1. Minnesota Department of Health
Highlights from the Sexually Transmitted Disease (STD) 2014 Surveillance Report
Minnesota Department of Health
STD Surveillance System

2. Minnesota Department of Health
Announcements

3. Minnesota Department of Health
STDs in Minnesota Rate per 100,000 by Year of Diagnosis,
The rate of chlamydia in MN reached an all time high at 375 per 100,000. This is an increase of 6% from 2013.
The rate of gonorrhea in MN is the highest in the past decade at 77 per 100,000. This is an increase of 5% from 2013.
The rate of primary and secondary syphilis is also the highest it’s been in the past decade at 4.8 per 100,000. This is an increase of 33% from 2013.
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

4. STDs in Minnesota: Number of Cases Reported in 2014
Minnesota Department of Health
STDs in Minnesota: Number of Cases Reported in 2014
Total of 24,599 STD cases reported to MDH in 2014:
19,897 Chlamydia cases
4,073 Gonorrhea cases
629 Syphilis cases (all stages)
0 Chancroid cases
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

5. Minnesota Department of Health
CHLAMYDIA
STDs in Minnesota: Annual Review

6. Minnesota Department of Health
Chlamydia in Minnesota Rate per 100,000 by Year of Diagnosis,
375 per 100,000
229 per 100,000
Chlamydia has continued to increase over the past decade.
There has been a 64% increase from 2004 to 2014.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

7. Minnesota Department of Health
Chlamydia Infections by Residence at Diagnosis Minnesota, 2014
Total Number of Cases = 19,897
All counties in Minnesota are affected by chlamydia. There were at least 2 cases in all counties.
Roughly a third of the cases are in the cities of Minneapolis and St. Paul, a third in the Suburban area surround the cities, and a third in Greater Minnesota.
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

8. Age-Specific Chlamydia Rates by Gender Minnesota, 2014
Minnesota Department of Health
Age-Specific Chlamydia Rates by Gender Minnesota, 2014
The rates of chlamydia went up in both males and females in Females continue to have higher rates of chlamydia than males in age groups 39 and under. In 2014 the males have higher rates in the 40 and over age groups. The rate in males increased more than the rate in females in 2014.
The highest rates of chlamydia continue to be in females year of age at 3188 per 100,000.
The age group with the largest increase in rate was males at a 23% increase over 2013.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

9. Minnesota Department of Health
Chlamydia Rates by Race/Ethnicity Minnesota,
2014 rates compared with Whites:
Black = 9x higher
American Indian = 4x higher
Asian/PI = 2x higher
Hispanic = 2.5x higher
There continues to be disparities in rates of chlamydia.
The Black/African American population has rates that are 9 times higher than that of whites. The rate in the Black/African American population was 1587 per 100,000 compared to the rate in the White population at 178 per 100,000.
The American Indian population had a rate that was 4 times higher at 780 per 100,000
The Asian/Pacific Islander population had a rate that was 2 time higher at 312 per 100,000
The Hispanic/Latino population, which can be of any race, had a rate that was 2.5 times higher at 440 per 100,000
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

10. Minnesota Department of Health
GONORRHEA
STDs in Minnesota: Annual Review

11. Minnesota Department of Health
Gonorrhea in Minnesota Rate per 100,000 by Year of Diagnosis,
The rate of gonorrhea in MN is the highest in the past decade at 77 per 100,000. This is an increase of 5% from 2013.
The rate continues to climb after a decrease from between
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

12. Minnesota Department of Health
Gonorrhea Infections in Minnesota by Residence at Diagnosis, 2014
Total Number of Cases= 4,073
The majority of the gonorrhea cases, 35%, continue to be residents of the City of Minneapolis.
The next highest area is the Suburban area at 27%.
However, Greater Minnesota saw the largest increase in the number of cases from 2013 at 21%.
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

13. Age-Specific Gonorrhea Rates by Gender Minnesota, 2014
Minnesota Department of Health
Age-Specific Gonorrhea Rates by Gender Minnesota, 2014
The rates of gonorrhea went up in males and down females in 2014.
For the first time in the past decade males have higher rates of gonorrhea than females.
Females continue to have higher rates of gonorrhea than males in age groups 24 and under. In 2014 the males have higher rates in the 25 and over age groups. The rate in males increased from 2013 by 23%.
The highest rates of gonorrhea continue to be in females year of age at 362 per 100,000. However, the males in this age group are second highest at 361 per 100,000.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

