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.

Opportunity Knocks: Important Information to Share During a Teachable Moment

Gina Desiderio

This blog post is the third part of a series (Part 1, Part 2) highlighting Healthy Teen Network’s resources on using teachable moments to reach youth, through our Opportunity Knocks resources, including a fact sheet and pre-packaged, fully designed presentation, ready for you to use.  The Opportunity Knocks series is based on Healthy Teen Network’s belief that: With accurate information and adequate support, young people can make healthy and responsible decisions about having sex and using contraception. Adults can be most effective by providing the information and support needed to promote responsible decision-making in youth and help ensure transition to adulthood is safe and healthy.

In order to make the most out of a teachable moment, here is some important information about sex you should know to share with youth

“It’s important to protect yourself.”

  • Many types of protection are available and can be low cost (contraception, condoms, etc.): a clinician can help a teen identify the right type.
  • Remember that all youth need information about protection, even abstinent youth.  You should still first convey the message that abstinence from vaginal, anal, and oral sex is the only 100% way to prevent pregnancy, STIs, and HIV, but it’s important for all youth to have this information.  Youth may currently be abstinent, but it’s important for them to be prepared for when they do engage in sex, which will happen at some point in their lives.  They may be thinking about or preparing to engage in sex.  Also, youth may be defining “abstinent” differently—they may not realize that engaging in oral sex, for example, still puts them at risk.
  • All youth—girls AND boys—need this information.   For example, often, girls are the focus of teen pregnancy, STI, and HIV prevention messages, but it’s obviously important that boys are engaged in the conversation and receive this information too.
  • It’s important to recognize that, for example, a young woman who identifies as a lesbian and lets the trusted adult know this will probably not be interested in hearing about contraception.  If you do provide information on contraception, she may feel as if you are not listening to her.  However, youth who may be questioning their sexual orientation may engage in sexual risk-taking behaviors.  For example, a girl may engage in sexual activity with a boy, but she may not protect herself.  Therefore, it’s important to tailor your approach and information provided to the individual.
  • Plan ahead: it is much easier for teens (or anyone, for that matter!) to think about protection ahead of time, and there are many more options before having sex.
  • Teens need to choose the contraceptive method that is right for them: methods that may not have worked for a friend or relative may work well for another teen.
  • Youth should talk to partners to make it easier to make decisions together.  For example, youth can use these techniques when talking to partners:
    • Say “no” to sexual risk-taking behaviors.
    • Explain why they want to make safer decisions (i.e., prevent pregnancy, STI, HIV).
    • Offer alternatives or strategies to show they still care about their partners and want to have a relationship with them.  Talking through feelings together can help grow a relationship and ease any tension.
  • An integrated message is best: discussion of both pregnancy prevention and reducing sexually transmitted infections is crucial.  Both partners should use protection (such as condoms and/or birth control) to increase protection against pregnancy and STIs.  However, it is not safe to use two condoms at a time.  This is sometimes referred to as double bagging and can actually increase the likelihood of the condom breaking

Emergency contraception (EC) is safe, highly effective, and available.

  • It’s the only existing way to prevent pregnancy after having unprotected sex[1].  EC is now available without a prescription for 17 year olds.  Healthy Teen Network has an Advocacy Resource Guide on Emergency Contraception, available online for free download.

It’s Confidential!

  • Youth can feel comfortable seeking medical advice about protection because confidentiality laws protect their privacy.  Youth have rights; confidentiality laws protect their privacy to access confidential health care services. It’s okay to talk about sex!  Healthy Teen Network has a series of resources on Confidential Access to Contraception, but here are some important points to remember:
  • Many young people indicate that they would not use the services of a family planning clinic if their parents had to be informed, but few say they would stop having sex.[2], [3]
  • A majority of young people share information about sensitive issues such as sexual activity with their parents and other adults in their lives,[4] but sometimes adolescents need or want confidential services.
  • When adolescents are discouraged from seeking health care because their care will not be confidential, the result can lead to adverse health outcomes and significant social and economic costs.[5], [6]
  • At least two recent studies have estimated the potential increase in pregnancies and sexually transmitted infections (STIs)—with the likelihood of significant increases in public financial costs—when adolescents are discouraged from seeking health care.[7]

It can be intimidating for adults to share this important information during a teachable moment.  However, there are some helpful hints and steps you can take to prepare yourself:

  • Know your own limitations and comfort level; it’s okay to refer a young person to another trusted adult if the conversation moves outside of your personal boundaries, but check in with the young person to make sure that someone did indeed answer all of his/her questions.
  • Use humor, when appropriate, as it can go a long way.
  • It is okay to say “I don’t know” and look up answers together; be sure to use a credible source of information.
  • Know other trusted allies and youth friendly professionals for referral.
  • Build a network of trusted adults in your community.
  • Make condoms readily available in your office/home.
  • Be prepared to talk about sex to all youth (e.g., LGBTQ youth, straight youth, abstinent youth, etc.).

What is other important information you always make sure to share during a teachable moment?

What are some other helpful hints or steps you take to prepare for teachable moments?

Gina Desiderio is the Director of Marketing and Communications at Healthy Teen Network.

[1] Emergency Contraception (2009). Office of Population Research, Princeton University. Retrieved online from:

[2] Reddy, D.M., Fleming, R., & Swain, C. (2002). Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. The Journal of the American Medical Association, 288(6), 710-714.

[3]Jones, R.K., Singh, S., & Purcell, A. (2005). Parent-child relations among minor females attending U.S. family planning clinics. Perspectives on Sexual and Reproductive Health, 37(4), 192-201.

