Which contraceptives are most effective for teens and why? What services can doctors provide to minors confidentially? What is the best way to care for lesbian, gay, bisexual, and transgender youth? How should a doctor counsel a pregnant teen? What are the most pressing sexual health issues for young men?
These are just some of the questions that medical practices with adolescents patients should be prepared to tackle; however, many medical providers may not have the full training needed to do so. “They want to do the right thing but they may lack confidence or have gaps in knowledge about current practices,” explained Marina Catallozzi, MD, an adolescent medicine physician and assistant professor of Pediatrics and Population and Family Health, who is part of a statewide training initiative working to change these circumstances in New York State.
The initiative, known as NYPATH—New York Promoting & Advancing Teen Health—aims to build the capacity of clinicians to provide comprehensive sexual and reproductive health care to adolescents by providing training and serving as a clearinghouse for information on best practices. Founded nearly five years ago, NYPATH is led by the Heilbrunn Department of Population and Family Health in collaboration with Physicians for Reproductive Health, the New York State ACT Center of Excellence, and the New York Society for Adolescent Health and Medicine. Clinicians trained include pediatricians, family practitioners, nurse practitioners, physician assistants, and gynecologists.
“In many cases, the provider may have some knowledge or outdated knowledge on a topic like IUDs [intrauterine device] but they have not spent any CME [Continuing Medical Education]-training on updating their knowledge because they did not realize it was important,” Dr. Catallozzi observed. In other cases, she noted, clinicians may avoid a subject like birth control because they are not sure what they are allowed to say and do under the law for patients under 18 years of age.
With the large size of New York State in mind, NYPATH began its work by conducting a needs assessment of providers to determine how to focus its trainings and outreach. “There is a lot going on for adolescent healthcare throughout New York State but we wanted to know what providers felt they needed,” said Judy Lipshutz, RN, MSW who directs the project. “We also focused on where teen pregnancy rates are highest as that is where the training opportunities might have the highest impact.”
In Photo (L-R): Susan Billinghurst-Hamlet, Family Planning Program Director, Tammy Gruenberg, Medical Director – WHBP, Yunilda Perez, Health Educator , Vanessa Arenas, Family Planning Program Coordinator, Judy Lipshutz, NYPATH Director, Erica Gibson, MD, Medical Director NYPATH, Rachel Kreiger, NYPATH Project Assistant, Stefany Diaz, Social Worker and Jason Rodriguez, Outreach Worker
Since its inception, NYPATH has worked to build skills, knowledge, and confidence by conducting in-person and on-line trainings reaching more than 2,000 medical providers. Each year, NYPATH conducts 10 to 15 in-person, CME-approved trainings in counties across the state. As a complement to such efforts, NYPATH also delivers training through its website. There are six interactive, CME-certified adolescent health service delivery training modules on the website.
NYPATH also provides webinars to share information and training. In the past year and half, NYPATH has conducted webinars on eight subjects: Providing Adolescent-Friendly Reproductive Health Services; Adolescent Sexual History Taking; Understanding the Family Planning Benefit Program; Adolescents and LARC; Providing Competent Care to LGBTQ Youth; STIs and Adolescents; Adolescent Males’ Sexual and Reproductive Health; and, Motivational Interviewing. “Webinars are turning out to be a very popular option for people who want to receive additional training,” Ms. Lipshutz said.
NYPATH selects the topics for its webinars and trainings based on recently released research and information collected through regular needs assessment surveys, Ms. Lipshutz explained. In the past year, for example, these surveys showed providers wanted trainings focused on how to serve LGBTQ youth and how to use of motivational interviewing, a patient-centered method of counseling that has been shown to help promote behavior change in adolescents. NYPATH created new online and in-person trainings focusing on both.
The project also works hard to ensure providers are up-to-date on current research about adolescent sexuality and behavior, best practices for healthcare, and related policy developments. For example, during the past year, NYPATH shared updated statistics on adolescent health from the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey and details on contraceptive use, birthrates, and sexual health from the National Survey for Family Growth. It also sent members information about new guidelines for over-the-counter access for Emergency Contraception and a variety of new policy documents related to adolescent sexual and reproductive health.
“We work hard to increase awareness in areas where providers may not be aware of the most current research,” Ms. Lipshutz explained. For example, in recent years, NYPATH has educated health care providers about a compelling body of research showing that adolescents can safely use long-acting reversible contraception (LARC) as their method of birth control. “There has been a lot of research indicating that the new IUDs and implants are the most effective methods of birth control and that they are equally safe for adolescents and adult women,” she said, adding that this option received a major boost this past fall when the American Academy of Pediatrics issued a new policy statement stating that LARC methods “should be considered first-line contraceptive choices for adolescents.”
This strategy of taking the pulse of providers and delivering trainings that meets their needs has worked well. “I think one of the important developments [of the past few years] is the extent to which people are now talking about our materials and training,” Dr. Catallozzi said, adding that many of the projects’ on-site training programs result in a ripple effect of additional training requests.
Dr. Catallozzi noted that, as a result of its steadfast work over the past four years to increase awareness and training across the state, NYPATH is now “a known entity” in critical program and health care policy arenas. “We have a seat at the table for major [City and state-led] discussions on subjects ranging from LARC, to sex education, to school-based health,” she said.
NYPATH’s work and success to date, Dr. Catallozzi posits, is due to its genuine effort to meet providers “where they are” in terms of their current practice with adolescents. NYPATH identifies and understands the barriers that prevent individuals from addressing certain sexual health-related subjects. It also focuses on using science-based best practices that are supported by major medical associations and the CDC to outline standards for adolescent sexual and reproductive health care.
“I think it is enormously helpful that we start with science—what does current evidence show us works best,” Dr. Catallozzi said, adding, “It also helps that we come into these trainings as fellow doctors who are willing to say, ‘I address the issue in my practice and here is some language that you can consider for introducing this topic.’”
At the core of all of NYPATH’s training—and indeed PopFam’s overarching approach to the promotion of adolescent sexual and reproductive health—is a positive emphasis on the potential that all young people have to make sound and responsible choices in their lives. “We emphasize that young people be can be enormously resilient and we promote a positive paradigm of sexuality that can be lacking in adolescent health care,” Ms. Lipshutz said.
Finally, NYPATH aims to leverage opportunities during adolescence to promote long-term health. “This is when so many behavioral patterns are set,” explained PopFam Chair John S. Santelli, MD, MPH, an adolescent medicine physician and the Principal Investigator for NYPATH, adding, “Adolescence is a critical time for clinicians to intervene and help young people learn how to take care of themselves and their health.”