14. Minnesota Department of Health
Gonorrhea Rates by Race/Ethnicity Minnesota,
2014 rates compared with Whites:
Black = 18x higher
American Indian = 7x higher
Asian/PI = 0x higher
Hispanic = 2x higher
There continues be even larger disparities in gonorrhea compared to chlamydia.
The Black/African American population has rates that are 18 times higher than that of whites. The rate in the Black/African American population was 543 per 100,000 compared to the rate in the White population at 31 per 100,000.
The American Indian population had a rate that was 7 times higher at 217 per 100,000.
The Hispanic/Latino population, which can be of any race, had a rate that was 2 times higher at 75 per 100,000.
The rate among the Asian/Pacific Islander population was roughly the same as the White population at 39 per 100,000.
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

15. Minnesota Department of Health
Gonorrhea Rates by Race/Ethnicity Minnesota,
You can see the increase in rates that has occurred in the American Indian population since 2010 more clearly after removing the Black/African American data. This is an increase of 210% since 2010.
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

16. Minnesota Department of Health
SYPHILIS
STDs in Minnesota: Annual Review

17. Syphilis Rates by Stage of Diagnosis Minnesota, 2004-2014
Minnesota Department of Health
Syphilis Rates by Stage of Diagnosis Minnesota,
Rates of all stages of syphilis increase from 2013 to 2014.
The overall syphilis rate is up to 11.9 per 100,000.
Of concern is the increasing rate of primary and secondary syphilis which is now up to 4.8 per 100,000.
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

18. Minnesota Department of Health
Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2014
Total Number of Cases = 257
Over half of all primary and secondary syphilis cases reside in the City of Minneapolis.
The suburban area has 28% of the cases, St. Paul has 14% of the cases, and Greater Minnesota only has 7% of the cases.
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

19. Minnesota Department of Health
Age-Specific Primary & Secondary Syphilis Rates by Gender, Minnesota, 2014
Males have higher rates of primary and secondary syphilis than females in all age groups. The rate in males is 11 times higher than females. This difference has decreased since 2011 where males had a rate that was 27 times higher than the females.
The yr old males have the highest rate at 27.7 per 100,000
The yr old females have the highest rate of the female population at 3.2 per 100,000
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

20. Minnesota Department of Health
Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota,
The rates of primary and secondary syphilis are 7 times higher in the Black/African American population than that of the White population.
The rates of primary and secondary syphilis in the Black/African American population are 23.8 per 100,000 compared to 3.6 per 100,000 in the White population.
The rates in the Hispanic/Latino population are 8.8 per 100,000 which is 2.4 times higher than the White population.
The rates in the Asian/Pacific Islander population are 6.8 per 100,000 which is 2 times higher than the White population.
The rates in the American Indian population are 3.0 per 100,000 which is slightly lower than the White population.
* Persons of Hispanic ethnicity can be of any race.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

21. Minnesota Department of Health
Topics in the spotlight:
Chlamydia and Gonorrhea among Adolescents and Young Adults (15-24 years of age)
Early Syphilis Among Men Who Have Sex With Men in Minnesota
STDs in Minnesota: Annual Review

22. CHLAMYDIA AND GONORRHEA AMONG ADOLESCENTS & YOUNG ADULTS
Minnesota Department of Health
CHLAMYDIA AND GONORRHEA AMONG ADOLESCENTS & YOUNG ADULTS
(15-19 year olds) (20-24 year olds)
STDs in Minnesota: Annual Review

23. Minnesota Department of Health
Chlamydia Disproportionately Impacts Youth
MN Population in 2010
(n = 5,303,925)
Chlamydia Cases in 2014
(n = 19,897)
Chlamydia disproportionately impacts youth. The year olds make up only 14% of the population, but account for 66% of all chlamydia cases reported.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

24. Minnesota Department of Health
Gonorrhea Disproportionately Impacts Youth
MN Population in 2010
(n = 5,303,925)
Gonorrhea Cases in 2014
(n = 4,073)
Gonorrhea disproportionately impacts youth. The year olds make up only 14% of the population, but account for 51% of all gonorrhea cases reported.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

25. Minnesota Department of Health
Gonorrhea Rates Among Adolescents & Young Adults† by Gender in Minnesota,
The rates of gonorrhea are higher in females compared to males in the year old age group. As I mentioned before, this has changed in all of the age groups above 24, where males have higher rates than females.
We saw a decline in the rates of female adolescents & young adults this year for the first time since 2011.
Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.
† Adolescents defined as year-olds; Young Adults defined as year-olds.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

