Ten Ways to do “it”
or
FP without condoms!
Heather Wood
April 2009
School Nurse
Family Nurse Practitioner
Patricia Kelly
Collaborative Physician
Objectives
z Strategies
to address FP/RH
z Case examples
z Power of Permission
Disclaimer: Teens in clinic setting
1. Post the Issues
Confidentiality
z Sexuality
z Pregnancy
z STI / HIV Risk and Testing
z HPV vaccination
z Dating Violence
z
HIV Testing
Relationships
2. Exploit Opportunities
Comprehensive Health Visit
z Acute Care
z Sports PE
z Classroom
z Conversation
z
Comprehensive Well Care
Reproductive Health Care
z Developmentally appropriate
z Culturally sensitive
z Strength Based
z Parental engagement
z
Bright Futures: AAP and MCH
Acute Care make a link…
z
z
z
16 yo male
Sore throat
Strep negative
¾ Oral Sex?
?Confidentiality
? STI risk
? Sexual partners
? HIV testing
3. Recognize Risks
z
z
z
z
z
z
Adolescenthood
Family pattern
Sexually active
friends/sibs
Pregnant friends/sibs
Depression
Poor school record
z
z
z
z
z
Abuse
Substance Use
Early Puberty
Homelessness
Decision making
Adolescent … “ism”
One risky behavior is a risk
for another risky behavior.
Alcohol : YRBS 2007
z During
•
past 30 days
45% drank
• 26% binge > 5 / row
• 23% used alcohol /
drugs with sex
HEADSS….risks and strengths
Home
z Education
z Activities
z Drugs
z Suicidality
z Sexual
Relationships…
z
15 yo ♀ 9th grade
Presents with URI
z Requests school excuse
z Frequent absences
z “Home”
z
• 17 yo sister and her baby
Assets and Strengths
Exploit an opportunity
z Recognize Risks
z Acknowledge Assets
z Promote strengths
z
4. Make no assumptions
¾ Sexual Identity
¾ Sexual behavior
¾ “Partner”
GLBQ Youth
Suicide
z Victim of Abuse
z Substance
Abuse
z
5. “I” The LMP is a VITAL sign
z
z
z
z
Date
Timing
Character
Pattern
z
z
Medications
Vaccinations
Pregnancy
Miscarriage
STI
Chronic Disease
16 yo ♀ Acne
Irregular periods; Rx OCPs
z LMP: late = 6 weeks ago
z Lost her OCPs
z ? Sexually Active
z ? Condom use
z ? Emergency Contraception
z
6. Set the Stage
z
z
z
Receptionist
Nurse
Office
Define the Practice
• Healthy body
• Emotional well
being
• Safe Behaviors
z
z
z
Confidentiality
Parental Engagement
Community Resources
7. Scout friends, places…
User friendly providers and places
z Nurture contacts
z Facilitate access
z
• Phone #
• Directions
• Rules
• Expectations
8. Inquire with respect
z
Foster Decision
Making
Dating… Serious Partner
Females
78% steady
Males
73% steady
First Sexual Intercourse
9. Offer Options
No one provider/place “fits” all
z Alternatives are not intuitive
z Parental Engagement
z
10. (K) Now your stuff
z
Guidelines
• Bright Futures:
AAP / MCH
• SAM
• ACOG
• USPS
• CDC / MMWR
z
Facts vs Myths
• Not all teens
sexually active
• Parents are
important influence
Power of Permission
Enhances the Relationship
• Re-Focus
• Respect
• Trust
First step Motivational Interviewing
• Comfort level
Power of Permission
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Post the issues
Exploit opportunities
Recognize Risks
Make no assumptions
I The LMP is a VITAL Sign
Set the stage
Scout friends, places, the web
Inquire: Weight the weights
Offer options
N (K)now your stuff