PRC Newsletter - Sept 2020 - Clinician and Parent Engagement

Father and Son

Finding a Complementary Balance: Adolescent Confidentiality and Parent Engagement

Two key aspects of adolescent healthcare seem contradictory at face value: Adolescent confidentiality and parent engagement. Quality adolescent preventive care includes the availability of confidential services and an opportunity for adolescents to discuss health topics alone with their provider. At the same time, parents play a very important role in the health and development of their children, even in adolescence. While balancing these two aspects can be tricky, confidentiality and parent engagement are actually complementary.

Wanting to better understand this balancing act from the perspective of primary care clinicians, team members from the Confidential Adolescent Sexual Health services study (CASH; PI: Sieving) interviewed primary care clinicians around Minnesota. Interviews were conducted with 25 pediatricians, family physicians, and nurse practitioners who provide care to 11-17-year-olds in urban and rural areas throughout the state. Analysis of the interviews identified three key ways that primary care clinicians engaged parents in adolescent health and healthcare topics.

First, clinicians noted that they asked parents if they had questions or concerns about their adolescent’s health. These questions were typically general, such as “What are your priorities?” Second, clinicians aimed to facilitate parent-adolescent communication, for example, “Make sure you talk to your teen about alcohol and drugs.” Third, clinicians engaged parents by introducing them to resources, such as a website they could use as a reference for a particular adolescent health topic. Within these three ways of engaging parents, there was a lot of variation. Clinicians stated that even though they knew the importance of discussing certain adolescent health topics with parents, they were less likely to engage parents around these topics if they did not think the conversation would align with the parent’s values. However, they were more likely to discuss specific topics if a parent initiated the conversation. Clinicians also reported that some topics were more or less comfortable for them to discuss and that this shaped their interactions with parents.

“These findings highlight two important takeaways,” said Chris Mehus, CASH investigator who presented this research at the 2019 American Public Health Association conference.  “First, clinicians understand the importance of engaging parents and make attempts to do so. Second, there are clear opportunities to identify strategies and resources that could support primary care clinicians in the complicated task of engaging parents in their adolescent’s health and healthcare.” For example, clinicians who tell parents to talk to their adolescents about drugs might find it useful to learn how to help parents do this effectively. As another example, providing clinicians with simple scripted responses to objections that parents may raise about discussing particular topics could alleviate some of the hesitancy clinicians feel about bringing up these topics.

“Being able to provide clinicians with tools and supports to prepare them for tougher or more uncomfortable, but necessary, conversations with parents, will help to create a more open dialogue between clinicians and parents. These tools could also assist in empowering parents and creating opportunities for them to have more open communication with their adolescents,” said Mehus.