Primary care
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Adolescent relationship violence (ARV) is associated with a host of negative health outcomes that can impact individuals across the lifespan. This second article in a two-part series provides clinical context for ARV to assist clinicians who are caring for adolescents and offers practical advice based on current recommendations. ⋯ Professional organizations recommend screening women of childbearing age. However, because ARV occurs frequently across all genders and few teens identify or self-report ARV, providing universal education to all teens can overcome barriers associated with delayed disclosure and intervention.
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This article discusses the use of substances among adolescents, the unacceptable overdose death rates they bear, and the relevant evidence-based harm reduction strategies available in primary care, including medications for opioid use disorder. Access to these medications, as well as to harm reduction strategies generally, is insufficient for adolescents. Many adolescents who use substances and who are most at risk for overdose regularly visit primary care, which is an appropriate setting for treatment and harm reduction delivery.
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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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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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Primary care providers have a unique opportunity to provide high-quality care to lesbian, gay, bisexual, transgender, queer, intersex, asexual and other identities not encompassed (LGBTQIA+) adolescents. Providers should be familiar with the various identities and definitions in the LGBTQIA + community, as well as social determinants of health and health disparities amongst LGBTQIA + adolescents. Providers should also understand how to foster a welcoming clinical environment, address gender affirming care to adolescents, and demonstrate clinical comfort with pre-exposure human immunodeficiency virus prophylaxis.