Selected Podcast
Adolescent Healthcare: Why It's Different and So Specialized
Think tweens and teens are hard to figure out? They may be impulsive and unpredictable, but they are also full of hope and possibilities. Meet a couple of doctors at Children's of Alabama who are passionate about all things "adolescent." Doctors Tamera Coyne-Beasley and Nefertiti Durant lead a team of healthcare professionals at the William A. Daniel, Jr. Adolescent Health Center who are committed to helping young people navigate through physical and emotional changes, and unlock their full potential.
Featured Speaker:
Nefertiti Harmon Durant, MD, MPH is an associate professor of pediatrics in the Division of Adolescent Medicine at the University of Alabama at Birmingham (UAB). She holds a secondary appointment in the Division of Preventive Medicine. Dr. Durant attained her MD from the Johns Hopkins School of Medicine. She completed her pediatric residency at Duke University Medical Center. Dr. Durant received her Masters of Public Health (MPH) from the Harvard School of Public Health. While working toward her MPH, Durant completed three concurrent fellowships in Pediatric Health Services Research, Health Policy and Adolescent Medicine at Children’s of Boston and the Harvard School of Medicine. She is board certified in general pediatrics and adolescent medicine. Her clinical interests include menstrual disorders, preventative health care in adolescents and young adults and transition care of adolescents and young adults to adult care. Currently, Dr. Durant is director of the Adolescent Health Center at Children’s of Alabama. She is also director of the Female Adolescent Bleeding Clinic (FAB), a Women and Girls Bleeding Disorder (WGBD) Clinic of Excellence.
Tamera Coyne-Beasley, MD, MPH, FAAP, FSAHM | Nefertiti Durant, MD, MPH
Tamera Coyne-Beasley, MD, MPH, FAAP, FSAHM is the Derrol Dawkins, MD Endowed Chair in Adolescent Medicine. Dr. Coyne-Beasley is Division Director of Adolescent Medicine at the University of Alabama at Birmingham (UAB) and Children’s of Alabama. She is also Vice Chair of Pediatrics for Community Engagement and a professor of pediatrics and internal medicine. She has expertise and training in adolescent medicine, preventive medicine, epidemiology and public health. Her academic, community work, policy development and research have focused on adolescent health and risk behaviors. She has specific interests in sexual and reproductive health, health promotion and disease prevention, reducing health disparities, immunizations, improving health care access, community-based participatory and engaged research, and practice-based research. She is also past president of the Society of Adolescent Health and Medicine, the largest international, multidisciplinary organization of providers serving adolescents and young adults in the world, and serves as the past-presidents’ council representative to the board of directors.Nefertiti Harmon Durant, MD, MPH is an associate professor of pediatrics in the Division of Adolescent Medicine at the University of Alabama at Birmingham (UAB). She holds a secondary appointment in the Division of Preventive Medicine. Dr. Durant attained her MD from the Johns Hopkins School of Medicine. She completed her pediatric residency at Duke University Medical Center. Dr. Durant received her Masters of Public Health (MPH) from the Harvard School of Public Health. While working toward her MPH, Durant completed three concurrent fellowships in Pediatric Health Services Research, Health Policy and Adolescent Medicine at Children’s of Boston and the Harvard School of Medicine. She is board certified in general pediatrics and adolescent medicine. Her clinical interests include menstrual disorders, preventative health care in adolescents and young adults and transition care of adolescents and young adults to adult care. Currently, Dr. Durant is director of the Adolescent Health Center at Children’s of Alabama. She is also director of the Female Adolescent Bleeding Clinic (FAB), a Women and Girls Bleeding Disorder (WGBD) Clinic of Excellence.
Transcription:
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I'm Tiffany Kaczorowski and today we’re talking about adolescent medicine with two physicians here at Children’s of Alabama. Dr. Tamera Coyne-Beasley is the division director of adolescent medicine. She’s a professor in the department of pediatrics at UAB—the University of Alabama at Birmingham—and she’s also the vice chair of community engagement. Dr. Nefertiti Durant is medical director of the William A. Daniel Jr. Adolescent Health Center, and she’s an associate professor in the UAB department of pediatrics. Both of these doctors have been working with adolescents from tweens to teens and beyond for over 20 years. So welcome ladies.
Tamera Coyne-Beasley MD, MPH (Guest): Thank you.
Nefertiti Durant MD, MPH (Guest): Thank you.
Host: So one of the things I just wanted to ask, very basic question, what is adolescent medicine?
