Workshops: Thursday, March 7


10:45 a.m. - 12:15 p.m. Sessions

Causes and Consequences of Sleep Disruption: Implications for Accurate Diagnoses and Effective Treatment Plans
J. Roxanne Roxanne Prichard, PhD
University of St. Thomas
Track: Core Clinical Topics

Description: American adolescents and young adults are among the world’s most sleep deprived populations, outside of new parents and active-duty soldiers. More than 4% of young adults under the age of 25 have reported falling asleep at the wheel in the last month, and >30% of college students describe sleep as “traumatic or difficult to handle.” The obstacles to obtaining restorative, sufficient sleep include a perfect storm of environmental, physiological, pharmacological, psychological and sociological factors. Adolescents with disturbed sleep are more likely to contract communicable diseases and infections, engage in risk-taking behavior, report depressed and anxious moods, and attempt suicide. Recognizing and addressing sleep problems early on would likely lead to improved health and wellness across a number of clinically relevant measures. Although sleep is a requirements for life, most clinicians receive very little formal instruction in sleep. In fact, most medical school students receive less than two hours of training in sleep medicine. This goal of this workshop is to help clinicians feel more comfortable recognizing the signs of disturbed sleep, discussing practical ways to improve sleep, and determining when a referral to a sleep clinic is warranted. Specifically, the workshop will include: *an overview of the neuroscience of sleep; *a thorough discussion of the endogenous and environmental factors that most often disturb sleep in young adults; *a review of the physiological and psychological symptoms of sleep deprivation; and *a discussion of available screening tools to identify sleep disorders, pathological levels of excessive daytime sleepiness, and poor sleep hygiene.

Educational Objectives:
  1. Describe the predominate challenges in obtaining consistent, restorative sleep for adolescents and emerging adults
  2. Recognize the physical and psychological consequences of sleep deprivation and circadian rhythm desynchronization
  3. Identify effective sleep screening tools and health promotion strategies
Faculty Expertise: I am the scientific director of the Center for College Sleep, and serve on the NCAA Taskforce on Sleep and Wellness.  I have a Ph.D. in neuroscience, with a research focus in the neuroanatomy of sleep. As a professor of psychology, I regularly teach courses on Sleep and Circadian Rhythms, Physiological Psychology, and Psychopharmacology. For the past 14 years, I have researched and published in the field of college student sleep. I have given dozens of invited lectures and continuing education workshops on sleep, including keynote addresses for the American College Health Association and the Big East Athletic Conferences. My research on the relationships between stress, sleep, health and academic success in college students has been summarized in numerous news outlets including the Huffington Post, USA Today, Science Daily, US News and World Report, and (forthcoming) the New York Times.

One Size Does Not Fit All: Novel Approaches to Tailoring Contraceptive Services for Adolescents and Young Women
Aletha Y. Akers, MD, MPH, FSAHM, FACOG1; Andrea Hoopes, MD, MPH2; Alix Timko, PhD3
1Children’s Hospital of Philadelphia; 2Kaiser Permanente Washington; 3Perelman School of Medicine at The University of Pennsylvania
Track: Clinical Advances

Description: Promotion of reproductive health and well being for adolescent and young adult (AYA) women requires supportive health systems and health providers who understand this population’s evolving developmental needs. It also requires an awareness of effective tools for counseling patients, while being mindful of the power dynamics operational during clinical encounters and avoiding inadvertent coercive interpersonal dynamics. Missed opportunities to provide such patient-centered care can lead to unplanned pregnancies and suboptimal health and social consequences for AYA women. Unfortunately, health providers often lack the tools and resources to appropriately identify and meet individual AYA women’s contraceptive needs. This workshop orients attendees to the unique neurodevelopmental factors that influence the shared-decision making process during contraception counseling sessions with AYA women. We will review existing evidence-based strategies to improve contraceptive use, including effective contraceptive counseling approaches (e.g., GATHER model, WHO efficacy based counseling, Contraceptive CHOICE model), health system approaches (e.g., removing financial barriers, offering same day services), and adherence tools. The session highlights the fact that AYA women are a diverse population for whom a one-size-fits-all approach to contraceptive service delivery may not optimally meet the needs of all women in this age group. We will provide insights from the development of a new contraceptive needs assessment tool tailored for AYA women, plus findings from a novel health coaching intervention to improve contraceptive continuation among AYA women. The session will be led by a multidisciplinary panel that includes a clinical psychologist, a health coach, an adolescent medicine physician, and a pediatric gynecologist.

