Providing Youth-Friendly Clinical Services the “Rights” Way: 5 Tips

Mousumi Banikya-Leaseburg

Mousumi Banikya-Leaseburg

Those interested in the topic of youth-friendly clinical services are perhaps well-versed on what constitutes such services. Healthy Teen Network has certainly covered this topic extensively through our blog, webinar, on-site training, and technical assistance.

Youth-friendly services include

                • convenient location and hours,
                • affordable fees,
                • friendly staff
                • competent clinicians,
                • comprehensive services, and
                • community support, among others.

The above characteristics reflect the “whats” of youth-friendly clinical services. But what about the “hows”? How do you provide services in a manner that is more youth friendly? These are two intimately connected but separate entities. You can have the “whats” such as comprehensive sexual health services, but without the “hows” (such as providing these services with confidentiality and respect), you will not be truly creating a youth friendly environment.

It is important to employ a “rights-based approach” to provide clinical services that are truly youth-friendly. Basing provision of clinical services, particularly sexual and reproductive health services for young people, solely on their needs, does not bridge a gap in services—it creates one. A needs-based approach alone does not guarantee that youth will use these services. On the other hand, the rights-based approach is proactive instead of reactive and puts us in a better position to meet the real and perceived, unique needs of youth.

In addition to focusing on needs, the rights-based approach also focuses on empowering youth to realize their sexual rights and provides them with opportunities to participate in their own healthcare decision making processes. By adopting such an approach, health care providers/institutions are more likely to attract underserved youth and are more likely to retain their young clients for continuing care (IPPF, 2012).

The Interagency Youth Working Group and the International Planned Parenthood Federation developed five keys to implementing a rights-based approach relative to youth friendly services. These keys are:

  1. Understand evolving capacity. Evolving capacity means being cognizant that with time and varying circumstances, adolescents gradually develop the ability to take full responsibility for their own actions and decisions. Every health professional must strive to find the balance between protecting young clients and enabling them to exercise autonomy.
  2. Ensure confidentiality. Confidentiality is defined as the duty of those who receive private information not to disclose it without a patient’s consent. Confidentiality ensures privacy. Young people must feel comfortable disclosing accurate information about their health, concerns, and behavior to access services and continue doing so.
  3. Obtain informed consent. Obtaining informed consent is vital to being youth-friendly. One must apply the concept of evolving capacity during the process of obtaining informed consent. To give consent, young people need to be able to readily access accurate and comprehensive information. As youth-serving professionals, it is our job to provide this information and not merely get signatures on forms. The mere act of visiting a clinic for the first time may be daunting for a young person, and they may lack the confidence to manage the decisions that follow—but lacking confidence does not mean they lack the ability to make these decisions. The process is an important part of personal development and can be a positive experience and immensely empowering.
  4. Celebrate diversity. Celebrating diversity means being cognizant that youth come from diverse backgrounds in terms of race, ethnicity, gender, sexual orientation, socioeconomic status, age, physical abilities, religious beliefs, political beliefs, and other ideologies. Additionally, individuality adds to diversity. Accepting diversity with respect is central to a youth-friendly approach. This does not mean merely tolerating differences; it means recognizing the many layers of diversity, embracing this diversity, and truly accepting youth for who they are.
  5. Adopt a sex positive approach. Sex-positivity is an attitude that views sexuality as something that enhances life by infusing happiness and energy into it. Sex positive approaches promote sexual well-being rather than trying to prevent negative sexual experiences and/or consequences of sex. The risks and concerns associated with sexuality are acknowledged but without shaming or reinforcing fear or stigma of young people’s sexuality or gender.

At the end of the visit, your ability to offer a youth-friendly experience to your young clients depends on your ability to adopt these approaches and offer youth two things: options and choices. The array of options that every young person should have access to in order to promote and protect his/her sexual and reproductive health and well-being, and the choice to say “no” to every single option you provide despite how excellent the options may be.

If you can bite your tongue and overcome the urge to tell them they are making a mistake, if you can resist the temptation to tell them you are a clinician and you know best, if you can maintain a caring demeanor and with utmost respect and a non-judgmental tone and attitude, to encourage them to think the options over and let you know if they change their mind, you would have upheld their rights and provided youth-friendly clinical services the “rights” way. The likelihood of them returning to you or your clinic, although not guaranteed, would have certainly increased, for they would have felt respected and empowered to make their own decisions. Chances are that the next time he or she comes for a visit, you may be successful in encouraging him to use condoms correctly and consistently each time he has sex, or in supporting her in her decision to have a LARC (i.e., long-acting reversible contraceptive) method inserted.

It is not an elusive magic solution that we are looking for here—it is pure common sense. Listen and treat them well—with dignity and respect—and they will return.

