Workshops: Saturday, March 9

SESSION TIMES

7:30 - 9:00 a.m. Sessions



Medications to Ease the Pain of Addictions
Steven C. Matson, MD1; Scott Hadlund, MD, MPH, MS2; Andrea E. Bonny MD1; Rachel H. Alinsky, MD3
1Nationwide Children's Hospital; 2Boston University School of Medicine Boston Medical Center; 3Johns Hopkins University School of Medicine
 
Track: Core Clinical Topics

Description: The WHO states that substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. The extent of worldwide substance use is estimated at 2 billion alcohol users, 1.3 billion smokers and 185 million illicit drug users. These 3 categories of substance use inflict their disease burden on different age groups, with illicit drug use’s mortality burden mostly involving adolescents and young adults. Data from the SAMHSA’s 2016 National Study of Drug Use and Health revealed that there were 300,000 (12-17 year olds) and 2.6 million adults with both a substance use disorder and a serious mental health problem. Few of these patients receive treatment for both. Early intervention for these problems will prevent more severe addictions down the line. Although Medication Assisted Treatment (MAT) is best known for opioid use disorder, there are many pharmacologic interventions for other substance use disorders. This workshop will present specific MAT for tobacco, alcohol, cannabis, benzodiazepines, and opioids. Additionally, other medications to assist with withdrawal, depression, anxiety, and insomnia will be presented. Patient videos will be used to show efficacy and a detailed hand-out will give each learner all they need to know to utilize these medication.

Educational Objectives:
  1. Describe the medications that are useful in treating patients with addictions.
  2. List the medications that will assist patients with specific addictions to: alcohol, tobacco, cannabis, benzodiazepines, and opioids.
  3. Identify medications useful for the treatment of symptoms associated with addictions including: nausea, withdrawal, constipation, pain, depression, anxiety, and insomnia.
Faculty Expertise: Dr. Matson is a pediatrician board certified in Adolescent Medicine and Addiction Medicine. He has been treating patients with opioid use disorder (OUD) and other substances for the past 10 years. He has made numerous national presentations and published numerous manuscripts on Medication Assisted Treatment (MAT) and substance use and abuse. Dr. Hadland is a specialist in adolescent addiction medicine. His clinical work and research focus on youth who use opioids. Dr. Hadland was the 2016 recipient of the New Investigator Award from SAHM. He has a K23 career development award from the National Institute on Drug Abuse that seeks to improve care for youth with opioid use disorder. Dr. Bonny is an Adolescent Medicine MD that is nationally recognized for her provision of MAT for adolescents with severe OUD. For the past 7 years, she has provided MAT to youth with OUD and has numerous publications focusing on clinical outcomes and predictors of treatment success in this population. Dr. Alinsky is Med-Peds trained, and pursuing an MPH concentrated on health policy, and fellowships in Adolescent Medicine and Addiction Medicine. Her interests include interventions aimed at reducing preventable adolescent morbidity and mortality attributable to substance use disorders.  

 
When Reproductive Health Care Gets Complicated: Managing the Medically Complex Patient
Jennifer Carlson, MD1; Rachel Goldstein, MD1; Paula Hillard MD1; Catherine Miller, MD2
1Stanford University School of Medicine; 2University of Michigan
 
Track: Core Clinical Topics

Description: This workshop will focus on the reproductive health needs of adolescents and young adults with chronic and severe health conditions. As strides have been made in the medical management of chronic and severe health conditions across the world, more medically complex children are surviving and thriving into their reproductive years. Appropriate reproductive health care depends on both reaching adolescents and young adults (AYA) where they are (both physically and developmentally), as well as understanding the nuances that may be associated with specific medical conditions. The workshop presenters will address reproductive health concerns including menstrual management and contraception from the perspectives of both adolescent medicine and adolescent gynecology.

Educational Objectives:
  1. Identify opportunities to increase reproductive health access for medically complex adolescents and young adults.
  2. Discuss management of menses and contraception relevant to chronic and severe illnesses.
  3. Describe an overall framework for menstrual and contraceptive needs using hormonal management in medically complex patients.
Faculty Expertise: Dr. Paula Hillard is a Professor in the department of Obstetrics and Gynecology at the Stanford University School of Medicine and practices Adolescent and Pediatric Gynecology at the Lucile Packard Children’s Hospital. She is an internationally-recognized expert in adolescent gynecology with a focus on contraception and menstrual regulation. She has contributed to over 100 book chapter and 140 peer-reviewed articles and abstracts. Dr. Rachel Goldstein and Dr. Jennifer Carlson are faculty in Adolescent Medicine at Stanford University School of Medicine. Their clinical and research focus is on reproductive health care, and they have developed inpatient and outpatient reproductive health programs to improve access to care. Dr. Catherine Miller is a faculty member in Adolescent Medicine at the University of Michigan with a clinical and educational interest in reproductive health care for AYA in hospital and outpatient settings.


Productive Partnerships: Engaging Patients, Caregivers, and Providers Together to Enhance Outcomes
Ashley Solomon, PsyD1; Heather Dlugosz, MD1; Carolyn Blair Burnett, M.S. (Ph.D Candidate)2
1Eating Recovery Center; 2Virginia Commonwealth University
 
Track: Clinical Advances

Description: Providers of care frequently struggle with how to effectively engage patients and caregivers in the development and implementation of treatment. This historically held true in the field of eating disorders, built on a legacy of systemic exclusion of caregivers, in particular, from the treatment process. This exclusion is counterproductive to patient recovery, since active participation and respectful partnerships between providers, patients, and caregivers are crucial to the efficacy of treatment interventions. In response to detrimental deficits in the eating disorders profession, patients, caregivers, and committed providers developed a guide to creating productive partnerships using their collective lived experience. This presentation will draw upon the perspectives of two clinicians from different disciplines, a parent, and a former patient, hailing from various parts of the globe, to share lessons from the development of this guide to productive partnerships, named World Eating Disorder Healthcare Rights. This document highlights opportunities for effective connection between stakeholders, and outlines the responsibilities of providers to ensure that communication, participation, and support are acknowledged and implemented in practice. The presentation will use the development and utilization of World Eating Disorder Healthcare Rights, which has a broad application, as a springboard to discuss opportunities for collaboration with patients and caregivers across various mental health fields. The presenters will share personal and professional studies of benefits and barriers to providers, patients, and caregivers working together, and will elucidate opportunities for attendees to forge productive partnerships with patients and caregivers in their own work.

Educational Objectives:
  1. Identify at least two benefits of establishing personal or institutional partnerships with patients and caregivers.
  2. Describe at least two of the World Healthcare Eating Disorder Rights.
  3. Analyze one practice opportunity to develop a partnership with patients and caregivers.
Faculty Expertise: As a licensed clinical psychologist and Certified Eating Disorder Specialist, I have served as the clinical director of an eating disorder specialty clinical for the past eight years. In that capacity, I have overseen the provision of individual and family services at higher levels of care from intensive outpatient to residential. I am an active member of the Academy for Eating Disorders, serving as co-chair of the Patient-Carer Committee and the Stakeholders United Special Interest Group. I serve as a Board Member of the Bing Eating Disorder Association. I have presented nationally and internationally on topics related to social media, trauma, non-suicidal self-injury, and more recently on establishing patient/caregiver/provider relationships. I frequently write for popular media on these topics as well. I have received specialized training in this area via Emotion Focused Family Therapy and Family Based Treatment, which have helped inform my conceptualization of family engagement in treatment.

