Tips for Making Your Practice Teen Friendly
You can reduce the structural and interpersonal barriers to adolescents’ access to care by systematically addressing the following aspects of your practice:
Provide information and training on the developmental and health needs of adolescents so that practice staff and receptionists
- Adopt a friendly and nonjudgmental approach.
- Understand that teens will sometimes be late for appointments, often through no fault of their own. (They may be relying on public transportation or an adult to transport them.)
- Are sensitive to adolescents’ concerns about privacy and confidentiality and take steps to safeguard their confidentiality.
- Avoid stereotyping teens from culturally diverse backgrounds and are sensitive to any cultural issues or particular needs they may have.
- Explain to teens why they have to wait, if there is a long waiting time, because they may not understand the process of medical consultation.
- Understand adolescents’ health rights and explain billing procedures to all teens who present alone.
- Consult the adolescent on the best way to contact her for follow-up or test results to protect her confidentiality.
- Are familiar with community and youth resources to refer teens to appropriate support services.
Reception/Waiting Area and Examination Rooms
Create a relaxed and welcoming environment for teens.
- Have adolescent-specific posters, pamphlets, and other reading material available on subjects such as substance use and mental and sexual health. This provides a nonverbal message that you are happy to discuss these matters.
- Make brochures on sensitive topics available in the examination rooms so that teens can take them without feeling embarrassed or worrying about possible scrutiny.
- Provide a range of youth-oriented magazines on topics such as entertainment or sports.
- Display posters and resources portraying a diverse population (eg, minorities, youth with special health care needs).
- Display information about the practice’s confidentiality policy.
- Display waiting times.
- Develop a clinic policy on how to deal with adolescents, covering issues such as confidentiality, consent, crisis calls, and billing procedures.
- Adopt flexible administrative and appointment booking procedures for teens.
- Allow extra time for longer consultation, drop-ins, crisis situations, or case conferencing.
- Keep an individual file on adolescent patients (separate from family’s file).
- Promote your practice to local schools and community groups.
- Reduce waiting times for young people.
- Accept drop-in patients.
- Have a simple information sheet for teens that provides information about consultation times, making appointments, and services that pediatricians can provide.
Billing and Payment
Use strategies to obtain payment for confidential care without violating the patient’s confidentiality.
- See if a third-party payer covers the cost of laboratory tests in a way that does not compromise confidentiality.
- Facilitate family communication. Often, adolescent patients are willing to disclose a great deal to parents if they can be helped in framing the disclosure in a less “incriminating” context.
- Charge the adolescent only what it costs the office for the laboratory test and set up a confidential account to which the adolescent can make payments of any amount at any time.
- Have the adolescent agree to pay for services rendered, with the bill sent to him directly, often at a nonhome address.
- Have the laboratory conducting the confidential tests agree to bill the practice directly, rather than sending a bill to the patient’s home.
- Be aware of other community resources (eg, school-based clinics, Planned Parenthood) for confidential, low-cost or free services for teens.
Providing an Adolescent-Specific Service
Some pediatricians have established an adolescent-specific service within their practices. This may involve
- Setting aside separate clinic space or waiting areas for adolescent patients
- Opening at hours more convenient for young people (eg, late afternoon, evenings, weekends)
- Offering youth-only clinics (ie, setting aside a particular time or afternoon for young people only)
- Conducting outreach services for youth organizations and schools
Adapted from Adolescent Health: Enhancing the Skills of General Practitioners in Caring for Young People From Culturally Diverse Backgrounds: A Resource Kit for GPs (www.caah.chw.edu.au/resources/gp-introduction.pdf and Rainey DY. Office-based care of adolescents: part 1, creating a teen-friendly office. Adolescent Health Update. 2003;16.