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Working with Adolescents Michelle Cook and Gen Lean Family Planning Victoria

Working with Adolescents Michelle Cook and Gen Lean Family Planning Victoria. Understanding adolescence. An adolescent is a youth, is a young person... Adolescence 10-19 years Youth 15-24 years Young people 10-24 years Age alone does not help to define adolescence.

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Working with Adolescents Michelle Cook and Gen Lean Family Planning Victoria

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  1. Working with AdolescentsMichelle Cook and Gen LeanFamily Planning Victoria

  2. Understanding adolescence An adolescent is a youth, is a young person... Adolescence 10-19 years Youth 15-24 years Young people 10-24 years Age alone does not help to define adolescence... Australian Medical Association and the World Health Organisation

  3. A time of profound changes… • Physical (sexual maturity) • Cognitive (concrete to abstract) • Psychosocial (identity and personality, peer relationships, vocational, educational goals, moral values, financial independence, mental health etc.)

  4. Typical milestones for an adolescent girl in 1950’s Slide courtesy of Professor George Patton, Centre for Adolescent Health, Melbourne First sex Marriage - leaving home Finishing education Menarche Parenthood 10 15 20 25 30 Ten years

  5. Typical milestones for an adolescent girl in 2000 First sex Leaving home Finishing education Parenthood ‘Marriage’ Menarche 10 15 20 25 30 20 years Slide courtesy of Professor George Patton, Centre for Adolescent Health, Melbourne

  6. Which direction?

  7. Confidentiality Matters • Young people would like to discuss more sensitive topics with a health professional • 1 in 5 young people report not sharing important information with health professional because of fear parents would find out • Doctors report they are insufficiently trained about confidentiality and other medicolegal aspects of adolescent health Sanci et al, MJA 2005

  8. Confidentiality Exclusions: Notifiable infection Suspected abuse – sexual or physical Self Harm – suicide Public safety Disclosure to a third party: Consent must be given

  9. Unintentional breaches of confidentiality • sending information to the home • calling at home and/or leaving a message • pathology/radiology/consultation bills • Pap test reminders or results • parents calling demanding to know why you saw their child • Check if young person is concerned about confidentiality in relation to their parents or others

  10. Consent to medical treatment • In Victoria parental power to consent on behalf of the young person ceases when the young person is 18 years old • A person younger than 18 is a ‘minor’ • The law recognises the consent of minors if they can fully understand the nature and effects of treatment and consequences of non-treatment The Privacy Act 2001 (C’th) and the Health Records Act 2001 (Vic)

  11. HEADSSS H home, housing E education/employment/eating/exercise A activities/support networks/peers D drugs/cigarettes/alcohol S sex/sexuality/(abuse) S suicide/depression S safety/spirituality Making a ‘mature minor’ or ‘competency’ assessment John M Goldenring & Eric Cohen Contemporary Paediatrics July 1988 pp 75-90

  12. Medicare card eligibility • >15 + may be enrolled on their own Medicare card • <15 yrs can get their own card/duplicate card only with the authorisation of the person’s parents or guardian is required. http://www.medicareaustralia.gov.au/public/update/index.jsp

  13. Medicare card eligibility The HIC has the following privacy guidelines concerning young people: • Under 14: information released if parent applies in writing. • 14 or over: may request, and be sent, their own information. • Information released to the child’s parent listed on the same card if child signs a written authority • A Medicare card holder can request financial information about any person listed on their card but will need written consent if it is about a person over 14 years of age.

  14. 4th National Survey of Australian Secondary Students (ARCSHS) • National study of almost 3000 Yr 10 & 12 students • Majority of young people (78%) in Yr 10 & 12 are sexually active in some way • 27% Yr 10 and 56% Yr 12 students have had sexual intercourse (same as 2002) • Of sexually active students, 30% report 3 or more partners (up from 20% in 2002)

  15. Sexual Activity The majority of young people in Years 10 & 12 are sexually active in some way. This can include: • deep kissing • Yr 10 71% Yr 12 89% • genital touching • Yr 10 56% Yr 12 78% • giving or receiving oral sex • Yr 10 34% Yr 12 58% Source : ARCSHS 2008

