Current challenges in school-based health center care: COVID, mental health care, immigrant youth, expansion of telemedicine.

School based health centers (SBHCs) have been providing preventive, acute and chronic care in schools across the United States (US) for the past 40 years. A discussion of that care is provided in a companion article to this one. Several major societal issues of the 2020s, affecting the care provided in SBHCs, have taken place over the past 4 years. These issues, which will be discussed in this article, include the following: 1. The COVID pandemic had a major impact on utilization and services required at SBHCs, both at the peak of the pandemic, when schools were closed and since the peak of the pandemic, when schools reopened. 2. The transformation of mental health services, due both to increasing mental health needs of youth, as well as progression to new therapeutic modalities, has required expansion of services provided at SBHCs. 3. New immigrant health care needs and services have required a response by SBHCs to the substantial increase of new immigrants, most of whom are impacted by significant trauma, entering public schools nationally. 4. Telehealth integration into SBHC medical and mental health services, and its expansion to incorporate new technologies, have provided avenues for increased provision of services by SBHCs.

Menstrual and reproductive health in female adolescents with developmental disabilities.

Youth with intellectual and developmental disabilities (I/DD) are impacted by pubertal changes and the onset of menses disproportionately. Despite the fact that for most youth with I/DD, the progression of puberty, menarche, and irregular cycles due to axis immaturity appear to be consistent with the general population, cyclic behavioral changes and premenstrual symptoms may be more common. Furthermore, for some disabled youth there are endocrine or medication effects that may impact menses disproportionately. Education and access to care is essential for this group to address many aspects of treatment, from prepubertal anticipatory guidance to menstrual management, with special attention required for addressing issues concerning hygiene, cyclic pain, behavior changes, sexuality, potential for abuse, and pregnancy prevention.1-4 This article will provide an overview of the policies and guidance available for management of the menstrual issues encountered in adolescents with intellectual and developmental disabilities and complex medical disorders. Included will be a review of studies that evaluate the different types of methods that are utilized for menstrual management and the different conditions that are encountered.

Contraception for Adolescents with Medically Complex Conditions.

Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have developed, published, and updated evidence-based guidelines to support medical providers in the provision of contraceptives to patients with specific medical conditions or characteristics. The goal of these guidelines is to provide recommendations on the safe use of contraceptives with the goal of removing unnecessary medical barriers to access and use of contraceptives, thus decreasing the number of unintended pregnancies. Many medical conditions increase a patient's risk of venous thromboembolism; a risk that may also be increased with specific contraceptives. Specific conditions that require more enhanced contraceptive counseling due to their frequency in adolescence and their association either with adverse events during pregnancy or with increased risk for specific contraceptives are detailed by the WHO and CDC and are summarized herein. Adolescents with morbid obesity, migraine headache, cardiac conditions, hypertension, diabetes mellitus, hyperlipidemia, systemic lupus erythematosus, sickle cell anemia, cystic fibrosis, inflammatory bowel disease, or seizure disorders would benefit from greater attention to the urgency of exploring highly effective contraceptive methods. Details of the considerations that should be used in providing contraceptive care to adolescents with each of these medical conditions, as per WHO and CDC guidelines, are provided in this review. The ultimate goal in contraceptive counseling is the balancing of risk and benefit to arrive at the best therapeutic option, maintaining patient preference as a priority, as that will enhance adherence and comfort with the contraceptive method. Each patient must be assessed for pregnancy risk and be allowed full risk reduction and education regarding contraceptive options.

Pediatric providers' attitudes and practices regarding concussion diagnosis and management.

Background Concussions, a form of mild traumatic brain injury, are a current "hot topic" in sports and medicine, with current research focusing on diagnosis, treatment, and the long-term effects of repeated concussions on development of chronic traumatic encephalopathy. Concussions represent 8.9% of all high school athletic injuries, and pediatricians see many of these patients in their practices, however evolving guidelines and recommendations have resulted in varying practices among providers. Objective To assess how local pediatricians in New York Chapter 2 of the American Academy of Pediatrics (AAP) diagnose and treat concussion patients, and to evaluate the need for continuing education in this area. Design and methods Survey Monkey™ was used to query providers regarding their diagnosis and treatment of concussion patients. A total of three emails containing a link to the 22 question multiple-choice survey were sent to AAP Chapter 2 members between January 2015 and June 2015. The survey was adapted and modified with permission from one previously used by "Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers' self-reported knowledge, practices, and attitudes about concussion. Pediatrics. 2012;130:1120-5". Results We received 115 responses from 1436 potential participants to whom the survey link was sent, resulting in an 8% response rate. We excluded subspecialists from our data analysis, resulting in data from 95 primary care pediatricians. Of the PCPs 98.7% reported seeing at least one child or adolescent with a concussion in the previous 12 months and 76.6% reported referring some or all of their concussion patients for ongoing management. The most common reason for referral was "I am not always comfortable with management" and the most common subspecialist referral was to a neurologist. Most providers reported that they did not use any guidelines for management (58.3%) and only 57.4% were familiar with the New York State Education Department concussion guidelines. Almost half reported inadequate training in performing neurocognitive assessments (48.6%). Most were comfortable educating families about the diagnosis of concussion (81.7%), as well as recommending the appropriate time to resume school (70.4%) and prescribing and monitoring a return to play protocol (62%). A total of 84.3% also responded, however, that they would be interested in a webinar for a continuing medical education(CME) credit focused on concussion diagnosis and management. Conclusions Most pediatric providers care for patients who have suffered a concussion, however many identify barriers to diagnosis and treatment, which results in patients being referred to subspecialists for further management. Many providers are also unfamiliar with, or do not use, published concussion guidelines and report varying practices in treatment of concussion patients due to evolving recommendations. This study demonstrates that there is a need for further education for pediatric providers who see patients with concussion.

Testing and treatment for sexually transmitted infections in adolescents--what's new?

BACKGROUND: Significant changes are taking place in the diagnosis and management of sexually transmitted infections (STI) in adolescents and young adults. FINDINGS: In this review article, we provide an update of STIs in adolescents and young adults including: (1) Adolescent risk; (2) Screening guidelines; (3) Clinical manifestations; (4) Diagnostic testing; (5) Treatment; and (6) Prevention; with an emphasis on "what's new" in the field. CONCLUSIONS/SIGNIFICANCE: While the impacts of STI epidemiology and health care access are leading to new recommendations for screening and prevention, changes in technology and drug resistance are promoting new methods of STI testing and ongoing revisions of STI treatment recommendations.