Clinical Care Guidelines

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LGBT Youth
Adolescents with Disabilities
Incarcerated Youth
Adolescents with Cancer


Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations
World Health Organization, 2014
In these consolidated guidelines on HIV prevention, diagnosis, treatment, and care for key populations, the WHO brings together all existing guidance relevant to five key populations: men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people. Adolescents and young people from key populations are at significant HIV risk, higher than that of their older peers in these populations. (See Section 1.2.7 and Box 6.2 on adolescents and young people from these key populations.)

LGBT Youth

Recommendations for Promoting the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Adolescents
Society for Adolescent Health and Medicine, 2013
Adolescent health care providers frequently care for patients who identify as LGBT or who may be struggling with or questioning their sexual orientation or gender identity. This SAHM position paper encourages providers to understand the impact of these developmental processes as well as the impacts of concurrent potential discrimination when caring for LGBT adolescents.

Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth
American Academy of Pediatrics, 2013
This policy statement affirms that pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. A technical report is also available.

Health Care for Lesbians and Bisexual Women
American College of Obstetricians and Gynecologists, 2012
This Committee Opinion (No. 525) states that health care providers should offer quality care to all women regardless of sexual orientation. ACOG endorses equitable treatment for lesbians and bisexual women and their families, not only for direct health care needs, but also for indirect health care issues.

Practice Parameter on Gay, Lesbian or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents
American Academy of Child and Adolescent Psychiatry, 2012
These guidelines aim to foster clinical competence in those caring for children and adolescents who are growing up LGB, gender variant, or transgender, reflecting what is currently known about best clinical practices for these youth

Primary Care Protocol for Transgender Patient Care
Center of Excellence for Transgender Health, University of California, San Francisco, Department of Family and Community Medicine, 2011
This protocol is intended to provide accurate, peer-reviewed medical guidance as well as provide a resource containing references to additional materials for further study to improve treatment capabilities as well as access to care for transgender patients. (See section: Youth: Special Considerations).

Caring for Transgender Adolescents in British Columbia: Suggested Guidelines
Vancouver Coastal Health, Transcend Transgender Support & Education Society, and the Canadian Rainbow Health Coalition, 2006
These guidelines cover clinical management of gender dysphoria in adolescents and ethical, legal, and psychosocial issues in care of transgender adolescents. This document is intended to assist health and social service professionals whose adolescent patients and/or family members ask for assistance relating to trans-specific concerns.

Health Care for Transgender Individuals
American College of Obstetricians and Gynecologists, 2011
This Committee Opinion (No. 512) states that obstetrician–gynecologists should be prepared to assist or refer transgender individuals with routine treatment and screening as well as hormonal and surgical therapies. ACOG opposes discrimination on the basis of gender identity and urges public and private health insurance plans to cover the treatment of gender identity disorder.

Endocrine Treatment of Transsexual Persons
The Endocrine Society, 2009
These clinical practice guidelines include recommendations for adolescents and adults. The guidelines recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty
with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. (See section on Treatment of Adolescents, page 13.)

Adolescents with Disabilities

Reproductive Health Care for Adolescents With Disabilities (Supplement to Guidelines for Adolescent Health Care, Second Edition)
American College of Obstetricians and Gynecologists, 2012
This supplement to the Guidelines for Adolescent Health Care, Second Edition, is designed to provide information necessary for the provision of health care services to adolescents with disabilities. (Member access only; non-members contact ACOG for access.)

Menstrual Manipulation for Adolescents With Disabilities
American College of Obstetricians and Gynecologists, 2009/Reaffirmed 2012
Defining the reasons for intervention and the precise goal of treatment are the most critical issues regarding use of interventions to alter menstrual flow in adolescents with disabilities. This Committee Opinion (No. 448) provides recommendations regarding first-line treatment options and endometrial ablation in adolescents.

Incarcerated Youth

Reproductive Health Care for Incarcerated Women and Adolescent Females
American College of Obstetricians and Gynecologists, 2012
Increasing numbers of women and adolescent females are incarcerated each year in the U.S. This Committee Opinion (No. 535) highlights the importance of understanding the needs of incarcerated women and adolescent females and how it can help improve the provision of health care, including sexual and reproductive health, in the correctional system.

Health Care for Pregnant and Postpartum Incarcerated Women and Adolescent Females
American College of Obstetricians and Gynecologists, 2011/Reaffirmed 2013
Clinicians who provide care for incarcerated women and adolescents should be aware of the special health care needs of pregnant incarcerated women and adolescents. This Committee Opinion (No. 511) also focuses on the specific issues related to the use of restraints during pregnancy and the postpartum period.

Health Care for Youth in the Juvenile Justice System
American Academy of Pediatrics, 2011
This policy statement provides an overview of the health needs of youth in the juvenile correctional system, and recommendations are provided for the provision of health care services to youth in the juvenile correctional system as well as specific areas for advocacy efforts.  (See section on Reproductive Health, which includes Sexual Activity/Contraception, STIs/HIV, and Pregnancy/Fatherhood.)

Adolescents with Cancer

Gynecologic Concerns in Children and Adolescents with Cancer
American College of Obstetricians and Gynecologists, 2014
Cancer and its treatment may have immediate or delayed adverse effects on reproductive health. As recommended by this Committee Opinion (No. 607), obstetricians-gynecologists should be prepared to manage gynecologic concerns in young cancer patients and survivors before, during, and after their treatment.
Cancer and Contraception
Society of Family Planning, 2012
As a result of advances in cancer diagnosis and treatment, young women within the reproductive-aged group are now more likely to survive cancer. These recommendations were created after reviewing the evidence regarding the safety and efficacy of available methods of contraception for women who have been diagnosed with cancer.

Options for Prevention and Management of Heavy Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment
American College of Obstetricians and Gynecologists, 2014
Adolescents undergoing cancer treatment are at high risk of heavy menstrual bleeding, and gynecologists may be consulted either before the initiation of cancer treatment to request strategies for menstrual suppression or during an episode of severe heavy bleeding to stop the bleeding emergently. This Committee Opinion (No. 606) provides guidelines for treatment.

The goal of the AHRQ-funded project, Youth Providers 2.0 (YP2.0), is to improve the use of evidence-based practices among health care providers caring for adolescents and young adults. To accomplish this goal, SAHM will engage in a number of activities using new media to improve the dissemination of patient-centered outcomes research (PCOR) to health professionals.