 
Person-centered and Empowering Care for Adolescents with Chronic Conditions during Transition to Adulthood
Ewa-Lena Bratt, PhD1; Mariela Acuna Mora, MSc1; Markus Saarijärvi, MSc1; Sandra Skogby, MSc1; Anna-Lena Brorsson, PhD2; Carina Sparud-Lundin, PhD1
1University of Gothenburg, Sweden; 2Dalarna University;
 
Track: Core Clinical Topics

Description: All societies recognize the difference between being a child and becoming an adult; this transition is defined and recognized differently between cultures and over time. There are however, specific situations when measures are needed to support the transition to adulthood. Today, the majority of children with chronic conditions survive to adulthood, yielding a need for life-long medical follow-up. During childhood, care is provided in pediatric health care settings. When becoming adult, they are transferred to adult care. To prepare for the imminent transfer to adult care and the transition to adulthood, transition programs have been developed. Patient empowerment is an important concept within adolescent health since it aims to increase autonomy, participation, awareness and consciousness, as well as promote the development of relevant psychosocial skills. By increasing empowerment, the young person has the opportunity to ask questions, express opinions and make informed decisions. Transition programs that empowers young persons with chronic conditions may lead to improved wellbeing with better psychosocial and medical outcomes. During transition to adulthood, person-centered and empowering care can help fulfill clinical and developmental needs by supporting the young person develop skills such as goal-setting, self-management and decision-making. Developing successful transition programs, health care providers must verify that the intervention is appropriate within the culture it is executed and that the implementation is sustainable. The aim with this workshop is to emphasize and discuss transitional care for adolescents with chronic conditions from an international perspective and exemplify how empowerment can be addressed in a transition program.

Educational Objectives:
  1. Emphasize empowerment as a process and outcome in supporting adolescents with chronic conditions during transition to adulthood
  2. Reflect on person-centered care as a strategy for empowering adolescents with chronic conditions to promote psychosocial wellbeing
  3. Problematize empowerment during adolescence from an international transcultural perspective
Faculty Expertise: The faculty expertise involves experienced researchers and clinicians within pediatric care and adolescent health and are conducting research on young persons with chronic conditions and their significant others; healthcare professionals; and policy makers. Ongoing research aims to generate new knowledge about transitional care aspects; to develop interventions to improve transitional care; and to evaluate the impact and effectiveness of such interventions. The scope of research activities within the group is broad, and comprises for instance explorative studies; instrument development; intervention mapping; complex interventions and effectiveness research, amongst others. In an ongoing research project, a person-centered transition program for young persons with congenital heart disease (CHD) is currently under evaluation in a randomized controlled trial conducted in seven hospitals in Sweden. The aim is to support young people with congenital heart disease (CHD) so they become active partners in their own care through increased participation and increased responsibility.


“Now what do I do?” – Retention and Adherence: Approaches to Helping Young People in Obesity Weight Management Programs
Mari Radzik, Ph.D.-Clinical Psychology
USC Keck School of Medicine - Children's Hospital Los Angeles
 
Track: Core Clinical Topics

Description: The failure to manage weight gain in the pediatric population has serious and long term health effects on children and adolescents and affects our communities of color and low SES groups the most. The many social justice issues that act as a barrier lead to non-adherence to obesity related treatment. Understanding retention to interdisciplinary medical interventions has amply demonstrated that many children and adolescents often leave medical treatment before completion of the treatment regimen. Successful obesity related engagement and treatment includes addressing barriers in the medical management of obesity. There is variability in the lack of follow up in differing medical conditions, but the end result can be medically serious and has a large societal impact on the management of health care issues. This workshop will review the issues and needs that lead to effective medical and psychological management of pediatric obesity. This workshop will engage in active dialog about what are the factors that assist the pediatric patient and their family in retaining treatment services in weight management programs. What are the objective weight loss findings, what are the family characteristics and what are the patient and parents’ description of why they have stayed in this clinic even if they have not lost weight at this time will be reviewed. Interventions such as MI, family intervention, allied services will be reviewed within a culturally aware and sensitive context.

Educational Objectives:
  1. Further the awareness of barriers to successful engagement in weight management program as it relates to both social justice concerns, self-awareness and health care provision.
  2. Develop an attitude of awareness of barriers towards treatment of diverse populations by reviewing the cultural diversity seen in clinics, and mindful of these rich culture and social issues, discuss how to modify or adapt interventions.
  3. Introduce strategies and effective culturally sensitive trauma informed practices that can be implemented in the health care work place which will help guide health care providers toward change among youth living with obesity.
Faculty Expertise: Dr. Radzik is faculty at the USC Keck School of Medicine and a clinical psychologist who has extensive clinical experience working with adolescents and young adults at the Division of Adolescent and Young Adult Medicine (DAYAM) at CHLA. She is currently a member of the EMPOWER (Energy Management for Personalized Weight Reduction) Weight Management Clinic at CHLA treating patients in this interdisciplinary clinic (MD, RD, PT and psychology). She is currently conducting research on weight management-variables include understanding clinic retention. She has a degree in health psychology and has worked in the DAYAM since 1991, she is also actively involved in the training of medical, psychology and other interdisciplinary trainees. At the DAYAM and the UCEDD (University Center for Excellence in Developmental Disabilities at CHLA) she coordinates the Evidenced Based Practices, Motivational Interviewing and Seeking Safety. She works within a trauma informed framework utilizing cultural sensitivities while imparting these ideals to the CHLA trainees at the DAYAM and the UCEDD.


Addressing Mental Health and Other Causes and Consequences of Violence: Adolescent and Youth Engagement in Peace-building through Civic Participation, the Creative Arts, and Community and Social Responsibility
Irene AnneJillson, PhD1; Evelyn Eisenstein, MD, MPH2
1Georgetown University; ; 2Rio de Janeiro State University
 
Track: Public Health/Advocacy

Description: This workshop focuses on engagement of participants in analysis of findings regarding Adolescent and Youth Engagement in Peace-building through Civic Participation, the Creative Arts, and Community and Social Responsibility, and data regarding the Mental Health and Other Causes and Consequences of Violence and how adolescent/youth engagement in peace-building contributes to addressing these. For several years, there has been a focus on youth and violence, in particular in areas of conflict post-conflict. As a consequence, international, regional and national policies and programs have focused on negative aspects of these phenomena, rather than on the many positive examples of youth engagement in peace-building at the community, national and international levels. These youth-initiated, effective peace-building activities are found in multiple regions of the world, including for example, the Middle East and North Africa, sub-Saharan Africa, Central Asia and Latin America and the Caribbean. In order to contribute to these positive developments through both public health actions and individual clinical care, and to more effectively address mental health causes and consequences of violence, adolescent health policy makers and clinicians must be more aware of these adolescent and youth involvement in positive change and the factors that contribute to effective adolescent and youth-engaged peace-building.

