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<p>By the time most American adolescents reach the age of 13 they stop seeing a pediatrician. Young females most often transition seamlessly to a provider for gynecologic and contraceptive needs that connects them, even if loosely, to providers who can flag health issues beyond gynecological needs. However, young males often do not have a regular healthcare provider who serves as a gatekeeper for their ongoing health needs.</p>

Engaging Young Males in Family Planning Settings

By Susan Wysocki, WHNP-BC, FAANP

By the time most American adolescents reach the age of 13 they stop seeing a pediatrician. Young females most often transition seamlessly to a provider for gynecologic and contraceptive needs that connects them, even if loosely, to providers who can flag health issues beyond gynecological needs. However, young males often do not have a regular healthcare provider who serves as a gatekeeper for their ongoing health needs.

For the most part, young males’ interactions with the healthcare system involve episodic care, such as sports physicals, emergency department visits, and, when needed, care related to sexually transmitted infections (STIs). Unlike young females who can easily identify where to go for ongoing preventive care, most adolescent and young adult (AYA) males are largely on their own to find a way to connect with healthcare providers and the healthcare system for wellness care.

Consider that data from the Centers for Disease Control and Prevention identify higher risks for AYA males vs. females for death by suicide, attention deficit deficit hyperactivity disorder, substance abuse, homicide, risky behaviors, accidental injury, and certain STIs.

In addition, due to a lack of continuity of care for AYA males, illnesses that can be prevented or modulated are not identified until they are further along the path toward chronic problems or illness.

It is important to systematically recognize the unique and unmet needs of AYA males and to identify and develop points of care that keep AYA males connected to services that are designed to keep them healthy beyond episodic health visits.

Unfortunately, very few services are designed to engage young males. Many family planning clinics offer focused services to males for STI testing and treatment. However, once the STI is tested and treated, the male’s interaction with the clinic often is not continued for primary care or preventive care.

Program Connects with AYA Males

Dennis Barbour, JD, president, chief executive officer (CEO), and co-founder of the Partnership for Male Youth (PMY) and former president of the Association of Reproductive Health Professionals (ARHP), notes that when he asked the ARHP members how young males were being served in family planning clinics, including Planned Parenthood, he was met with blank stares and an obvious lack of enthusiasm.

Barriers to care for young males include lack of training and education of providers to treat males, even for STI checks. In particular, as the president and CEO for the Nurse Practitioners in Women’s Health, I received a number of calls from nurse practitioners (NPs) who expressed their discomfort in treating males. Some of that discomfort related to a lack of training while other concerns related to how to communicate with males. There also were explicit or implicit concerns about how to deal with the awkwardness of female providers examining males. The majority of NPs in women’s health and family planning are female.

David Bell, MD, co-founder of PMY, president-elect of the Society of Adolescent Health and Medicine, and medical director of the Young Men’s Clinic (YMC) at Columbia New York-Presbyterian, has been engaged with AYA male health for decades.

YMC is one of the most recognized health programs for young men in the United States. It grew out of the Title X family planning clinic for women. The program began as a street outreach and condom distribution program in the late 1980s. Early on, faculty and students worked with community agencies to sponsor sports events, dances, and other community-based activities. These community collaborations created a foundation for trust by the community’s adults and youth. Today, the YMC provides services at almost 4,000 visits each year. In addition to Title X funds, foundation grants, Medicaid, other insurances, and patient fees also support the clinic.

YMC is a model for establishing and providing services to AYA males whether as an expansion of family planning clinics or as independent entities. The clinic provides a broader scope of services than just sexual and reproductive healthcare, including physical exams for sports, school, work, and general healthcare. Other services include medical care for minor injuries and illness; individual and group health education; counseling for stress and relationship issues; and other health concerns. In addition, the clinic provides referrals to education, employment, vocational programs, and social services.

YMC occupies a separate space at the family planning clinic. Rather than males walking into a clinic primarily focused on women and decorated with women in mind, the YMC is designed with males in mind. The atmosphere conveys that males are welcome. It is their space.

The importance of comprehensive services is illustrated in the experience of one young male, who was born in the United States and grew up in the Dominican Republic. In his early teens, he returned to the United States with a language barrier and few resources for housing, food, or healthcare. Shortly after returning, he was homeless, living on the street, and had a respiratory infection. He found his lack of insurance and ability to pay thwarted his best efforts to access care. Finally, he found the YMC, where he received treatment for his respiratory infection. Bell said, “Now, we need to address these other issues such as getting a roof over your head and getting regular food.” Now, the young man is applying for medical school. He also is an advocate for the YMC among his peers. In fact, young males learn about the clinic by word of mouth from trusted friends.

This example demonstrates the importance of integrated services and relational health. Relational healthcare creates a connection between the provider and patient. Relational health is the creation of a connection where the patient feels valued by others. It involves more than seeing the patient from the narrow perspective of their problem — it is about seeing the whole person.

Approaching interactions with patients/clients from a relational health perspective can have a significant effect on patient outcomes. Relational health may be especially important in interactions with young males. Niobe Way, PhD, a PMY board member, professor of applied psychology at New York University, and founder of the Project for the Advancement of Our Common Humanity, has studied young males for decades. Her research has shown that boys in their early teens (ages 12-15 years) have close relationships with other boys they describe with affectionate terms like “I love my best friend.” These young, adolescent males also talk about their best friends as the people with whom they can share their secrets. In later adolescence, boys may lose that kind of connection. Terms of affection for friends are swapped for statements that reflect male “norms” that discourage close connections with other males. “This goes against the nature of males and their desire to have male friendships,” Way explains.

It is with this understanding that the PMY has assembled a broad swath of organizations and experts that touch the lives of AYA males. This includes representatives from health institutions, juvenile justice, federal agencies, education, sports organizations, and community service agencies.

Early on, PMY recognized the humanity of young males struggling with their own identities in a world that does not match what they really feel. Many programs today for AYA males center on rape prevention and consent. However, there is a need to foster healthy lives for AYA males.

PMY has continued to engage a think tank group representing a wide range of agencies and leaders to develop the next summit for PMY. The outcome became a mandate for the next PMY summit to address relational health needs for AYA males at points of contact that can improve their health and well being.

Plans for a summit in 2020 and beyond are ongoing.