Guidelines from the AAP and other professional organizations highlight provision of confidential care and time alone with a clinician as critical elements of adolescent preventive services. However, recent research highlights a gap between professional guidelines around confidential services and practice.
A nationwide study with parents of teens found that of adolescents who had a clinic visit in the past year, only 30 percent reported time alone with their health care provider. In another study examining confidential services and private teen-clinician discussions, adolescents, parents, and clinicians all expressed strong support for confidential adolescent services but also voiced ambivalent attitudes about these services. This ambivalence often reflected the desire to promote adolescents’ independence as health care consumers, while also wanting to continue to protect them from harm. Our current research–involving Minnesota-based clinicians, parents and teens—explores the balance between confidential services and parent engagement.
Considering the triadic relationship between clinicians, adolescents, and parents, multiple strategies emerge for developmentally-appropriate partnerships to promote adolescent health. Key among these—a strategy that is endorsed by the majority of parents—is supporting communication between adolescent patients and their parents. Quality teen-parent communication is protective for adolescent health and can decrease risk-taking behaviors.
Strategies to engage adolescents and their parents around confidential services and teen-parent communication include:
- Normalizing (with both parents and teens) time alone and confidentiality as a part of routine care, not based on the clinician’s perception of a teen’s risk. Simply stated, these are recommended components of quality health care for all adolescents.
- Discussing relationships between pediatrician, teen, and parent, and their respective roles in the adolescent’s health (e.g. with teens, “This is a fun age because, you have a little more independence each year and so have to be thoughtful about the decisions you make; and your parents support you in that, by knowing who your friends are, where you’re going, and being a resource for any questions you have; and I get to be a resource for you if you have any questions or concerns you’d rather ask your doctor than your parents.”)
- Starting conversations with parents around sensitive subjects by validating their experiences (e.g., “This really is one of the hardest stages of raising kids, walking that fine line of their increasing independence and still obviously wanting to encourage healthy behaviors”) and providing general anticipatory guidance about confidential health topics that may actually be tailored to an adolescent patient’s needs, but without specifically disclosing the adolescent’s confidential information.
- Encouraging supportive teen-parent communication. Pediatricians can emphasize to parents that they are an important resource for their children during their teen years, and that ongoing communication is an effective way to support teens’ healthy behavior. With teens, pediatricians can help adolescents see potential advantages to communicating with their parents and offer to facilitate discussions in ways that are supportive of the adolescent patient.
Pediatricians should feel reassured that most parents support time alone with adolescent patients and confidential services and that these services are backed up by both professional organizations and state laws.
Within the context of confidential care, pediatricians can support parent-adolescent relationships, facilitate teen-parent communication, and function as if they were a partner with parents, even while seeing adolescent patients privately for developmentally appropriate care.
References available upon request.