Dr. Coyne-Beasley: Well thank you for asking that questions. Adolescent medicine is an exciting specialty that actually focuses on and takes into consideration the unique physical, psychological, social, and sexual health needs of young adolescents and puts it in the framework of their normal development.
Host: Is this a fairly new specialty? When you're thinking about just medicine in general and the development of medicine, is adolescent medicine as a focus?
Dr. Coyne-Beasley: Yeah. It is a relatively new specialty, but it’s been in existence for over 50 years. It really developed as we began to understand in a profession that adolescence is a time period where you have very unique situations. Whether it be the things that we see in the changes in body that come along with puberty, but it also is related to some of the tremendous social pressures they have. Whether that be how do they fit it, what’s the peer pressure they're experiencing, and how do they do well and excel in school? It’s a time also when they're trying to develop their social and emotional identity in the context of a world that might actually send them different messages—for instance—about their moral identity and what they should care about.
Host: Sure, okay. So one of the things that we have discussed before is the fact that adolescents can come to an adolescent clinic regardless of whether they have some of those issues that you mentioned, or if it’s just more for a well check or a well visit. Just to be able to address those specific needs. You guys are going to be asking those questions related to those peer pressures and those social anxieties and things like that, right?
Dr. Coyne-Beasley: Yes.
Host: Okay.
Dr. Coyne-Beasley: I guess just for the audience’s understanding. When we talk about the patients that we see as adolescent medicine specialist, that generally is between the ages of 11 to 26. Although, most people will only be able to see people in their clinic until age 21 because of system related issues.
Host: Sure.
Dr. Coyne-Beasley: It’s not arbitrary. I mean the reason why it actually goes up to age 21 or 26 as opposed to 18 as many people think is that we know that the young brain is still developing, and that young people think about things differently. That can be motivated more about things that bring them immediate gratification as opposed to the concrete thinking that they may have as they get older.
Host: Right. Yeah, they might be more impulsive. Well, we think of teenagers as being much more impulsive.
Dr. Coyne-Beasley: Sure, but they still have cognitive abilities to think through some things given guidance.
Host: So Dr. Durant, what are some of the common issues that adolescents may face today? We touched on it earlier with Dr. Coyne-Beasley.
Dr. Durant: So there are many more social pressures today than, of course, we faced as kids. Some of those social pressures come because of so much exposure to the internet and social media. One important issue is bullying. Of course, bullying today is much different from what it was for us. So one thing that we talk about frequently in our visits is cyber bullying. So kids have to be very careful with social media and cyber bullying. There’s also depression. There’s substance use. There’s violence. There’s obesity, and there’s also alcohol use.
Host: I would think also just anxiety in general because the pressure is on when you're going to school at this age. When you're a teenager, the pressure is one because you're thinking about college or trade school or jobs.
Dr. Durant: Yes, yes. So there’s those normal everyday pressures and thinking about your performance. There’s also thinking about your performance in sports and athletics and how people perceive you. There is body image—thinking that you're too big or too small. There are all those types of things to think about.
Dr. Coyne-Beasley: I think what gives us an advantage—particularly at our health center—is that we actually have a multidisciplinary approach. So when we’re talking about the health of young people, we’re talking really about the health and wellbeing of adolescents. So that includes their psychosocial health, that includes their nutrition. So in our clinics we also—in addition to having physicians who are trained in adolescent medicine—we also have individuals who are nurses, who are psychologists, who are actually nutritionists and social workers all working in our clinic. Many of them have actually been trained to be leaders in adolescent health.
Host: So it’s really a multidisciplinary clinic. It’s a clinic that encompasses all of these different facets, all of the different types of needs that these patients may have all in one.
Dr. Coyne-Beasley: Yes, and that’s the goal. We really believe—and the profession of adolescent medicine believes —that you really are able to more comprehensively deal and provide the health and wellbeing care that young people need when you have a multidisciplinary team that looks at the young person as a whole individual—his body and mind.
Host: Okay. List some of the clinics that you guys do have. Some of those subspecialty clinics that pediatricians or family practice doctors might refer to.
Dr. Durant: Yes. So we have our ABHD clinic. As Dr. Coyne-Beasley mentioned, that is a multidisciplinary clinic that includes our psychologists and our social workers. We also have our adolescent and nutrition clinic. That is a clinic that focuses on not only a holistic approach to nutrition, but performance nutrition. We also have our eating disorders clinic. Also a multidisciplinary clinic that has our adolescent trained physicians in addition to our psychologists and our social workers. That clinic focuses on eating disorders and disordered eating. We have our FAB clinic, which is our female adolescent bleeding clinic. The FAB clinic is a women and girl’s bleeding disorder clinic of excellence. We do that clinic with our pediatric hematologists. That clinic is a wonderful clinic where we have young women who bleed too much, young women who bleed too little, and also young women who have painful periods. We also have our long-acting reversible contraception clinic. We have our LEAH clinic, which is our Leadership in Education and Adolescent Health clinic; our SHINE clinic, which is our pediatric weight management clinic; and our substance use assessment clinic.
