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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Ames JL, Anderson MC, Cronbach E, Lee C, Onaiwu MG, Vallerie AM, Croen LA. Reproductive healthcare in adolescents with autism and other developmental disabilities. Am J Obstet Gynecol 2024; 230:546.e1-546.e14. [PMID: 38218512 PMCID: PMC11070300 DOI: 10.1016/j.ajog.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Adults with developmental disabilities often have less access to reproductive health services than adults without these disabilities. However, little is known about how adolescents with developmental disabilities, including autism, access reproductive healthcare. OBJECTIVE We aimed to characterize the use of reproductive healthcare services among adolescents with autism and those with other developmental disabilities in comparison with adolescents with typical development. STUDY DESIGN We conducted a cohort study of a sample of adolescents who were continuously enrolled members of Kaiser Permanente Northern California, an integrated healthcare system, from ages 14 to 18 years. The final analytical sample included 700 adolescents with autism, 836 adolescents with other developmental disabilities, and 2187 typically developing adolescents who sought care between 2000 and 2017. Using the electronic health record, we obtained information on menstrual conditions, the use of obstetrical-gynecologic care, and prescriptions of hormonal contraception. We compared healthcare use between the groups using chi-square tests and covariate-adjusted risk ratios estimated using modified Poisson regression. RESULTS Adolescents with autism and those with other developmental disabilities were significantly more likely to have diagnoses of menstrual disorders, polycystic ovary syndrome, and premenstrual syndrome than typically developing adolescents. These 2 groups also were less likely than typically developing peers to visit the obstetrician-gynecologist or to use any form of hormonal contraception, including oral contraception, hormonal implants, and intrauterine devices. Adolescents in all 3 groups accessed hormonal contraception most frequently through their primary care provider, followed by an obstetrician-gynecologist. CONCLUSION Adolescents with autism and those with other developmental disabilities are less likely than their typically developing peers to visit the obstetrician-gynecologist and to use hormonal contraception, suggesting possible care disparities that may persist into adulthood. Efforts to improve access to reproductive healthcare in these populations should target care delivered in both the pediatric and obstetrics-gynecology settings.
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Affiliation(s)
- Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | | | - Emily Cronbach
- The Permanente Medical Group, Obstetrics and Gynecology, Kaiser Permanente Northern California Park Shadelands, Walnut Creek, CA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Morénike Giwa Onaiwu
- Autistic Women and Nonbinary Network, Lincoln, NE; Rice University Center for the Study of Women, Gender, and Sexuality, Houston, TX; AJ Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Amy M Vallerie
- The Permanente Medical Group, Obstetrics and Gynecology Kaiser Permanente Northern California, Oakland, CA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Lutz CM, Onwuka A, Fuchs ME, Carey M, Griffey J, Hobensack VL, Sharpe Scandinaro J, McCracken K. Sexual and reproductive health education for patients with myelomeningocele. Dev Med Child Neurol 2023; 65:1105-1111. [PMID: 36631940 DOI: 10.1111/dmcn.15494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023]
Abstract
AIM To evaluate the sexual and reproductive health education received by patients with myelomeningocele, the most severe form of spina bifida. METHOD A survey designed to assess the sexual and reproductive health education given by a healthcare provider to patients with myelomeningocele was offered to all English-speaking patients aged 12 years or older with a myelomeningocele clinic visit. RESULTS In total, 67 surveys were completed. Menstruation and menstrual management were discussed at a rate of 85% in females. Few patients had discussions with a provider about fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had a relationship with a reproductive healthcare provider (54%). Differences by sex were observed for contraceptive education. The rate of discussions increased with age. A total of 67% of female patients and 33% of male patients requested a referral to a reproductive healthcare provider. INTERPRETATION Sexual and reproductive health education is part of comprehensive care for all patients and those with disabilities should not be excluded. The lack of consistent education received by patients supports the need for increased attention to this topic. We encourage multidisciplinary myelomeningocele clinics to establish a process for delivering complete and patient-specific sexual and reproductive health education.
