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Let’s Talk About Sex
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Let’s Talk About Sex
By Deanna Bell, MD
“ I came out where?” -my 5 year old stared at me with wide-eyed disbelief as I struggled to affirm confidence in God’s design of how babies enter the world.
The fact is, even in the sexually emancipated society we live in, most parents struggle when discussing issues of sexuality and reproduction with their children. Many of us squirm as we remember awkward “birds and bees” discussions with our own parents. However, a few tips may help parents in navigating these discussions.
1) Start early and talk often
Sexuality and reproduction are big topics. They cannot be covered in one discussion. They need to be introduced at age appropriate levels very early, as sexual curiosity normally develops before age 4. These discussions should continue as part of everyday life as our children grow older. This facilitates ongoing communication and openness over time. However, it is important to tackle this subject in baby-steps, and I strongly discourage special occasion talks or the colossal “birds and bees” talk.
Young children need to understand for their own safety what body parts they have, how they are different from others, and safe and unsafe touches.
Puberty tends to occur earlier and earlier in developed countries secondary to good nutritional status, and normal puberty can start as early as age 6 in girls. Early development in girls has been linked with poor self-esteem and anxiety later in life. As a result, even elementary school children need to know about how bodies change over time and understand at an age appropriate level where we come from. Issues of safety need to be routinely reinforced at this age.
Even the most stayed teenager I have interviewed is impressionable, and most kids have ideas about sex by their pre-teen years. It is very important to keep an ongoing dialogue with our pre-teens and teens about issues of sexuality in their friends, their environment, and themselves. Children vary in their developmental readiness, but most children should understand the mechanics of sex no later than 11 or 12. Issues of dating safety, emergency safety plans, future family planning, contraception, and family values concerning sexuality should be openly discussed.
2) Use every day examples to spur discussion about topics including sexuality, development, consequences, and values.
In 2009, 37% of Tennessee High School Students reported being sexually active by age 15, and 53% had intercourse by
graduation. The same study reported 13% of Tennessee female high school students reported being forced into sex. (Tennessee Youth Risk Behavior Survey, 2009)
It is much easier to problem solve and use rational thought when an issue not related to your family is being discussed. Use examples from television shows, the community, and your teenager’s school to discuss issues of sexuality, choices, and consequences with your child. Asking questions is the best way to assess what your child already knows or thinks and to help him or her in their own problem solving before a real life situation arises.
Incorporating topics into our everyday lives is how we pass culture and values to our children. Like vacationing in a specific spot, or celebrating a specific holiday, traditions and values are handed down through practice and discussion of their importance in our lives. In discussion of various events surrounding our children, we will have more success if we remain non-judgmental in our tone; this facilitates more feedback from our children. It is also important to not let the non-judgmental tone be interpreted as acceptance; we should clearly communicate our values and the reasons behind those values to our children. It is absolutely staggering to me how many Christian families fail to discuss issues of sexuality and reproduction with their teenagers. Some who do discuss are afraid to be labeled as old-fashioned if they promote abstinence and have tolerated blatant promiscuity in their children. Most of the teenage patients I have seen who have remained abstinent have had parents who openly acknowledge their teenager’s sexuality, discussed this as a normal part of development, yet clearly communicated the family’s value system.
3) Don’t be afraid to say you don’t know or need to think more about an issue
Since sexuality and reproduction are such large, often emotionally-charged topics, it is alright to be stumped. Do not feel afraid to tell your child or teen, “I’m not sure about that. Let me think about it and get back to you.” Demonstrating a thoughtful, rational approach to socially and emotionally charged issues is good behavior modeling for your child. Searching scripture references for insight on particular topics to share after a discussion is something I like to encourage.
4) Model good behavior for your child and teen
It is very important that children see healthy, productive relationships modeled. However, with over 50% of my patients living in a single parent household, I have watched many parents struggle with dating and modeling relationships while raising children. I think being a good single parent is one of the hardest jobs in the world. This is a subject I could write about for days. However, most of what I can say can be summed up with this: If you do not want something for the life of your child and his or her relationships, do not model that in your relationships in front of your child.
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Medical Home for Chronic Care
1 CommentThe National Survey of Children with Special Health Care Needs documents that chronically ill children and youth often have inadequate health care insurance, are disproportionately of minority status, and often receive care at institutions unequipped to provide a medical home for the chronically ill.
With the majority of Mercy’s patients either on TennCare coverage or having no insurance, and an estimated 51% of our patients having minority status, Mercy is in a unique position to access these children.
Although Mercy has been caring for children and youth with special healthcare needs (CYSHN) for many years, we formerly launched an innovative Medical Home for Chronic Care in 2008. Since then, Mercy has identified and enrolled 450 CYSHN patients for proactive disease management by a dedicated team of pediatricians, a disease manager, a psychiatrist, case managers, social workers, and subspecialty service providers.
What Is a Medical Home?
This idea of a “medical home” — a place where everybody knows your name and your medical records are complete — is nothing new. In fact, that term has been used in medical and government circles for well over a decade.
A medical home combines place, process, and people. It is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home represents an approach to pediatric health care in which a trusted physician partners with the family to establish regular ongoing care. Through this partnership, the primary health care professional can help the family and patient access and coordinate specialty care, other health care services, educational services, in and out of home care, family support, and other public and private community services that are important to the overall health of the child and family. Providing a medical home means addressing the medical and non-medical needs of the child and family.
A pediatric medical home is defined by the AAP as having the following characteristics:
- The medical care of infants, children, adolescents, and young adults ideally should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.