Educational Objectives:
  1. Understand neurodevelopmental factors that influence adolescent and young adult women’s (AYA) needs during contraceptive counseling and service provision
  2. Describe traditional , evidence-based contraceptive counseling techniques used in family planning service delivery
  3. Review the evidence regarding effective counseling strategies for improving contraceptive use among AYA women
  4. Describe the development of a contraceptive needs assessment tool for pediatric primary care and family planning providers
  5. Describe a novel health coaching intervention as a strategy for improving contraceptive continuation among AYA women
Faculty Expertise: Dr. Akers is a pediatric gynecologist and researcher who has lead multiple projects to improve counseling and delivery of contraceptive services to teens. Dr. Hoopes is an adolescent medicine clinician and researcher who has conducted qualitative and survey-based research on the contraception decision making needs of adolescents. Dr. Timko is a licensed psychologist with expertise in acceptance-based behavioral approaches and family-based treatment for children, adolescents, and young adults with eating disorders. She also specializes in the application of Acceptance and Commitment Therapy to improve women’s health. Alanna Butler is a health educator and researcher who has led health coaching and reproductive health education programs for teens and young adults.

Eating Disorder Clinical Conundrums: A Multidisciplinary Approach to Complex Inpatient Cases
Jonathan Avila, MD1; Jennifer Carlson, MD1; Jennifer Derenne, MD1; Allyson F. Sy, MS, RD2
1Stanford University School of Medicine; 2Stanford Children's Health - Lucile Packard Children's Hospital
Track: Core Clinical Topics

Description: Several medical complications warranting inpatient admission for patients with eating disorders can be attributed to weight loss from energy imbalance. For most of these patients, energy imbalance is the result of severe dietary restrictions, frequently combined with excessive energy expenditure, and thought to stem from their underlying eating disorder psychopathology. Since weight loss in these adolescents is typically attributed to their eating disorder, a potential coexisting medical condition altering metabolic demands may be missed. The opposite is also true where providers may miss the diagnosis of an eating disorder in patients with medical conditions that affect metabolism and lead to weight loss. We present a number of challenging cases of patients admitted to a multidisciplinary eating disorder inpatient treatment unit whereby their atypical presentation led to the diagnosis of a coexisting medical condition or whose complex medical or psychiatric presentation led to rethinking of typical inpatient management of patients with eating disorders. Their cases will be contextualized by a multidisciplinary expertise panel providing medical, psychiatric, and nutritional perspectives for each case.

Educational Objectives:
  1. Identify aspects in the history of patients with eating disorders that can be concerning for an underlying coexisting medical condition leading to weight loss.
  2. Identify aspects in the history of patients with chronic medical conditions that affect metabolism that can be concerning for a coexisting eating disorder psychopathology.
  3. Utilize a collaborative and multidisciplinary approach to address atypical presentations and clinical management of patients with medical instabilities from malnutrition.
Faculty Expertise: Jonathan Avila is a dual adolescent medicine and endocrine fellow with clinical interests in the intersectionality of eating disorders and endocrinological conditions as well as eating disorders and gender dysphoria. Jennifer Carlson, MD has been an attending physician in the inpatient and outpatient eating disorder programs at Stanford Children’s Health for the past 12 years. She has published multiple articles and chapters on the management of patients with eating disorders and has a specific focus on the athlete population. Jennifer Derenne, MD is the psychiatric director of Stanford Children's inpatient eating disorders unit. She is the co-author of “Promoting Safe and Effective Transitions to College for Youth with Mental Health Conditions: A Case-Based Guide to Best Practices.” She has led several national workshops on adolescents with eating disorders. Allyson Sy, MS, RD is a clinical lead dietitian with extensive experience in managing eating disorders in young people across a variety of settings. She is involved in a currently ongoing NIH-funded multicenter randomized controlled trial of refeeding in patients with anorexia nervosa.