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Affiliation(s)
- Carley M Lutz
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly E Fuchs
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Margaret Carey
- Myelomeningocele Clinic, Nationwide Children's Hospital, Columbus, OH, USA
| | - Judy Griffey
- Myelomeningocele Clinic, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Kate McCracken
- Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, OH, USA
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Newby-Kew A, Horner-Johnson W. Healthy and Respectful Relationship Education: Differences by Disability Status and Associations With Sexual Abuse. THE JOURNAL OF SCHOOL HEALTH 2023; 93:565-572. [PMID: 36815452 DOI: 10.1111/josh.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Education about healthy and respectful relationships (HRR) is a key component of comprehensive sexual health curricula and is supposed to be universally provided in Oregon. This study: (1) assesses the extent to which high school students with disabilities received HRR education, and (2) examines associations between HRR education and experiences of sexual abuse. METHODS Using data from the 2019 Oregon Healthy Teens survey, we conducted multivariable Poisson regression to compare 11th grade students with and without disabilities on self-reported receipt of school based HRR instruction (N = 10,992), and to measure associations between HRR education and sexual abuse experiences among teens with (N = 3736) and without (N = 7256) disabilities. RESULTS Students with disabilities were 41% more likely than students without disabilities to say they had never been taught in school about HRR (adjusted prevalence ratio 1.41, 95% confidence interval: 1.25-156). Experiences of sexual abuse victimization were more common for all students who did not receive HRR education (34.1% vs 21.6% among students with disabilities; 16.2% vs 7.5% among students without disabilities). CONCLUSIONS Students with disabilities are less likely to have received school-based HRR education than their peers without disabilities. Providing inclusive HRR education may help reduce risk of sexual abuse and is essential for addressing health disparities affecting youth with disabilities.
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Affiliation(s)
- Abigail Newby-Kew
- Oregon Health Science University and Portland State University School of Public Health, Portland, OR
| | - Willi Horner-Johnson
- Oregon Health Science University and Portland State University School of Public Health; Institute on Development and Disability, School of Medicine, OHSU, Portland, OR
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Giles ML, Juando-Prats C, McPherson AC, Gesink D. “But, You’re in a Wheelchair!”: A Systematic Review Exploring the Sexuality of Youth with Physical Disabilities. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The Role of Healthcare Professionals in Providing Sexuality Education to Young People with Disabilities: A Scoping Review on Barriers and Challenges. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sexual Assistance for People with Intellectual Disabilities: Proposal for a Service Delivery Model. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractThe figure of the sexual assistant is increasingly demanded as a right in the disabilities field. This figure requires debate, adaptation to the characteristics of countries and cultures, as well as to the characteristics of people with intellectual and developmental disabilities. This study presents the work carried out with representatives of Spanish organizations of people with intellectual disabilities to develop a proposal for the figure of support staff for sexual behavior. Together with a rights perspective, this proposal is aligned with the Supports paradigm to better meet the health and behavior needs of users. The figure is framed within the auto-erotic and therapeutic model of sexual assistance. This figure excludes characteristics of the erotic model that involves interaction or sexual exchange between the sexual assistant and the individual with a disability. Several advantages and disadvantages need to be carefully considered before implementing this support in a delivery service model. We argue that the proposed figure requires specific accreditation, training, and monitoring.
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Contraception and Reproductive Health Care for Adolescent and Young Adult Women with Epilepsy. J Pediatr 2022; 241:229-236. [PMID: 34728232 DOI: 10.1016/j.jpeds.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
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McFadden V, Bauer SC, Porada K, Mehta S, Pickett ML. Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care. Hosp Pediatr 2022; 12:53-61. [PMID: 34918092 DOI: 10.1542/hpeds.2021-006038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children's hospital Pediatric Hospital Medicine service. METHODS We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions. RESULTS From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected. CONCLUSIONS The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.
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Affiliation(s)
| | | | | | | | - Michelle L Pickett
- Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Aslan E, Yılmaz B, Acar Z. Reproductive Health, Sexual Function and Satisfaction Levels in Women with Physical, Hearing, and Visual Disabilities. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grubb LK, Powers M. Emerging Issues in Male Adolescent Sexual and Reproductive Health Care. Pediatrics 2020; 145:peds.2020-0627. [PMID: 32341182 DOI: 10.1542/peds.2020-0627] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.
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Affiliation(s)
- Laura K Grubb
- Departments of Adolescent Medicine, Pediatrics, and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and
| | - Makia Powers
- Departments of Pediatrics and Public Health and Community Medicine, Morehouse School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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Kessler R, Hinkle BT, Moyers A, Silverberg B. Adolescent Sexual Health: Identity, Risk, and Screening for Sexually Transmitted Infections. Prim Care 2020; 47:367-382. [PMID: 32423720 DOI: 10.1016/j.pop.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Development of SOGIE (sexual orientation and gender identity and expression) is not unique to minority populations, as all adolescents grapple with their sexuality and identity. Health care providers straddle the unique positions of authority figure and advocate and can help these young people establish behaviors that will allow them to flourish as adults. This article discusses the appropriate language to use while conducting a sexual history, summarizes the epidemiologic data on sexually transmitted infections, and reviews the screening and reporting guidelines set forth by the United States Preventive Services Task Force and the Centers for Disease Control and Prevention.
