8.7 Adolescent Services

Part II: Guidelines for Client Services and Clinic Management

Adolescents are a special segment of the population and attention should be given to their individual needs. Adolescent clients require skilled counseling and age appropriate information. Clinic staff working with adolescents should have at least a basic understanding of adolescent development as the adolescent's stage of development plays a significant role in how they make decisions.

Delegate agencies must address service delivery to adolescents in their annual work plan. The plan must include the total number of teens the agency anticipates it will serve and written protocols must address adolescent services. Specialized services for adolescents must include:

  • Priority scheduling of appointments for counseling and clinical services for teens.
  • Assurance of confidentiality, including:
    • All minors receiving any services funded by Title X are entitled to confidentiality and the parents/guardians of minors cannot access their minor children's medical records unless the minor agrees. This confidentiality also includes not confirming the client's clinic attendance.
    • Family planning services shall be provided to minors with no requirement of consent from a parent or guardian.
    • No notification will be made to a parent before or after a minor has requested or received family planning services.
    • If follow-up to the clinic visit is necessary, every attempt must be made to assure the privacy of the adolescent. Adolescents must be informed that their confidentiality will be maintained whenever possible; however situations may arise where it is necessary for contact (such as an abnormal pap report). An alternative method of contacting a "no contact" minor must be established at the time of the initial visit. Adolescents must also be informed that in special cases (e.g., sexual coercion or abuse) reporting to authorities is required.
  • Adolescents should be fully informed of all of the procedures usually performed at the first clinic visit prior to their examination. Clinics must create an atmosphere in which teens are comfortable asking questions.
  • Adolescents seeking contraceptive services must be informed about all methods of contraception. Abstinence, as well as all other contraceptive options to reduce risks for pregnancy, must be discussed with all adolescents. Abstinence is defined as the decision not to have sex (vaginal, oral or anal). As the contraceptive needs of adolescents frequently change, counseling should prepare them to use a variety of methods effectively. Adolescents should be advised to contact the provider if they are dissatisfied with their contraceptive method before stopping the method.
  • Because adolescents are at high risk for STD and HIV infection, delegate services must encourage adolescents to undergo examination and testing and treatment, as indicated, either on site or by referral.
  • During the initial visit, the physical examination for adolescents may be deferred for 3-6 months, if necessary. Refer to Section 8.3 in this manual for further information on examination deferrals.

Additional services with a specialized teen focus should be available. These services should include one or more of the following:

  1. Teen peer counselors;
  2. Special clinic hours for teens;
  3. Community education programs;
  4. Representation from delegate agencies on local advisory committees or to school districts on teen sexuality issues, teen pregnancy programming, or adolescent health issues.

It is important for clinic staff members not to assume that adolescents are sexually active simply because they have come for family planning services. The decision to become sexually active should be discussed with the adolescent. If the adolescent is not sexually active, the family planning staff should provide support for that decision. Refer teens to the IDHS Abstinence Only programs, as appropriate.

If the adolescent client is sexually active, the current sexual relationship must be assessed for behavior that reflects sexual coercion. Family planning staff should avoid assuming that the adolescent is completely comfortable with being sexually active. All adolescent clients must be provided with counseling on resisting attempts to coerce minors into engaging in sexual activities Refer to Section 8.8 for detailed information. If the adolescent shares that she/he is not freely choosing to be sexually active, the family planning staff should assist in the clarification of the relationship and explore family involvement. Refer also to Appendix L for the IDHS Adolescent Care Mandates Policy.

Family Involvement Counseling:

Adolescents requesting family planning services should be counseled about involving their parent(s), caregiver(s) or other significant adult(s) in their decision to use contraception or about a pregnancy or sexually transmitted diseases. The minor's feelings about parental involvement should be explored, and every effort should be made to encourage them to involve their parent(s), caregiver(s) or other significant adult(s). If parental involvement is not possible, the adolescent must not be denied services and the adolescent client must know that family involvement is not a requirement to receive services.

Counseling sessions, which include the adolescent and his/her parent(s), caregivers(s) or significant other adult(s) should be offered.

Counseling to involve families in decisions about family planning services and counseling to resist sexual coercion must be documented in the client's medical record.

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