Addressing Suicide Risk for Transgender and Gender Expansive Youth: A Multidisciplinary, Systemic Approach
Bridgid Mariko Conn, Ph.D.1; Jamie Julian, MSW, LCSW1; Kaitlin Venema, Ph.D.1; Terez Yonan, DO, MPH2
1Children's Hospital Los Angeles; 2Children's Hospital of Orange County
Track: Clinical Advances

Description: Suicide is a crucial public health problem in the United States among youth, particularly as rates of suicide attempts have risen steadily over the past two decades. As a result, there have been calls for increased depression screening in primary care and greater efforts to address the factors that increase or mitigate risk for suicidality among those individuals who may be most vulnerable. While suicide is the second leading cause of death in adolescents in the US, rates of suicidality and suicide attempts are significantly higher among transgender and gender expansive (TGE) youth. Still, growing research supports several protective factors that have been found, including social and parental support and acceptance, lower experienced transphobia or homophobia, having personal identification reflecting gender identity, and access to medical intervention. Due to the sensitive and critical nature of suicide risk, practitioners often report feeling under-prepared or uncomfortable asking about or addressing suicidal ideation, particularly among gender minority youth. Using a transcultural, developmental perspective, this workshop will provide an updated review of current literature on suicide risk among gender minority youth, as well as intrapersonal and systemic protective factors. Attendees will participate in interactive training exercises focused on increasing screening for suicide risk, addressing chronic risk factors and promoting protective factors and assets, including socio-cultural resources, and developing strengths-based interventions to promote overall psychological well-being for gender minority youth. Implications for clinic-based practices and medical and social justice advocacy will be discussed, including recommendations and resources for supporting under-served communities and integrating transcultural approaches.

Educational Objectives:
  1. Describe recent trends in prevalence of suicidality among transgender and gender expansive (TGE) youth and identify intrapersonal and environmental factors that increase risk of suicide or mitigate such risk.
  2. Identify and evaluate tailored interventions and person-centered approaches to address suicide risk for TGE youth grounded in a multidisciplinary, systemic perspective.
  3. Develop clinic-based, local, national, and global initiatives to support gender affirming care, model inclusivity, and engage in advocacy for TGE youth.
Faculty Expertise: Dr. Conn is a licensed psychologist at Children's Hospital Los Angeles in the Division of Adolescent and Young Adult Medicine and specializes in the assessment, management, and prevention of suicidality among under-served, diverse adolescents. She has presented and educated on suicide assessment/intervention and postvention approaches for high-risk youth, including LGBTQ communities, with a range of audiences. Jamie Julian is a licensed clinical Social Worker for the Center for Transyouth at Children's Hospital Los Angeles. She partners with young people and families as they navigate crisis and connects them with services. Dr. Venema is a postdoctoral psychology fellow at Children's Hospital Los Angeles with specialized interest in providing therapeutic services to transgender and gender expansive youth and their families. Her former research includes examining the correlates of bullying and suicide in LGBT youth, as well as cultural aspects of suicidality. Dr. Yonan is a board certified adolescent medicine specialist at Children's Hospital Orange County. She is also board certified in pediatrics. She specializes in providing medical care to all teenagers and has expertise in adolescent gynecology, transgender youth care, LGB health, and adolescent mental health.

Nutrition for the Young Athlete
Chris Renjilian, MD, MBE, FAAP, CAQSM1; Kimberly Cover, MS, RD, CSSD, LPC, LDN1; Cora Breuner, MD, MPH, FAAP2; Albert Hergenroeder, MD, FAAP, CAQSM3
1Children’s Hospital of Philadelphia; 2Seattle Children's Hospital; 3Texas Children's Hospital
Track: Core Clinical Topics

Description: Across the globe, Adolescent health providers routinely care for youth who participate in sports or physically active recreation. More broadly, adolescent health providers and health leaders share the goal of promoting healthy physical activity and nutrition for all youth. For these professionals, formal training and access to information about the basics of sports nutrition is highly variable and, in most cases, scarce. At the same time, healthprofessionals, families and youth alike routinely encounter claims about the performance-enhancing properties of specific diets and nutritional supplements. These claims appear in popular media, social niches (e.g., sports teams), and professional opinions. t Nutrition-related claims and practices can evolve quickly, and the scientific evidence for and against these trends – particularly as they relate to young athletes -- can be difficult to ascertain, making it a challenge for many adolescent health professionals to keep pace. This session is designed to review the core evidence-based concepts of sports-related nutrition, which can be applied in a variety of clinical contexts and programmatic areas. The session also aims to identify trends in nutritional supplementation and provide a summary of current evidence that can be helpful to primary care and specialty professionals in their efforts to provide current, high-quality clinical advice for youth.