Host: Okay. Okay. So let’s dive into a few of those clinics and just give a little bit more detail for people who may not understand what they're all about. So you mentioned on the eating disorders clinic, it’s not just anorexia and bulimia but also disordered eating, which could include many other things, right?
Dr. Durant: Yes, yes. So we have patients there who may not eat criteria for anorexia nervosa or bulimia, but some kids who may have trouble with different textures of certain types of foods or who may have had an event that just tipped off them not eating for a certain period of time and who are having trouble getting back to eating. So we see those types of patients as well.
Host: Okay. Dr. Coyne-Beasley, tell us a little bit more about the ADHD or attention deficit hyperactivity disorder clinic. We can delve into that one.
Dr. Coyne-Beasley: Yeah. This is a common clinic that we get referrals too, particularly from people who may not be performing up to par or performing up to expectations in school. The nice thing about this clinic is not only are we able to do standard evaluations and management for ADHD, we’re actually able to differentiate some things that are commonly mistaken for ADHD such as behavioral disorders or impulsivity or even anxiety. So in fact working in concert with our psychologists—if someone requests a more thorough evaluation—can do a series and battery of tests that can help us more define what the hyperactivity may be or what the attention deficit might actually be and provide more of a specific diagnostic diagnosis as well as providing better management and more specific management and treatment.
Host: Okay. So you're going more in-depth with those test and just trying to find out the root causes maybe.
Dr. Coyne-Beasley: The root cause.
Host: Okay. So next is the LEAH clinic. First of all, what does LEAH mean?
Dr. Durant: LEAH means Leadership in Education and Adolescent Health. I'm so glad you asked this question because we are proud to be one of seven LEAH clinics in the country and the only LEAH clinic in the southeast.
Host: Oh, wow.
Dr. Durant: Yes. So we would love for people to refer to this clinic. This clinic is for our children, our adolescents and young adults, who have complex medical problems and psychosocial needs. What makes this clinic so wonderful is that we have medical doctors, we have phycologists, we have social work, we have nutrition, and we have nursing. These are all providers who are being trained to be leaders in adolescent health, and they're all there at one time. So you can be referred directly into this clinic to get help in all those areas for your young person.
Host: Okay. Y’all were saying that some kids are referred directly into the LEAH clinic based on their symptoms and then others are referred once they’ve seen one of you guys in the adolescent health center and then you feel like they're a candidate for the LEAH.
Dr. Durant: That’s correct. That’s correct.
Host: Okay. Are these appointments going on and on like follow up? I would imagine when you’ve got a complex patient like that--
Dr. Durant: They are. You start with an initial appointment. Then usually the adolescent and young adult continues to follow in the LEAH clinic with those providers. So it’s quite a longitudinal experience and quite a rewarding experience for those patients and families.
Host: Okay. Then let’s talk about the FAB clinic. By the way, for a clinic that has to do with young girls and women, how appropriate, FAB.
Dr. Durant: Yes, yes. It makes it sound like some place that you want to come to, which is what we want for our young people. So the Female Adolescent Bleeding clinic is something that we recently started. Again, it’s a partnership with pediatric hematology here. We are part of a national network of women and girls bleeding disorders clinic of excellence.
Host: Wonderful. So this is something that you said earlier. It could be that they're having a lot of bleeding, they're having very little, they're just concerned about what’s going on and what may be the cause.
Dr. Durant: Yes, yes. Now for that clinic specifically—for the FAB clinic—that’s more of our young women who are having too many periods or too many periods that are painful.
Host: Okay.
Dr. Coyne-Beasley: I think the other thing though that I would just like to highlight about your clinic that’s very special—and Dr. Durant is actually the director of our FAB clinic—is that sometimes a menstrual disorder, when someone is bleeding too much, it’s really just the sign of symptom that there’s a bleeding disorder going on. So it may manifest itself as lots of bleeding. But through being evaluated, you can actually find our well maybe you actually have a bleeding disorder such as Von Willebrand or something else.
Host: Okay.
Dr. Coyne-Beasley: So it’s not just about periods, but often periods are the symptoms that bring people in for their bleeding disorder.
