT sexual abuse
Faculty Expertise: Both Dr. Veronica Gomez-Lobo and Dr. Rome are past presidents of the North American Society for Pediatric and Adolescent Gynecology (NASPAG), and Dr. Rome is immediate past president of NASPAG's international counterpart, the Federation Internationale de Gynecologie Infantile et Juvenile (FIGIJ). Both have spoken on this topic locally, nationally and internationally.

Adolescents, young adults and migration: an interprofessional and transcultural approach for primary care professionals
Thomas Patrick Pernin, MD, MPH1; Anne Meynard-Colomb, MD2; Dagmar M. Haller, MD, PhD3
1Geneva University Hospitals; 2Unité des Internistes Généralistes et Pédiatres (UIGP), Faculté de médecine; 3University of Geneva, HUG & The University of Melbourne
Track: Clinical Advances

Description: The recent increase in the number of adolescent migrants, including many unaccompanied minors, in several countries, has prompted medical and social professionals to adapt their care to respond more appropriately to their needs. Specific elements of an initial health check for these young people, transcultural skills and a good knowledge of the local network are necessary to provide optimal management. As these young people grow up and reach legal majority in their host countries, it is important to anticipate a transition towards actors in the adult medical world. We propose an integrative and transversal understanding of this initial health check, follow up of chronic diseases and transition by exploring relationships with the community, associative, social, educational and mental health. This workshop is also a place to discuss differences of approaches between international professionals and discover tools such as a proposition of adapted HEADSS and cultural formulation.

Educational Objectives:
  1. Encourage participants to exchange about differences in practice depending on local contexts as primary care professionals for young migrants and discuss screening approaches depending on patient’s origins and local guidelines
  2. Offer a tool (adapted HEADSS approach) to guide the first encounter with an adolescent in situation of migration and explain cultural formulation to help clinicians to investigate patients’ representations of health and illness
  3. Discuss modalities of transition towards adult care for young migrants who have been followed in adolescent medicine units or community medicine
Faculty Expertise: T. Pernin: Certificate of Advanced Studies « Transcultural approaches in Health Care and Diversities », Geneva and Lausanne Universities, Switzerland (2017). Inter-Academic Degree in Health Sciences Teaching (Paris, France, 2016), Master in Public Health (Honors). Adolescent Medicine Physician with a specific consultation for unaccompanied minors (2 years experience). Prior experience as a general practitionner for adult migrants and creation of therapeutical education tools inspired by cultural formulation for migrants in precarity. Member of the Geneva University Hospitals transcultural multidisciplinary expert group. Teacher at Geneva Medical School in Transcultural Medicine. Head of Internal General Medicine Consultations for Students, Primary Care Division, Geneva University Hospitals. A. Meynard : More than 10 years of clinical experience working with immigrant youth. Member of EU Teach Program. Lecturer at Geneva Medical School. DM Haller : Professor of Adolescent Medicine. More than 10 years of clinical experience working with immigrant youth. Head of Research for the Primary Care Unit at Geneva Medical School with numerous publications.

Employing a Trauma Informed and Resiliency Focused Approach to Adolescent Primary Care
Binny Chokshi, MD; Lee Beers, MD; Stacy Hodgkinson PhD, Danielle Goodman Dooley, MD, MPhil, FAAP
Children's National Health System
Track: Clinical Advances

Description: Research has shown that traumatic exposures, such as adverse childhood experiences (ACEs), can have lasting negative effects on health. Vulnerable neural connections can be permanently disrupted through exposure to adversity and resultant toxic stress, which can disrupt the groundwork for future health and well-being. In adolescence, the health impact of early childhood adversity can start to manifest clinically through diagnoses such as ADHD, obesity, and poorly controlled asthma. Furthermore, as traumatic experiences can affect the development of the frontal cortex, affected adolescents can also display increased propensity to engage in risky behaviors. There is a growing understanding within health systems and amongst clinicians regarding the need to translate the science of trauma and ACEs into health care practice. Adolescent health providers are uniquely positioned to identify and respond to a patient history of traumatic exposures. A trauma informed approach to care can offer providers an opportunity to buffer the link between adversity and related poor health outcomes and risky behaviors for vulnerable adolescent patient populations. This interactive workshop will review the connection between trauma, adversity, and health outcomes. It will focus on the Substance Abuse and Mental Health Services Administration’s (SAMHSAs) trauma informed approach, which strives to understand the context within which a patient’s health develops and to empower patients by collaborating with them and giving them a voice in their own medical care. The facilitators will then briefly describe a strengths based trauma informed approach, with a review of the components of resiliency building in adolescent populations.

