http://www.hivcareforyouth.org/adol?page=md-module&mod=01-02-01

Psychosocial Assessment

Making Adolescent Patients & Their Parents Your Care Allies

Because most young adults do not access health care routinely, it is important to create a clinical atmosphere that engages them and retains them in care. Adolescents are not interested in whether a provider dresses like them or is up to date with the latest slang. They want to be respected, have their opinions considered, and be allowed to participate in their health care. An environment and approach to care that is sensitive, nonjudgmental, and respectful regarding cultural norms, sexuality, sexual orientation, risk-taking behaviors, and youth culture can help young people take responsibility for their own health care.

Episodic health care should be discouraged, because unmet medical needs may not be identified during these brief contacts. Instead, annual visits should be strongly encouraged, as they provide the opportunity to monitor medical, psychosocial, and emotional well-being. Regularly scheduled contact supports development of therapeutic alliances with adolescents and their families as well as long-term retention in care. In an effort to promote continuity of care and appropriate follow-up, youth should be encouraged to seek medical care for all nonemergent problems with their primary care practitioner.

Parents also can play a key role in improving adolescents' health care. Providers should take the opportunity to address key adolescent health issues with parents, including:

  • Psychosocial and physical development in the early, middle, and late stages of adolescence
  • Adolescent nutrition and fitness recommendations
  • Peer pressure perils
  • Communicating with teens about sex, sexuality, and substance use
  • Internet safety

Remember that family and community ties are very strong among many Blacks/African Americans, AI/ANs, AA/PIs, and Latinos, and they can play an important role in all aspects of life. For example, Blacks/African Americans may have "non-blood kin" who are significant caregivers for young family members.9 Among Latinos, godparents (compadres and comadres) may assume responsibility as coparents of children. Extended family such as aunts, uncles, grandparents, and others in the community may be very valuable resources for youth. Among AA/PIs, an individual is seen as interdependent with his/her family members, instead of autonomous as is generally believed in mainstream American culture. Many AA/PIs , especially when sick, turn to family members as their primary source of help and support.713 Within AI/AN families, emotional and social support from extended families may be available to the adolescent. Get to know who is important in young patients' lives and who will be involved in their health care. Be prepared to educate godparents or non-blood kin in the same way you would educate biological parents.

How providers can help patients with limited health literacy

Managing HIV requires active participation from patients and their support networks.

  • Identify patients with limited literacy levels
  • Use simple language and short sentences, and define technical terms
  • Supplement instruction with appropriate materials (videos, models, pictures, etc)
  • Ask patients to explain your instructions (teach back method) or demonstrate the procedure
  • Ask questions that begin with "how" and "what," rather than close-ended yes/no questions
  • Reflect the age, cultural, ethnic, and racial diversity of patients
  • For patients with limited English proficiency, provide information in their primary language
  • Offer assistance with completing forms

www.hrsa.gov/healthliteracy/

References

  1. Chodon T. The Role of Culture in HIV/AIDS Health Care -- A Practical Guide for Providers Serving Asian and Pacific Islander Americans. New York, NY: Asian & Pacific Islander Coalition on HIV/AIDS, Inc. 2001.
  2. Boyd-Franklin N. Black Families in Therapy: A Multisystems Approach. New York: Guilford; 1989.
  3. Yep GA. HIV/AIDS in Asian and Pacific Islander communities in the US: A review, analysis and integration. International Quarterly of Community Health Education 13:293-315. 1993.