JOURNAL OF ADOLESCENT HEALTH 1992;13:445-4&
LETTER TO THE EDITOR
To the Editor: I am grateful that Drs. Klein et al. have articulated the goals and strategies for improving adolescents’ access to health care (1). However, the strategies enumerated by them fail to address the role parents can play in the medical enfranchisement of their teenage children. Although I applaud the emphasis which SAM takes in providing confidential care to our adolescent patients, I worry that many will read the position paper and assume that health care for such patients is usually undertaken without the parent’s knowledge or consent. Although I acknowledge that there is a disturbingly large adolescent population in the United States that is homeless, doctorless, and parentless, a much larger subgroup of teens still have parents with whom they live and communicate, despite experiencing barriers to health care. I believe that these parents can and do play a major role in determining whether or not their children reach the health-care system. If they are not made aware of what the health-care system can offer their teen (or even themselves as the parent of d teen), then they will continue to practice the benign neglect that justifies their child’s absence from the office or clinic. With a parent’s encouragement, I have found that most teens will grudgingly consent to a medical visit. If this experience is a representative one, then I propose that SAM emphasize that most teens want health care which is private, confidential, but not necessarily secret. Understanding this, we as providers can be more successful in recruiting underserved U.S. adolescents by educating parents to the health-care needs of their teenage children while at the same time working on breaking down the barriers that prevent them from obtaining that care.
Bruce R. Brown, Jr., M.D. Director, Adolescent and School Heah Programs
References 1. Klein JQ, SlapGB, Elster AB, Schonberg SK. Access to health Cm? for adolescents:A Position Pzpr of the Society for Adolescent Medicine. J Adolesc Health 1992; 13162-170.
To the Editor: While Dr. Brown is correct in assuming that parents can and do play major roles in their children’s behavior, including their health-care utilization, the “Access to Health Caie for Adolescents” Position paper (1) does not ignore the critical contributions that families can make to their adolescents’ health. Among the seven criteria for Assess to Health Care for Adolescents (availability, visibility, quality, sonfidentiality, affordability, flexibility, and coordination) the principle of confidentiality states that “adolescents should be encouraged to involve their families in health decisions whenever possible; however, when such involvement is not in the best interest of the adolescent or when parental involvement may prevent the adolescent from seeking care, confidentiality must be assured.” Families should ideally be involved in their adolescents’ care, and families have a key role in promoting health for their children. Many adolescents, however, consistently report they would delay or defer care seeking, especially for sensitive issues such as sexuality, if pbrental notification were required (2). It is important to recognize that these youth are not the homeless or parentless; they are youth from our suburbs and our cities alike. I share Dr. Brown’s concern that we as providers must educate both parents and adolessent patients about the importance of clinical preventive health services. The Society for Adolescent Medicine has a committee currently studying the content of preventive care. All providers will need to work to inform both adolescents and their parents if we hope to prevent risky health behaviors and help foster healthy, well adjusted adolescents. Jonathan D. Klein, MD, MPH Assistant Professor of Pediatrics
@Societyfor Adolescent Medicine, 1992 Publishedby Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010