Educational Objectives:
  1. To analyze the mental health and other consequences for adolescents and youth of national or community violence
  2. To describe at least three examples of adolescent/youth-initiated peace-building programs that have demonstrated impact (using the program's definition of impact)
  3. To describe 3 factors that contribute to the success of adolescent/youth-initiated peace-building programs and 3 that inhibit the success of such programs, and at least one approach to addressing each of these.
Faculty Expertise: Dr. Jillson has been Principal Investigator or primary advisor on multiple studies of youth behavioral health; youth inclusion and exclusion in political and social change; youth participation in peace-building, in multiple countries (e.g., Somalia, Tunisia, Tajikistan, Iraq); primary author of reports based on the research; extensive speaking experience; have designed and taught multiple courses at Georgetown University Medical Center, including Global Health Research & Global Health Ethics. She has received multiple awards. Dr. Eisenstein has significant experience in Medicine and Pediatrics, and is internationally known for her experience in Adolescent Health, including for her creative and effective approaches in a wide range of adolescent health, including but not limited to behavioral health, infectious diseases, primary care, homeless (street) children, and the use of innovative technologies and community-based approaches. Currently, she is Telemedicine Coordinator of FCM-UERJ and Coordinator of the GIS of Health of Children and Adolescents of the Telemedicine University Network, RUTE; Director of the Adolescent Clinic and CEIIAS, Center for Integrated Studies, Childhood, Adolescence, Health. She received the 2015 Outstanding Achievement in Adolescent Health and Medicine award from the Society for Adolescent Health and Medicine. She is author of numerous published articles, book chapters, and research reports.


Navigating the Publication Process: Tips from the Journal of Adolescent Health
Tor D. Berg, B.A.; Charles E. Irwin, Jr., M.D.; Teresa Dal Santo, Ph.D.
Journal of Adolescent Health
 
Track: Research

Description: The editors of they Journal of Adolescent Health will be on hand to offer their views on what makes a successful manuscript submission. The curriculum is intended to demystify what can be a mysterious and confusing publication process. In addition, attendees should gain some ideas on how to gain a wider audience for their articles once they have been published in a journal.

Educational Objectives:
  1. Review the publication process of a peer-reviewed academic journal.
  2. Identify the key components of a successful manuscript submission.
  3. Develop a plan for the broad dissemination of scientific results following manuscript acceptance.
Faculty Expertise: Tor Berg and Charles Irwin have been on the staff of the Journal of Adolescent Health since 2004. Teresa Dal Santo joined the staff in 2013. During their tenure, they have seen over 15,000 manuscript submissions and have published over 2,500.They have seen all manner of successful and no-so-successful manuscripts and are able to generalize about what makes a successful publication. This and similar workshops have been presented at many previous SAHM meetings and at various international forums.

9:15 - 10:45 a.m. Sessions


E-cigarettes and Adolescents: Responding to the New 'Nicotine Epidemic'
Nicholas Chadi, MD1; Scott E Hadland, MD, MPH, MS2; Deepa R. Camenga, MD, MHS3; Abbey R. Masonbrink, MD, MPH4; Sion K. Harris, PhD1,5
1Boston Children's Hospital; 2Boston University School of Medicine; 3Yale School of Medicine; 4University of Missouri-Kansas City School of Medicine; 5Havard Medical School
 
Track: Clinical Advances

Description: More than any other psychoactive substance, the use of nicotine delivered through electronic cigarettes (e-cigarettes) has sky-rocketed among adolescents and young adults in the past five years. As a product routinely marketed by manufacturers for smoking cessation in adults, e-cigarettes have become commonplace among youth and are now widespread in schools around the world. Recent press around the “JUUL” (a small e-cigarette device that has the appearance of a computer USB drive) and other e-cigarette products that appeal to youth have appropriately drawn the attention of physicians, researchers, and policymakers alike. E-cigarettes, with their high nicotine content, low costs, wide availability and discreet designs threaten five decades of progress in the fight against tobacco use and its many health consequences. Most adolescents that use e-cigarettes are youth who would have otherwise never smoked traditional cigarettes. These youth are two to three times more likely to use traditional cigarettes and marijuana and up to seven times more likely to misuse opioids and other illicit drugs. In this interactive multidisciplinary workshop, participants will learn practical knowledge and skills regarding the latest research on e-cigarettes including epidemiological trends, health risks of e-cigarettes and neurobiology of nicotine in youth. Facilitators will provide key strategies for e-cigarette prevention and cessation through brief intervention, including a focused simulation of motivational interviewing skills adapted to adolescents. Through challenging cases presenting different aspects of e-cigarette use in ethnically and culturally diverse youth populations, participants will develop a concrete approach to confidently address e-cigarette use in their practice.

Educational Objectives:
  1. Describe the latest trends in e-cigarette use among adolescents and young adults (AYAs) according to recent national and international observational studies.
  2. Explain the unique neurobiology of nicotine use in AYAs and how this leads to vulnerability to e-cigarettes as well as associated health risks.
  3. Develop a structured youth-centered and strength-based approach to nicotine use disorders, including e-cigarettes, among high-risk AYA populations through screening, brief intervention and treatment using key motivational interviewing techniques.
Faculty Expertise: Our multidisciplinary team has extensive clinical and research experience on the topic of e-cigarette use. Nicholas Chadi is an adolescent medicine physician, pediatric addiction fellow as well as co-author of the Canadian Pediatric Society guidelines on prevention/cessation of nicotine use in adolescents. He has published and lectured on several occasions on the topic of youth nicotine use. Scott Hadland is an adolescent and addiction medicine specialist and researcher who works in a specialized adolescent substance use treatment program and frequently gives lectures on the topic of e-cigarettes. Deepa Camenga is a member of the American Academy of Pediatrics Committee on Substance Use and Prevention, and adolescent addiction medicine specialist and researcher. Her research focuses on understanding the impacts of e-cigarette use in youth. Abbey Masonbrink is a pediatric hospitalist and public health specialist with a specific interest for e-cigarettes. Her research focuses on health risk behaviors in adolescents in the hospital setting. Sion Harris is a researcher and the director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. Her research focuses on screening and brief intervention strategies for adolescent substance use disorder prevention and understanding the impacts of substance use on the developing brain.


Sexual and Reproductive Health Needs of Adolescents and Young Adults with Disabilities
Rosemary Claire Roden, MD1; Cynthia Holland-Hall, MD, MPH1; Elizabeth Schmidt, MOT, OTR/L1; Beth  Thielman MA2
1Nationwide Children's Hospital; 2Nashville Disability Justice Caucus
 
Track: Core Clinical Topics

Description: Deficiencies in sexual and reproductive health (SRH) for people with disabilities are noted to be a global problem by the World Health Organization (WHO), and the United States is the largest high-income country not to ratify the United Nations Convention on the Rights of Persons with Disabilities. WHO has stated that the SRH needs of people with physical and intellectual disabilities are largely unmet and understudied, and that these deficiencies are the results of actions taken by those without disabilities. Healthy sexuality is fundamental for all people, regardless of ability, and often this part of the human development of people with disabilities is overlooked by healthcare and service providers. In this workshop, we will explore the intersection of disability and SRH. We will present the Ex-PLISSIT (Expanded: Permission, Limited Information, Specific Suggestions, Intensive Therapy) model for addressing SRH, which may be used by health care providers (HCP) in a variety of disciplines. We will share strategies and resources that HCP may use to address the sexual health risks faced by adolescents and young adults with disabilities while still facilitating the development of healthy sexuality. We will discuss specific adaptations and approaches to promote a healthy sex life, techniques for physical exam (including the pelvic exam), and a discussion of practical techniques for menstrual hygiene and menstrual regulation for patients/clients with various disabilities.