Educational Objectives:
  1. Review key principles that govern the nutritional requirements of young athletes with the aim of developing a comprehensive understanding of nutrition as an essential building block for athlete health and preparation for optimal performance
  2. Identify and review strategies to accurately estimate the energy and macronutrient requirements of individual athletes in the clinical setting.
  3. Review current trends in supplementation among athletes who aspire to optimize training and performance. Discuss the evidence and relevant clinical pearls that should guide counseling and recommendations for youth regarding these supplements.
Faculty Expertise: Kimberly Cover is a registered dietitian specializing in sports nutrition at the Center for Sports Medicine and Performance at the Children’s Hospital of Philadelphia. For two decades, Kim has counseled competitive athletes in a variety of sports and levels of competition, up to the intercollegiate level for NCAA Division I programs. In addition to her work with young athletes in the clinical setting, Kim has built a career as an experienced presenter on mindfulness, sports nutrition and eating disorders for multidisciplinary groups across the nation. Drs. Breuner, Hergenroeder, and Renjilian are clinical experts in adolescent medicine and sports medicine. They are experienced in the clinical care of young athletes, including issues related to nutrition and disordered eating.

Breaking the Glass Ceiling: Promoting Professional Development and Leadership of Underrepresented Providers of Health Care Professions
Maria Veronica Svetaz, MD, MPH, FSAHM, FAAFP1; Michele A. Kelley, ScD, MSW, MA2; Marissa Raymond-Flesch, MD, MPH3; Veenod L. Chulani, MSEd, FSAHM4; Michele Lee Allen, MD, MS5
1Hennepin Healthcare System; 2University Of Illinois at Chicago; 3UCSF; 4Phoenix Children's Hospital; 5Univesity of Minnesota
Track: Professional Development/Training/Education

Description: The purpose of this workshop is to provide strategies for institutional change that support the development and integration of leaders from minority or underrepresented populations which can be applied by members of those groups as well as their allies. Addressing diversity in the workplace is a priority for public and private sector organizations given the increasing diversity of stakeholders. Evidence shows that administrators and service providers who share personal characteristics, cultural identities, and common community and ancestral histories with the communities they serve can make a positive difference in tailoring programs and services to better match community needs and preferences. This is especially true for marginalized groups, where underrepresented providers may play a vital role in enhancing access to services, assuring quality of services, and optimal outcomes. There are documented increased demands and stressors on providers that are associated with being a member of an underrepresented group. The sources of these demands and stressors are both internal to the workplace (e.g., racism, imposter syndrome, leadership gaps, inadequate, unresponsive systems; cultural insensitivity), as well as inherent in the role of advocating for and directly responding to meet needs of marginalized groups (vicarious trauma, “going it alone”, constant representation and interpretation of population issues and needs), in this case, underserved or socially marginalized adolescents and young adults and their families. Concurrently, there is a middle management glass ceiling for leaders from minority and/or marginalized populations that limits their voice in upper leadership and their ability to change the culture of our institutions

Educational Objectives:
  1. Describe impostor syndrome and address strategies to overcome it.
  2. Describe approaches to address institutional structural biases, like racism, sexism, ageism, etc, in workplaces and to promote systemic change.
  3. Identify strategies to foster leadership among diverse/underrepresented professionals by increasing personal effectiveness for self-renewal.
Faculty Expertise: Dr. Svetaz is a family /adolescent medicine immigrant from Argentina that has been working on MN Safety Net on Adolescent Health and Health Equity since 2001. She has extensive work done and presentation around Health Equity and is the current Chair of SAHM Diversity Committee. Dr Michele Kelley is a public health social scientist with expertise in youth participatory action research. She teaches leadership and advanced practice and grantsmanship in the MPH Core and is former co-chair of the Adolescent and Young Adult Committee of the American Public Health Association . Dr. Vinny Chulani is a cisgender, queer physician who has been active in clinical program development and health profession education on care of gay, lesbian, bisexual, transgender, and questioning youth. Marissa Raymond-Flesch , MD, MPH is a Mexican-American physician and public health researcher with a focus on the health and health care access of undocumented youth. Dr. Allen is the new Director of the Program in Health Disparities Research at the U of MN and has been working applying CBPR to Health Equity issues in MN since 2001, in settings like healthcare and schools.

