What are 'must-have' services for your adolescent males?
What are 'must-have' services for your adolescent males?
Increased emphasis to come in Title X guidance update
Does your facility provide reproductive health care for adolescent males? If so, add two newly published reports to your knowledge base to provide optimum care for teen boys.1,2 The two reports highlight the need for greater recognition of the sexual and reproductive healthcare needs of teen boys and enumerate which services should be provided at least once a year to this often-overlooked population segment.
One problem is that there are no established national guidelines on what services are required for adolescent male care, says Arik Marcell, MD, MPH, director of adolescent services and the Title X program at the Harriet Lane Clinic in Baltimore and assistant professor in the Department of Pediatrics and Department of Population, Family & Reproductive Health, Division of General Pediatrics and Adolescent Medicine at Johns Hopkins University. Marcell served as lead author on both reports.
The first report, published in the December 2011 issue of Pediatrics, offers a list of clinical practice recommendations to help fill that gap, notes Marcell. The second report, based on interviews with 17 primary-care clinicians who specialize in male teen health, identifies what providers deem core sexual and reproductive services every male teen should receive during annual physical exams.
Get ready for further information to emerge when the Department of Health & Human Services' Office of Population Affairs issues revised Title X guidelines in 2012, says Marcell. The new guidance will include expanded information on provision of male reproductive health services, says Marcell, who is participating in development of the clinical information.
What are top services?
Which services should be performed during every adolescent male annual exam? According to primary care clinicians who specialize in adolescent male health, "go-to" services include:
- a physical exam that includes a genital exam to assess pubertal growth and screen for inherited disorders of sexual differentiation, such as Klinefelter syndrome and fragile X syndrome, as well as for non-sexually transmitted infections that can affect sexual function and reproduction;
- screening and counseling for sexually transmitted infections that include the offer of HIV testing to those age 13 and older;
- screening for substance abuse and mental health;
- screening for physical/sexual abuse;
- discussion of the male role in pregnancy prevention, including condom use and abstinence.2
Other suggested core services include making hepatitis A, B, and HPV vaccinations part of the annual exam and urging parents to engage their sons in age-appropriate discussions of sexuality and health.1
Counseling is a big part of providing optimum care for adolescent males, but it often goes lacking, Marcell notes. Research indicates that primary care providers are three times more likely to take sexual health histories from female than male patients, and they are twice as likely to counsel female patients on the use of condoms.3,4
Clinicians also need to strategize on reaching young men outside of routine visits to deliver more of the necessary services, says Marcell. Such clinical "hooks" as sports physicals and acne follow-up visits can help keep young men enrolled in general and sexual/reproductive health care. Facilities should consider promoting an annual sexual/reproductive health visit for male adolescents to address core sexual/reproductive health issues.1
Get men in the picture
Researchers involved in developing the two new reports say they hope their findings will be a catalyst for policymakers and adolescent health experts to draft and issue national guidelines and recommendations. Medical school and residency training programs curricula on teen males' sexual and reproductive health should be expanded to better prepare the next generation of providers to care for adolescent males.
"Our study indicates that clinicians who specialize in male teen health agree on the services they deem essential for their patients," Marcell says. "What we need now is a set of uniform guidelines to help all pediatricians do the same."
Developing evidence-based guidance for male services is challenging, given that most research in the field ranks as "I" (insufficient), meaning the risk versus benefit balance cannot be assessed, observes Marcell. Most research on reproductive health care and delivery to date has focused on women and clinical services surrounding women's care, he observes.
This focus has extended to clinical practice as well, notes Warren Seigel, MD, MBA, FAAP, FSAHM, chairman of the Department of Pediatrics and director of adolescent medicine at Coney Island Hospital in Brooklyn, NY. Seigel served as a co-author of the report in Pediatrics.
"I believe that we as pediatricians and adolescent medicine providers have historically focused more on the females within our practices and have given little attention to the healthcare needs of males," says Seigel. "Issues like teen pregnancy have caused us to look toward ways to reduce the pregnancy rates in our young adolescent women, but we have unfortunately done this at the exclusion of our young adolescent men."
Federal and state funds often go toward adolescent females as well, adds Seigel. The result?
"We have neglected this important segment of our adolescent population," Seigel comments.
Make it "male-friendly"
What are some practical tips to help males who seek services in a family planning setting? Remember that men coming to a family planning clinic are coming into unknown territory; help them get and stay as comfortable as possible, said Wayne Pawlowski, ACSW, LICSW, CSE, a consultant, trainer, and clinical social worker based in Fort Lauderdale, FL, and Washington, DC. Pawlowski participated in an April 2011 male services webinar program, sponsored by the Philadelphia-based Male Training Center for Family Planning and Reproductive Health in collaboration with the Region VIII Family Planning Training Center, JSI Research and Training Institute, and the Colorado Department of Public Health and Environment, all in Denver. (To review the webinar, visit the Male Training Center for Family Planning and Reproductive Health site, www.fpcmtc.org. Select "Resources," and then under "Media Room," select "here." Across from the title "Improving Communication between Family Planning Staff and Male Clients," select "View Webinar.")
Clinicians can explain the clinical process and everything that is going to happen; this explanation can help to relieve the stress and anxiety of "not knowing," said Pawlowski.
"When guys are sharing personal/sexual/embarrassing information, it can feel DISempowering to do so," he says. "It can feel like they are handing power over to the receiver. Power and control are big issues in male culture, so handing power over is a huge deal; it is not experienced as simply communicating information."
Don't start by asking a male patient if he has any questions, advised Pawlowski. Start the conversation with wording such as "Most men have questions about XYZ, so if you would like, I can explain that to you." Or you can say, "Can I share with you some things that have worked for guys I have worked with in the past?" Clinicians also may choose a more direct approach, Pawlowski suggested. Such wording could include, "Most men have questions about this, so to be sure I am doing my job, I am going to explain it all to you, even though I know I am likely to go over things you already know."5
References
- Marcell AV, Wibbelsman C, Seigel WM, et al. Male adolescent sexual and reproductive health care. Pediatrics 2011; 128:e1,658-e1,676.
- Marcell AV, Ellen JM. Core sexual/reproductive health care to deliver to male adolescents: perceptions of clinicians focused on male health. J Adolesc Health 2011. Doi:10.1016/j.jadohealth.2011.10.013.
- Lafferty WE, Downey L, Holan CM, et al. Provision of sexual health services to adolescent enrollees in Medicaid managed care. Am J Public Health 2002; 92:1,779-1,783.
- Lafferty WE, Downey L, Shields AW, et al. Adolescent enrollees in Medicaid managed care: the provision of well care and sexual health assessment. J Adolesc Health 2001; 28:497-508.
- Pawlowski WV. Improving communication between family planning staff and male clients. Accessed at http://www.region8familyplanning.org/Materials/Male1of4Presentation.pdf.
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