Educational Objectives:
  1. Develop an appreciation for how childhood trauma and adversity can affect adolescent health outcomes
  2. Describe the principles of a trauma informed approach to care and the components of adolescent resiliency building
  3. Apply the principles of a trauma informed care approach and adolescent resiliency building to clinical patient scenarios
Faculty Expertise: Dr. Binny Chokshi co-leads an interdisciplinary collaboration to develop a hospital wide trauma informed approach at Children’s National Health System (CNHS), which in the last year trained over 700 hospital staff on trauma informed care principles. Together with Dr. Lee Beers, she recently created three electronic case based modules on trauma informed care approaches in primary care. Dr. Lee Beers co-founded the DC Collaborative for Mental Health in Pediatric Primary Care, and most recently co-founded the Early Childhood Innovation Network, which focuses on developing interventions that are rooted in science and community voices to offer holistic approaches to address ACEs. Both workshop leaders, Drs. Beers and Chokshi, have both completed the Master Teacher and Leadership Development Program through the George Washington University School of Medicine and Health Sciences and therefore have been specifically trained in adult learning principles and workshop facilitation. Dr. Stacy Hodgkinson, a clinical psychologist, has received extensive training in trauma informed care approaches. Drs. Beers, Chokshi, and Hodgkinson have been called upon to give trainings related to trauma informed care both within the CNHS system and throughout the DC metropolitan area, to a variety of audiences including physicians, school resource officers, circuit judges, and community health workers.

4:30 - 6:00 p.m. Sessions

“It’s NOT all in your Head: A Structured Integrative Clinical Care Pathway to Paediatric Somatic Complaints”
April Suanne Elliott, HBsc. MD, FRCPC; Tyler Scott Pirlot, MD, FRCP(C)
University of Calgary
Track: Core Clinical Topics

Description: Somatic complaints refer to significant physical complaints that interfere with functioning, cause distress, but aren’t explained by other medical disorders, and are viewed psychiatric in origin. These complaints are often associated with increased use of healthcare resources, social and academic/occupational difficulties, chronicity and dissatisfaction for the patient and clinicians. A diverse population due to myriad presentations, and often comorbid with medical and/or other psychiatric problems. Stages of development like puberty can have an upswing in prevalence of symptoms and the problem is thought to be as common as depression (10% in general; higher in the chronically ill population). Research has demonstrated the significant burden that the medical-psychiatric patient creates at all levels of health care. The ‘costs’ are high both in terms of quality of life for the youth and parents, and the utilization of health care resources that can lead to delayed diagnosis, discharge from inpatient care or upon discharge, unnecessary or inappropriate medical investigations/interventions, excessive pharmacotherapy, and utilization of significant community pediatric resources. Description of somatization varies with the medical subspecialty (e.g. idiopathic pain syndrome, pain amplification, functional abdominal pain, visceral hyperalgesia; and medically unexplained symptoms), this causes communication and diagnostic difficulties for clinicians and families. Using a structured, system wide approach to this population is highly recommended. Treatment of these youth and families is multi-modal including; medical management, somatic symptom alleviation, accommodations to environment (e.g. school, social), assessment and therapeutic intervention involving the mind-body connection, treatment of associated mental health diagnoses and therapeutic work with families.