Host: Okay. So any other services that you’d like to highlight as part of the adolescent clinic?
Dr. Coyne-Beasley: We provide assessment and screening for mental health issues among all of our patients because often times young people are struggling with mental health issues and you don’t even know if because they don’t have anyone they feel that they can talk to. So we screen all of our patients who come in for their well exams. We also are the only place that actually provides management of individuals who are at high risk for HIV infection with pre-exposure prophylaxis, which is a medication that actually decreases their risk of getting HIV. There’s nowhere else in the surrounding area that provides it to young people under the age of 18.
The other really important thing that we do that parents may not be thinking of and even the adolescents themselves is transition care. We provide a service to actually help young people transition into adult care. That’s particularly important not only if your person has a chronic illness such as diabetes or hypertension or obesity, but even people who are well need to be able to transition successfully into adult care.
Host: Yeah. I would think sometimes there’s some anxiety associated with that because a child or adolescent has been seeing a particular provider, particular medical doctor for so long, and then they will need to transition over and become an adult and see someone else. So they may have some anxiety associated with that.
Dr. Coyne-Beasley: Right. We try to alleviate that anxiety and help them to think about issues about how they're going to support that transition financially because there’re actually insurance issues to consider as well.
Host: Absolutely. One of the hot topics that we have to address today dealing with adolescents is vaping, juuling. It was in the news this morning on Good Morning America talking about the lungs and how they're effected, some of the research that’s now coming out about how dangerous it is. It is a nicotine product, correct?
Dr. Durant: Correct. It is a nicotine product. We do screen for vaping and juuling in our clinic. When we have young people who are engaging in that behavior, we do make them aware that it is a nicotine based product. That you can become addicted. We can help young people with that. We give them educational resources and we can also engage them in a process called motivational interviewing. This allows the young person to set their own goals. It helps them become engaged in the process of decreasing that addiction.
Dr. Coyne-Beasley: Motivational interviewing is actually a process that can be used with a lot of risk taking behaviors. Again, as Dr. Durant has said, you allow the young person to participate with you in developing their goals for decreasing whatever behavior that may be in a way that is acceptable to them and decreasing it hopefully to the point of eliminating that. We actually, again, do that in conjunction with our psychologists.
Host: So now a little bit about you guys as physicians. What led you into adolescent medicine? What led you into this field? Then also what keeps you so passionate about it today? Obviously you guys are passionate about what you do every day. These adolescents, these teens, they bring you to work every day.
Dr. Coyne-Beasley: I actually am trained as a pediatrician and an internist. So I started out doing internal medicine pediatrics first. Then when it came time for me to think about what I might like to specialize in, it was clear to me that I wanted to focus on adolescent health. Part of the reason was there’s an exciting group of young people who actually have the potential to change the world. Their trajectory, their ability to learn, their ability to be creative is incredibly undervalued. It was so undervalued that I actually wanted to help augment that. That is so much more overshadowed by all the risk taking behavior that people talk about, but risk taking is normative. It’s something that all of us went through if we’ve become adults. So what I wanted to do was to be able to focus on a young group of people that had the potential, had great potential to change the world, to make it better, and who were being kind of left out of that discussion. They also have real issues, real medical issues. It’s a great group of individuals. Most of them are healthy. Most of them will be healthy regardless of their risk taking behavior, and that can really just be supported through their psychosocial means whether that be physicians or psychologists or the people that we work with in our clinics.
Host: Okay. Dr. Durant?
Dr. Durant: So I'm trained in pediatrics and then chose to go into adolescent medicine because young people are so vibrant. What I saw in young people and going into adolescent medicine was the ability to make impactful change. That if I could be a mentor to the young patients that I was seeing, that if I could just support them through that period in their lives, then that they would be more than okay. They could do great things. What I saw when I was in medical school was that there were a lot of adolescents who were struggling that just did not have a lot of support. That what they needed was support in their lives from teachers and from doctors and nurses and all different kinds of professionals. That if they could just get that little push then they might get over the different barriers that they had. Then they could be successful. I saw an opportunity to make an impact. I thought the best way to do that would be through adolescent medicine.
Host: Wonderful. It sounds like a common thread and the reason why you guys are so passionate. Really trying to make a difference when that child is on the cusp of okay, can I go this way or that way? You want to be able to steer them in the right direction. So we have some exciting news about the adolescent health center. You guys have recently renovated, expanded. Tell us about that.