1:30 - 3:00 p.m. Sessions

“Can You Fill Out My 504?: Psychological Testing 101 for the Healthcare Provider”
Ariella Silver, PsyD; Caroline Barangan, M.D., FAAP
Icahn School of Medicine at Mount Sinai
Track: Core Clinical Topics

Description: Adolescents that present with behavioral and /or emotional concerns have symptoms that are due to multiple etiologies, each requiring distinct treatments. For these adolescents, the road to psychological wellbeing starts with a comprehensive psychological, or psychoeducational evaluation. Comprehensive psychological reports serve as mental health treatment road maps, providing diagnostic clarity based on an integrative understanding of an adolescent’s cognitive, education and neurological capabilities, as well as their emotional and personality structure. Recommendations derived from these assessment findings guide adolescents and families towards actionable next step towards improved functioning. Furthermore, a report's findings and recommendations serve as a powerful tool in obtaining and advocating for critical services from multiple institutions, including the DOE and OPWDD. For many, the services a psychological evaluation provides access to, are tremendously impactful and life changing. The routine and repeated contact healthcare providers have with adolescents serve as a critical starting point for families to identify mental health difficulties and begin directing families to appropriate care. It is the aim of this workshop to further enhance the medical community’s ability to appropriately identify adolescents who could benefit from a comprehensive psychological evaluation, as well as provide a sound understanding of the utility of the evaluation, its components, its breath of coverage, as well as its limitations.

Educational Objectives:
  1. Screen and identify at-risk adolescents who should be referred for psychology/ psychoeducational evaluation
  2. Incorporated psychological evaluation results into their patient care based on an understanding of the content of a psychological evaluation
  3. Utilize a psychological evaluation to identify which services can be obtained with the support of the evaluation’s findings and recommendations.
Faculty Expertise: For the last three years I have coordinated the Psychological Assessment Program at Mount Sinai Adolescent Health Center (MSAHC). My responsibilities in this role include supervising all (3) APA Psychology Interns, our psychology postdoctoral fellow, and psychology assessment extern. In addition, I run a weekly group assessment supervision, provide workshops in administering and scoring specific assessment measures, and offer workshops to psychology trainees on psychodiagnostic testing for ADHD and autism spectrum disorder. I assist my supervisees in scoring and interpreting measures, as well as advise them on appropriate recommendations and referrals. I also edit, review and sign off on all psychological testing reports conducted at the center. Furthermore, I annually educate all of MSAHC interdisciplinary staff on the importance and utility of psychological evaluations. Additionally, I routinely provide workshops to MSAHC's Adolescent Medical Fellows on the utility of psychological assessment, specific learning disabilities, and methods of screening and identifying at-risk youth within their medical practices. I am also available to all of MSAHC's interdisciplinary staff for assessment consultations. My training in my APA internship and postdoctoral fellowship focused on gold-standard practices for conducting psychological evaluation to identify individuals with developmental disabilities, learning disabilities, autism spectrum disorder, and ADHD.