Educational Objectives:
  1. Review the DSM 5 somatic symptom and related disorders
  2. Formulate a child/teen’s somatic symptoms within a biopsychosocial framework and acquire the 4-phase model for treating somatization
  3. Demostrate evidence-based interdisciplinary approaches and apply to cases based on the phase of somatization in the clinical setting
Faculty Expertise: Dr. Tyler Pirlot is a Child and Adolescent Psychiatrist at Alberta Children’s Hospital (ACH) who founded the Pediatric Consultation-Liaison Psychiatry Service in 2005. He helped distill previously used models for treating somatic symptom disorders (SSD) down to an easier to understand an implement 4-phase treatment approach. In 2017, he was instrumental in the Somatic Rehabilitation Clinic (SRC) at ACH to address SSD cases in the general pediatric population. He has presented on treating SSD at past conferences of the American Academy of Child and Adolescent Psychiatry, Canadian Academy of Child and Adolescent Psychiatry and Canadian Paediatric Society. Dr. April Elliott is an Adolescent Medicine Specialist at ACH. She is Chief of Adolescent Medicine and an Associate Professor in the Department of Paediatrics at the University of Calgary. She was instrumental in developing Adolescent Health as a sub-specialty and building collaborative youth centered programs. She has been providing services to youth with somatic symptoms for years and has joined the SRC team with Dr. Tyler Pirlot to formalize the management approach in these very complex SSD cases. She has multiple publications, presentations and grants on topics such as Eating Disorders, Adolescent Brain Development, Mindful Communication, Physician Wellness, and Street-Involved Youth Health.

Breast Disorders in the Adolescent: Medical and Surgical Perspectives, a NASPAG-sponsored workshop
Ellen S. Rome, MD, MPH1; Veronica Gomez-Lobo, MD2
1Cleveland Clinic; 2Children's National Health System

Track: Core Clinical Topics

Description: Breast disorders in children and adolescents can cause high anxiety in patients, parents, and providers unfamiliar with the spectrum of what is normal and what is not. Although most breast disorders in adolescents are benign, fear of cancer can raise the level of anxiety and cause pursuit of unwarranted procedures for a benign problem. This workshop will help the beginner, intermediate and advanced clinician recognize the specturm of normal and abnormal breast disorders, identify benign and malignant breast masses, and recognize what imaging and/or diagnostic testing to pursue. Medical and surgical perspectives will be shared through a case-based, interactive format. If possible, patient(s) will share their viewpoint on what worked and did not work for them during diagnosis and/or treatment .

Educational Objectives:
  1. To recognize common and uncommon breast disorders in children and adolescents.
  2. To understand which disorders require imaging and/or diagnostic procedures, in order to provide quality, cost-effective care for the adolescent.
  3. To learn to prevent unnecessary procedures on children and adolescents with nonsurgical breast disorders.
Faculty Expertise: Drs. Rome and Gomez-Lobo are both past presidents of the North American Society for Pediatric and Adolescent Gynecology (NASPAG), and Dr. Rome is the immediate past president of the Federation Internationale de Gynecologie Infantile et Juvenile (FIGIJ), its international counterpart, with 6000+ members. Both Drs. Rome and Gomez-Lobo have spoken locally, nationally and internationally on breast disorders in adolescents, and both see multiple patients with medical and surgical breast disorders in their daily practice.

 Providing Care for Child Welfare Involved Youth
Katherine Strater Hogan, CNM, MA, PhD; Shamieka Virella Dixon, MD; Jennifer M. Thomas, PhD
Levine Children's Hospital at Atrium Health
Track: Core Clinical Topics

Description: Almost half of youth in child welfare custody exceed clinical cut-off scores on measures of mental health functioning and an estimated 93% are exposed to trauma. Over 50% of youth in custody have special healthcare needs, including chronic health conditions or developmental disabilities. Despite high levels of clinical needs, youth typically have limited access to health care services; only 16%-28% of youth in custody receive a specialty mental health service within one year of child welfare investigation. Left unmanaged, these health concerns contribute to long-term consequences and place financial burden on child welfare and health services systems. Healthcare professionals can play a pivotal role in the experiences of youth in child welfare custody. Through partnership with the Mecklenburg County Department of Social Services, Teen Health Connection, an adolescent integrated care facility, serves as the medical home for youth in custody. Teen Health Connection operates with a team of five licensed psychologists who conduct comprehensive psychological assessments for youth as they enter custody to ensure their needs, whether mental health, academic, social, or environmental, are identified and addressed. Through this partnership, Teen Health Connection has become a vital partner for the child welfare system and community stakeholders, including district court judges, foster parents, and Guardians ad Litem. This workshop will provide a comprehensive overview of Teen Health Connection’s service model for youth in child welfare custody and will explore the specific trauma-informed strategies and administrative procedures that have enhanced the delivery of care for this unique population.

