Privacy and Confidentiality Practices in Adolescent Family Planning Care at Federally Qualified Health Centers

CONTEXT:

The confidentiality of family planning services remains a high priority to adolescents, but barriers to implementing confidentiality and privacy practices exist in settings designed for teenagers who are medically underserved, including federally qualified health centers (FQHCs).

METHODS:

A sample of 423 FQHCs surveyed in 2011 provided information on their use of five selected privacy and confidentiality practices, which were examined separately and combined into an index. Regression modeling was used to assess whether various state policies and organizational characteristics were associated with FQHCs' scores on the index. In-depth case studies of six FQHCs were conducted to provide additional contextual information.

RESULTS:

Among FQHCs reporting on confidentiality, most reported providing written or verbal information regarding adolescents' rights to confidential care (81%) and limiting access to family planning and medical records to protect adolescents' confidentiality (84%). Far fewer reported maintaining separate medical records for family planning (10%), using a security block on electronic medical records to prevent disclosures (43%) or using separate contact information for communications regarding family planning services (50%). Index scores were higher among FQHCs that received Title X funding than among those that did not (coefficient, 0.70) and among FQHCs with the largest patient volumes than among those with the smallest caseloads (0.43). Case studies highlighted how a lack of guidelines and providers' confusion over relevant laws present a challenge in offering confidential care to adolescents.

CONCLUSIONS:

The organizational practices used to ensure adolescent family planning confidentiality in FQHCs are varied across organizations.

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By:  Beeson T1, Mead KH2, Wood S2, Goldberg DG2, Shin P2, Rosenbaum S2.

• 1Department of Health, Educational Administration and Movement Studies, Central Washington University, Ellensburg, WA. tbeeson@cwu.edu.
• 2Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC. 
• Perspect Sex Reprod Health. 2016 Feb 17. doi: 10.1363/48e7216.

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When Psychotherapy Is Indefinite & There Is No Final Outcome: Case Study of a Community Mental Health Clinic

Little is known about long-term patients for whom there is no anticipated endpoint to treatment. In this qualitative case study, we used a focus group methodology to understand how psychotherapists at a community mental health clinic work with low-income adult patients who are seen indefinitely. 

Narrative themes that emerged from the focus group discussion include the nature of these patients' diagnoses and life problems; the sociocultural contexts in which they live; the kinds of treatment goals and interventions; the internal and external barriers to termination; and how therapists recognize the need to work indefinitely with some patients to keep them alive or functioning in the community. 

Although a diagnosis of major mental illness was the foremost reason for not planning a termination, participants also mentioned working indefinitely with some higher functioning patients whose lives are perpetually in crisis. Participants emphasized the importance of having a compassionate clinical team and supportive administration for seeing patients indefinitely, even when third party payments end. 

Results are discussed in terms of their implications for service delivery as well as their implications for future investigations of psychotherapy that has no foreseeable endpoint.

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By:  Friedlander ML1, Austin CL1, Cabrera P1.

• 1Department of Educational and Counseling Psychology. 

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Improving Treatment Completion Rates for Latent Tuberculosis Infection: A Review of Two Treatment Regimens at a Community Health Center

Prophylactic treatment of latent tuberculosis infection (LTBI) is necessary for controlling TB in low-incidence settings. However, treatment is often limited by poor completion rates.

At a community health center serving low-income Hispanics, treatment completion among patients accepting 12 weekly doses of isoniazid (INH) plus rifapentine (RPT) administered as directly observed therapy (DOT) was compared with that among patients accepting nine months of daily self-administered INH during 2012 and 2013 (n=139).

Among patients who agreed to treatment, INH-RPT combination therapy was associated with higher completion rates (OR 3.06; 95% CI, 1.23–7.62; p=.016) when compared to INH only. Overall completion rates were 77.8% (35/45) for INH-RPT combination therapy and 52.1% (49/94) for INH monotherapy.

High completion rates for LTBI treatment can be achieved at a community health center using INH-RPT administered via DOT. Greater success treating with INH-RPT may be attributed to DOT strategy and a shorter treatment regimen.

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By:  Gregory Lines, Paul Hunter, Sarah Bleything

 

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Sexual Risk Behaviors & Psychosocial Health Concerns of Female-To-Male Transgender Men Screening for STDs at an Urban Community Health Center

The sexual health of female-to-male (FTM) transgender men remains understudied. De-identified electronic medical records of 23 FTMs (mean age = 32, 48% racial/ethnic minority) who screened for sexually transmitted diseases (STDs) between July and December 2007 at a Boston, Massachusetts area health center were analyzed. 

Almost half (48%) were on testosterone and 39% had undergone chest surgery; none had undergone genital reconstruction. The majority (57%) were bisexual, and 30% reported sex with nontransgender males only in the prior three months. One individual was HIV-infected (4.3%) and two (8.7%) had a history of STDs (all laboratory-confirmed). Overall, 26% engaged in sexual risk behavior in the prior three months (i.e., unprotected sex with a nontransgender male, condom breakage, or anonymous sex). 

The majority (61%) had a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis (52% depression, 52% anxiety, and 26% adjustment disorder), and regular alcohol use was common (65%). Alcohol use, psychosocial distress histories, and sex with males only (versus with males and females) were associated with sexual risk in the past three months. 

Transgender men have concomitant psychosocial health vulnerabilities which may contribute to sexual risk behaviors. Future research is needed to understand the myriad social, behavioral, and biological factors that contribute to HIV and STD vulnerability for FTMs.

Full article at: http://goo.gl/CDtiZy

By: Sari L. Reisner,a,b,* Jaclyn M. White,a Kenneth H. Mayer,a,c and Matthew J. Mimiagaa,d,e

^aThe Fenway Institute, Fenway Health, Boston, MA, USA

^bDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

^cDepartment of Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA

^dDepartment of Epidemiology, Harvard School of Public Health, Boston, MA, USA

^eDepartment of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

^*Corresponding author. Email: gro.htlaehyawnef@rensiers

  

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