Educational Objectives:
  1. Identify conversational strategies for addressing sexual and reproductive health with patients/clients with physical or intellectual disability
  2. Identify two areas of increased health risk for patients/clients with disabilities
  3. Access resources for facilitating the provision of appropriate sexual and reproductive health care and education to persons with disabilities
Faculty Expertise: Dr. Roden is a fellow in adolescent medicine, with special interest in the sexual and reproductive healthcare (SRH) of people with complex medical conditions and disabilities. Dr. Holland-Hall is an adolescent medicine specialist and frequent lecturer at AAP and SAHM national meetings. She has published on the SRH of persons with disabilities as well as providing clinical care and education to these families. Liz Schmidt is an occupational therapist and PhD candidate researching and providing sexual health education for individuals with intellectual and developmental disabilities (I/DD). She also has experience working with adults after spinal cord injury to return to activities of daily living, including sexual activity. Ms. Thielman is co-founder of the Nashville Disability Justice Caucus, a grassroots volunteer community focused on fostering greater agency and equality for people with disabilities. As a person with a disability, she has lifelong experience as a self-advocate and peer mentor.


Adapting Family - Based Treatment in Home and Community-based Settings
Christina Tortolani, PhD1; Andrea Goldschmidt, PhD2; Eva-Molly Petitto Dunbar, M.A.3; Elise Hall, LICSW4; Abigail  Donaldson, MD1,5
1Rhode Island College; 2Brown Medical School/ Miriam Hospital; 3University of Rhode Island; 4Gateway Healthcare/ Bradley Hospital; 5Brown Medical School/Rhode Island Hospital
 
Track: Clinical Advances

Description: Family-based treatment (FBT), a behavioral intervention for adolescents with eating disorders in which caregivers are charged with the primary task of re-feeding the ill child and normalizing his/her eating behaviors and weight status, has a strong evidence base. Yet, despite research supporting its efficacy, implementation of FBT remains low outside of specialty research and private practice settings. Additionally, many families, particularly those of lower socioeconomic status, may have difficulties accessing treatment at these specialty practices due to transportation constraints, costs of treatment, and conflicting schedules which make family attendance challenging. In addition, FBT demands intensive engagement by caregivers that might be impossible for adults who have less flexible work schedules, work multiple jobs, single-parent, or may be unable to take a leave of absence from work. Home-based care may be a viable alternative for families of diverse backgrounds for whom standard outpatient FBT is not feasible. The purpose of this workshop is to present an introduction to implementing FBT in the home, including specific modifications needed to adapt manualized FBT into the novel home-based setting, and the introduction of ongoing research designed to test the efficacy of this approach. This workshop will be geared towards multidisciplinary treatment providers who implement healthcare services with adolescents suffering from eating disorders, particularly those working as part of a treatment team. Through interactive educational methods, we hope to provide practical insights on implementing FBT in the home-based setting with diverse populations, and to generate discussions around adapting FBT for other novel settings.

Educational Objectives:
  1. Describe the basic tenets of family-based treatment (FBT) for adolescents with eating disorders.
  2. Identify strategies and challenges associated with modifying FBT for delivery in the home environment and other nontraditional settings.
  3. Identify and address barriers to optimal implementation of FBT in the home setting including collaborating with treatment providers; managing agency-level, legal, and insurance-related concerns; addressing unique patient and familial characteristics.
Faculty Expertise: Christina Tortolani is a psychologist who has worked with children, adolescents, and adults with eating disorders within various contexts, levels of treatment, and evidence-based treatment modalities for the past 15 years. Andrea Goldschmidt is a clinical psychologist with 15 years of experience researching and treating eating and weight disorders using family-based treatment (FBT) and other evidence-based treatment approaches. Eva-Molly Petitto Dunbar is a clinical psychology PhD student at the University of Rhode Island who is currently practicing home-based FBT within a community-based mental health agency. Elise Gilbert Hall is a clinical social worker who has worked with individuals in their homes, schools, and communities. She is managing the home-based FBT team a community-based mental health agency. Abigail Donaldson, is a board-certified Adolescent Medicine physician and Medical Director of the Eating Disorders Program at Hasbro Children’s Hospital where she treats individuals with eating disorders in inpatient and outpatient settings, instructs trainees, and lectures on medical care for eating disorders. *The presenters are currently collaborating on a project to disseminate and implement FBT for adolescents in the home and are developing a manual for home-based FBT. They are training and supervising novice, multidisciplinary providers in delivering FBT in non-traditional settings.


“I Want to Make the Most of My Experience”: Making Meaning for the Adolescent and Young Adult Transitioning with Major Medical Conditions
Mari Radzik, Ph.D.-Clinical Psychology; Diane K. Tanaka, MD; Stephanie Wright, Psy.D., Clinical Psychology
USC Keck School of Medicine-CHLA
 
Track: Core Clinical Topics

Description: The overarching focus of this workshop will be on making meaning of different facets of the adolescent’s experience living with serious medical issues as it relate to their individual development, and the intersection with our medical interventions, and while building the medical and allies professional development. The workshop will introduce curriculums emphasizing developing competencies regarding cultural and individual diversity with specific focus on cognitive, social, cultural, and affective development. We will discuss the role that a primary care provider or adolescent medicine specialist plays in the assessment and identification of mental health issues impacting the health of youth living with complex medical conditions. We will discuss the utilization and integration of the PHQ9 and the HEADSS into health care visits with these patients. In addition, we will discuss the interdisciplinary team approach to working with this special population, as well as the impact of poverty, precarious housing, and undocumented immigration status on their mental health. Patient cases from our clinic will be utilized to highlight the use of motivational interviewing and trauma informed care in assisting these youth in their journey to adulthood.

Educational Objectives:
  1. Further the participants professional skills by discussing the role that a provider or adolescent medicine specialist plays in the assessment and identification of mental health issues of the health of youth living with complex medical conditions.
  2. Introduce the use, utilization and integration assessment measures like the PHQ9 and the HEADSS into interventions with these patients. Patient cases will inform using interventions like motivational interviewing and trauma informed care.
  3. Participants will discuss the interdisciplinary team approach to working with this special population, including addressing social justice issues such as poverty, precarious housing, and undocumented immigration status on their mental health.
Faculty Expertise: The presenters work in the field of adolescent health and medicine, have extensive clinical experience, and are currently actively involved in training medical, psychology and other interdisciplinary trainees. Drs. Tanaka and Radzik are faculty at the USC Keck School of Medicine. Diane Tanaka, MD is the medical director of the My VOICE Transition Clinic, CHLA which she developed 8 years ago. She provides direct clinical services to over 400 adolescents and young adults living with complex medical conditions working closely with an interdisciplinary team comprised of social work, case managers, nursing, and psychologists. She has 25 years of experience working with adolescents and is a Board Certified Adolescent Medicine Physician and Pediatrician. Dr. Tanaka has given at least 100 lectures nationwide on issues affecting adolescents, including their transition to adult care. Dr. Radzik assists in the coordination of the Behavioral Health Services at the Division of Adolescent and Young Adult Medicine, CHLA. She has 25 years of experience working with adolescents, actively presenting on many adolescent related topics including transition health care issues and interventions such as Motivational Interviewing and Seeking Safety. Dr. Wright is a LEAH Psychology Fellow in Pediatric Psychology and Adolescent Medicine.