Educational Objectives:
  1. Identify the unique health needs of youth in child welfare custody and the legislation and best-practice guidelines (e.g., American Academy of Pediatrics, Fostering Connections to Success Act of 2008) that shape the standard of care for these youth.
  2. Inventory improvements to practice, both individual and organizational, to better provide care for youth in child welfare custody.
  3. Apply specific trauma-informed practices to enhance the delivery of care for youth in child welfare custody.
Faculty Expertise: Since 1992, Teen Health Connection has provided medical and mental health services for youth in the custody of child welfare and has served on community committees as advocates for this population, including the state-mandated Child Fatality Prevention and Protection Team, Mecklenburg County Provider Council, Mecklenburg County Task Force for Child Exploitation, Fostering Health North Carolina, Mecklenburg County Model Courts, and the System of Care Collaborative of Mecklenburg County. Presenters have direct experience with child welfare administrations and with providing care for youth in custody. Kate Hogan, PhD, helped to develop procedures around the delivery of Teen Health Connection’s services for youth in custody and has evaluated these services since 2014. Shamieka Dixon, MD, is Teen Health Connection’s medical director and Assistant Professor of Pediatrics at Atrium Health’s Levine Children’s Hospital. Dr Dixon is board certified in Adolescent Medicine and oversees a team of four medical providers on site. Jennifer Thomas, PhD, leads a team of four licensed psychologists and two support staff who conduct extensive psychological assessments for youth entering child welfare custody. Dr. Thomas has been trained in trauma-focused and trauma-informed care practices and has provided assessment, therapy, training, and consultation within this area of practice for a decade.

Caring for the Physical & Psychological Well-being of Adolescents who Engage in Nonsuicidal Self-Injury: Risk Assessment & Treatment
Nicholas J. Westers, Psy.D.1; Heather Needham, MD, MPH, FAAP2; Alison J. Culyba, MD, PhD, MPH3
1Children's Medical Center Dallas & UT Southwestern Medical Center; 2Baylor College of Medicine & Texas Children's Hospital; 3University of Pittsburgh School of Medicine
Track: Clinical Advances

Description: Despite the high international prevalence of nonsuicidal self-injury (NSSI) that spans across cultures, little research has focused on helping youth-serving professionals effectively assess and respond to NSSI. Unfortunately, lack of understanding of NSSI and about those who engage in it can lead to unnecessary emergency department visits, costly inpatient hospitalizations, or improper care. Led by presenters from multiple disciplines (psychology, medicine, public health), this workshop will provide a brief overview of the definition, etiology, and prevalence of NSSI using both international and U.S. data from peer-reviewed research and the Youth Risk Behavior Surveillance System. We will review research differentiating NSSI from suicide as well as research showing what to screen for and how to assess specific characteristics of NSSI that, if present, may increase the risk of a suicide attempt. We will critically appraise interventions that target NSSI and the contexts within which it occurs. Using perspectives from both mental health and medicine, we will focus on how youth-serving professionals can respond to adolescents who self-injure and provide brief, targeted advice and medical care. Common treatment approaches to NSSI will also be presented, including tips for managing adolescent confidentiality and considerations for diverse populations. We will situate these individual-level approaches within a larger public health framework to address novel social and contextual strategies for intervention.

Educational Objectives:
  1. Explain key characteristics of NSSI behavior that may increase the risk for future suicide attempt, and recall 3 essential questions to ask adolescents who engage in NSSI
  2. Discuss strategies for providing brief, targeted counsel/advice and medical care to adolescents who engage in NSSI
  3. Synthesize public health and individual-level intervention approaches to NSSI
Faculty Expertise: Faculty facilitating this workshop are clinicians and researchers with expertise in treating adolescents who engage in NSSI, training pediatric residents and fellows in assessing and addressing NSSI among adolescents, and publishing on NSSI in peer-reviewed journals. Nicholas Westers, Psy.D., is a clinical psychologist with expertise in treating, teaching, researching, and publishing on adolescent NSSI. Heather Needham, MD, MPH, FAAP is an adolescent medicine physician with experience treating patients with NSSI and eating disorders in a multi-disciplinary team, and promoting the education of pediatric residents to be comfortable with assessing for NSSI. Alison Culyba, MD, PhD, MPH is a clinician and injury prevention epidemiologist whose research focuses on social and environmental contextual factors that protect youth from violence.
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