Why do you think it is important to adopt a rights based approach to deliver youth-friendly clinical services? How do you uphold the rights of your young clients while delivering quality clinical care?

Mousumi Banikya-Leaseburg, MD, MPH, CPH is a Program Manager at Healthy Teen Network.

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3 Steps to Establish a Clear Goal to Engage Communities

Healthy Teen Network's Education & Outreach Department

Healthy Teen Network’s Education & Outreach Department

What is Community Engagement?

The Centers for Disease Control and Prevention Committee on Community Engagement defines community engagement as “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.” Community engagement “involves partnerships and coalitions that help mobilize resources and influence systems, change relationships among partners, and serve as a catalyst for changing policies, programs, and practices.”

In other words, community engagement is the synergistic process of bringing a diverse group together for the purpose of reaching a shared goal. It is a process that is both evidence-based, rooted in social science, as well as a creative process built on strong, cooperative relationships.

Building and sustaining community engagement is critical to the long-term success of community programs, and ultimately, achieving better health outcomes for youth. With that in mind, establishing a clear goal is the centerpiece of working collaboratively with a community stakeholder or advisory group, to support community engagement. These three steps will support establishing a clear goal:

  1. Assess Community Needs and Resources. With project partners, conduct a thorough needs and resource assessment. Use quantitative data (e.g., surveys, vital statistics, etc.) and qualitative data (e.g., focus groups, interviews, etc.) to identify youth, community resources, and potential partnerships.
  2. Share Findings with the Community. Tell the story of the initiative, complete with the purpose and vision. Use methods such as community or town hall-style meetings, hold a press conference, publish stories in local papers or newsletters (e.g., articles, letters to the editor, etc.), and spread the word via social media (e.g., Facebook, Twitter, etc.). Sharing findings should be a routine and regular task, to build mutual understanding and collaboration for the project. Sharing also builds reciprocity and can support leveraging community resources and wisdom, particularly when the community is encouraged to respond to and contribute to project findings and planning.
  3. Partner with Appropriate Individuals and Organizations. The assessment and outreach to share findings will help you to partner with appropriate individuals and organizations. Think about people and organizations who could be involved in the community stakeholder or advisory group. It’s important to consider capacities and characteristics, such as:
    • Diverse knowledge, skills and capacities
    • Thinkers and “doers”
    • Manageable size
    • These three steps will build the foundation of community engagement. From here, of course, there’s much work to be done, in the ongoing partnership with the community and key stakeholders, to sustain the project.

Here are some more resources to support you in your efforts to engage the community:

What are some challenges or lessons learned you’ve realized in your efforts to engage the community?

 

Ending Child Sex Trafficking in the United States, One Child at a Time

Rajani Gudlavalleti

Rajani Gudlavalleti

Upwards of 300,000 U.S. children—as young as 13 years of age—are exploited by sex trafficking annually (United States Department of Justice). Contrary to common belief, almost all child victims of trafficking in the United States are born here—forced to work in brothels, private parties, and truck stops. These are youth who did not have a trustworthy adult support system to help them avoid exploitation. To ensure that all young people lead healthy and fulfilling lives, it is essential for everyone who works with kids, including teachers and social workers, to understand U.S. child trafficking, how to identify these kids, and to develop appropriate solutions to get them out.

How do U.S. children get trafficked?

According to the Trafficking Victims Protection Act, anyone under 18 committing commercial sexual acts is a victim of severe human trafficking. These victims are mostly girls who have been abused and forced by fear to either run away from home and/or caretakers prevented them from returning home out of anger. Traffickers coerce these children into prostitution by exploiting their desperation to meet basic needs. These adults use manipulation to gain the trust of these children and often compel them to believe that prostitution is their only option for survival.

How can I help?

  1. Learn about federal protections for trafficking victims: Victims can access publicly-funded services to meet their immediate needs (e.g., housing, food, health care), as well as counseling and income assistance.
  2. Confirm that the child is a victim of trafficking and build trust: For resources on recognizing the signs of a trafficking victim, please visit Polaris Project, FAIR Girls, or CAASE. Unfortunately, you may not be able to get children out immediately—but you can help them feel comfortable enough to eventually request help. Focus on gaining the child’s trust. Speak together in a safe and confidential environment, away from other adults.
  3. Work with the child to “come out”: To ensure that the child feels comfortable about escaping exploitation and accessing federal protections and services, the child must first “come out” to law enforcement as a victim of trafficking. However, these children almost always feel stuck, ashamed of their actions, and afraid to seek help. Use indirect strategies to teach the child about the legal protections afforded to victims who escape, without pressuring the child to take action.
  4. Research your local law enforcement agency’s practices in trafficking situations: Most law enforcement agencies—including the FBI—use insensitive “rescue” models, which involve large-scale police raids that sweep everyone on sight and do not take individual victims’ circumstances into account. For example, children who run away from home—an arrestable offense in some jurisdictions—are often returned to the unsafe home that sent them running in the first place. And, victims of trafficking often return to prostitution because they have no alternative means of survival.
  5. Develop a sustainable plan that empowers the child to be a successful adult: The most effective strategy to rescue children from trafficking is to address their needs one-by-one. Create a team of caring adults to ensure the child’s safe escape and re-integration into the community. Identify alternative means of livelihood by coordinating with homeless family services and/or youth job training programs.