26. Minnesota Department of Health
Gonorrhea Rate Among Adolescents and Young Adults† by Race, Minnesota, 2014
There are still disparities in rates among the adolescent and young adults.
The Black/African American population has higher rates than all other races and ethnicities in both males and females.
Rate=Cases per 100,000 persons based on 2010 U.S. Census counts.
† Adolescents defined as year-olds; Young Adults defined as year-olds.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

27. Minnesota Department of Health
Topic of Interest:
Early Syphilis Among
Men Who Have Sex With Men
in Minnesota
STDs in Minnesota: Annual Review

28. Early Syphilis† by Gender and Sexual Behavior Minnesota, 2004-2014
Minnesota Department of Health
Early Syphilis† by Gender and Sexual Behavior Minnesota,
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

29. Early Syphilis† Cases Among MSM by Age Minnesota, 2014 (n=283)
Minnesota Department of Health
Early Syphilis† Cases Among MSM by Age Minnesota, 2014 (n=283)
Mean Age = 36 years
Range: 17 to 72 years
Early syphilis in men who have sex with men is found in all age groups.
The year old men who have sex with men has the highest number of cases.
The ages range from 17 to 72.
The average age is 36.
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

30. Early Syphilis† (ES) Cases Co-infected with HIV, 2006-2014
Minnesota Department of Health
Early Syphilis† (ES) Cases Co-infected with HIV,
37% of all early syphilis cases are co-infected with HIV.
50% of all men who have sex with men early syphilis cases are co-infected.
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

31. Characteristics of Early Syphilis† Cases Among MSM, Minnesota, 2014
Minnesota Department of Health
Characteristics of Early Syphilis† Cases Among MSM, Minnesota, 2014
Gay and bisexual men account for 76% of cases among men.
79% of cases among MSM are White, but a disproportionate number of cases (11%) are African American.
56% in the City of Minneapolis and 26% live in the suburbs
50% of cases are also infected with HIV.
MSM=Men who have sex with men
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

32. Minnesota Department of Health
SURVEILLANCE SUMMARY

33. Summary of STD Trends in Minnesota
Minnesota Department of Health
Summary of STD Trends in Minnesota
From , the chlamydia rate increased by 64%. The rate of gonorrhea increased by 5% between 2013 and Rates of reported syphilis increased in 2014 compared to 2013 by 18%.
Minnesota has seen a resurgence of syphilis over the past decade, with men who have sex with men and those co-infected with HIV being especially impacted.
Persons of color continue to be disproportionately affected by STDs.
STD rates are highest in the cities of Minneapolis and Saint Paul. However, chlamydia and gonorrhea cases in the Twin Cities suburbs and Greater Minnesota account for 61% of the reported cases in 2014.
Adolescents and young adults (15-24 years) have the highest rates of chlamydia and gonorrhea, making up 64% of new infections in 2014.
Between 2013 and 2014, early syphilis cases increased by 24%. Men who have sex with men comprised 76% of all male cases in 2014; cases among women are continuing to increase.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review

34. Future Updates to STD Reporting
New case report form to accommodate changes in treatment guidelines will be available when CDC releases the changes
Case report form is be able to be filled out on a computer and printed to be mailed or faxed in
All cases co-infected with HIV/Gonorrhea, HIV/Syphilis, and Early Syphilis will be continue to be assigned to MDH Partner Services for follow-up
Starting in April 2015 all Gonorrhea cases have the potential for being contacted by MDH for additional follow-up

35. For more information, contact:
STD Surveillance Data
MDH Partner Services Program

36. Syphilis: Deciphering the Great Imitator
Cynthia Lind-Livingston
Syphilis Lab Surveillance Coordinator
STD/HIV and TB Section
Minnesota Department of Health
To contact me: – or telephone –

37. Objectives
Transmission
Staging
Diagnosis
Testing
Treatment

38. Transmission
Contact with infectious, moist lesion(s), most commonly during oral, anal or vaginal sex
30-50% risk of infection per exposure to early (primary or secondary) syphilis
Less common through casual skin to skin contact
Cannot be spread by use of toilet seats, swimming pools, hot tubs, shared clothing or eating utensils.

