“We, as providers, have to be all about making the choices right for teens; not with what we think is right, but with resources and voices that support the choices they’re trying to make, and have already made.”
With these words, Mary Reich Cooper, MD, JD, Co-chair Women’s Health Council of RI, summarized the presentations and panel discussions at the Council’s fourth Critical Workshop Training.THE VENUE: Tsetse Gallery in Providence Featuring “Children of Children,”
New Ideas in Adolescent Girls’ Healthcare begin with a “Strengths-Based” approach that engenders trust, safety and better choices.
All too often teens don’t feel safe telling their truths to their parents, or at school, or to their doctors. So they avoid getting the medical help or counseling they need, until they face a daunting problem.
“Rather than seeing teens at risk,” advised Keynote speaker Patricia Flanagan, MD, “instead see youth at promise.” Use knowledge of teenage girls’ developmental stages to help them build on their strengths, by praising the skills they have mastered and effective contributions they have made.
As one teen panelist recommended, “Be open with teens. Make it safe, because in reality teens want someone safe to talk with about what they are facing.”
What is needed in many situations is a closer relationship between pediatrics and psychology, so that a teen who is struggling with addiction, abuse, pregnancy and/or sexual identity is referred to a professional who can provide the counseling and resources she needs—and provide support for her choices.
Behavior Patterns While adolescents are generally healthy, they have high rates of STD’s, and the highest growth in HIV (18-25 group). 23% of adolescents have high glucose or other pre-diabetic signs. Early substance and alcohol abuse puts adolescents at greater risk for dependency in later years. It appears that when these patterns are set in adolescent years, it signals poorly for their health as adults.
Brain Patterns Adolescents experience a non-linear growth of their pre-frontal cortex during their teen years. In their developing brain, neuronal growth expands, followed by a pruning process. So with this changing mental environment, they need help making good choices, seeing alternative solutions, understanding nuanced social cues and suspending their own beliefs long enough to hear someone else’s story.
Protective Patterns Research proves that the protective effects of family are long-lasting. Teens who feel loved and accepted no matter what survive better, and thrive. Family can be found in many places. Helping a teen find the family she wants and needs builds resilience in her life, so she can grow into a strong adult with the capacity and resources to care for herself and her children.
Each of the panels in this workshop was comprised of a provider and a teenager who has shown exceptional resiliency in managing one of the following challenges. The spectrum of parental care the teens experienced ranged from strong support, to modeling addiction and recovery, to outright abuse and rejection.
Teen Pregnancy is a community issue. Providers need to promote pregnancy prevention and also embrace teens who are already pregnant or mothers, so they do not give up their dreams.
“I was so afraid to tell my mom I was pregnant, but getting a calm response from her has helped me a lot.” This teen did not want to drop out of school and give up her dreams. With the help of a supportive family, school and the baby’s father, she has learned how to manage motherhood, her education and now a job. “It’s a lot, but we’re learning how to manage it all.”
For a school project, she created a workshop that gave students the hard facts about being a teenage mom, including the day-to-day costs of infant care products, and details about the real demands motherhood makes.
Her recommendations: Provide emotional support by repeating “You can do it!” Schools can provide day care and help new moms keep up. This teen’s teacher brought school-work to her home so she could study every day after the birth and still graduate with her class.
Substance Abuse In addictive families, the priority is to keep the child safe, often by helping the parent address their own health needs.
This teen panelist’s stepfather was addicted to drugs; her mother to alcohol. She drank because she saw her mom do it. ‘I didn’t like the taste, but I liked how it made me feel. Happier and more energetic!” She didn’t have anyone to talk to about it, (she didn’t want to disappoint her mother), until she went to an AA meeting with her stepfather. “AA was a powerful reality check” and gave her the safe environment she was looking for. She is now sober, and both parents are in recovery.
She says: “Teens want to talk about what’s happening with them. They will, if it is safe.”
