- The Washington Times - Sunday, August 27, 2000

When Natasha Rochester turned 12, she stopped seeing a pediatrician and began visiting an adolescent health specialist at Children's National Medical Center in the District. Natasha's mother, Mary Allen-Rochester, thought the switch to nurse practitioner Colleen Townsend-Acton would help both mother and daughter confront the teen years.

"I was fine talking to Natasha about health," says Ms. Allen-Rochester, who also is a nurse at Children's. "But not about sex. Natasha, who is 21 now, was very closemouthed. I felt she was in good hands."

Adolescent-care professionals are usually board-certified pediatricians or nurse practitioners (experienced nurses who can conduct exams and write prescriptions) who have taken advanced training in caring for preteens and teen-agers.

The adolescent specialist can help bridge the gap from childhood to adult health issues, says Dr. Jennifer Johnson, an Irvine, Calif., physician and chairman of the American Academy of Pediatrics' (AAP) section on adolescent health.

"It is important to be non-judgmental and still function as an adviser," Dr. Johnson says. "We may be the only adult that the patient can talk to about sex."

Therein lies the fine line of confidentiality. Adolescent specialists are seeing patients who have adult concerns but are tech-nically minors under the care of their parents.

Health professionals are bound by state law to maintain confidentiality unless they fear the patient is going to harm himself or others, says Dr. Kathy Woodward, director of inpatient and community health service at Children's National Medical Center. That means patients older than 13 can seek confidential care for concerns such as contraception, pregnancy, substance abuse or mental health.

Dr. Johnson says she tries to facilitate communication on these subjects between parents and children. She says she finds most parents are relieved that children will talk to someone.

"I never ask kids sensitive questions if parents are in the room," she says. "I have a little spiel I give, where I say something like: 'Mrs. Smith, Mark is in eighth grade now, and I would like to spend some time talking to your son. I want your son to trust me, but if anyone has done anything to harm him or he is doing something to harm himself, then I will have to share that information. After we have talked, I may have recommendations to make that we will discuss.'

"I will not betray confidences," Dr. Johnson says, "and I always include parents in the beginning and the end of the conversation."

There are issues other than reproduction that concern teens. Dr. Woodward has a checklist she goes over with adolescent patients. Some of the main points include:

• Home. What is the patient's family structure? How is school? What is the child doing after school?

• Employment. Does the patient have an after-school job? Is he or she looking for one? This is a good chance to discuss workplace behavior, such as proper grooming and showing up on time, Dr. Woodward says.

• Exercise. "Third-graders run," Dr. Woodward says. "Cool sixth-graders chill. But they still eat as much. This is the time to talk about obesity and getting exercise." This is especially important because, by the teen years, many food choices are made by the child, not the parent, she says.

• Activities. What is the teen involved in? Sports? Church? Is he driving? If so, time to talk about seat belts, drinking and driving, and the dangers of joy riding.

• Drugs. Included in Dr. Woodward's conversation about illegal drugs such as marijuana and alcohol is a talk about caffeine.

• Depression. "I am writing more prescriptions for anti-depressants than I ever have," Dr. Woodward says, "but I also try to get kids to go to counseling." Dr. Woodward screens for depression by asking what the patient does when he or she is sad, or if he has ever tried to harm himself.

• Safety. The discussion of bike helmets and fire extinguishers continues, but also included is a talk about guns. Does the child feel safe at school? Does he have a gun? Is he aware of the dangers of guns?

"The Washington area is a pretty savvy area," Dr. Woodward says. "It is nice that teens can go to special places with special professionals and no more Big Bird and other baby things."

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