PRC Newsletter - March 2020 - Confidential Adolescent Health Services

Teen provider picture

Understanding Primary Care Providers' Perceptions and Practices in Delivering Confidential Sexual and Reproductive Health Services to Adolescents

PRC Director Renee Sieving, along with PRC researchers Annie-Laurie McRee and Christopher Mehus and colleagues from Columbia University, University of Illinois at Chicago and the American Academy of Pediatrics recently had a first paper from the Confidential Adolescent Sexual Health Services (CASH) study accepted for publication. The CASH study examines facilitators and barriers to providing confidential sexual and reproductive health (SRH) services to adolescents from adolescents’, parents’ and primary care providers’ perspectives. To be published in the Journal of Adolescent Health, this particular paper explores providers’ perspectives and practices in delivering SRH services to adolescents.

This paper is an analysis of in-depth interviews conducted by the CASH study team with 25 primary care providers – family physicians, pediatricians, and nurse practitioners --from 4 areas of Minnesota representing urban and rural communities, and areas of the state with higher and lower rates of teen pregnancy and sexually transmitted infections. In study interviews, providers were asked to share their opinions and practices related to one-on-one time and other confidential services for their adolescent patients; SRH screening, counseling and treatment services they offered; and their referral practices. 

Sieving noted “Most providers endorse the importance of private time and confidentiality with adolescent visits, and they also acknowledge that these elements are not always included in individual visits.”  Providers voiced a clear understanding of the need for guidelines around routine SRH screening. Whether a SRH topic is discussed in-depth, briefly addressed, or not covered during an adolescent’s routine checkup depends in part on providers’ comfort with a specific SRH topic (e.g., normal body changes of puberty, STIs, birth control, sexual orientation, gender identity). In addition, policies and protocols of the clinic, the availability of SRH resources within and outside of the clinic, and parent engagement in the visit contribute to variations in SRH services.

“This research is important as it helps to understand why a substantial gap exists between professional guidelines around confidential SRH services for adolescents and real-world practice,” said Sieving.  “Findings from this study suggest there are opportunities for additional training for providers and clinic staff. Findings also suggest that routine communication from clinics to adolescents and their parents may garner teen and parent support for private time. And changes in clinic policies and protocols may enhance the quality of SRH services for adolescents,” said Mehus. 

“Understanding these barriers and facilitators to providing SRH services gives us important information for trainings and resources for providers, clinic staff, and parents. If we can create clear protocols for primary care providers to use in discussing SRH with adolescents, we can improve the quality of care young people receive.” said McRee.