PEDIATRIC AND ADOLESCENT HEALTH

FROM THE NACHC LENS Creating Welcoming and Affirming Spaces for Adolescent Patients Quality adolescent sexual and reproductive health (ASRH) care is essential to the health and wellbeing of young people and can help reduce disparities in adverse ASRH outcomes such as unintended pregnancy and sexually transmitted infections. Creating a clinic environment that is welcoming, affirming, and accessible to adolescents is one strategy that has been associated with improved ASRH outcomes including increased patient satisfaction, use of contraception, and reduced teen pregnancy.* “There is a misconception that adolescent patients don’t know what is best or right for them. It is important to understand that they have their own rights, their own opinions, and they are able to advocate for themselves and have their needs understood,” says Glorimar Irizarry, Women’s Health Program Lead, Holyoke Health Center, Holyoke, MA, which serves a multicultural Latinx adolescent population where one-third of its 14,000 patients are under 24 years. As a participant earlier this year in a pilot of Quality for Teens: A Quality Improvement Package for Adolescent Sexual and Reproductive Health Care, Holyoke Health Center sought to finesse and refine its environment for providing ASRH services. Due to staff turnover, there was an increased need for training and education to deliver the same messages, information, and provide a welcoming experience. The health center also has experienced an increase in youth who are open to identifying as LGBTQIA+, so it wanted to ensure that these adolescents’ needs were being met too. Holyoke Health Center convened a diverse group of teens (patients and non-patients) who were incentivized with free food and gift cards. Over the course of two evenings, the teens completed a modified version of a Youth-led Assessment Tool developed by the University of Michigan.  Through their assessments and discussions with teens, the staff learned that the health center did offer a welcoming space, but there were a few areas for improvement including: Creating more signage about LGBTQIA+ inclusivity and equity Offering more information on mental health issues and services  Creating a safe space for teens within the pediatrics area because the current environment was geared towards very young children  All three recommendations were realistic and achievable, and importantly, had support from senior leadership. Pronoun pins for staff to wear on their lanyards are now being distributed to all staff. Wearing of these pins creates opportunities for providers and youth to have more open conversations about gender identity. The teen focus groups were so successful that the health center plans to continue them with the creation of a teen advisory board to help continue to ensure the health center maintains a welcoming and affirming space for its teens.

Implementation Tips for Creating Youth-Friendly Spaces

Use signage and language that is inclusive of and appealing to diverse adolescent patients Offer an area for adolescents to complete screening assessments confidentially Place white noise machines at reception to increase privacy Provide Wi-Fi, outlets, charging stations, and teen friendly TV/magazines in the waiting room Have snacks for adolescents available because often they come from school and may not have had a chance to eat Designate gender-neutral bathrooms Don’t forget virtual spaces—promote ASRH services on the health center website in a way that appeals to adolescent patients (e.g., interactive features, illustrated concepts, quick to navigate) *Source: Quality for Teens: A Quality Improvement Package for Adolescent Sexual and Reproductive Health Care pending publication by NACHC together with the Centers for Disease Control and Prevention (CDC) and Cicatelli Associates Inc. (CAI)   Email cmo@nachc.org for a copy.

