Conference Abstract Compendium Examples from the ... - CityMatCH

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2009 CityMatCH Urban MCH Leadership ConferenceOvercoming barriers to confidential care for inner-city adolescentsPRIMARY CONTACT:Katherine S Lobach, MDProfessor Emerita of PediatricsAlbert Einstein College of Medicine,Bronx, NY238 Kensington OvalNew Rochelle, NY, 10805Phone: (718) 920-6497Fax: (718) 920-5289Email: kslobach@aol.comCATEGORYAdolescent health / pregnancy preventionFOCUSProgram Policy FocusCO-PRESENTER(S)/AUTHOR(S):Elizabeth Alderman, ealderma@montefiore.org(Presenter)ISSUEAlthough state laws provide for confidential care for adolescents, many teenagers are not aware of thisright, their parents do not understand it, and providers are uncertain about how to offer it. This programaims to ensure that Bronx teenagers have ready access to confidential care at the sites where they obtainprimary and preventive care services.SETTINGThe program is in progress at 19 primary care sites (clinics, community health centers, and officepractices) operated by a large Bronx medical center; about 40,000 adolescents (aged 13-21) use the sitesannually. Young people and their families, site administrators, professional and support staff are allinvolved.PROJECTPolicy development, systems changes, communication and education have been key components of thisinitiative, carried out under the auspices of a group of medical center physician and administratorvolunteers.Initial activities were designed to raise all stakeholders’ awareness of New York State law protectingconfidentiality for certain types of care to minors. Then came efforts to ensure that adolescents arecomfortable with seeking confidential care, and to help parents accept this aspect of their children’s care.Methods were also developed to facilitate confidentiality in provision of care by providers and supportstaff, such as accepting calls from teens to make their own appointments, routinely seeing youngstersalone for part of each visit, and arranging for selected insurance claims to bypass family notification.Evaluation plans include follow-up chart reviews and post-visit surveys of teens and families.138
2009 CityMatCH Urban MCH Leadership ConferenceACCOMPLISHMENTS/RESULTSThe need for this initiative was demonstrated to medical center leadership and staff by:• Focus groups of adolescents at several sites, supported by a CATCH grant from the American Academyof Pediatrics (AAP), showing that younger teens often didn’t know their rights and older ones didn’talways trust doctors to keep their secrets;• An informal survey of reception staff and first level supervisors revealing gaps and variation inunderstanding of state laws; and• Review of over 300 medical records finding no documentation of teenagers being seen alone.Several thousand copies of a “Teens Health Care Bill of Rights” in a colorful, user-friendly version by theNY chapter of the AAP and the NY Civil Liberties Union have been distributed to youth at various sites.An official medical center policy, “Care of the Unaccompanied Minor” has been adopted and discussed atin-service, staff conferences and other meetings of site administrators, house officers, nurses, receptionand billing staff. It has also been posted and distributed electronically. A preprinted medical record formfor the adolescent preventive care visit has been prepared and adopted that includes a check-off box forwhen a patient is seen alone. This serves both as a reminder and for documentation.BARRIERS• Variations in size and heterogeneity of staffing patterns among different sites require multiple venuesand formats for communication.• Obtaining approval for new policies and procedures in a large medical center is a lengthy andcomplicated process.• Achieving uniform compliance when introducing new systems and procedures at multiple sites in a nonhierarchicalorganization is a continuing challenge.LESSONS LEARNEDRecognition of the problem and the need for change by a broad constituency of health professionals canhelp overcome existing barriers. Expect a multiyear effort, and prepare to do ongoing monitoring ofresults.INFORMATION FOR REPLICATIONExcept for the CATCH grant, there was no specific funding for this work. Administrators cooperated andphysicians donated their time for meetings and paper work. Materials such as the Teen Bill of Rights werealso donated. Dedicated leadership by members of the Division of Adolescent Medicine made it happen.139
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Conference Abstract Compendium Examples from the ... - CityMatCH

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