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Affiliation(s)
- Roanna Kessler
- Johns Hopkins University Student Health and Wellness Center, Homewood Student Affairs, 1 East 31st Street, N200, Baltimore, MD 21218, USA
| | - B Tate Hinkle
- Total Healthcare at Russell Medical Center, 3504 Highway 280, Alexander City, AL 35010, USA; Department of Family Medicine, UAB Huntsville Regional Medical Campus, 301 Governors Drive SW, Huntsville, AL 35801, USA
| | - Amy Moyers
- Department of Family Medicine, WVU Medicine, 6040 University Town Center Drive, Morgantown, WV 26501, USA
| | - Benjamin Silverberg
- Department of Family Medicine, WVU Medicine, 6040 University Town Center Drive, Morgantown, WV 26501, USA; Department of Emergency Medicine, WVU Medicine, 1 Medical Center Drive, Box 9149, Morgantown, WV 26506, USA; Division of Physician Assistant Studies, Department of Human Performance, West Virginia University School of Medicine, 64 Medical Center Drive, Box 9226, Morgantown, WV 26506, USA.
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Verlenden JV, Bertolli J, Warner L. Contraceptive Practices and Reproductive Health Considerations for Adolescent and Adult Women with Intellectual and Developmental Disabilities: A Review of the Literature. SEXUALITY AND DISABILITY 2019; 37:541-557. [PMID: 33005065 PMCID: PMC7527256 DOI: 10.1007/s11195-019-09600-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whereas progress has been made on increasing access to comprehensive healthcare for individuals with intellectual and developmental disabilities (I/DD), disparities continue in health outcomes, including those related to the reproductive health of adolescent and adult women with I/DD. This review summarizes reproductive care considerations for adolescent and adult women with I/DD and current practices regarding the delivery of contraceptive services to these women. Forty-seven (47) articles based on research conducted in the US between 1999 and 2019 were selected for inclusion in the review. Primary themes discussed include (1) common reproductive health concerns for adolescent and adult women with I/DD, other than pregnancy prevention; (2) contraceptive methods and disability-related concerns; (3) informed consent and reproductive decision-making; and (4) provider knowledge and education. The management of menses and hormonal dysregulation were identified as concerns that providers encounter among patients with I/DD and their families. Disability-related concerns with regard to use of contraception in general and considerations regarding certain methods in particular include challenges with prescription adherence, physical effects of hormonal therapies, drug interactions for individuals with additional health conditions, and legal and ethical concerns involved with decision-making and consent. The results of this review also suggest that focused efforts in partnership with health care providers may be needed to address barriers that adolescent and adult women with I/DD face when trying to obtain quality reproductive health services and contraceptive guidance.
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Affiliation(s)
- Jorge V. Verlenden
- Morehouse School of Medicine, Satcher Health Leadership Institute, Atlanta, USA
- Atlanta, USA
| | - Jeanne Bertolli
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
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Engelen MM, Knoll JL, Rabsztyn PRI, Maas-van Schaaijk NM, van Gaal BGI. Sexual Health Communication Between Healthcare Professionals and Adolescents with Chronic Conditions in Western Countries: An Integrative Review. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09597-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Adolescent patients and healthcare professionals find it difficult to initiate the discussion on sexual health in consultations. The aim of this integrative review is to give an overview of determinants in the communication about sexual health between adolescents with chronic conditions, their parents, and their healthcare professionals. A systematic literature search for the period of January 2000 to October 2018 was conducted in four databases (Cinahl, Cochrane, PsycINFO, and Pubmed) and resulted in fifteen included studies. Four determinants were found in these studies: attitude, beliefs, knowledge, and self-efficacy. Patients, parents, and healthcare professionals experienced sexual health as a taboo topic and felt not comfortable talking about it. Both patients and professionals expressed a need to discuss sexual health, however personal and practical barriers withhold them from initiating the discussion. This in-depth overview suggests that all four determinants should be targeted to improve communication about sexual health in healthcare settings. Future research should be conducted to give more insight in the experiences and support needs of adolescent patients. On the long term, the discussion about sexual health should become normalized by improving knowledge, training, and support for healthcare professionals and integrating sexual health in education and hospital policies.
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