Do No Harm: Exploring Weight Stigma in the Clinical Context
Lauren Collins, MSW
Seattle Children's Hospital
 
Track: Core Clinical Topics

Description: Experiences of weight stigma affect adolescents' physical, psychological, and emotional health and wellbeing. Weight-based harassment by peers is the most prevalent form of harassment reported by adolescent girls, and the second-most common by adolescent boys (Bucchianeri, Eisenberg, & Neumark-Sztainer, 2013). Health care providers spend less time and engage in less discussion in office visits with patients with a higher BMI and are more reluctant to perform health screenings (Gudzune, Beach, Roter, & Cooper, 2013). The scientific literature indicates a variety of effects of weight stigma on adolescents: poor social and emotional adjustment, loneliness, disordered eating, fewer friends, school avoidance, psychological distress, somatic systems, health care appointment cancellations, preference for sedentary activities, increased calorie consumption, and increased depression, anxiety, substance use and self harm. Mitigating the harm caused by adolescent experiences of weight stigma in clinical and non-clinical settings is a key component in promoting psychological and emotional well being in this population. This workshop will provide a review of the prevalence of weight stigma in the health care context and resulting patient health outcomes. Participants will learn supportive and affirming methods that they can incorporate in clinical and non-clinical settings with adolescents of a larger size, and practice ethical, culturally-responsive approaches to weight stigma. With the rise of worldwide obesity (tripling since 1975, according to the World Health Organization), the need to share and generate strategies to promote psychological and physical well-being among young people of a larger size is integral to serving this population compassionately and effectively.

Educational Objectives:
  1. Review the prevalence of weight stigma in the clinical context, including negative provider attitudes towards large patients and the resulting impacts on quality of patient care and patient health outcomes
  2. Apply methods to mitigate negative effects of weight stigma on adolescent patients
  3. Practice non-stigmatizing clinical approaches to larger weight adolescent patients
Faculty Expertise: This workshop is based off of a peer-reviewed presentation and research project completed during my LEAH training. I presented a version of this workshop to approximately 50 Seattle Children's Adolescent Medicine providers and staff. Based off of provider feedback, 86% of providers surveyed indicated that they were willing to incorporate at least one suggested non-stigmatizing approach to larger-sized adolescent patients. Other expertise: Clinical social worker, adolescent wellness weight management clinical program, Seattle Children's Hospital Adolescent Medicine Division (1 yr); Group facilitator, adolescent wellness intensive 16-week program, topics: body shame, weight stigma; 5 prior presentations on topic of weight stigma (to Adolescent Medicine providers, Dietetic providers & general public), topics: Weight Stigma in the Clinical Context, The Intersection of Sizeism/Weightism and Other Stigmas, the Journey from Body Shame to Body Acceptance, and Health at Every Size 101: Weight-neutral Approaches to Wellbeing in the Health Sciences. Trainings received: workshop/group facilitation methods, Medical Management of Eating Disorders, Health at Every Size: A Clinical Introduction, Monthly Health at Every Size Virtual Provider Consult Group (since Fall 2016), The Body Positive Facilitator Training, Sexuality and Eating Disorders .


Policy and Practice of Confidential Health Services: transcultural perspectives from East Africa
Mychelle Farmer, MD1; Bertha Onduso, Student2; June Nguru, Student3; Jane Otai BA4; Tamera Coyne-Beasley, M.D., MPH5
1Advancing Synergy; 2University of Nairobi; 3University of Maryland Baltimore County; 4Jhpiego; 5University of North Carolina, Chapel Hill

Track: Public Health/Advocacy

Description: This interactive workshop, organized by youth, provides unique insight into youth perspectives on confidential health services as provided in East African countries. National guidelines for adolescent health services will be reviewed with special focus on confidential services. Workshop participants will learn first-hand about youth experiences accessing confidential clinical care for mental health, reproductive health, and related services. Youth will discuss ways that national policy either supports or challenges adolescent confidential health services. Experiences of youth living in East Africa will be contrasted with experiences of Kenyan youth based in the United States, to describe the transcultural experiences affecting confidential services. Kenyan and US health experts will review options for confidential services in East Africa and US. Participants will also explore ways global guidelines such as WHO's Global AA-HA! Framework can support adolescent confidentiality.

Educational Objectives:
  1. Describe the manner in which confidential health services are addressed in global and national adolescent health guidelines.
  2. Compare and contrast the youth perspectives of clinical management of confidentiality within multiple cultural settings.
  3. Identify at least two factors challenging adolescent confidentiality and two factors to strengthen adolescent confidentiality within culturally diverse settings.
Faculty Expertise: Bertha Onduso is a medical student at the University of Nairobi, and June Nguru is an undergraduate at the University of Maryland Baltimore County. Bertha is a leader of the medical student association, and June is majoring in psychology. Jane Otai is Adolescent Health Advisor for Jhpiego, and she has supported adolescent health guideline development as an advisor in Kenya. Mychelle Farmer and Tamera Coyne-Beasley are physicians with expertise in global adolescent health including the development of guidelines and research related to adolescent health.


Using Human Centered Design to Support Innovative Interventions for Adolescent Health
Holly BFontenot, PhD, RN/NP1; Chokdee  Rutirasiri BS BA2
1Boston College; The Fenway Institute; 2Story+Structure
 
Track: Research

Description: Today’s adolescents are redefining ways of communication and engagement. Online portals/ websites, mobile applications, and social media have become a daily part of adolescent’s lives. Recent research has documented that youth would like to rely on technology to seek out health information and engage with health providers. Therefore, providers and researchers need to embrace the adolescent culture and move into the digital world to seek solutions for complex health problems and reduce health disparities associated with adolescence. Human-centered design is an inclusive approach that builds upon participatory action research to solve problems or to build systems that are more relevant, useful, engaging, satisfying, and health promoting to the end users (e.g. adolescent patients, research participants). This presentation will provide foundational information about human-centered design, describe its use in health care, and review an exemplar case. Topics to be covered in this case presentation include: approaches to recruitment through the social/sexual networking app, the use of online focus groups to elicit preferences for HPV vaccine app development, and how we used these preferences in collaboration with a human-centered design firm to build a web-enabled app that addresses HPV vaccination and other sexual health issues. Digital patient engagement cannot fall to software developers alone who may not be able to understand the unique perspectives and health needs that adolescents face, both the youth and the providers need to collaborate to design the future of health delivery.

Educational Objectives:
  1. Identify the guiding principles of human-centered approach: user research, brainstorming, rapid prototyping, and co-designing
  2. Understand, through a case study approach, steps in building a mobile application designed to facilitate sexual health and HPV vaccination
  3. Verbalize and initiate incorporation of human-centered design approaches in research to solve complex adolescent health problems and increase digital health engagement with youth
Faculty Expertise: Dr. Fontenot is an Associate Professor at Boston College, and her research focuses on the promotion of sexual health and prevention of STDs (primarily HPV and HIV) among sexual and gender minority youth. She has had success in multiple studies utilizing novel technologic approaches to recruit and engage with youth for research. Her current study utilized a human-centered design approach to develop and employ an innovative mobile application to a) provide sexual health and HPV vaccine information, and b) connect youth to a local LGBT-affirming community health center for care. Mr. Rutirasiri has designed solutions for higher education, health and human services, healthcare, arts, manufacturing, government, technology, startups, and non-profit since 1995. He founded Story+Structure, an innovative human-centered design firm, in 2007. He is a featured speaker, panelist, and moderator at national conferences in education and design including the annual MIT CIO Symposium.