Sexual Identity Sex is not a teen thing, or a bad thing. The message should be to do it in a way that’s right for the individual
Teen: “I knew at the age of 10 that I was gay, but I never had anyone safe to talk to about it.” She didn’t trust her doctor because of emotional and sexual abuse at home. Her family pressured her to “get over it” When she finally found a gay foster home, she was encouraged to openly acknowledge her sexual identity. At school, a Gay-Straight Alliance teacher helped her deal with students who didn’t like her and attacked the way she dressed. “I’ve learned that if people don’t accept you for who you are, they are not your friends. Fortunately, I have broad shoulders that have helped me deal with the abuse.”
Her advice to providers: ‘Tell them you’re there for them, and that you support them.”
At puberty, psychosocial screening is as important as the physical exam. For help screening teenage girls, download the Adolescent Girl’s Health Pocket Card, which suggests questions to ask and resiliency skills to praise.
1. See her alone. Ask her parent to consider you an ally. What the teen tells you is confidential unless there is a safety issue involved that the parent needs to know about.
2. Set manageable goals both you and the teen can agree on.
3. Build a scaffolding of support by helping her understand:
4. Acknowledge and support high aspirations. For example, the teen mother who determined that she did not want to be “just a statistic” (meaning a high-school drop out) because of her baby. She was committed to a college education and more. These kinds of aspirations need support from parents, doctors and school officials.
5. Consider how to make the time and place of meetings and screenings more accessible to teen schedules, especially If she is a teen mom without a good support system, or struggles with an addiction in a family where a parent is also addicted, or is an LGBTQQ teen whose family does not accept her identity.
6. Give her your card. New technology to consider: PING MD, whereby teen can text her provider, communicate in the way she is most comfortable, and still be protected by HIPPA standards.
7. Family Acceptance Projects teach parents to accept their children no matter what.
In a subsequent meeting, Lisa Carnevale, Interim Director of the Rhode Island Tobacco Control Network, warned that 13.3% of RI youth are using tobacco. The tobacco companies are relentless at creating addictive tobacco products that look like colorful candies, and which are readily accessible at convenience stores around the state. Without a close look, it’s hard to tell that these are nicotine-based products. Kids become loyal consumers and help to keep these stores profitable.
Carnevale advised: “This is not your grandmother’s tobacco. Parents should check the ingredients of any new product their child brings home…it just might contain nicotine!”
Clinicians are needed to talk to policy-makers at the State House about the considerable physical risks these products represent.
Contact Lisa Carnevale at 401 533 5175, or go to www.ritcn.org.
Panel Dialogues between youth leaders and the providers who care for them.
5:00-5:50 PM Registration, Box Dinner and Exhibition Viewing
5:50-6:00 PM Workshop Opening Mary Reich Cooper, MD, JD
6:00-6:20 PM Introduction: A Strengths-Based Approach Patricia Flanagan, MD
6:20-7:35 PM PANEL DIALOGUES: Introductions by Rosa E. DeCastillo
PANEL 1 Teen Pregnancy: Prevention, Behaviors, Resources
Beata Nelken, MD
PANEL 2 Teen Substance Abuse: Prevention, Behaviors, Resources
Selby Conrad, PHD,
PANEL 3 Health Issues in the Teen LGBTQQ* Community: Prevention, Behaviors, Resources
Michelle Forcier, MD
7:35-7:55 Panel Q&A
Maureen Phipps, MD, Facilitator
7:55-8:00 Closing Remarks
Mary Reich Cooper, MD, JD
*LGBTQQ: Lesbian, Gay, Bi-Sexual, Transsexual, Queer and Questioning
RI Adolescent Girls’ Health Report Card: Compares statistics between RI and US on topics of Demographics, High School Environments, General Health Indicators, Substance Use and Reproductive Health.
Strengths-Based-Approach: This pocket card combines questions that “get into adolescent heads” with prompts to strengthen their resiliency indicators throughout the psychosocial screening.
CRAFFT: Helps determine the probability of substance abuse and dependency; from the Children’s Hospital in Boston.