Dr. Coyne-Beasley: So we’re really grateful to Children’s of Alabama for allowing us to expand our clinical setting. This gives us the opportunity to provide more services, to see more patients in a facility that’s adolescent friendly and gives us the opportunity to also engage more with technology with our young people as well. So we’re excited about that space. We actually are operating in that space. We moved into it two weeks ago. We’ll be having an open house at the end of the month and we just really invite people to come by and to see us and to recognize as Dr. Durant already said that every adolescent between the ages of 11 and 21 should have a visit with an adolescent provider whether they feel like they need it or not. Because we really need to make sure that they're seen at least once a year to assess for any risk taking behavior but also to assess for their resiliency. What are the things in their strengths that they have that we can augment to help them to be successful, to help them to even realize that they're strengths for them.
We also need to do immunizations. We also need to make sure that people are doing well. So when we screen and we see that someone isn’t vaping, we can provide positive reinforcement. We take on a strength based framework or resiliency to help the young person realize what is good and what is wonderful about themselves and how they can build on those strengths that they have.
Host: Okay. So let’s talk about how patients and parents can get ahold of you guys to get their patients into clinic. Can they self-refer, or do they need to have a referral from a primary care physician?
Dr. Durant: Yes. So if you would like to establish care at the adolescent health center for primary care appointments, you can self-refer. We would love for you to do that. You can call 205-639-9231. If you want an appointment in our sub-specialty clinics, you can have your primary care doctor to refer to our clinic. If you want to come for a same day appointment for a primary care appointment, you actually can come in same day. The best thing to is to call that number 205-635-9231 early in the morning starting at 8:00. Our hours are Monday through Friday 8:00 to 5:00 p.m.
Host: Okay. For more information, you can go to our website. It’s childrensal.org/adolescentmedicineclinics. Thanks so much you guys for joining us today.
Dr. Durant: Thank you.
Dr. Coyne-Beasley: Thank you.
Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at childrensal.org/insidepediatrics.
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I'm Tiffany Kaczorowski and today we’re talking about adolescent medicine with two physicians here at Children’s of Alabama. Dr. Tamera Coyne-Beasley is the division director of adolescent medicine. She’s a professor in the department of pediatrics at UAB—the University of Alabama at Birmingham—and she’s also the vice chair of community engagement. Dr. Nefertiti Durant is medical director of the William A. Daniel Jr. Adolescent Health Center, and she’s an associate professor in the UAB department of pediatrics. Both of these doctors have been working with adolescents from tweens to teens and beyond for over 20 years. So welcome ladies.
Tamera Coyne-Beasley MD, MPH (Guest): Thank you.
Nefertiti Durant MD, MPH (Guest): Thank you.
Host: So one of the things I just wanted to ask, very basic question, what is adolescent medicine?
Dr. Coyne-Beasley: Well thank you for asking that questions. Adolescent medicine is an exciting specialty that actually focuses on and takes into consideration the unique physical, psychological, social, and sexual health needs of young adolescents and puts it in the framework of their normal development.
Host: Is this a fairly new specialty? When you're thinking about just medicine in general and the development of medicine, is adolescent medicine as a focus?
Dr. Coyne-Beasley: Yeah. It is a relatively new specialty, but it’s been in existence for over 50 years. It really developed as we began to understand in a profession that adolescence is a time period where you have very unique situations. Whether it be the things that we see in the changes in body that come along with puberty, but it also is related to some of the tremendous social pressures they have. Whether that be how do they fit it, what’s the peer pressure they're experiencing, and how do they do well and excel in school? It’s a time also when they're trying to develop their social and emotional identity in the context of a world that might actually send them different messages—for instance—about their moral identity and what they should care about.
Host: Sure, okay. So one of the things that we have discussed before is the fact that adolescents can come to an adolescent clinic regardless of whether they have some of those issues that you mentioned, or if it’s just more for a well check or a well visit. Just to be able to address those specific needs. You guys are going to be asking those questions related to those peer pressures and those social anxieties and things like that, right?
Dr. Coyne-Beasley: Yes.
Host: Okay.
Dr. Coyne-Beasley: I guess just for the audience’s understanding. When we talk about the patients that we see as adolescent medicine specialist, that generally is between the ages of 11 to 26. Although, most people will only be able to see people in their clinic until age 21 because of system related issues.
Host: Sure.
Dr. Coyne-Beasley: It’s not arbitrary. I mean the reason why it actually goes up to age 21 or 26 as opposed to 18 as many people think is that we know that the young brain is still developing, and that young people think about things differently. That can be motivated more about things that bring them immediate gratification as opposed to the concrete thinking that they may have as they get older.
