Starting a Teen Clinic within a FM Residency

Starting a Teen Clinic within a FM Residency Program Victoria Hayes, MD Megan Staton, MD MAINE MEDICAL CENTER FAMILY MEDICINE RESIDENCY

Maine Medical Center n n n Portland, Maine’s largest city 600 -bed, community-based, affiliated with University of Vermont 9 residencies, 8 fellowships 190 house-staff, 21 FP residents

GETTING STARTED… n Key Players: n n Faculty: Dr Hayes Residents: Megan Staton, Jamie Bowman, Tara Pelletier

Initial Considerations n n Buy-in from FM Dept. Scope of practice: n Mission statement n Chronic dz? Mental health? n Gateway to our practice

MISSION STATEMENT n To provide confidential and comprehensive quality health care to adolescents in a safe and open environment that promotes global wellness and encourages responsibility

Initial Considerations n Location : n n n Portland vs. Falmouth Name Hours: n n Accommodate after school n 5 -8 pm 1 st/3 rd Tuesday every month n Walk-in vs appt n Age group: n 11 -21

Initial Considerations n Staffing Logistics: n n n No support staff Run with Choice Care Preceptor and volunteer residents 1 st/3 rd Tuesday every month Payment/Billing: n n n Insurance Medicaid/Medicare Sliding scale—% discount

Initial Considerations n Funding: n n $400 from defunct FM Dept Account n purchased condoms, medications, educational anatomic models n small grants, hospital auxiliary, fund raiser Legal: n Hospital Legal Dept: n Maine Statutes for treatment of minors n Parental consent form

Pharmacy n Meds: n Change in FM policy n No meds vs pharmacy vs free samples vs Rx to hospital with rapid delivery vs purchasing from hospital and dispensing free n Need pharmacy license to dispense for fee n Pre-packaged doses n Log in, Log out, label, expiration dates, locked, med info handouts n Contraceptives, ABX, immunizations n ? antidepressants n monthly audit by hospital, State audit

Marketing Presentation to Hospital Administration n Informed Peds/ Planned Parenthood n Hospital Marketing Director, Wayne Clark n Announcement in hospital newsletter n Article in local paper-Community Leader n Mailings to 55 area schools, RN's, counselors, athletic trainers n

Marketing n n Printed business cards and brochures Paired with our Learning Resource Center n Series of lectures n n n Self-injury Stress Reduction Nutrition Skin care Distributions during key events: n Adolescent Services Network n Natural Helpers lecture n Falmouth High school events n Cable TV promo Teen Health Fair n Eating D/O research presentation

Marketing Sign in lobby n Awareness within FM Dept. n Hire a teen n Local schools n FM website n

Set-Up n Waiting Room n Separate, private, age-appropriate Room set-up n Longer appointments n Intake form n Parental consent n Survey n Confidential payment n Charting (TC identifier) n

n n n n Name Concerns PMHx/PSHx All/Meds Risk assessment Confidentiality/pmt Free-form

Collaboration Dept. of Pediatrics n Homeless teen clinic n ED n Planned Parenthood n Outpatient Behavioral Health n Inpatient and crisis n

Over Time Residents assigned as part of ped’s rotation n Medical student participation n Stocked fewer meds n Marketing focused more internally n Parent volunteer n Develop local resources n Teaching file n

Future n n n n Education vs service, scope, community served, location Continue resident ownership Outreach to schools Marketing Funding Research Coffee shop, phone line Teen liaison

Adolescent Curriculum n n n n Participation in Teen Clinic on outpatient ped’s month and voluntary Participation in school-based clinics Participation in Smile. Doc Monthly adolescent lecture series Didactic sessions Continuity clinic Adolescent elective Adolescent pathway

Resources n www. teenmed. org STFM website—Family Medicine Adolescent Fellowship at Hennepin County Med Center, MN n Links to Teen Facts, Health Topics, Screening, Teen Progress Notes, Confidentiality Forms, Consent Forms n n www. aafp. org Link to AAFP Curricular Guidelines for Adolescent Medicine n Link on teenmed website under education n

Adolescent Curriculum STFM n List serve for adolescent topics Contact: ahayes@stfm. org (Ms. Aleta Hayes) n Adolhealthstfm@topica. com n n Plan for group work on adolescent curriculum at next National STFM meeting

“REFLECTIONS” ON SURVEY n 1. What features would your ideal health clinic possess? Doctors that care, easy to talk to n Easy access/availability n Friendly, helpful staff n Appointments on time n On site lab testing n Confidential info on birth control n

SURVEY SAYS… n 2. What features would your ideal health provider possess? n n n n Empathetic/understanding Open/comfortable Honest/Trustworthy Non-judgmental Caring Friendly Knowledgeable Young

SURVEY SAYS… n 3. What is the most important thing in building a good patient-physician relationship? Trust n Open/mutual honesty n Listening skills n Confidentiality n Non-judgmental attitude n

SURVEY SAYS… n 4. What are your top 5 health concerns (physical/social/mental/preventive)? n n n n n Birth control/pregnancy STDs Skin PMS Cancer Drugs/Etoh/Addictions Weight/Body image Keeping Healthy/Health Maintenance Mental health/Happiness

SURVEY SAYS… n 5. If you or a friend had a health concern where would you turn? Parents (58%) n Doctor (25%) n Friends (16%) n Clinic/hospital (8%) n

SURVEY RESULTS 1. I feel comfortable talking w/ my doctor about health issues 2. I feel comfortable talking w/ my doctor about Etoh/drugs /tob/ sex 3. I receive accurate /useful information about my health from my doctor 4. I receive accurate /useful information about my health from my parents 5. I receive accurate /useful information about my health from my friends

SURVEY RESULTS 6. Confidentiality is very important to my health care 7. Trust is the most important aspect of building good pt-physician relationship 8. If there was a confidential teen clinic in falmouth I would use their services 9. I would/currently use PP for contraception/sex health needs 10. I would get involved in helping develop an ideal teen clinic