Those interested in the topic of youth-friendly clinical services are perhaps well-versed on what constitutes such services. Healthy Teen Network has certainly covered this topic extensively through our blog, webinar, on-site training, and technical assistance.
Youth-friendly services include
- convenient location and hours,
- affordable fees,
- friendly staff
- competent clinicians,
- comprehensive services, and
- community support, among others.
The above characteristics reflect the “whats” of youth-friendly clinical services. But what about the “hows”? How do you provide services in a manner that is more youth friendly? These are two intimately connected but separate entities. You can have the “whats” such as comprehensive sexual health services, but without the “hows” (such as providing these services with confidentiality and respect), you will not be truly creating a youth friendly environment.
It is important to employ a “rights-based approach” to provide clinical services that are truly youth-friendly. Basing provision of clinical services, particularly sexual and reproductive health services for young people, solely on their needs, does not bridge a gap in services—it creates one. A needs-based approach alone does not guarantee that youth will use these services. On the other hand, the rights-based approach is proactive instead of reactive and puts us in a better position to meet the real and perceived, unique needs of youth.
In addition to focusing on needs, the rights-based approach also focuses on empowering youth to realize their sexual rights and provides them with opportunities to participate in their own healthcare decision making processes. By adopting such an approach, health care providers/institutions are more likely to attract underserved youth and are more likely to retain their young clients for continuing care (IPPF, 2012).
The Interagency Youth Working Group and the International Planned Parenthood Federation developed five keys to implementing a rights-based approach relative to youth friendly services. These keys are:
- Understand evolving capacity. Evolving capacity means being cognizant that with time and varying circumstances, adolescents gradually develop the ability to take full responsibility for their own actions and decisions. Every health professional must strive to find the balance between protecting young clients and enabling them to exercise autonomy.
- Ensure confidentiality. Confidentiality is defined as the duty of those who receive private information not to disclose it without a patient’s consent. Confidentiality ensures privacy. Young people must feel comfortable disclosing accurate information about their health, concerns, and behavior to access services and continue doing so.
- Obtain informed consent. Obtaining informed consent is vital to being youth-friendly. One must apply the concept of evolving capacity during the process of obtaining informed consent. To give consent, young people need to be able to readily access accurate and comprehensive information. As youth-serving professionals, it is our job to provide this information and not merely get signatures on forms. The mere act of visiting a clinic for the first time may be daunting for a young person, and they may lack the confidence to manage the decisions that follow—but lacking confidence does not mean they lack the ability to make these decisions. The process is an important part of personal development and can be a positive experience and immensely empowering.
- Celebrate diversity. Celebrating diversity means being cognizant that youth come from diverse backgrounds in terms of race, ethnicity, gender, sexual orientation, socioeconomic status, age, physical abilities, religious beliefs, political beliefs, and other ideologies. Additionally, individuality adds to diversity. Accepting diversity with respect is central to a youth-friendly approach. This does not mean merely tolerating differences; it means recognizing the many layers of diversity, embracing this diversity, and truly accepting youth for who they are.
- Adopt a sex positive approach. Sex-positivity is an attitude that views sexuality as something that enhances life by infusing happiness and energy into it. Sex positive approaches promote sexual well-being rather than trying to prevent negative sexual experiences and/or consequences of sex. The risks and concerns associated with sexuality are acknowledged but without shaming or reinforcing fear or stigma of young people’s sexuality or gender.
At the end of the visit, your ability to offer a youth-friendly experience to your young clients depends on your ability to adopt these approaches and offer youth two things: options and choices. The array of options that every young person should have access to in order to promote and protect his/her sexual and reproductive health and well-being, and the choice to say “no” to every single option you provide despite how excellent the options may be.
If you can bite your tongue and overcome the urge to tell them they are making a mistake, if you can resist the temptation to tell them you are a clinician and you know best, if you can maintain a caring demeanor and with utmost respect and a non-judgmental tone and attitude, to encourage them to think the options over and let you know if they change their mind, you would have upheld their rights and provided youth-friendly clinical services the “rights” way. The likelihood of them returning to you or your clinic, although not guaranteed, would have certainly increased, for they would have felt respected and empowered to make their own decisions. Chances are that the next time he or she comes for a visit, you may be successful in encouraging him to use condoms correctly and consistently each time he has sex, or in supporting her in her decision to have a LARC (i.e., long-acting reversible contraceptive) method inserted.
It is not an elusive magic solution that we are looking for here—it is pure common sense. Listen and treat them well—with dignity and respect—and they will return.
Why do you think it is important to adopt a rights based approach to deliver youth-friendly clinical services? How do you uphold the rights of your young clients while delivering quality clinical care?
Mousumi Banikya-Leaseburg, MD, MPH, CPH is a Program Manager at Healthy Teen Network.