Host: Right. Yeah, they might be more impulsive. Well, we think of teenagers as being much more impulsive.
Dr. Coyne-Beasley: Sure, but they still have cognitive abilities to think through some things given guidance.
Host: So Dr. Durant, what are some of the common issues that adolescents may face today? We touched on it earlier with Dr. Coyne-Beasley.
Dr. Durant: So there are many more social pressures today than, of course, we faced as kids. Some of those social pressures come because of so much exposure to the internet and social media. One important issue is bullying. Of course, bullying today is much different from what it was for us. So one thing that we talk about frequently in our visits is cyber bullying. So kids have to be very careful with social media and cyber bullying. There’s also depression. There’s substance use. There’s violence. There’s obesity, and there’s also alcohol use.
Host: I would think also just anxiety in general because the pressure is on when you're going to school at this age. When you're a teenager, the pressure is one because you're thinking about college or trade school or jobs.
Dr. Durant: Yes, yes. So there’s those normal everyday pressures and thinking about your performance. There’s also thinking about your performance in sports and athletics and how people perceive you. There is body image—thinking that you're too big or too small. There are all those types of things to think about.
Dr. Coyne-Beasley: I think what gives us an advantage—particularly at our health center—is that we actually have a multidisciplinary approach. So when we’re talking about the health of young people, we’re talking really about the health and wellbeing of adolescents. So that includes their psychosocial health, that includes their nutrition. So in our clinics we also—in addition to having physicians who are trained in adolescent medicine—we also have individuals who are nurses, who are psychologists, who are actually nutritionists and social workers all working in our clinic. Many of them have actually been trained to be leaders in adolescent health.
Host: So it’s really a multidisciplinary clinic. It’s a clinic that encompasses all of these different facets, all of the different types of needs that these patients may have all in one.
Dr. Coyne-Beasley: Yes, and that’s the goal. We really believe—and the profession of adolescent medicine believes —that you really are able to more comprehensively deal and provide the health and wellbeing care that young people need when you have a multidisciplinary team that looks at the young person as a whole individual—his body and mind.
Host: Okay. List some of the clinics that you guys do have. Some of those subspecialty clinics that pediatricians or family practice doctors might refer to.
Dr. Durant: Yes. So we have our ABHD clinic. As Dr. Coyne-Beasley mentioned, that is a multidisciplinary clinic that includes our psychologists and our social workers. We also have our adolescent and nutrition clinic. That is a clinic that focuses on not only a holistic approach to nutrition, but performance nutrition. We also have our eating disorders clinic. Also a multidisciplinary clinic that has our adolescent trained physicians in addition to our psychologists and our social workers. That clinic focuses on eating disorders and disordered eating. We have our FAB clinic, which is our female adolescent bleeding clinic. The FAB clinic is a women and girl’s bleeding disorder clinic of excellence. We do that clinic with our pediatric hematologists. That clinic is a wonderful clinic where we have young women who bleed too much, young women who bleed too little, and also young women who have painful periods. We also have our long-acting reversible contraception clinic. We have our LEAH clinic, which is our Leadership in Education and Adolescent Health clinic; our SHINE clinic, which is our pediatric weight management clinic; and our substance use assessment clinic.
Host: Okay. Okay. So let’s dive into a few of those clinics and just give a little bit more detail for people who may not understand what they're all about. So you mentioned on the eating disorders clinic, it’s not just anorexia and bulimia but also disordered eating, which could include many other things, right?
Dr. Durant: Yes, yes. So we have patients there who may not eat criteria for anorexia nervosa or bulimia, but some kids who may have trouble with different textures of certain types of foods or who may have had an event that just tipped off them not eating for a certain period of time and who are having trouble getting back to eating. So we see those types of patients as well.
Host: Okay. Dr. Coyne-Beasley, tell us a little bit more about the ADHD or attention deficit hyperactivity disorder clinic. We can delve into that one.
Dr. Coyne-Beasley: Yeah. This is a common clinic that we get referrals too, particularly from people who may not be performing up to par or performing up to expectations in school. The nice thing about this clinic is not only are we able to do standard evaluations and management for ADHD, we’re actually able to differentiate some things that are commonly mistaken for ADHD such as behavioral disorders or impulsivity or even anxiety. So in fact working in concert with our psychologists—if someone requests a more thorough evaluation—can do a series and battery of tests that can help us more define what the hyperactivity may be or what the attention deficit might actually be and provide more of a specific diagnostic diagnosis as well as providing better management and more specific management and treatment.
Host: Okay. So you're going more in-depth with those test and just trying to find out the root causes maybe.
