Primary care
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Adolescent relationship violence (ARV) is the use of coercive, controlling, and violent behavior within romantic adolescent relationships. It presents with patterned behaviors that occur in a cyclic fashion. ⋯ Exposure increases risk for serious acute and chronic physical and mental health consequences, including death. In the first article of this 2-part series, the authors describe the social, psychological, and medical context of ARV; in part two, the author's focus on practical aspects for approaching ARV in clinical encounters.
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With increasing prevalence of behavioral and mental health concerns, the need for equitable and accessible care is paramount. School providers and primary care physicians (PCPs) can collaborate to provide a full continuum of services, enhancing the overall likelihood of success for school-aged youth with mental health and developmental disorders. To facilitate meaningful collaboration, PCPs should have a general understanding of special education and disability law surrounding determination procedures of a student with a disability. In addition to pharmacologic treatment, PCPs should support evidence-based psychosocial interventions that can be implemented in an educational context.
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Review
Healthy Sex: Contraception, Sexually Transmitted Infections, Media, Consent, and Confidentiality.
Adolescence is a natural time for sexual exploration; developmentally-appropriate sexual education is essential to promote healthy behaviors and prevent long-term morbidity. Adolescents may confide in their primary care clinicians, who are responsible for providing information and access to evidence-based care including family planning, contraception, and abortion. Clinicians are essential in sexually transmitted infection prevention, screening, treatment, risk mitigation, and harm reduction for sexually active adolescents. Clinics should pay special attention to electronic medical record settings and insurance procedures to prevent unexpected lapses in confidentiality.
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Adolescent anxiety, depressive, and eating disorders are a worsening population health issue that primary care clinicians play a critical role in addressing. Implementing universal screening into clinical practices for depression at age 12 years and anxiety at age 8 years is the first step to diagnosis. Referencing 5th edition of the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria is essential to making the correct diagnosis after ruling out underlying medical conditions. The evidence-based mainstays of treatment are unique to each specific disorder.
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Trauma-informed care (TIC) is a patient-centered, strength-based approach to caring for and empowering patients. The adolescent well visit is an opportune moment to assess and address the impact of trauma. Given the well-documented impact of trauma exposure on adolescent health, and the relationship present between social determinants of health and trauma, physicians and advanced practice practitioners are well positioned to utilize TIC in the medical visit. This article will explore tools to incorporate trauma-informed practices in adolescent well visits in the context of medical care, mental health screening, and in promoting health equity.