Primary care
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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.
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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 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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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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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.