Dr. Coyne-Beasley: The root cause.
Host: Okay. So next is the LEAH clinic. First of all, what does LEAH mean?
Dr. Durant: LEAH means Leadership in Education and Adolescent Health. I'm so glad you asked this question because we are proud to be one of seven LEAH clinics in the country and the only LEAH clinic in the southeast.
Host: Oh, wow.
Dr. Durant: Yes. So we would love for people to refer to this clinic. This clinic is for our children, our adolescents and young adults, who have complex medical problems and psychosocial needs. What makes this clinic so wonderful is that we have medical doctors, we have phycologists, we have social work, we have nutrition, and we have nursing. These are all providers who are being trained to be leaders in adolescent health, and they're all there at one time. So you can be referred directly into this clinic to get help in all those areas for your young person.
Host: Okay. Y’all were saying that some kids are referred directly into the LEAH clinic based on their symptoms and then others are referred once they’ve seen one of you guys in the adolescent health center and then you feel like they're a candidate for the LEAH.
Dr. Durant: That’s correct. That’s correct.
Host: Okay. Are these appointments going on and on like follow up? I would imagine when you’ve got a complex patient like that--
Dr. Durant: They are. You start with an initial appointment. Then usually the adolescent and young adult continues to follow in the LEAH clinic with those providers. So it’s quite a longitudinal experience and quite a rewarding experience for those patients and families.
Host: Okay. Then let’s talk about the FAB clinic. By the way, for a clinic that has to do with young girls and women, how appropriate, FAB.
Dr. Durant: Yes, yes. It makes it sound like some place that you want to come to, which is what we want for our young people. So the Female Adolescent Bleeding clinic is something that we recently started. Again, it’s a partnership with pediatric hematology here. We are part of a national network of women and girls bleeding disorders clinic of excellence.
Host: Wonderful. So this is something that you said earlier. It could be that they're having a lot of bleeding, they're having very little, they're just concerned about what’s going on and what may be the cause.
Dr. Durant: Yes, yes. Now for that clinic specifically—for the FAB clinic—that’s more of our young women who are having too many periods or too many periods that are painful.
Host: Okay.
Dr. Coyne-Beasley: I think the other thing though that I would just like to highlight about your clinic that’s very special—and Dr. Durant is actually the director of our FAB clinic—is that sometimes a menstrual disorder, when someone is bleeding too much, it’s really just the sign of symptom that there’s a bleeding disorder going on. So it may manifest itself as lots of bleeding. But through being evaluated, you can actually find our well maybe you actually have a bleeding disorder such as Von Willebrand or something else.
Host: Okay.
Dr. Coyne-Beasley: So it’s not just about periods, but often periods are the symptoms that bring people in for their bleeding disorder.
Host: Okay. So any other services that you’d like to highlight as part of the adolescent clinic?
Dr. Coyne-Beasley: We provide assessment and screening for mental health issues among all of our patients because often times young people are struggling with mental health issues and you don’t even know if because they don’t have anyone they feel that they can talk to. So we screen all of our patients who come in for their well exams. We also are the only place that actually provides management of individuals who are at high risk for HIV infection with pre-exposure prophylaxis, which is a medication that actually decreases their risk of getting HIV. There’s nowhere else in the surrounding area that provides it to young people under the age of 18.
The other really important thing that we do that parents may not be thinking of and even the adolescents themselves is transition care. We provide a service to actually help young people transition into adult care. That’s particularly important not only if your person has a chronic illness such as diabetes or hypertension or obesity, but even people who are well need to be able to transition successfully into adult care.
Host: Yeah. I would think sometimes there’s some anxiety associated with that because a child or adolescent has been seeing a particular provider, particular medical doctor for so long, and then they will need to transition over and become an adult and see someone else. So they may have some anxiety associated with that.
Dr. Coyne-Beasley: Right. We try to alleviate that anxiety and help them to think about issues about how they're going to support that transition financially because there’re actually insurance issues to consider as well.
Host: Absolutely. One of the hot topics that we have to address today dealing with adolescents is vaping, juuling. It was in the news this morning on Good Morning America talking about the lungs and how they're effected, some of the research that’s now coming out about how dangerous it is. It is a nicotine product, correct?
Dr. Durant: Correct. It is a nicotine product. We do screen for vaping and juuling in our clinic. When we have young people who are engaging in that behavior, we do make them aware that it is a nicotine based product. That you can become addicted. We can help young people with that. We give them educational resources and we can also engage them in a process called motivational interviewing. This allows the young person to set their own goals. It helps them become engaged in the process of decreasing that addiction.