It is not only essential for us to keep our eyes open for these victimized children, but we must work together to support them safely and effectively. As adults working to ensure that adolescents lead healthier sexual and family lives, we are obliged to ensure that victims of child sex trafficking survive, escape, and thrive.

Rajani Gudlavalleti is program coordinator for Open Society Institute-Baltimore, working primarily in the Criminal and Juvenile Justice Program.

 

One Hobby Lobby Story

Emily Gargiulo

Waiting to witness history.

Last Tuesday, the Supreme Court listened to oral arguments in the case of Sebelius v. Hobby Lobby Stores, which will determine if a for-profit company can deny its employees health coverage of contraception based on the religious objections of the company owner. The case represents the latest controversy in the health reform/reproductive justice/religious liberty debate—just how that debate is defined is often an indicator of where one stands.

My story

I grew up in a devout Catholic household in Brooklyn, NY. As a child, I learned early that many of my friends and neighbors did not share my family’s beliefs—the gift and consequence of growing up in one of the most diverse cities in the world. Nevertheless, we recognized that we all enjoyed the same protections to believe and not believe, to practice and not practice a given faith. It is this principle that has most clearly defined my views today, but one that Hobby Lobby appears to question. The store owners and supporters suggest that their religious freedom should trump that of their employees. The court’s definition of this freedom will impact the rights of women across the country to make this choice for themselves.

I decided months ago that I needed to be present for this historic case, but I knew making this a reality would be no easy feat. The Supreme Court contains roughly 400 seats for viewers; of these, many go to friends and colleagues of the justices, groups that have assisted in the counsel of the two legal teams, and the press. The limited numbers of leftover seats are made available to the public. In the days leading up to hearing, forecasts predicted snow, slated to start right in the middle of the night. I enlisted one crazy friend still willing to take a chance to witness history.

As the day finally arrived, we drove from Baltimore to DC, armed with blankets, snacks, and a few vain hours of sleep. Joining the line shortly after 3am we were giddy with the anticipation of the hours ahead. Students of all ages—high school, college, and law school—surrounded us on the street, all attracted to the line by a common spirit. We embodied the hopeful, bushy-tailed energy of the nation’s capital, where policy and society collide in the democratic process. We’ve lived in a time when contraception is legal and not just accepted by our peers, but considered a right. We’re also living in a time where companies have unprecedented power and speech. We knew the collision of these individual and corporate rights may well decide the next period of our lives.

Around 6 am, we were told to pack up and prepare for the first groups to start entering the building. (In reality, the very front of the line would not go in until 7:30am, while others, myself included, waited two more hours to snatch up the last few public seats.) At this point, the protestors started to gather. As we anxiously waited to learn our viewing fate, we watched the physical demonstration of colliding principles. Each side fought to be the loudest, the biggest, and the least able to ignore. Advocates all had their own story of why they came, what they believe, and the result they seek.

After hours of camping, standing, and snow, we were among the final public viewers to make it in the courtroom. The 90 minutes of testimony were among some of the most exhilarating minutes two health policy students/reproductive rights advocates could ask for. There are ample sources across the internet where one might read about the arguments considered, so I will not analyze these here. (A decision is expected in June.) What I do think is worth mentioning is just what that courtroom represented—nine highly esteemed justices, serving life tenures, spent 90 minutes asking questions regarding legal standards and the health and economic costs of these decisions. Hundreds of reporters and legal experts listened for those justices’ tones, signs of opinion, and precedence. Students and other lay public marveled at the judicial process, and the chance to experience history. But outside that courtroom, hundreds of activists withstood snow and opposition to openly declare their principles. They wore shirts and raised signs like scarlet letters, a symbol of solidarity to the views and people they represent.

Beyond that courtroom or the surrounding streets, there are millions of women who stand to feel the impact of this decision. No matter how you define the debate, the answer is monumental for the individual rights to healthcare, religion, and freedom of choice for all Americans. My Hobby Lobby story is just one of the millions that remain to be told.

Emily Gargiulo is a Health Policy graduate student at Johns Hopkins Bloomberg School of Public Health and a Research & Evaluation Assistant at Healthy Teen Network.

Check out a short video of Emily waiting to go inside the Supreme Court.

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