Beyond Birth Control Pills: Therapeutic Challenges Encountered in a Combined Pediatric Endocrinology/Gynecology PCOS Clinic
Seema Menon, MD1; Alvina Kansra, MD1; Kyndal Hettich, Masters in Dietetics2
1Medical College of Wisconsin; 2Children's Hospital of Wisconsin

Track: Core Clinical Topics

Description: The goal of this workshop is to review diagnostic approaches to amenorrhea and oligomenorrhea and highlight the importance of incorporating cultural concerns and psychological well-being into treatment plans. This workshop will review the evaluation of amenorrhea and oligomenorrhea, two conditions that are commonly seen in an adolescent medicine practice. In addition to the complexity inherent to this evaluation, these conditions often bring up sensitive topics such as hormone management, fertility and weight management. Treatment approach will focus on polycystic ovarian syndrome, but other conditions diagnosed in our combined pediatric endocrinology/gynecology clinic such as premature ovarian insufficiency will also be discussed. Hormone therapy and lifestyle modification are the cornerstones to polycystic ovarian syndrome management. However, treatment efficacy is often suboptimal. Understanding cultural concerns surrounding the use of hormones in the adolescent population can help overcome an important barrier to treatment efficacy. Providers must be aware of not only the cultural taboos some international families may carry restricting contraception use in adolescents, but also of the safety concerns marginalized populations have of contraception related to unjust practices in the not-so-distant past. Recognizing the existence of these types of issues helps practitioners provide care that is not only more culturally appropriate, but effective in the long run. Similarly, psychologic assessment of the adolescent is key when providing lifestyle management recommendations. This workshop strives to equip the practitioner with tools to navigate these challenging discussions in an effort to design more effective treatment plans.

Educational Objectives:
  1. State an efficient approach to the evaluation of amenorrhea and oligomenorrhea and develop treatment plans for common underlying conditions such as polycystic ovarian syndrome
  2. Identify the diversity of cultural beliefs surrounding the use of hormone therapy that can lead to treatment challenges and the impact psychologic well-being has on therapy involving lifestyle modification
  3. Employ interview skills that incorporates an assessment of psychologic well-being and cultural beliefs when developing an effective treatment plan
Faculty Expertise: Seema Menon is an Associate Professor in the Department of Obstetrics and Gynecology at the Medical College of Wisconsin. She is the gynecology section chief and the pediatric adolescent gynecology program director and has developed a multi-specialty polycystic ovarian syndrome clinic. She routinely provides lectures for residents and adolescent medicine fellows on PCOS and contraception and has presented a PCOS workshop at SAHM ACM in the past. Alvina Kansra is an associate professor in the Division of Pediatric Endocrinology, Department of Pediatrics, Medical College of Wisconsin. She also developed a multidisciplinary PCOS clinic at the Children’s Hospital of Wisconsin. She is also involved with preventive efforts for childhood obesity in the community setting. She has also presented a PCOS workshop at SAHM ACM in the past. Kyndal Hettich is a registered dietitian at Children’s Hospital of Wisconsin. She has worked in both the adolescent medicine clinic and in the pediatric endocrinology clinic concentrating on patients with PCOS, type 1 and 2 diabetes and eating disorders. She currently leads a workgroup to improve care of overweight and obese patients in the hospital system. In addition, she is involved in a Children’s Hospital task force to focus on health weight management.

Bodies Beyond the Binary: Developing a Collaborative Gender Affirming Approach to Eating Disorder Management in Gender Nonconforming Youth
Martha Perry, MD1; David J. Inwards-Breland, MD, MPH2; Laura Watson, MS, RD, CSP, CDE, LDN3; Lara Hayden, MSW, LICSW2
1UNC School of Medicine; 2Seattle Children's Hospital; 3Cone Health System
Track: Clinical Advances

Description: Body dissatisfaction along with the many behavioral health and psychosocial challenges encountered by gender nonconforming (TGNC) youth can lead to significant disordered eating behaviors, either to achieve a body to match gender identity or as a coping mechanism due to multiple stressors. If unrecognized, body dissatisfaction in TGNC youth can lead to body dysmorphic disorder or a clinical eating disorder. Many TGNC youth present for eating disorder treatment prior to seeking gender-affirming treatment. Providers caring for adolescents with eating disorders need to recognize gender dysphoria and use a gender-affirming approach to manage eating disorders in TGNC youth. The screening and intervention tools used to address body image issues and disordered eating were developed with a gender binary perspective and validated in a predominantly white cisgender female population. This workshop aims to assist providers with developing gender-affirming interview skills to assess disordered eating and recognize the body image expectations that are unique for TGNC youth. The workshop will introduce strategies to improve body image and manage eating disorders in TGNC youth, e.g. using caution with gender binary growth curves as a reference for expected weight, understanding body image concerns related to small stature in TGNC youth on pubertal suppression, and recognizing how the already extreme challenges faced by cisgender youth to achieve societal beauty norms are even more amplified for TGNC youth. This workshop's multidisciplinary team will present a cross-disciplinary understanding of the unique needs of TGNC youth with eating disorder using mental health, medical and nutritional approaches.