Dr. Coyne-Beasley: Motivational interviewing is actually a process that can be used with a lot of risk taking behaviors. Again, as Dr. Durant has said, you allow the young person to participate with you in developing their goals for decreasing whatever behavior that may be in a way that is acceptable to them and decreasing it hopefully to the point of eliminating that. We actually, again, do that in conjunction with our psychologists.
Host: So now a little bit about you guys as physicians. What led you into adolescent medicine? What led you into this field? Then also what keeps you so passionate about it today? Obviously you guys are passionate about what you do every day. These adolescents, these teens, they bring you to work every day.
Dr. Coyne-Beasley: I actually am trained as a pediatrician and an internist. So I started out doing internal medicine pediatrics first. Then when it came time for me to think about what I might like to specialize in, it was clear to me that I wanted to focus on adolescent health. Part of the reason was there’s an exciting group of young people who actually have the potential to change the world. Their trajectory, their ability to learn, their ability to be creative is incredibly undervalued. It was so undervalued that I actually wanted to help augment that. That is so much more overshadowed by all the risk taking behavior that people talk about, but risk taking is normative. It’s something that all of us went through if we’ve become adults. So what I wanted to do was to be able to focus on a young group of people that had the potential, had great potential to change the world, to make it better, and who were being kind of left out of that discussion. They also have real issues, real medical issues. It’s a great group of individuals. Most of them are healthy. Most of them will be healthy regardless of their risk taking behavior, and that can really just be supported through their psychosocial means whether that be physicians or psychologists or the people that we work with in our clinics.
Host: Okay. Dr. Durant?
Dr. Durant: So I'm trained in pediatrics and then chose to go into adolescent medicine because young people are so vibrant. What I saw in young people and going into adolescent medicine was the ability to make impactful change. That if I could be a mentor to the young patients that I was seeing, that if I could just support them through that period in their lives, then that they would be more than okay. They could do great things. What I saw when I was in medical school was that there were a lot of adolescents who were struggling that just did not have a lot of support. That what they needed was support in their lives from teachers and from doctors and nurses and all different kinds of professionals. That if they could just get that little push then they might get over the different barriers that they had. Then they could be successful. I saw an opportunity to make an impact. I thought the best way to do that would be through adolescent medicine.
Host: Wonderful. It sounds like a common thread and the reason why you guys are so passionate. Really trying to make a difference when that child is on the cusp of okay, can I go this way or that way? You want to be able to steer them in the right direction. So we have some exciting news about the adolescent health center. You guys have recently renovated, expanded. Tell us about that.
Dr. Coyne-Beasley: So we’re really grateful to Children’s of Alabama for allowing us to expand our clinical setting. This gives us the opportunity to provide more services, to see more patients in a facility that’s adolescent friendly and gives us the opportunity to also engage more with technology with our young people as well. So we’re excited about that space. We actually are operating in that space. We moved into it two weeks ago. We’ll be having an open house at the end of the month and we just really invite people to come by and to see us and to recognize as Dr. Durant already said that every adolescent between the ages of 11 and 21 should have a visit with an adolescent provider whether they feel like they need it or not. Because we really need to make sure that they're seen at least once a year to assess for any risk taking behavior but also to assess for their resiliency. What are the things in their strengths that they have that we can augment to help them to be successful, to help them to even realize that they're strengths for them.
We also need to do immunizations. We also need to make sure that people are doing well. So when we screen and we see that someone isn’t vaping, we can provide positive reinforcement. We take on a strength based framework or resiliency to help the young person realize what is good and what is wonderful about themselves and how they can build on those strengths that they have.
Host: Okay. So let’s talk about how patients and parents can get ahold of you guys to get their patients into clinic. Can they self-refer, or do they need to have a referral from a primary care physician?
Dr. Durant: Yes. So if you would like to establish care at the adolescent health center for primary care appointments, you can self-refer. We would love for you to do that. You can call 205-639-9231. If you want an appointment in our sub-specialty clinics, you can have your primary care doctor to refer to our clinic. If you want to come for a same day appointment for a primary care appointment, you actually can come in same day. The best thing to is to call that number 205-635-9231 early in the morning starting at 8:00. Our hours are Monday through Friday 8:00 to 5:00 p.m.
Host: Okay. For more information, you can go to our website. It’s childrensal.org/adolescentmedicineclinics. Thanks so much you guys for joining us today.
Dr. Durant: Thank you.
Dr. Coyne-Beasley: Thank you.
Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at childrensal.org/insidepediatrics.