11:00 a.m. - 12:30 p.m. Sessions


Dilemmas in Substance Use Disorders: Diagnosis and Treatment
May Lau, MD, MPH1; Sheryl Ryan MD2; David Atkinson MD1
1University of Texas Southwestern; 2Penn State Hershey Medical Center
 
Track: Core Clinical Topics

Description: Adolescent substance use is a problem worldwide. Young adults have the highest rates of illicit substance use disorders worldwide. The percentage of the adolescents and young adults who have substance use disorders have remained the same for over 15 years. Alcohol remains the most commonly used substance followed by marijuana, whereas the number of adolescents who misuse opioids is small. Yet, any adolescent and youth adult is at risk for misusing opioids. Youth use licit and illicit substances for many reasons including experimentation and peer pressure. Many youth use them to manage negative moods or anxiety, and relax. It is challenging for providers such as physicians, nurses, social workers, and psychologists who work with youth to identify those who are experimenting compared with those who have transitioned to more regular use or have a substance use disorder. This presentation will review the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 diagnostic criteria for substance use disorders. The use of one set of diagnostic criteria to determine severity of disease facilitates the diagnosis of substance use disorders. Screening approaches and methods will be discussed that can alert providers to those youth at risk for substance use disorders and who need additional assessment to determine if they have a substance use disorder. Providers will learn to conduct a brief negotiation intervention to assist the adolescent in identifying risky behaviors while using licit and illicit substances, and to deliver behavior change counseling. Finally, behavioral and medication-assisted treatment options will be discussed.

Educational Objectives:
  1. Describe techniques to screen and assess youth with substance use disorders, and be able to list the DSM 5 criteria for substance use disorders
  2. Perform the brief negotiation intervention for substance use counseling
  3. Explain the behavioral and varied medication-assisted treatment options for substance use disorders
Faculty Expertise: Dr. May Lau is the medical director of the Adolescent and Young Adult Program at the University of Texas Southwestern (UTSW)/Children's Health Dallas, where she identifies and counsels youth with substance use disorders. Dr. Sheryl Ryan is Professor of Pediatrics and Chief of the Division of Adolescent Medicine at the Penn State Hershey Medical Center. She is the current Chair of the AAP’s Committee of Substance Use and Prevention and has authored several position statements, technical reports, and clinical reports on substance use in youth. She was most recently a co-investigator on a SAMHSA-funded project designed to teach pediatric residents the techniques of SBIRT and performing brief interventions in primary care settings. Dr. David Atkinson is the medical director of the UTSW/Children's Health Dallas Teen Recovery Program, which specializes in treating mental health issues in substance-using youth. He is board certified in General Psychiatry, Child and Adolescent Psychiatry, and Addiction Psychiatry. He is the chairman of the Youth and Adolescent Committee of the American Academy of Addiction Psychiatry and a member of the Psychiatry Substance Use Committee of the American Academy of Child and Adolescent Psychiatry. He has authored clinical practice guidelines and chapters, and lectured on adolescent substance use.


Sex Talk: Tailoring Your Approach for Adolescents with Intellectual Disability in a Primary Care Setting
Karen L. Saroca, MD, MS1; Frinny Polanco Walters, MD2; Ireen Ahmed, MD3; Laura Coyle, MD3; Rebecca Monk Beyda, MD, MS4; Laura K. Grubb, MD, MPH3; Dasha Solomon, PsyD2
1Tufts Medical Center; 2Boston Children's Hospital; 3Floating Hospital for Children at Tufts Medical Center; 4University of Texas Medical School at Houston
 
Track: Core Clinical Topics

Description: Adolescents with intellectual disabilities are a population with limited, disparate access to care in the areas of reproductive and sexual health and sexual health education. Adolescents with learning difficulties may not receive appropriate sexual health education because of community myths that they are “asexual” or sexually naive. A lack of effective sexual education can lead to adolescents engaging in risky sexual activity resulting in teen pregnancy and sexually transmitted infections among students with intellectual disabilities. These individuals also may have communication challenges that make it difficult to be assertive and avoid unsafe and nonconsensual sexual practices. Misperceptions and stigma about sexuality and lack of sexual health education in youth with intellectual disability can affect health care providers’ comfort level in discussing sexual health with this patient population, as well as patients’ ability or willingness to ask questions or raise concerns. Primary care physicians may not be adequately trained to educate adolescent patients in the areas of sexuality, and there often lacks formal training for tailoring this approach specifically for adolescents with intellectual disabilities. This workshop session aims to improve providers’ knowledge, skills, and comfort levels for the provision of sexual health services and education with patients with intellectual disabilities and their parents. We will highlight the experience of a parent of a youth with intellectual disability, as well as provide information and resources from a variety of sources including scientific literature and sexual health education models and resources.

Educational Objectives:
  1. Analyze issues specific to youth with intellectual disabilities in the areas of puberty, sexual development, and sexual health
  2. Differentiate the unique needs of youth with intellectual disability and their families through parent testimony
  3. Prepare primary care clinicians to discuss sexual health issues in a developmentally appropriate manner for adolescents with intellectual disability
Faculty Expertise: Dr. Karen Saroca (Child & Adolescent Psychiatrist at Tufts Medical Center), Dr. Frinny Polanco Walters (Adolescent Medicine Fellow at Boston Children's Hospital), and Dr. Laura Grubb (Director of Adolescent Medicine at Tufts Medical Center) founded a project developing and teaching a sexual education curriculum in special education classrooms at a local high school in Boston. They received the AAP CATCH grant to fund this project, which also involves medical students and residents, and aims to include sexual health education in pediatric training. At the SAHM 2017 Annual Meeting, they presented a workshop entitled "Empowering Adolescents with Intellectual Disability: Enhancing Sexual Health Education through Community Collaboration." Dr. Ireen Ahmed (Triple Board Resident at Tufts Medical Center) serves as the current project leader. She co-authored the CATCH grant as well as the TUSM Community Service Learning (CSL) Grant. Dr. Laura Coyle (Pediatrics Resident at Tufts Medical Center) co-authored the CSL grant, assisted with curriculum development, and is the deputy project leader. Dr. Rebecca Beyda (Assistant Professor of Pediatrics & Adolescent Medicine at the University of Texas Medical School at Houston) has expertise providing medical care and consultation in a special needs clinic at a large, urban university hospital.


But My Kid is 18 Years Old . . . What Do I Do? The Potential Benefits and Challenges of Involving Family in the Treatment of Young Adults with Eating Disorders
Rollyn M. Ornstein, MD1; Jamal H. Essayli, PhD1; Rebecka Peebles, MD2; Karen Anderson, MD3
1Penn State Health Children's Hospital; 2Children's Hospital of Philadelphia; 3The Pennsylvania State University
 
Track: Clinical Advances

Description: Eating disorders, particularly anorexia nervosa (AN), are complex and dangerous psychological conditions that are notoriously difficult to treat. Unfortunately, most psychotherapy trials for adults with AN have yielded unimpressive results. In contrast, Family-Based Treatment (FBT) has been established as the treatment-of-choice for adolescents with AN. Despite this, families have not traditionally been included in the treatment of young adults (18 – 26 years old) with eating disorders. Given evidence that family support can significantly improve outcomes for adolescents with AN, it is reasonable to predict that FBT would also be an effective approach for young adults, and pilot case series have shown promising results. Actively involving family members may be critical to facilitating full recovery, rather than merely helping a patient become ‘less ill’. On the other hand, certain features that differentiate young adults from adolescents may prove challenging when including families in care. Emerging autonomy and the legal limitation of consent for family involvement in treatment are potential barriers, especially for college students living away from home. This workshop will review the potential benefits and challenges of involving family in the treatment of young adults with eating disorders, and will encourage the audience to consider FBT for adult patients as a novel treatment modality. Several interdisciplinary providers who specialize in eating disorders will share their experiences with family involvement for young adults in different treatment settings, including a partial hospital program, outpatient clinic, and university health center.

