Promoting engagement and privacy in teen healthcare

Implications

Preventive care visits (also called well-child visits) are an important time for healthcare providers to listen to concerns and questions about their patients’ health and to offer guidance on how to achieve healthy growth and development. When children are younger, most of the communication is with their parents, but as they become teens, preventive visits should pivot to increasingly involve the teen. Healthcare providers can do this by engaging the teen in the different aspects of the visit, including talking privately with the teen.

A teen-focused preventive visit can begin with engaging the teen in small but meaningful tasks, such as checking in for the appointment and completing health update and screening forms. This helps the teen feel comfortable at the clinic, improves their knowledge of their own health history, and gives them practice reporting their health status and symptoms. Findings from this Mott Poll suggest that many parents handle these tasks without involving their teen. While it is understandable that parents feel they can do these more efficiently and correctly, they are missing a “teachable moment” to help their child take the first steps toward being responsible for their own health and healthcare.

Parents also may not consider the possibility of decreasing the usefulness of the surveys and forms used at well visits. National recommendations call for screening teens for depression through a standardized form that asks about the teen’s emotions. Screening is intended to help providers identify concerns early and offer guidance or treatment when needed; however, screening is only effective if teens are able to provide honest information about their own experiences. When parents complete the screening form or monitor their teen’s answers, providers may not receive a fully accurate picture of the teen’s emotional wellbeing.

Adolescence is a time of physical, emotional, and social changes. Many teens have questions about puberty, mental health, reproductive health, or peer pressure. Private time between the teen and the healthcare provider – with the parent out of the room – is recommended to support honest communication during adolescent healthcare visits. These conversations allow teens to ask sensitive questions or discuss concerns they may feel uncomfortable raising in front of a parent. Private time also allows teens to get more comfortable talking with a healthcare provider and helps them learn how to describe their physical and emotional health.

In this Mott Poll, about two-thirds of parents agreed that private conversations are important. Despite this, only one-third of parents reported that private time occurred at their teen’s most recent preventive care visit, most often because the provider did not offer it. This suggests providers may be missing opportunities to normalize private conversations as a routine part of adolescent care that encourages teens to share concerns more openly.

State laws vary regarding minors’ ability to consent to certain reproductive health, mental health, or substance use services; in addition, some healthcare systems limit parent access to portions of the teen’s medical record to protect confidentiality. Many parents also expressed hesitance about healthcare confidentiality for their teen, including some who were concerned that they might not approve of the advice or treatment their teen receives. Few parents recalled the provider discussing confidential services for teens or limitations on what information parents can view through the teen’s patient portal. This lack of guidance is problematic; providers should explain to parents what the clinic’s confidentiality policies entail, including the reasons for those policies, and be prepared to address parents’ concerns. Clear communication from providers about these policies and their purpose may help families better navigate the balance between supporting their teen in becoming more responsible for their own health while maintaining appropriate parental involvement.