A team of teen educators in Wisconsin teach their peers about reproductive healthcare and how to advocate for their own needs.1
“These are peer-to-peer sessions where teens go out and educate other teens about their healthcare,” says Erica Koepsel, MA, implementation director of Providers and Teens Communicating for Health (PATCH) with the Wisconsin Alliance for Women’s Health.
Teen educators, typically ages 15-18 years, are hired in the summer and usually are ready to provide educational sessions by fall. “They do education around sexual and mental health, social justice, and equity,” Koepsel says.
PATCH teens also help educate providers on various topics:
• Building a relationship with a teen. This covers body language and how to make teens feel more comfortable around the provider, Koepsel says.
• Explaining patient rights. “We want providers to know that teens have rights, and teens don’t always know they have rights,” she explains. “We talk about confidentiality and how providers can better explain confidentiality to them and what it means to have parents in the room.”
• Talking about teen patients’ responsibility. “This piece is making sure providers are helping teens transition from adolescent to adult care,” Koepsel says. “Teens can make their own doctor’s appointments.”
Providers also can speak with teens in ways that show respect for where they are in their transition to adulthood.
• Making sure they know about confidentiality. “If something is wrong in the provider relationship, and if they feel they are not heard, we encourage them to find another provider,” Koepsel says. “We say, ‘You have a right to confidentiality.’”
Sometimes, teens react angrily to being told about confidentiality. “They say, ‘You mean you’re telling me I could have a conversation alone with my doctor and have no one with me?’” she says.
Confidentiality laws vary from state to state. But all states permit teenagers to consent to some treatment for sexually transmitted infections, and many states permit teens to access contraceptive care, HIV testing, or other care related to reproductive health,2 Koepsel says.
“The American Academy of Pediatrics suggests allowing one-on-one time with providers and young persons, starting as early as 11 or 12 years old,” she adds. “They cannot consent to their own care, really, but they can have a conversation about confidentiality.”
Teen are less likely to open up to their physicians about their sexual health or mental health if a parent or siblings are in the room with them. “They don’t want to disappoint the people in their lives with their decisions,” Koepsel explains. “The provider can’t force the parent out of the room, but they can make a suggestion.”
Providers also can find subtle ways to get one-on-one time with adolescent patients. For example, they could say, “Wait here. I’m going to take Suzy back. We’re going to have a conversation, and then you can join us,” she suggests.
“We’ve also seen providers take the child to the room first and talk to the teen while taking their height and weight,” Koepsel adds. “Teens don’t want to ask for it themselves, so it’s really about the provider initiating the [confidential] conversation. There are abundant ways that people are doing this well.”
Title X clinics are a safe way for teens to access confidential care. Many have learned about these clinics through peers or the internet, and visit without their parents or guardians. “We have teens who take a lot of their peers to Title X clinics around here,” she says. “We see a lot of teens supporting teens, which is great.”
Confidentiality also continues after the teen leaves the clinic. Without precautions, this could be a major privacy breach for vulnerable patients. For example, one teen took a confidential pregnancy test before starting contraception. Two weeks later, the clinic mailed the teen an explanation of benefits, listing the test, and her parents saw this.
“This young person, luckily, had a good home environment,” Koepsel recalls. “But it made an uncomfortable dinner.”
Clinicians should recognize this confidentiality challenge and find a safer way to send the patient follow-up results and information. For instance, one tactic many family planning clinics use is to ask for results and benefits information to be mailed back to the clinic where the patient could return to pick it up on a return visit, Koepsel suggests.
• Watching body language. Clinicians should be cognizant of their own body language as well as the teenage patient’s, as these messages are important when working with this population. Since many healthcare organizations have adopted electronic records and patient notes, this has made it a bit more challenging to watch patients’ body language.
“It can feel impersonal, taking down information with virtual notes,” Koepsel says. “Get on the patient’s eye level, letting them know that you’re interested in them as a person.”
• Showing interest to improve rapport. “Find something to talk about with teens. It doesn’t have to be about healthcare,” she says.
Providers can ask patients about their high school sports or club activities. Then, providers can explain what they are doing and what any procedure or test might entail.
The teenagers say they want providers to get to know them, to explain what will happen, and to treat them like young adults, giving them respect through body language (not expressing boredom or being in a hurry) and in how they speak with them. “They say, ‘Don’t assume we know everything, and don’t talk down to us,’” Koepsel says. “‘Treat us like young adults.’”
One model that providers can use is the HEADSS model, a method for asking about the adolescent patient’s life, from the least sensitive to the most sensitive conversations. This model can start with the patient’s activities and move toward drug and alcohol use and sexuality.3
“We talk about the [HEADSS] model, and that’s where a teen’s body language comes into play,” Koepsel says. “If you ask about their family first, the teen will shut down, cross arms over chest.”
The HEADSS model covers these interview topics:
- home and environment;
- education and employment;
- suicide and depression.
The theory is that it is better to start the conversation with questions about school, an afterschool activity, or interest before asking questions about the teen’s drug use, sexual experience, mental health, and relationship with parents.
“We see that providers do really well with getting to know teens and making them feel comfortable,” Koepsel notes. “When providers share pieces of themselves, tell them something they’re interested in, teens respond well to that. It’s a two-way relationship that means a lot.”
Teens also appreciate it when providers explain what is happening, diving into details. “Some teens are interested in becoming healthcare providers one day, and they enjoy learning,” she says.
“Our hope is that providers will examine what they’re doing and determine if it’s serving patients the way they want to serve patients,” Koepsel adds. “Are they providing young people the opportunity to learn about their healthcare? Are they defining words for them and asking them about their family history, instead of asking the parent or guardian?”
- Community partner — Providers and Teens Communicating for Health (PATCH) program. University of Wisconsin-Madison Interprofessional Continuing Education Partnership. https://ce.icep.wisc.edu/15501-CP-PATCH#:~:text=The%20Providers%20and%20Teens%20Communicating%20for%20Health%20(PATCH),and%20is%20part%20of%20the%20larger%20PATCH%20vision!
- Guttmacher Institute. An overview of consent to reproductive health services by young people. Updated March 1, 2021. https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law
- HEADSS — A psychosocial interview for adolescents. British Columbia Children’s Hospital. http://www.bcchildrens.ca/youth-health-clinic-site/documents/headss20assessment20guide1.pdf