Addressing Sexual Well-being with Adolescents: The AHWG Sexual Health Toolkit

1. Addressing Sexual Well-being with Adolescents: The AHWG Sexual Health Toolkit Erica Monasterio, MN, FNP-BC UCSF Division of Adolescent Medicine & Family Health Care Nursing Adolescent Health Working Group

2. Objectives • Think differently and more comprehensively about sexual health • Orient you to the NEW AHWG Sexual Health Toolkit • Provide an update on sexual health care for adolescents • Encourage you to become familiar with the provider, youth & parent resources so you will USE THEM!

3. What is Sexual Health in Adolescents? • Becoming a sexually healthy adult is a key developmental task of adolescence. • Achieving sexual health requires the integration of psychological, physical, societal, cultural, economic, and spiritual factors. Consensus Statement on Adolescent Sexual Health SIECUS

4. Sexual health encompasses: • Sexual development • Reproductive health • The ability to: • Develop and maintain meaningful relationships • Appreciate ones own body • Interact with both genders in respectful and appropriate ways • Express affection, love & intimacy in ways consistent with ones own values Consensus Statement on Adolescent Sexual Health

5. Adults can encourage adolescent sexual health by: •  Providing accurate information and education about sexuality • Fostering responsible decision-making skills • Offering youth support and guidance to explore/affirm their own values • Modeling healthy sexual attitudes and behaviors Consensus Statement on Adolescent Sexual Health

6. Society should encourage adolescents to delay sexual behaviors until they are ready physically, cognitively, and emotionally for mature sexual relationships. Consensus Statement on Adolescent Sexual Health

7. What does a healthy adolescent relationship look like? • Responsible adolescent intimate relationships, like those of adults, should be based on shared personal values, and should be: • Consensual • Non-exploitative • Honest • Pleasurable • Protected against unintended pregnancies/ STDs, if any type of intercourse occurs

9. A few basic premises about the toolkit Takes the stance that adolescent sexuality(and it’s expression) is developmentally normative Is written from an inclusive perspective (content related to LGBT youth, disabled youth, male youth etc. in integrated in, not separated out) Is based in the evidence (when there is evidence to base it in)

10. Be Prepared! • Address issues of: • Confidentiality • Financing of services • Referral network • Health education interventions & materials that are • Age and developmental stage appropriate • Culturally and linguistically inclusive • Inclusive of the range of sexual orientation and expression

11. Assure that staff is prepared • Train ALL staff interacting with youth • Be present and LISTEN • Discuss confidentiality up front • Negotiate the agenda • Use inclusive language • Respect your clients

12. Be there for parents too • Parental involvement can be a gift, rather than a burden • Youth and parents needs support and guidance • Parents of LGBT youth can benefit from additional psycho-education and support

13. Consent and Confidentiality Rights are Key • Youth avoid care and under-disclose key information due to confidentiality concerns • Know the law • Communicate the concepts in accessible language

14. Strive for CLEAR Communication • Keep information • simple • specific to the individual youth you are working with • Use developmentally appropriate language and concepts

16. Provider’s Toolkit series: www.ahwg.net

17. Your Turn • Find resources to help providers prepare to engage with youth about their sexual health • Find parent resources related to discussing sexual health with their teen

18. Focus on Healthy Relationships • Relationship quality is an often overlooked topic • Address: • Trust • Communication • Respect • Comfort • Pleasure

19. Be prepared to discuss Adolescent Relationship Violence (ARV) • ARV is associated with: • Poor contraceptive practices • Contraceptive sabotage • Early childbearing • Adult IPV

20. Your Turn • Find youth resources related to relationship quality • Find parent resources related to relationship quality

21. Discuss Choice and Decision-making • View through the lens of normative development • Elicit and validate the youth’s perspective • Encourage communication • Between youth and parents • Between youth and their partners

22. Your Turn • Find youth resources related to sexual decision-making

23. Engage with your young male clients about their role • Young men want to know about • Pregnancy prevention • EC • Fathering • STI risk reduction

24. Take an adequate and appropriate history

25. Stay up-to-date on screening recommendations • Find other resources for screening and treatment recommendations • Identify some recent changes in screening

26. STD Screening • Chlamydia: • All sexually active adolescent and young adult females should be screened annually for CT • All positives should be treated and then screened for re-infection 4 months after treatment • Option of partner delivered therapy to facilitate treatment of all sexual contacts

27. STD Screening • Gonorrhea : • All sexually active adolescent and young adult females should be screened annually for gonorrhea • Screen all pregnant women • An STD diagnosis is an indication for GC screening

28. STD Screening • Syphilis: • Screening decisions should be based on local prevalence data • Screen all pregnant women • An STD diagnosis is an indication for screening

29. HIV Screening • Universal “opt-out “ screening for all • Special consent is not required • Provide repeat testing as indicated http://www.adolescentaids.org/healthcare/acts.php

30. HIV Screening Recommendations • All patients seeking treatment for STDs, including all patients attending STD clinics, should be screened routinely for HIV during each visit for a new complaint, regardless of whether the patient is known or suspected to have specific behavior risks for HIV infection.

31. HIV Re-screening Recommendations • Annually for persons likely to be at high risk: • injection-drug users and their sex partners, • persons who exchange sex for money or drugs • sex partners of HIV-infected persons • MSM or heterosexual persons who themselves or whose sex partners have had more than one sex partner since their most recent HIV test.

32. Cervical Cancer Screening • Recommendations for Pap Smears: • Obtain a Pap Smear at age 21 (ACOG) • Option to manage LGSIL in adolescents with repeat cytology 12 months after index Pap, follow with cytology if <LGSIL, colposcopy if > HGSIL (ASCCP) • HPV DNA testing is not recommended for adolescents as it will not impact on management (ACOG 2007)

33. Counsel competently about contraceptive choices

34. New Approaches to Prescribing Hormonal Contraception • Effective use of hormonal contraception is more likely if a teen can initiate the method right away • Offer Quick Start for all methods • Not every woman wants to bleed every month • Discuss alternatives to monthly cycling • Offer the option of menstrual suppression

37. Your Turn • Find provider resources related to contraceptive counseling and prescribing • Any new ideas/info? • Find youth resources related to contraceptive choice

38. EVERYBODY needs to know about EC!

39. Pregnancy scares can be a key intervention point • A negative test should engender as much intervention as a positive test • ALWAYS determine if youth is trying to avoid or achieve a pregnancy

40. Your Turn • Find youth resources related to pregnancy decision-making • Find parent resources related to teen pregnancy

41. Can we talk about PLEASURE???

42. Your Turn • Find provider resources related to sexual function and satisfaction • Find youth resources related to sexual function and satisfaction

43. Sexuality and Virtual Reality

44. Youth-Friendly Web Resources

45. Your Turn • Find one • Provider resource • Youth resource • Parent resource that hasn’t been identified yet that you think you will use in your work