39. Transmission (cont) Mother-to-child transmission
Perinatal transmission can occur:
At any time during pregnancy
At any stage of the disease
Chance of vertical transmission by stage of infection
Primary syphilis = 50%
Early latent syphilis = 40%
Late latent syphilis = 10%
Tertiary syphilis = 10%

40. Stages of Syphilis Primary: Chancre
Appears days after infection, on average 21 days
Typically single, painless, clean-based lesion with rolled edges
Appears at site where infected person’s lesion contacted person
Resolves/heals without treatment

41. Stages of Syphilis (cont)
Secondary:
Occurs 3-6 weeks after primary chancre
Rash (75-90%)
Generalized lymphadenopathy (70-90%)
Constitutional symptoms (headache, nausea, weight loss, vomiting, sore throat, slight fever) (50-80%)
Mucous patches (5-30%)
Condyloma lata (5-25%)
Patchy alopecia or hair loss (10-15%)
Symptoms of nuero-involvement (1-2%)

42. Stages of Syphilis (cont)
Latent (Early & Late):
No clinical symptoms: only evidence is positive serologic test
60-85% remain asymptomatic for years without treatment
Divided into two stages for treatment purposes
Early Latent Syphilis : <1 year in duration:
Prior negative test result in past year
Documented exposure to an early case of syphilis
Symptoms consistent with primary and/or secondary syphilis in the past 12 months
Two (2) dilution sustained increase in titer

43. Stages of Syphilis (cont)
Late Latent Syphilis: >1 year in duration:
No prior negative test result in past year
No documented exposure to an early case of syphilis
No symptoms consistent with primary and/or secondary syphilis in the past 12 months
No two (2) dilution sustained increase in titer

44. Stages of Syphilis (cont)
Tertiary Syphilis
70% of untreated patients remain asymptomatic
30% of untreated patients progress to tertiary stage in 5-20 years
▪ Gummas: destructive lesions of soft tissue, cartilage,
internal organs and bone
▪ Cardiovascular involvement: aortic aneurysm, aortic insufficiency
▪ Central nervous system involvement: memory loss, vision
issues, unsteady gate, hyporefexia, hearing loss
Neuro-involvement
Neuro-involvement can occur at any stage of disease
Lumbar puncture

45. Syphilis & HIV Syphilis is a marker for HIV risk
Atypical presentation of disease sometimes occurs
Multiple ulcers, overlapping stages
Higher non-treponemal titers
Syphilis facilitates HIV transmission
Increased the number of receptor cells
Increases HIV viral load in genital lesions, semen or both

46. Syphilis Diagnosis Clinical Suspicion High Risk Population
HIV Positive
Annual Physical / STD Screen
Pregnant

47. Syphilis Testing Microscopy Serologic Test for Syphilis (STS)
Darkfield
Biopsy
Serologic Test for Syphilis (STS)
Nontreponemal
Treponemal

48. Syphilis Testing (cont)
Nontreponemal (VDRL, RPR, USR)
Measures antibodies which are not specific to Treponema pallidum
Quantitative
Reflects disease activity
Advantages:
Rapid & inexpensive for screening
Easy to perform
Use in evaluation of patients with symptoms or possible re-infection
Use for follow-up assessment after treatment

49. Syphilis Testing (cont)
Disadvantages:
Biological false positive reactions (BFPs)
Acute infections (Mononucleosis, herpes, viral illness)
Chronic Infections (TB, lupus, rheumatoid arthritis)
Intravenous drug use
False negative reactions
Prozone effect
Early primary and late latent stages

50. Syphilis Testing (cont)
Treponemal tests (TPPA, FTA-abs, EIA)
Specific to T. pallidum
More sensitive and specific than non-trep tests
More expensive and labor intensive
Usually remains positive for lifetime
However 15-25% treated during primary state revert to seronegative after 2-3 years
Does not correlate with disease activity or treatment

52. Treatment Early Syphilis Benzathine PCN G 2.4 million units IM once
PCN-allergic:
Non-Pregnant
Doxycycline 100 mg po BID x 14 days
Pregnant:
Desensitize
Benzathine PCN G 2.4 millions units IM once
Alternative Therapies
Tetracycline 500 mg po QID x 14 days
Ceftriaxone 1 gm IM/IV QD x 8-10 days

53. Treatment (cont) Late-Latent and Unknown Duration: Neuro-involvement
Benzathine PCN G 7.2 million units, administered as 3 doses of 2.4 million units IM, at 1 week intervals
Neuro-involvement
18-24 million units daily, administered as 3-4 million units IV q 4 hours x days

