9/2/2015. Sex, Drugs, and Rock & Roll: Talking to Teens Christy Blanco DNP, APRN, WHNP Kathryn Reveles PhD, DNP, APRN, CNS-M/C, CPNP-PC.

Transcription

1 Sex, Drugs, and Rock & Roll: Talking to Teens Christy Blanco DNP, APRN, WHNP Kathryn Reveles PhD, DNP, APRN, CNS-M/C, CPNP-PC Disclosures We have no financial conflict to disclose. Learning Objectives List 3 techniques for talking to teenagers Understand the Texas laws that apply to teens having sex Demonstrate asking the difficult questions with a teenager 1

2 Talking to Teenagers (Objective 1) See the patient alone Know developmental stages Establish confidentiality Allow longer time Attitude of the Provider Show: Genuine interest Concern Maximum personal attention Awareness of your own emotional blind spots Avoid: Authoritarian/judgmental attitude Hurried visit Over-solicitousness Teen-like behavior/speech Getting Information on the S Topics Don t start here Degree of intimacy Ask so that you avoid cultural hurdles Or generalize Exaggerate 2

3 Adolescent Texas Laws (Objective 2) Minors can consent to treatment when: On active duty 16 y/o, not residing with parent/guardian, manages own financial affairs Unmarried and pregnant Unmarried and parent, consents for child Treatment of disease reportable to DSHS Chemical dependency Suicide prevention, abuse Confidentiality Provider legally required to maintain confidentiality The provider should not write/call parent to discuss issues Medical records of minor should be marked confidential Texas Health Steps requires adult present younger than 15 Confidentiality Family Planning 47% of young people would stop family planning clinic services if their parents were notified they were requesting birth control 11% reported they would delay testing or treatment for STDs or HIV 99% of the teens reported they would continue having sex 3

4 HIPPA Privacy Rule Parents are personal representatives for minor children, can have access to medical records, on behalf of their minor children Exceptions: Minor obtains care without parental consent and minor consented Parents consent to confidentiality agreement Accessing Medical Records Natalie, a 16-year-old patient of Dr. Hart, had a weekend appointment for strep throat. Dr Hart noted that Natalie was due for her Texas Health Steps preventive medical checkup and mad an appointment for the following week. During that checkup, Natalie privately requested HIV and STD testing, which Dr Hart performed. Natalie told her sister about the tests, and her sister told her mother. Natalie s mother came to the clinic the following day and demanded to know the results of Natalie s HIV and STD tests Is Dr Hart required to disclose the test results to Natalie s mother? Sexual Activity More than 40% of young people engage in sexual activity before any discussion with their parents about sexually transmitted infections (STIs), condom use, or birth control. 4

5 Family Planning Contraceptives Minors may purchase nonprescription contraction (e.g. condoms) Minors may receive information about family planning Minors must get a parent s permission to receive prescription contraception Exceptions: Funded by Medicaid or Title X Family Planning Program Legally emancipated 16 y/o and living on their own Which situation must a parent provide consent under Texas law? a) A 17- year old tells her NP she wants condoms for her boyfriend to use when they have intercourse. B) A 16-year old girl living on her own but still in contact with her parents tells her doctor she needs birth control pills. c) A 17-year old girl tells her doctor she needs birth control pills but does not want her parents to know. d) A 15-year old girl covered by Medicaid asks her doctor about nonprescription contraceptives but does not want her parents to know. Alcohol & Substance Abuse CRAFFT Questionnaire screen adolescents for substance abuse Positive answer to 2+ questions indicates need for intervention 5

6 CRAFFT Questionnaire C Have you even been in a Car driven by someone, including yourself, who was high or had been using alcohol or drugs? R Do you eve use alcohol or drugs to Relax, feel better about yourself, or fit in? A Do you use alcohol or drugs while you are by yourself, Alone? F Do you ever Forget things you did while using alcohol or drugs? F Do your family members or Friends ever tell you that you should cut down on your drinking or drug use? T Have you ever been in Trouble while using alcohol or drugs? Ethical Dilemma Nico, who is 16, is interested in strengthening his body by lifting weights. He works out at a gym where other boys his age and older have had success with bodybuilding. While seeing Dr Nurse for a sore shoulder, Nico says he wants to bulk up like his friends and that he can already see and feel a difference from his efforts. He also says that he tried anabolic steroid tablets for a week because his friends say they work. Nico asks Dr Nurse not to tell his parents. Ethical Dilemma Which of the following is the better course of action for Dr. Nurse? Dr Nurse reminds Nico that anabolic steroid use is illegal, then explores Nico s thoughts and feelings about using the drug. At the boy s request, he explains the drug s side effects on a developing body, and Nico agrees to return for a checkup in two weeks. Dr Nurse tells Nico that he must alert his parents to the boy s illegal activities, and he gives Nico literature about the drug s harmful effects 6

7 Practice Scenario (Objective 3) Candace, age 16, comes in for a well check-up. Normally she is outgoing and engaging. Today, she is avoiding eye contact and is quiet. Practice Scenario You have a 17 year old female come to your office because she is bleeding when she has sex. Practice Scenario 16 year old Randy is in for a well check up and you ask about Alcohol use. He says he doesn t drink because he needs to stay in shape, but that his friends are pressuring him. He also admits to riding in cars with his older brother s friends who drink and drive. New Year s Eve is coming up. 7