[4] Jones, R.K., Singh, S., & Purcell, A. (2005). Parent-child relations among minor females attending U.S. family planning clinics. Perspectives on Sexual and Reproductive Health, 37(4), 192-201.

[5] Ford, C.A., & English, A. (2002). Limiting confidentiality of adolescent health services: What are the risks? The Journal of the American Medical Association, 288(6), 752-753.

[6] English A. & Ford, C.A. (2004). The HIPAA privacy rule and adolescents: Legal questions and clinical challenges. Perspectives on Sexual and Reproductive Health, 36(2), 80-86.

[7] Franzini, L., Marks, E., Cromwell, P.F., Risser, J., McGill, L. Markham, C., Selwyn, B., & Shapiro, C. (2004). Projected economic costs due to health consequences of teenagers’ loss of confidentiality in obtaining reproductive health care services in Texas. Archives of Pediatrics and Adolescent Medicine, 158(12), 1140-1146.

Opportunity Knocks: Teachable Moments

This blog post is part of a series highlighting Healthy Teen Network’s resources on using teachable moments to reach youth, through our Opportunity Knocks resources, including a fact sheet and pre-packaged, fully designed presentation, ready for you to use.  The Opportunity Knocks series is based on Healthy Teen Network’s belief that with accurate information and adequate support, young people can make healthy and responsible decisions about having sex and using contraception. Adults can be most effective by providing the information and support needed to promote responsible decision-making in youth and help ensure transition to adulthood is safe and healthy.

Gina Desiderio

A “teachable moment” is a general term, but one that I’m sure you’ve come across or used in your experiences working with youth. A teachable moment is a situation where opportunity knocks—a time at which a person, especially a child, is likely to be particularly disposed to learn something or to be particularly responsive to being taught or made aware of something.[1]

Teachable moments offer some advantages when trying to reach youth:

  1. Youth can make healthy and responsible decisions: With accurate information and adequate support, young people can make healthy and responsible decisions about having sex and using contraception.
  2. Adults can promote responsible decision-making: Adults can be most effective by providing the information and support needed to promote responsible decision-making in youth and help ensure transition to adulthood is safe and healthy.
  3. Creating a positive interaction opens the door for future opportunities: A key component for adults is taking advantage of teachable moments to discuss sex and the use of contraception with young people.  Youth are often hesitant to talk with adults about sex.  When young people are willing to discuss this topic, adults must be prepared to help by providing information and resources.  When the interaction is positive, it is more likely that the youth will return to the adult again.

Sometimes, adults are afraid that talking about sex leads to sex, but this is simply not true.  Talking about sex does not lead to sex.  Also, risk-taking can be part of normal adolescent development; adults can be most effective by promoting healthy decision-making during this stage. Talking about sex does not mean an adult is advocating sexual activity. Making the best use of teachable moments can help youth make better choices if and when they do make the decision to become sexually active.  Furthermore, sexual feelings are a part of normal adolescent development.[2]

Teachable moments can make initiating conversation about sex and contraception easier and more comfortable for everyone involved.   There are two kinds of teachable moments—those that spontaneously occur, and those that can be prompted based on a situation.  With spontaneous teachable moments, youth initiate the conversation.  With prompted teachable moments, the adult initiates the conversation, using the current situation or topic as a jumping off point.

Media often provide the opportunity for a prompted or a spontaneous teachable moment.  A television show, movie, or song, for example, may present a storyline or subject that contains an important lesson or example. Youth may bring these topics up, or you may be able to take advantage of this example and use it as a “jumping off point” in your discussion about safer sex and contraception. This type of teachable moment may seem contrived, but it is a great way to begin a conversation that may otherwise be difficult to initiate.

What are some ways you have used media examples or current events to prompt a teachable moment?

A helpful hint is not to limit your teachable moments to media that interests you; take some time to understand what interests the youth you work with. Read their magazines and be aware of popular television shows, movies, and music. These images, storylines, songs, and ads are what they are absorbing all of the time.

Teachable moments may also occur if a young person discloses something to, or confides in, you. As an educator, nurse, social worker, clinician, or other direct service provider, it is important to feel confident in your response if a young person discloses a personal situation or asks for advice. This type of teachable moment may catch you off guard, so it is important that you have the training, resources, and preparation to respond accordingly.

For example, I used to be a high school English teacher, and in my first year of teaching, I did not have any training or preparation in dealing with disclosure.  A student confided in me that she sometimes cut herself.  I was caught off guard; I didn’t know how to respond to her, in the moment, and I didn’t know what I was required to report, legally, or to keep confidential.

Whether the disclosure is spontaneous or prompted, it’s important to know the policy relevant to the situation.  While we aren’t able to review your specific organization’s or agency’s confidentiality and referral policy in just a single blog post, there are some important key points to be aware, in the event of a disclosure.  You should know:

  1.  What must be kept confidential (e.g., HIV status, sexual orientation)?
  2. What must be reported (e.g., abuse, intent to harm self or others)?
  3. What is your professional role expected to be (e.g., referral to counseling/crisis intervention or counseling/crisis intervention)?
  4. What are your professional boundaries?
  5. What  resources and referrals are available locally?

See your supervisor, credentialing organization, state law, etc., to find out more about your relevant confidentiality and reporting policies and laws.

It’s important to let youth know what’s confidential, as well.  This will help create a safe space, building trust, and encourage future opportunities for providing information, resources, and referrals.

Gina Desiderio is the Director of Marketing and Communications at Healthy Teen Network.

[1] Teachable Moments. (2009).  Encarta Dictionary. Retrieved online.

[2] Haffner, D. (Ed.). (1995). Facing facts: Sexual health for America’s adolescents. NY, NY: Sexuality Information and Education Council of the United States.

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