54. Treatment Response Jarisch-Herxheimer reaction
Healing of skin and mucosal lesions
Expected four-fold decrease in non-treponemal test titers in 6-12 months, depending on stage

55. Reporting
Providers must report syphilis cases within one working day by completing a Minnesota Confidential STD Case Report (CRC).
Reports of reactive results with symptoms consistent with primary or secondary syphilis can be called in immediately to MDH at

56. Resources Available
Materials available on our website:
Resources for clinicians, including toolkit for syphilis testing and treatment;
Dear Colleague letters and health notices;
Resources for the community
Archives of provider presentations and links to current awareness campaign materials

57. Exceptional Sexual Health Services for Adolescents
Caring & Connecting:
Exceptional Sexual Health Services for Adolescents

58. Objectives
I. Describe foundations of exceptional adolescent-centered sexual health care II. Provide overview of Hennepin County’s MyClinic project and Standards & Best Practices for Comprehensive Adolescent Sexual and Reproductive Health Care.

59. Better Together Hennepin Initiative
Better Together Hennepin is Hennepin County’s Initiative to reduce teen pregnancy and birth in the County.
The overarching goal of the project is to provide young people with the four key support, shown in the yellow box, that research tells us are key to helping young people delay pregnancy and develop into healthy adults
The initiative directly funds evidence-based programs and works to create systems change that leads to young people having better access to these supports
The MyClinic project (previously known as the Adolescent Reproductive Health Care Access Project) was born out of this desire to create systems change, and increase the capacity of clinics to provide exceptional adolescent-centered sexual health care to young people.
Modeling our work after the work of others around the country, specifically work being done in New York City, we convened an Advisory Board who then created the Standards and best practices that we are discussing today.
Advisory Board is made up of physicians, nurses, clinic managers and administrators - all these roles are key in addressing the way that adolescent clients experience their clinic.

60. Adolescent-centered care: what makes it unique?
So, let’s dive in – what makes adolescent care unique?

61. Exceptional, adolescent-centered care:
Confidential
Welcoming
Convenient & affordable
Respectful & nonjudgmental
Comprehensive
We’ve organized around these 5 main elements

62. Services are confidential
Clinic makes every effort to guarantee confidentiality and respects young person’s right to consent by:
Informing young person of their right to consent
Ensuring young person understands consent process
Taking every precaution possible in billing for confidential services
Allowing for private conversations between client and provider
Protecting confidential services when using electronic health records
Confidentiality also includes the issue of privacy, for example they have a place for private conversation with the provider
Young people have told us that they are also concerned about seeing friends/classmates in the waiting room
We know this is a huge challenge that we have to address and it is difficult for clinics particularly in large health care systems but we have to be thinking about this as a barrier to serving young people
And be up front with them when we can not guarantee confidentiality

63. Young people feel welcome
Young people feel welcome physically and emotionally in the following ways:
All staff show enthusiasm for working with young people
Physical environment of clinic is welcoming to adolescents (Posters, magazines, signage)
Services offered reflect needs of adolescent clients
Young people see their cultural backgrounds and customs reflected in environment and staff
Young people need to feel welcome.
We do this through the physical environment, but probably more so in how we treat them in the clinic, how are they greeted, are they treated as competent and capable and with compassion
And this starts on the phone when they call to make an appointment.

64. Services are convenient & affordable
Clinic hours reflect young people’s availability:
After-school, evening, weekend hours
Walk-in hours available
Fee schedules and billing procedures reflect young people’s income and insurance status:
Sliding fee scale
MFPP offered
Confidentiality in billing practices
This one is straightforward
We know this can be a challenge when working in larger clinics perhaps, but we know that young people do not always operate as we do as adults.
We need to be flexible and available to “catch them” when they are ready

65. Young people feel respected and heard
Clinicians use welcoming and sensitive, non-judgmental questions and language when interviewing, counseling and treating adolescents.
When interacting with adolescent clients, clinicians consider the young person’s
culture
religion
ethnicity
language
sex & gender
sexual orientation
developmental stage & educational level
We discussed our standards with groups of young people and this is the issue that they repeatedly said was most important to them: being treated with respect, and not feeling judged.
They want to know they can talk with adults and not feel like we have an agenda that we are driving before they even walk in the room.