  16. Same Sex Attraction • 9% of students did not report an exclusive heterosexual attraction. • 1% attracted only to people of own sex • 6% to people of both sexes • 2% Not sure Source : ARCSHS 2008

  17. Contraception • 10% are using withdrawal in the belief it will prevent conception • 0.2% of sexually active young people are using no contraception • Consistent condom use in about 50% (69% reported using condoms last time had sex) (same as 2002) • Condoms (68%) and the pill (50%) are the most common forms of contraception being used. Source : ARCSHS 2008

  18. Sexually active students who have ever had unwanted sex Males: 19% (23% 2002) Females: 38% (28% 2002) The most common reasons cited for having engaged in unwanted sex were: • 21% being too drunk or high • 18% pressure from a sexual partner • 3% pressure from friends Source : ARCSHS 2008

  19. 4th National Survey of Australian Secondary Students (ARCSHS) cont • Students mostly rely on mother, female friend and school education programs for education regarding sexual and reproductive health • Despite education programs, knowledge about STIs other than HIV/AIDS remains patchy but has improved since 2002 especially for Chlamydia • While most young women had the HPV immunisation their knowledge of HPV was poor • Contraception used at last sexual encounter: • PCI increased from 3.9% (2002) - 7.6% (2008) • COC increased from 37% - 50% Source : ARCSHS 2008

  20. Cases of Chlamydia from January 1997 – March 2009 Victorian infectious diseases bulletin - Volume 12 Issue 2 June 2009

  21. Interview style • Friendly, respectful, non-judgmental, understanding • Simple and clear language • Explain confidentiality and limits • Be aware of financial situation • Seek permission before asking questions about sensitive topics such as drug use and sex • Normalise (or generalise) experiences so the questions are not so threatening • Asking about sex and drugs does not increase these behaviours but rather education can increase choices and reduce risk behaviour

  22. Services/sites for young people • Kids helpline - 1800 551 800 www.kidshelp.com.au • Somazone - site run by and for young people, with questions answered by qualified health professionals www.somazone.com.au • Action Centre, FPV (adolescent sexual health service) 1/94 Elizabeth St, Melb - 9654 4766 (1800 013 952) • Frontyard (youth support service): Youth workers, Health workers, Youthlaw, Centrelink, Youth accom service, Reconnect, free computer access - 19 King St, Melbourne 9614 3688 (1800 800 531 country) www.frontyard.org • Youthlaw - 9611 2412 or email info@youthlaw.asn.au • Reconnect - for mediation, support and referral in family disputes/breakdown - 9611 3688 • Your sex health interactive website www.yoursexhealth.org

  23. Services/sites for young people • Legal advice for people under 25 www.lawstuff.org.au • Sex health site (QLDgov) - educational site for teenagers covering changes of puberty, STI’s and safer sex www.istaysafe.com • The hormone factory - site for young people aged 10-12 explaining sexual and reproductive development and physical, emotional and social changes associated with puberty (ARCSHS) www.thehormonefactory.com • Same sex attracted - site devoted to young people who are or think they are attracted to the same sex www.also.org.au/outreach • Bullying - www.bullyingnoway.com.au • Reachout - health information including contraception and depression www.reachout.com.au/home.asp

  24. Services/sites for young people • MoodGYM - free self-help program for teenagers and young adults moodgym.anu.edu.au/ • Queernet – Queer questioning youth www.dsrc.org.au • Beyondblue - national depression initiative beyondblue.com.au • Child Protection Crisis Line - 131 278 • Domestic violence - site developed by the Domestic Violence and Incest Resource Centre for children and teenagers living with domestic violence www.burstingthebubble.com • Domestic Violence & Incest Resource Centre - www.dvirc.org.au • Direct Line - 24hr information, referral and counselling service for drug and alcohol problems - 9416 1818 (1800 888 236 freecall)

  25. Action Centre Level 1, 94 Elizabeth St Melbourne 9660 4700 Family Planning Victoria 901 Whitehorse Rd Box Hill 9257 0100 Thank you

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