Combatting Pediatric Obesity Childhood overweight and obesity affects 1 in 4 children ages 2-5 and 1 in 5 children ages 6 -11, with the monthly rate of Body Mass Index (BMI) change in children ages 6-11 nearly doubling during the pandemic. Family stress, food insecurity, poverty, and other Social Drivers of Health contribute to health disparities in obesity and associated comorbidities such as diabetes and asthma.  Starting in 2018, the CDC and NACHC partnered to better understand how health centers can adapt and implement an evidenced-based pediatric weight management program that meets U.S. Preventive Services Task Force recommendations (To learn more about the program read the COMMIT FACT SHEET).  Two health centers, El Rio Health (Tucson, AZ) and Borinquen Health (Miami, FL) have participated in the collaboration since it began. Over the years they have modified the core program Mind, Exercise, Nutrition...Do it! (MEND) to better meet the needs of their primarily Latinx pediatric patients and families and respond to the COVID-19 pandemic environment. El Rio Health’s Powerful Familias has been offered in English and Spanish with the Spanish version customized to reflect the community being served. Borinquen Health’s program, Fit Family Club, is offered in English, Spanish, and Haitian-Creole. The kids speak English and providers translate for the parents. Throughout the year, one cohort will be English/Spanish, the next cohort is English/Haitian-Creole. Both programs run weekly cohorts with approximately 8 to 12 families completing each session. While the programs have unique differences, they share these core components: 26 sessions that combine physical activity, yoga, mindfulness, body image discussions, nutrition and cooking, healthy eating and food choices, and behavior change Twice weekly virtual meetings (began during the pandemic and are now a permanent component) for ten weeks Pre and post assessments include a provider visit for the child, vitals check and documentation, lab work, a 3-minute step test, and both child and family surveys Open and closing in-person sessions to promote connections among participants and their families Thursday sessions focus on cooking nutritious, fun, and innovative meals as a family Parents can either pick up groceries at the health center or are given $25 grocery store gift cards Children and their families are recommended to the programs by the children’s pediatrician, dietician, and/or behavioral health care teams. So it is critical to create good visibility of the program and share results to encourage patient referrals. Lessons Learned “The key is having the right staff who can make this program active and exciting for the children and their  families,” says Shelley Whitlatch, Program Manager, El Rio Health. “Be flexible, don’t be afraid to change an aspect of the program. If something is not working, modify it,” says Margarita Vroman, RN, BSN, CIC, Director of Ancillary Nursing, Infection Control Officer, Borinquen Health.

CARE TEAMS SPOTLIGHT

Glorimar Irizarry Women's Health Program Lead Holyoke Health Center, Holyoke, MA Born in Puerto Rico and raised in Holyoke, MA, Glorimar Irizarry found her calling for working in the sexual and reproductive health education space at the early age of 14. Ms. Irizarry was a paid peer educator for an after-school program and talked with other teens about preventative care and sexual health. Today, she oversees sexual and reproductive health services for women and adolescents, working closely with a nurse midwife. “The work that I do at the community health center allows me to serve the community the best way I can,” says Ms. Irizarry who strives to eliminate barriers and improve communication between patients and providers and among care teams. In her role, she ensures efficient workflows and systems are in place, education training needs are met, and aims for warm patient handoffs. In addition, Ms. Irizarry liaises with many community partners (i.e., schools, Boys and Girls Clubs, various teen parenting initiatives) to enhance and expand the health center’s services.  From her experience, Ms. Irizarry advises other health centers working in the ASRH space to: Be mindful that you understand adolescent patients come from their own lived experiences and cannot be disregarded as a child. Give them the respect they deserve, and the patients will open-up.  Avoid talking down to a patient. Move away from the mindset of having teens do what you say. Rather, take a more educational approach and what “we” can do to address an issue.   Be open minded which will help build trust with your adolescent patient

RESOURCES

Adolescent Sexual and Reproductive Telehealth Tools NACHC offers these new tools to improve access to ASRH telehealth services at health centers. Click here to learn more.  We Can Do This Short Videos on Administering New COVID-19 Pediatric Vaccine   NACHC has recently released two new short videos on the COVID-19 vaccines for children and clinical considerations for administering them. We Can Do This: What Clinicians Need to Know About the Pfizer-BioNTech COVID-19 Vaccine for Children We Can Do This: What Clinicians Need to Know About the Moderna COVID-19 Vaccine for Children

Schedule Device-Free Time Each Week  One of the biggest roadblocks to maintaining a peaceful mindset is technology. Between our laptops, tablets, and smartphones, we have become attuned to being connected nearly 24/7. Melissa Eisler, author of the blog Mindful Minute and the book The Type A's Guide to Mindfulness: Meditation for Busy Minds recommends finding small windows of time when you can be device-free to let your mind become very focused on the present. Here are a few ideas:  Go for a walk every day without your phone Take a technology break on Sundays by putting your phone away. If you aren’t ready to commit to a full day, try a few hours.   Silence your phone every evening from 6-8 p.m. (or another two-hour window of time) Create conscious intentions around picking up your phone: Ask yourself, do I really need that information, or do I need something else?  Source: https://mindfulminutes.com/2020-goal-how-to-make-your-year-more-mindful/

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