66. Young people get the services they need
Clinic staff follow the most current clinical guidelines with regard to pregnancy prevention and STI/HIV prevention and care.
Each clinic visit is taken as an opportunity to address the broad range of health care concerns most common to adolescents, including:
STI & pregnancy
Mental health
Substance use
Relationship issues
Typical growth & development
It is critical for clinics to be in line with what the most current research about adolescent services says best fits their needs
The other piece is practicing in a way that acknowledges that each opportunity that we see a young person in a clinic is an opportunity to have a broader discussion with them about what they see as the strengths and challenges to their health and well-being.
And often we may need to read between the lines of what they are telling us.
Since young people are generally healthy, and may only present to clinic for a sports physical, we need to take that sports physical as an opportunity to address sexual activity or ask about substance use
We know that in general most young people are sexually active well before they seek care for sexually related care, so we need to take every opportunity we can to address prevention.

67. MyClinic: Standards of Care for Comprehensive Adolescent Sexual and Reproductive Health Care

68. Standards of Care http://www.hennepin.us/bettertogether
When providing sexual and reproductive health care to adolescents, providers should:
Guarantee confidentiality and adolescents’ rights to consent to sexual and reproductive health care.
Make services accessible and facilities welcoming to adolescents.
Deliver patient-centered care that is sensitive to each adolescent’s culture, ethnicity, community values, religion, language, educational level, sex, gender and sexual orientation.
Screen all adolescents for sexual and reproductive health issues, including substance use and mental health concerns, and provide appropriate education, counseling, care or referral.
Provide contraceptive methods, including emergency contraception (EC), to adolescents at risk for unintended pregnancy.
Provide prevention, testing and treatment of sexually transmitted infections.
Offer information, assistance and support for all decisions regarding pregnancy.
7 Standards that reflect the essential elements we just covered. For each standard, there are specific best practices that reflect the standard. I will go through one of the standards to give you sense of the specificity of the standards. You can access the full standards and best practices on Hennepin County’s web page.

69. Standard 1: Guarantee confidentiality & adolescents’ right to consent to sexual and reproductive health care
Best Practices:
Every visit includes an opportunity for a confidential conversation between clinician and adolescent client.
Health care records, whether electronic or paper, are set up to protect client confidentiality.
Billing procedures are established to ensure client confidentiality.
Staff is routinely trained on Minnesota’s minor’s consent and confidentiality laws
Confidential contact information for adolescent patients is routinely collected and updated
Adolescent clients are encouraged to involve trusted adults in their care.
Clinic has a process for obtaining informed consent regarding services covered by MN minor’s consent and confidentiality laws (pregnancy, contraception, STIs, mental health and substance use)
Minnesota adolescent consent laws are prominently displayed.
As you can see, the best practices address a wide range of opportunities for ensuring confidentiality:
during the visit – that you have time alone with the adolescent client, without parent. That they have privacy in the waiting room.
in the health care records – particularly an issue for larger systems with electronic health records. There are models emerging for how to handle this.
in the billing system – this is an area that really requires larger systems change – changing EOB requirements. Key here is to let young person know limits of your control when they use insurance.
client contact outside of the office
Each of these areas pose potential threats to confidential care and the young person’s confidence that their privacy is ensured.
As an overlay to all of this, however, we know that it is best if a young person has a trusted adult as a partner in their health decisions and care.

70. Changing clinic practice to adapt to the Standards: MyClinic Self-Assessment Tool

71. MyClinic Self Assessment Tool
Better Together Hennepin has an on-line tool to help providers assess their practice
30+ clinics have completed the assessment tool
Key findings to date:
All clinics found it helpful
Most benefit came from completing tool as a team
Even clinics doing great adolescent-centered work found areas for improvement
General practice clinics found it a useful starting place
Easy to use
Contact Katherine Meerse for information about accessing the tool
Key findings:
All clinics that completed it found it helpful
Clinics seemed to benefit most when they completed assessment tool as a team.
Even the clinics doing great adolescent-centered work were able to find the tool useful in improving practice or targeting areas for improvement.
More “general-practice” clinics found the tool useful in helping them identify areas where they could be better at serving adolescents and potentially get better at attracting adolescent clients.
Easy to use.

72. Contact Information
Katherine Meerse, PhD, Manager, Better Together Hennepin

73. Thank you! For more information, contact:
STD Surveillance Data
MDH Partner Services Program
Syphilis Lab Surveillance
Better Together Hennepin Katherine Meerse, PhD, Manager