Educational Objectives:
  1. Identify the presenting signs and symptoms of body dissatisfaction and disordered eating in transgender and gender nonconforming youth
  2. Provide gender affirming assessment of disordered eating using skills and tools that more effectively define body image issues and disordered eating in transgender and gender nonconforming youth
  3. Develop key strategies for management of disordered eating that are unique for transgender and gender nonconforming youth
Faculty Expertise: Dr. Perry works with a multidisciplinary team in North Carolina that provides mental health, nutritional and medical care to high risk, complex adolescents, including those seeking gender affirming treatment. She is part of UNC Children's Gender Wellness Collaborative aiming to increase access to gender affirming care across the UNC health system including the cultural transformation to gender-affirming care in primary care. Dr. Inwards-Breland is an Adolescent Medicine specialist and founder of the multidisciplinary Seattle Children's Gender Clinic. He has broad experience with identifying and managing all forms of eating disorders and many years experience caring for transgender and gender non-conforming youth. Lara Hayden has spent many years providing clinical care and program management in LGBTQ community health, including student health programs, chronic and acute illness case management, and HIV clinical care coordination. At Seattle Children's Gender Clinic, she provides direct service to transgender and gender diverse patients, many with co-occurring diagnoses such as eating disorders and autism. Laura Watson is a Board Certified Specialist in Pediatric Nutrition and has been working with children and adolescents with eating disorders for several years. She has extensive experience working with gender divers clients and will receive additional training from Trans Folx Fighting EDs.

Navigating Medically Complex Cases Involving Transgender Adolescents- A Case Discussion
Gina Sequeira, MD1; Gerald Montano, DO, MS1; Linda Hawkins, PhD, LPC2; Stephen Rosenthal, MD3; Elyse Pine, MD4; Brittany Allen, MD5; Kelly Donahue, PhD, HSPP6; Cherie Priya Dhar, MD1;
1Children's Hospital of Pittsburgh; 2Children's Hospital of Philadelphia; 3UCSF; 4Chase Brexton Health Care; 5University of Wisconsin School of Medicine and Public Health; 6Indiana University School of Medicine
Track: Clinical Advances

Description: Psychological well-being is essential for healthy adolescent development. Unfortunately, many transgender youth experience a combination of gender dysphoria (distress over one’s body not matching one’s gender identity) and Minority Stress (stress from anti-trans stigma and discrimination). In recent years, healthcare providers are increasingly recognizing the impact both gender dysphoria and Minority Stress have on the health and well-being of transgender youth. In response, many Adolescent Medicine physicians have begun caring for the increasing number of transgender youth presenting to care. There are, however, many challenges to delivering high-quality health care for transgender youth: (1) a lack of research on transgender health (2) a combination of anti-trans stigma and discrimination from society; and (3) few opportunities to collaborate with other experienced providers about complex cases. This international conference environment provides a unique opportunity to bring individuals with diverse perspectives together to discuss challenging cases with other transgender health providers from across the globe. This session would be the first of its kind to use a case-based format to facilitate a dialogue between providers who have existing clinical experience caring for transgender youth. It is our hope that this collaboration and the opportunity to engage with members of a multidisciplinary expert panel, will provide attendees an opportunity to develop critical thinking skills to manage medically complex transgender adolescents in their clinical practice.