Educational Objectives:
  1. Identify novel approaches to involving family in the treatment of young adults with eating disorders
  2. Discuss ethical dilemmas and other challenges that commonly emerge when attempting to include family in the treatment of young adults with eating disorders
  3. Describe methods to overcome the challenges of family involvement when treating this clinical population
Faculty Expertise: This workshop includes an interdisciplinary panel of providers who are experts in the field of eating disorders and adolescent health, including physicians and a clinical psychologist. Dr. Ornstein is an adolescent medicine physician at Penn State Health Children’s Hospital and has almost 20 years of clinical and research experience in eating disorders. She has presented and published widely. Dr. Essayli is a clinical psychologist with expertise in cognitive-behavioral therapy and eating disorders, and serves as the program director for the young adult partial hospital and intensive outpatient eating disorders program at Penn State Health Children’s Hospital. Dr. Peebles is an adolescent medicine physician with expertise in family-based therapy for eating disorders, and serves as the Director of Research and Quality Innovations of the Eating Disorder Assessment and Treatment Program at Children’s Hospital of Philadelphia. She has presented on eating disorders at multiple conferences and is well-published. Dr. Anderson is a university physician at Penn State University and has seven years of experience on the multidisciplinary HEALS (Healthy Eating and Living Support) team. She has frequently managed the challenge of students with severe eating disorders on a college campus and the role the university and the families play.


Improving Readiness for Adult Care for All Youth and Young Adults: A New Clinician Toolkit
Patience White, MD, MA1; Charles E. Irwin, MD2; Maria Aramburu, MD, MPH3
1Got Transition; 2UCSF Benioff Children's Hospital; 3MedStar Georgetown University Hospital
 
Track: Clinical Advances

Description: According to the 2011 AAP/AAFP/ACP Clinical Report on Health Care Transition (HCT), transition planning support should be offered to all youth, beginning early in adolescence and continuing into young adulthood. Yet, national survey data reveal that 85% of adolescents are not receiving transition preparation from their health care providers. Planned and continuous attention to HCT becomes paramount for the psychological well-being of transition-age youth, who are facing transitions not only in health care but in many other areas of life. By offering a structured transition process, research shows that adolescents and young adults will have better health outcomes, improved health literacy and self-care skills, greater engagement and satisfaction with care, and less emergency room and hospital use. A newly developed toolkit, Incorporating Health Care Transition into Preventive Care for Adolescents and Young Adults, will be presented at this workshop. Developed jointly by The National Alliance to Advance Adolescent Health’s Got Transition program and the University of California, San Francisco’s Adolescent and Young Adult Health National Resource Center, this toolkit provides state-of-the-art guidance for clinicians to introduce HCT as part of routine preventive care, following the AAP’s Bright Futures general format and age groupings. Available in English and Spanish, this toolkit contains sample questions and anticipatory guidance for use with early adolescents (ages 11-14), middle adolescents (ages 15-17), late adolescents (ages 18-21), and young adults (ages 22-25). It also includes sample tools to strengthen adolescents’ and young adults’ ability to manage their own health and effectively use health care services.

Educational Objectives:
  1. Assess the level of their clinic’s/system’s implementation of evidence-informed health care transition activities.
  2. Discuss the newly developed Toolkit for Incorporating Health Care Transition into Preventive Care for Adolescents, which can be used with Bright Futures.
  3. Demonstrate best practices through interactive scenarios between clinicians and adolescent and young adult live presenters.
Faculty Expertise: Dr. Patience White is the Co-director of Got Transition, the national resource center on health care transition. She is a nationally recognized author and speaker on transition and is leading the update of the AAP/AAFP/ACP Clinical Report on Health Care Transition. Dr. Irwin is the Director of the National Adolescent and Young Adult Health Care Resource Center. With Dr. White, they created a new clinician toolkit on incorporating transition into the adolescent and young adult well visit, which will be presented at this meeting. Dr. Irwin is a well-known expert and teacher in the field of adolescent health. Dr. Aramburu is the medical director of Roosevelt SBHC in DC and has been working with Dr. White on an innovative quality improvement project to incorporate transition into routine school-based health center care. Dr. Aramburu is leader in community pediatrics, working with culturally diverse and immigrant populations in the District of Columbia.


Adolescent Obesity Management 2.0: Essential Psychological, Social, and Cultural Considerations
Maya Michelle Kumar, MD1; Taylor Argo, MD2; Jane Chang, MD3; Rebecca Chermak, Psy.D.4; Alicia Dixon Docter, MS, RDN, CD5; Preeti Galagali, MBBS, MD6; Janice Key, MD7; Erik Schlocker, MSW, LICSW5; Amy Weiss, MD, MPH8
1University of California San Diego; 2University of Minnesota; 3Weill Cornell University; 4Tampa General Hospital/University of South Florida Bariatric Center; 5Seattle Children's Hospital; 6Bangalore Adolescent Care & Counselling Centre; 7Medical University of South Carolina; 5Seattle Children's Hospital; 8University of South Florida

Track: Clinical Advances

Description: The prevalence of overweight is increasing among adolescents in both developed and developing nations. Treatment that solely focuses on portion control and physical activity is often ineffective in creating sustainable change. In this workshop, inspired by the theme of the 2019 SAHM Annual Conference, a multidisciplinary team will summarize mounting evidence that psychological, socioecological, and cultural factors are critical contributors to adolescent overweight around the world. Specific factors that will be discussed include: -Disordered eating, which is highly prevalent among overweight adolescents and may worsen weight gain; -Comorbid mental health conditions, particularly depression, attention deficit/hyperactivity disorder, and post-traumatic stress disorder, which may be associated with emotional or impulsive eating; -Peer and media influence on food choices; -Food insecurity, which may lead to co-existing overnutrition and undernutrition within a single household; -Weight bias and stigma among adolescents, parents, and providers, which may contribute to worsening of weight gain; -The intersection between weight and racial, cultural, and gender identities; -Family culture around food and exercise (including beliefs about nutrition, gender roles, and interpersonal dynamics while preparing and eating food) and influence from culture and religion; and -Environmental barriers to physical activity and nutritious food. This workshop will increase participants’ understanding of the factors beyond caloric intake and output that must be sensitively and comprehensively addressed for adolescent weight management to be effective. Participants will discuss solutions for improving clinical care through developmentally appropriate multidisciplinary support, family-based treatment, addressing implicit bias in clinical care and medical education, and advocating for broader societal change.

