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Cultural Competency and Adolescent Health

Cultural Competency and Adolescent Health. Outline. Cultural Competency and Adolescent Healthcare: What Does It Mean? Adolescent stages of development Identities and disparate health outcomes Movements to decrease bias and optimize health service delivery. Objectives.

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Cultural Competency and Adolescent Health

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  1. Cultural Competency and Adolescent Health

  2. Outline • Cultural Competency and Adolescent Healthcare: What Does It Mean? • Adolescent stages of development • Identities and disparate health outcomes • Movements to decrease bias and optimize health service delivery

  3. Objectives By the end of this presentation, participants will be able to:

  4. Cultural Competency and Adolescent Health

  5. Adolescence

  6. Stages of Adolescence • Early • Middle • Late

  7. A spurt of growth Beginning of sexual maturation Concrete thinking Early Adolescence

  8. Mid-Adolescence • Develop a stronger sense of identity • Relate more strongly to peer group • Thinking becomes more reflective

  9. Late Adolescence • The body fills out and takes its adult form • Distinct identity and more settled ideas and opinions

  10. The Culture of Adolescence

  11. An Adolescent’s Identity Includes: Religion/ Spirituality Race and Ethnicity Genetics Socioeconomic Status Geography Peer Group Ability Stage of Development Gender Identity Sexual Orientation Family Structure

  12. “Minority” Status in An Aspect of an Adolescent’s Identity Can Affect: • How and where healthcare is sought • Ability to obtain and pay for quality care • Patient-healthcare provider interaction • Societal stereotyping and marginalizing

  13. Living in Poverty Increases the Likelihood of Being Uninsured • 3.3 million (1 in 8) adolescents ages 12-17 lack health insurance • 8 million (1 in 4) youths ages 18-24 are uninsured

  14. Lack of Insurance Can = Lack of Care • Insured teens receive care twice as often as uninsured adolescents • In a survey of adolescent girls: • 50% of uninsured reported foregoing needed care • More than 2xs the rate of insured girls

  15. This Can Lead to Health Disparities, Including: • Higher incidences of sexual risk behaviors • Higher rates of: • Pregnancy • STIs • Depression • Drug and alcohol use

  16. For Example…

  17. Teen Pregnancy Has Continued to Declined

  18. Disparities in Teen Pregnancy Rates Persist

  19. Lesbian, Gay, and Bi Teens Report Sexual Risk Behaviors

  20. How Can Providers Improve These Health Outcomes?

  21. Strategies for Providing Optimal Care • Cultural Competency • Cultural Humility • Adolescent-Centered Care

  22. Cultural Competency • Movement to address health disparities through provider education • Trainings often required by many funders, accreditation bodies, and institutions

  23. Most Common Definition of Cultural Competency

  24. Cultural Competence: Strengths

  25. Cultural CompetenceProvider Guidelines

  26. Cultural Competency in Practice Berlin EA, Fowkes WC.1983

  27. Weaknesses in “Cultural Competency” • Not clearly defined • Denotes attainment of concrete level of knowledge • Risks cultural stereotyping • Focus on others instead of reflecting on individual and organizational biases and prejudices

  28. Building Upon Cultural Competency: Cultural Humility

  29. Cultural Humility • Puts onus on provider to self-evaluate how personal biases may affect service delivery • Redresses power imbalances in patient-physician dynamic Tervalon and Murray-Garcia, 1998

  30. Healthcare Providers’ Identities Profession Race and Ethnicity Medical Specialty Marital Status Parental Status Sexual Orientation Training Background Gender Identity Age Religion

  31. Issues to Confront Before Seeing an Adolescent Patient • How comfortable are you talking to adolescents? • What are your feelings/beliefs about adolescent sexuality? • Are you able to separate your own values in order to treat your patient?

  32. Self-Evaluation During a Clinical Encounter www.diversityRx.org

  33. Cultural Competence and Cultural Humility Combined: Adolescent-Centered Care

  34. Adolescent-specific Multi- and interdisciplinary Accessible Financially affordable Adolescent-focused materials on display Peer educator component Adequate space Confidential Flexible scheduling Comprehensive services Continuity of care Help transitioning into the adult medical care system Elements of Adolescent-Centered Services:

  35. Providing Care to Adolescents • Confront personal biases head on • Be prepared to refer patient for appropriate care if unable to provide it

  36. Adolescent-Centered Care

  37. Ways to Provide Adolescent-Centered Care

  38. The HEEADSSS Model • H: Home • E: Education/Employment • E: Exercise/Eating • A: Activities • D: Drugs • S: Suicide/Depression • S: Sexuality • S: Safety • S: Spirituality (Optional)

  39. Please Complete Your Evaluations Now

  40. Provider Resources www.prch.org- Physicians for Reproductive Choice and Health www.aap.org - The American Academy of Pediatrics www.acog.org - The American College of Obstetricians and Gynecologists www.adolescenthealth.org- The Society for Adolescent Medicine http://www.aclu.org/reproductiverights/- The Reproductive Freedom Project of the American Civil Liberties Union www.advocatesforyouth.org – Advocates for Youth www.guttmacher.org – Guttmacher Institute www.cahl.org/ - Center for Adolescent Health and the Law www.gynob.emory.edu - The Jane Fonda Center of Emory University www.siecus.org - The Sexuality Information and Education Council of the United States www.arhp.org - The Association of Reproductive Health Professionals

  41. Provider Resources PRCH’s Minors’ Access to Confidential Reproductive Healthcare Cards and Emergency Contraception: A Practitioner’s Guide ARHP Reproductive Health Model Curriculum AMA Guidelines for Adolescent Preventive Services (GAPS) The American College of Obstetricians and Gynecologists: Confidentiality in Adolescent Health Care Primary and Preventive Health Care for Female Adolescents Tool Kit for Teen Care—available at: http://www.acog.org/bookstore/Tool_Kit_for_Teen_Care_P348C84.cfm For emergency contraception, call 1-888-NOT-2-LATE

  42. Provider Resources Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002: www.cdc.gov/std/treatment/rr5106.pdf Building Emergency Contraception Awareness Among Adolescents, A ToolKit, Academy for Educational Development: http://www.aed.org/Publications/upload/ECtoolkit3283.pdf Henry J. Kaiser Family Foundation: public health policy, broken down by area (e.g., reproductive, state-specific, Medicaid, HIV/AIDS): www.kff.org. The Young Men’s Clinic of Columbia University: http://www.cumc.columbia.edu/dept/sph/popfam/ Mount Sinai Adolescent Health Center: http://www.mountsinai.org/msh/msh_program.jsp?url=clinical_services/ahc.htm

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