Overcoming Common Barriers to Treating Adolescents 

By Houkje Ross


Closing the Gap, Adolescence • November/December 2000


“T oo often, when a teen obtains health services, it’s like willing to seek health care without confidentiality protection, accordtwo ships passing in the night,” Claire Brindis, DrPH, ing to Abigail English, executive director of the Center for Adolescent 

said of the exchange between physician and patient. Dr. Health and the Law in Chapel Hill, North Carolina. 

Brindis is a pediatrics professor and executive director of the National “A provider should set up a policy within his or her practice to 

Adolescent Health Information Center at the University of California address confidentiality,” said Dr. Brindis. This can prevent things like 

at San Francisco. sending lab results for a pregnancy test home to parents, she said. The 

“When it comes to treating adolescents, physicians, nurses, and Society for Adolescent Medicine advises health professionals to enother health care workers need to take a comprehensive approach,” courage adolescents to involve their families in health decisions whensaid Dr. Brindis. “This means assessing psycho- ever possible. However, when such involvement 

social as well as physiological factors,” like men­ is not in the best interest of the adolescent or “When it comes to treating tal health, family structure, and socioeconomic when parental involvement may prevent the 

status. adolescents, physicians, nurses, adolescent from seeking care, confidentiality 

Adolescents and young adults are the least must be assured. 

likely of any age group to be insured, according and other health care workers “There are a range of legal protections at 

to statistics. But even teens with insurance aren’t the state and federal level to ensure that minors 

need to take a receiving the services they need to ensure a who are unable to involve their parents have 

smoother transition into adulthood, said Dr. access to essential health care. Health care pro­ comprehensive approach.” Brindis. Because most of the health risks for teens viders need to understand these protections and 

are more social in nature, rather than medical,
 explain them clearly to adolescent patients. 

unhealthy behaviors can be prevented or reduced if recognized and
 When parents are involved, physicians should explain the importance 

caught early on, according to many professional associations, includ­
 of confidentiality to them as well,” said English. 

ing the American Academy of Family Physicians.
 Other factors physicians and health care workers need to consider when treating adolescents, from the 1999 report Adolescents and 

Guidelines for Services the State Children’s Health Insurance Program: Healthy Options for Meeting the Needs of Adolescents: 

Guidelines for Adolescent Preventative Services (GAPS) provide •	 Expand Service Hours. Most teens have to rely on parents or 

physicians with recommendations to help prevent unhealthy behav­ family, public transportation, or walking to reach health care 

iors in teens. Supported by the Centers for Disease Control and services. When different services are in two locations, teens may 

Prevention and the American Medical Association, GAPS are designed be deterred by the inconvenience, according to a recent study. 

to help busy physicians identify at-risk adolescent patients and pro­ Clinics should consider location and hours of service to meet the 

vide them with information about preventing and changing unhealthy needs of teens. Long waiting times for teens, who don’t perceive 

behaviors. a problem as urgent, may also deter them from treatment. 

“Many doctors and other medical staff are missing opportunities •	 Provide community referrals. Making teens aware of their opfor prevention,” said Dr. Brindis. GAPS can help health care workers tions can maximize health outcomes. “They need more than one 

learn what types of questions to ask regarding social and emotional gateway for health services,” said Dr. Brindis. Consider referring 

development, physical development and health habits, sexual devel­ teens to school-based or school-linked health care centers, comopment, and family and school concerns of adolescents. Examples of munity-based organizations, health department clinics, Planned 

GAPS questions include: Has anyone talked to you about what to expect Parenthood, hospitals, and other neighborhood resources. 

as your body develops? How do you feel about the way you look? Have you •	 Be Sensitive. Adolescents are sensitive to the attitudes of the 

started dating? What do you do with your friends? “When a student individuals to whom they turn to for advice and care. Providers 

comes in for a sports exam, this is an opportunity to learn what else is need to consider teen feelings of insecurity, conflict about depengoing on in the student’s life and to intervene early,” said Dr. Brindis. dency, and the age difference between provider and teen. 

Trust and Confidentiality For more information on confidentiality laws, e-mail: 

info@adolescenthealthlaw.org, or call (919) 968-8850. GAPS are availGetting teens to talk at the doctor’s office can be difficult if teens able from the Adolescent Health Department of the American Medical 

don’t feel safe. Health care providers need to consider Association at http://www.ama-assn.org/adolhlth/ 

trust and confidentiality when working with teens. An adolhlth.htm . Contact the National Adolescent Health Inincreased desire for privacy and autonomy is a normal formation Center at http://youth.ucsf.edu.

part of adolescent development and teens may be unOffice of Minority Health Resource Center	 U.S. Department of Health and Human Services