Educational Objectives:
  1. Identify and verbalize critical psychological, socioecological, and cultural processes that contribute to adolescent overweight at the individual, family, and societal levels.
  2. Use a multidimensional approach to comprehensively evaluate adolescents struggling with overweight, and develop management plans that sensitively address all contributing factors to the furthest extent possible.
  3. Examine potential provider biases and advocate for broader changes in arenas beyond clinical care to improve nutritional health among adolescents around the world.
Faculty Expertise: The presenters include physicians, a dietitian, a psychologist, and a social worker, all of whom have extensive clinical experience as part of multidisciplinary teams treating both adolescent overweight/obesity and eating disorders. The presenters represent diverse practice settings from Canada, India, and across the United States. Presenters Kumar, Docter, Galagali, Weiss, Chang, Key, and Argo are active members of the SAHM Nutrition and Obesity Committee. The faculty presenters are frequently invited to teach lectures and workshops related to adolescent nutritional disorders at pediatric and adolescent health conferences (including previous SAHM annual conferences), school health conferences, academic grand rounds, and continuing medical education seminars. Presenters Kumar, Docter, Weiss, and Galagali are authors of the newly published 2018 SAHM Position Paper 'Addressing Nutritional Disorders in Adolescence.' Many of our faculty presenters have published and presented peer-reviewed research on effective management of adolescent nutritional disorders. Several faculty presenters have developed multidisciplinary weight loss programs for adolescents, including bariatric surgery programs, at their institutions. All presenters are active in teaching trainees, and several faculty support interdisciplinary trainees in Leadership Education in Adolescent Health programs. All presenters are outspoken advocates for a biopsychosocial approach to managing adolescent nutritional disorders.


Rights, Respect, Responsibility: Reframing Adolescent Sexual and Reproductive Health through a Reproductive Justice Lens
Tonya Katcher, MD, MPH1; Jamila Perritt, MD, MPH, FACOG2; Mariah Johnson1; Antoinette  Jones1
1Advocates for Youth; 2Planned Parenthood of Metropolitan Washington, DC
 
Track: Public Health/Advocacy

Description: Young people have the right to receive accurate sexual health information and to have access to the full range of reproductive health service options, freely and without coercion. Young people also deserve to be treated with respect, as individuals who have agency over their own lives. However, adolescent sexuality in the US has often been framed as a public health problem to be controlled; this framing may encourage clinicians to approach contraceptive counseling with bias and to insert their own priorities into patient care. This workshop will encourage participants to rethink their approach to providing reproductive health care to patients, to center young people and to support their agency. This workshop, which will be co-led by clinicians and youth, will explore the history of reproductive coercion, primarily targeting women of color, which has been carried out by policies and medical institutions in the United States, and will illustrate how that history contributes to current disparities in reproductive health outcomes. The workshop will also introduce and define the framework of reproductive justice and the importance of incorporating the framework into the provision of sexual and reproductive health services for adolescents and young adults. Understanding reproductive justice is essential for clinical providers to provide patient-centered, non-coercive care, particularly when providing contraception or counseling about pregnancy options.

Educational Objectives:
  1. Describe the coercive history of reproductive health in the U.S.
  2. Identify three impacts that historical reproductive rights abuses have had on reproductive health disparities today.
  3. Define the reproductive justice framework and the benefits of incorporating this framework into sexual and reproductive health services for adolescents and young adults.
Faculty Expertise: Dr. Tonya Katcher, Program Manager, Contraceptive Access at Advocates for Youth, works to improve reproductive health services and eliminate barriers to contraception for youth. Dr. Katcher is a pediatrician and practices adolescent medicine. She has an MD from the University of Minnesota and MPH from Johns Hopkins. Jamila Perritt, MD MPH FACOG, board certified Obstetrician/Gynecologist, is focuses her work on the intersection of sexual health, reproductive rights and social justice. A graduate of Howard University College of Medicine, Dr. Perritt collaborates with local and national organizations to provide support and expertise on sexual and reproductive health and reproductive justice. Mae Knight and Antoinette are members of Advocates’ Young Women of Color Leadership Council, a cohort of youth leaders from across the U.S. working to educate, include and empower their peer to mobilize in support of reproductive justice.

 
Using Quality Improvement Methodologies to Improve Adolescent Sexual and Reproductive Health in Pediatric Health Systems
Aletha Y. Akers, MDMPH, FSAHM, FACOG1; Kenisha Campbell, MD, MPH1; Sarah Wood, MD, MSHP1; Emily Gregory, MD, MHS1; Rosheen Grady, MD2
1Children’s Hospital of Philadelphia; 2McMaster Children’s Hospital
 
Track: Research

Description: Adolescents and young adults have the highest rates of adverse reproductive outcomes among people of all age groups. Rates of sexually transmitted infections (STI) and unintended pregnancies are highest in this age group, yet receipt of recommended reproductive health services is low. In this workshop, we describe quality improvement methodologies for optimizing health by improving clinical care processes. We describe tools for conducting QI research, including driver diagrams and explanation of PDSA (Plan-Do-Study-Act) cycles. We describe the quality improvement (QI) framework developed at the Children’s Hospital of Philadelphia (CHOP). This framework includes nine key components of quality and safety: 1) Leveraging electronic records to help clinicians to deliver high quality care, 2) Continuously implement and update practices to make care safe, 3) Reducing pediatric and adolescent patient discomfort, 4) Reducing unnecessary care, 5) Reducing emergency room visits and hospitalizations, and maximizing care coordination, 6) Promoting healthy lifestyles to improve individual and community health, 7) Increasing the efficiency and effectiveness, 8) Reducing the time to receipt of needed care, and 9) Reducing disparities in care We present three quality improvement projects that highlight the success of the CHOP QI framework at 1) improving STI screening, 2) providing contraceptive services to young people using teratogenic medications and 3) providing contraceptive services to parenting teens. Workshop attendees will work in small groups to develop and refine their own QI research question and prepare an outline for a quality improvement plan they can implement at their institutions and develop a dissemination strategy.

Educational Objectives:
  1. To provide an overview of quality improvement research methodologies and tools
  2. To discuss dissemination and publication plans for QI projects.
  3. To demonstrate use of QI processes to improve chlamydia screening in an urban pediatric primary care clinic
  4. To demonstrate use of QI processes to identify adolescent patients on teratogenic medications and to provide contraceptive services
  5. To demonstrate us of QI processes to identify parenting teens at newborn visits with unmet contraceptive need
  6. To assist attendees in developing a QI plan to address an adolescent sexual and reproductive health issue at their home institution
Faculty Expertise: Aletha Y. Akers: is a Pediatric Gynecologist with more than 20 years of experience developing research programs to improve adolescent sexual and reproductive health. Kenisha Campbell: is a board certified pediatrician and adolescent medicine specialist with a clinical focus on reproductive and sexual health, primary care and eating disorders. She also is the director of both primary care and subspecialty clinics in Adolescent Medicine and has both led and participated in several institutional QI projects. Sarah Wood: is an Adolescent Medicine and HIV Specialist with a research focus on biomedical prevention of HIV and sexually transmitted infections in adolescents. Emily Gregory: is a primary care pediatrician with clinical and research expertise in improving maternal-child health outcomes by enhancing interconception services for mothers during infant well visits. Rosheen Grady: is a board certified pediatrician and recent graduate of the CHOP Adolescent Medicine fellowship program. She has an interest in trainee involvement in QI, teaching safety and quality and has participated in QI workshops and certificate programs within Canada and the US.

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