- It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.
- The physician should be known to the child and family, and be able to develop a partnership of mutual responsibility and trust.
Children can be cared for at a physician’s office, a hospital outpatient clinic, a community health center, or a schoolbased clinic, as long as it provides the services that constitute comprehensive care. Those services include:
- Partnership: Provision of family-centered care through developing a trusting partnership with families, respecting their diversity and recognizing that they are the constant in a child’s life.
- Clarity: Sharing clear and unbiased information with the family about the child’s medical care and management and about the specialty and community services and organizations they can access.
- Primary care: Provision of primary care, including but not restricted to acute and chronic care and preventive services, including breastfeeding promotion and management, immunizations, growth and developmental assessments, appropriate screenings, health care supervision and patient and parent counseling about health, nutrition, safety, parenting, and psychological issues.
- Secondary care: Assurance that ambulatory and inpatient care for acute illnesses will be continuously available (24 hours a day, 7 days a week, 52 weeks a year).
- Continuity: Provision of care over an extended period of time to ensure continuity. Transitions, including those to other pediatric providers or into the adult health care system, should be planned and organized with the child and family.
- Referrals: Identification of the need for consultation and appropriate referral to pediatric medical subspecialists and surgical specialists. (In instances in which the child enters the medical system through a specialty clinic, identification of the need for primary pediatric consultation and referral is appropriate.) Primary, pediatric medical subspecialty, and surgical specialty care providers should collaborate to establish shared management plans in partnership with the child and family and to formulate a clear articulation of each other’s role.
- Intervention: Interaction with early intervention programs, schools, early childhood education and childcare programs, and other public and private community agencies to be certain that the special needs of the child and family are addressed.
- Coordination: Provision of care coordination services in which the family, the physician, and other service providers work to implement a specific care plan as an organized team.
- Record-keeping: Maintenance of an accessible, comprehensive, central record that contains all pertinent information about the child, preserving confidentiality.
- Assessment: Provision of developmentally appropriate and culturally competent health assessments and counseling to ensure successful transition to adult-oriented health care, work, and independence in a deliberate, coordinated way.
To meet the definition of medical home, a designated physician must ensure that the aforementioned services are provided, regardless of the venue in which the medical care is provided.
Is It OK to Leave Home?
Obviously, the ER does not meet those objectives, nor is it designed to do so. As its name implies, the ER is for emergencies only — when your child experiences a life-threatening illness or injury and can’t wait for a trip to the doctor’s office.
But what about walk-in health care centers, including the new breed of in-store clinics offered by major drugstore chains? Is it ever acceptable to go to a walk-in for relatively minor health complaints like earaches and sore throats?
Certainly, these clinics can be helpful, especially if you are away from home or an illness occurs after hours. But just like the ER, they don’t meet the definition of a medical home, and for the health of your child, you should think twice about using them routinely.
The need for an ongoing source of health care — ideally a medical home — for all children has been identified as a priority for child health policy reform at the national and local level. Over the next decade, with the collaboration of families, insurers, employers, government, medical educators, and other components of the health care system, the quality of life can be improved for all children through the care provided in a medical home.
This article was featured in Healthy Children Magazine. To view the full issue, click here.
“What is a Medical Home” Author
Colleen Marble, Healthy Children Magazine
Last Updated
12/1/2010
Source
Healthy Children Magazine, Winter 2007
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Electronic Medical Records: Healthier Children and Families!
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One of the pillars of Healthcare Reform is Electronic Medical Records (EMR) . . . changing those manila folders filled with your medical history into an electronic version that will be easily accessible by an emergency room, if needed, while you’re on family vacation in Florida or the laptop that your personal doctor now brings to the exam room when you visit. It will also speed up the process of check- in while speeding up outsourced lab tests and radiology as the results can now be sent over the internet. Additionally, you’ll be able to finish all that dreaded check-in paper work from your home computer before you ever arrive for an appointment. Don’t be concerned . . . there are loads and loads of HIPPA requirements in place to protect your privacy!
From the insurance companies point of view (and “Uncle Sam” for that matter with Medicaid and Medicare), the hope is to reduce their costs of healthcare by eliminating potential redundancies in tests and lab work. The desire for “second opinions” on behalf of a patient can easily turn into a “do over” of expensive, not-really-needed tests that can drive up the costs of care for everyone.
Mercy has had off and on discussions about the prospect of installing EMR for four or five years. It’s a very time consuming, labor intensive and expensive endeavor but one that has been made possible now through the efforts of friends and Federal Stimulus money.
Nearly a year ago, a local foundation that has supported Mercy Health Services, Siloam Family Health Center, and Faith Family Medical Clinic approached us about a joint effort to acquire and implement EMR. Like many foundations, they really appreciate collaborations and the leadership of each of these organizations was excited about the project. After many months and day trips to review different systems, we decided on the software we wanted. Together, each of the CEO/Executive Directors of the respective organizations traveled to the home office of the software company to determine the best deal for our collective interests. Our collaboration saved Mercy and the foundation tens of thousands of dollars.
Last week, Mercy’s staff began training on the product with the Practice Management piece (scheduling, billing, etc) of the software “going live” in our practice this week. Progress doesn’t come without its angst; we’ll be seeing fewer patients this week in order to spare them of having to deal with less than full-staffing due to training. Everyone will be moving from the comfort of a system they’ve used for years to a new one (you probably know that feeling). In a couple of months (after the busiest season of our practice), we’ll actually migrate the paper charts into the system and be full blown EMR.
The bottom line . . . better, more efficient care of our patients.