Educational Objectives:
  1. Demonstrate the ability to collaborate with other providers regarding medical management of complex transgender patients
  2. Formulate a plan of care for medically complex patients using a combination of empirical evidence, clinical knowledge, and experience
  3. Critically appraise management strategies and approaches to caring for medically complex transgender adolescents
Faculty Expertise: Dr. Sequeira is an Adolescent Medicine fellow at The Children’s Hospital of Pittsburgh. Dr. Dhar is a clinician and educator at The Children's Hospital of Pittsburgh. Dr. Montano is the Director of the Gender & Sexuality Development Clinic at The Children’s Hospital of Pittsburgh. Dr. Hawkins is Co-Director of the Gender & Sexuality Development Clinic at The Children's Hospital of Philadelphia. Dr. Donahue is a licensed clinical psychologist and Assistant Professor of Clinical Pediatrics at the Indiana University School of Medicine, where she provides clinical care at the Riley Hospital for Children's multidisciplinary Gender Health Program. Dr. Rosenthal is a Professor of Pediatrics at UCSF and co-founder and Medical Director of the UCSF Child and Adolescent Gender Center. He also served as a co-author for the Endocrine Society’s Clinical Practice Guidelines. Dr. Allen is a general pediatrician and assistant professor at the University of Wisconsin School of Medicine and Public Health (UWSMPH) as well as a co-medical director at the American Family Children's Hospital Pediatric and Adolescent Transgender Health (PATH) clinic. Dr. Pine is a board certified pediatric endocrinologist and Trans Youth Lead Physician at Chase Brexton Health Care in Maryland where she leads the Gender Journeys of Youth program.

Cleared for Takeoff? Ethical Issues in Athletic Participation
Catherine D. Shubkin, MD; Keith J. Loud, MD, CM, MMSc
Geisel School of Medicine, Children's Hospital at Dartmouth-Hitchcock
Track: Core Clinical Topics

Description: There are numerous health conditions which may cause dilemmas in conducting pre-participation “clearance” evaluations or determining return-to-play readiness for athletes, including eating disorders, cardiac conditions, concussion, splenomegaly in mononucleosis, and solitary paired organs, to name but a few. The risks of injury, including life-threatening injury, must be weighed against the benefits to physical and psychological well-being that participation can confer. In this highly interactive session, an adolescent sports medicine specialist and a pediatric bioethicist will provide scenarios and describe an ethical framework through which attendees will discuss the appropriate roles clinicians can play in helping adolescent and young adult patients, their families, and other stakeholders make decisions about athletic participation.

Educational Objectives:
  1. Develop an understanding of ethical dilemmas surrounding adolescent decision making and athletic participation.
  2. Develop a framework of ethical analysis to utilize when faced with athletic related ethical dilemmas.
  3. Recognize the competing and sometimes conflicting interests when providing care for medically complex patients participating in athletic activities.
Faculty Expertise: Dr. Catherine Shubkin is a pediatric ethicist who currently serves as an ethics consultant and the director of the ethics curriculum for the pediatric residency training program. In her role as the associate director of the pediatric residency program, she has led ethics symposia for medical students, residency, and faculty. She is currently the chair of the ethics education sub-committee for the ethics committee at Dartmouth-Hitchcock Medical Center responsible for coordinating annual regional interdisciplinary conferences. Dr. Keith Loud is board certified in Sports Medicine and has served as Executive Committee member for the AAP Council on Sports Medicine and Fitness. A regular Co-Leader of SAHM’s Sports Medicine SIG, he has presented workshops at the Annual Meeting on a half dozen occasions.

Career Tips – Positioning Yourself for Personal and Professional Success
Yolanda N. Evans, MD, MPH1; Theresa Anne Granger, PhD, MN, FNP, NP-C2; Lauren E. Wisk, PhD3
1Seattle Children's Hospital; 2University of Southern California, Suzanne Dworak-Peck School of Social Work; 3Boston Children's Hospital | Harvard Medical School
Track: Professional Development/Training/Education

Description: Due to the stress that comes with meeting career demands, burnout among early and mid-career professionals is common. If burnout is not effectively managed, exhaustion and feelings of inadequacy often set in, which can lead to physical symptoms and lack of motivation to succeed in the workplace. It is important for professionals to better understand the symptoms of burnout and to learn effective ways to cope with competing career demands before burnout sets in. This session focuses on using mindfulness techniques to promote resilience, prevent burnout, and strengthen overall psychological well-being.

Educational Objectives:
  1. Recognize burnout among early and mid-career professionals
  2. Express ways that mindfulness and resilience can strengthen individuals and prevent burnout
  3. Apply mindfulness and resilience principles in professional practice
Faculty Expertise:

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