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Melanie Cole (Host):  This is the UK Health Podcast on COVID-19 dated April 30, 2020.

These are unprecedented time for medical care across the board. But for teens, this can be an especially difficult time. This is UK HealthCast with the University of Kentucky Healthcare. Today, we’re talking about adolescent Telemedicine and how we can help our teens during this pandemic. Joining me is Dr. Alissa Briggs, she’s a licensed Psychologist and an Assistant Professor of Pediatrics and Dr. Mandakini Sadhir. She’s an Assistant Professor of Pediatrics and Board-Certified in Adolescent Medicine and they are both at UK HealthCare. Dr. Sadhir, I’d like to start with you. What is Adolescent Medicine and how does it help teens at this time but really all the time?

Mandakini Sadhir, MD, FAAP (Guest):  Yeah, thank you Melanie. I’m glad to be a part of our discussion here and as you mentioned, this is such an extremely important topic during this time. So, our Adolescent Medicine is a subspecialty that provides primary as well as consultative care to address adolescent concerns. As we all know, adolescence is a time period which is marked by physical, emotional and cognitive development. And teens are going through many physical and emotional changes and they are searching for independence. This time can be fun and exciting however, teens are also partaking in many risky behaviors that can have many long lasting and serious effects on their physical and emotional health.

And teens are often struggling with interpersonal relationships, dating violence, body image, sexual or gender identity concerns. And this puts them at risk for various mood disorders such as anxiety, depression, eating disorders, substance use, sexually transmitted diseases and teen pregnancy. In our Allison Medicine Clinic, our providers they specialize in taking care of teens and they spend a lot of time with teenagers to screen for risk taking behaviors, they talk with teens about how these behaviors can have long impact on their overall health. We have a team of medical and behavioral health providers and dieticians who provide this comprehensive patient centered care to our patients and families.

For Adolescent Medicine, our clinic follows those federal and Kentucky confidentiality guidelines and regulations for patient privacy of teenagers. So, pretty much our goal in Adolescent Medicine is to be there for teens and make sure we address their unique needs through our team approach and that addresses not just their physical but as well as their mental health as well.

Host:  Well thank you for that answer Dr. Sadhir and I’m going to stick with you for just a minute. One of the things in Adolescent Medicine I think is so important and you mentioned privacy and confidentiality; teens don’t always want to talk about their issues or tell the truth about those unsafe practices and certainly, right now, with the mental anxiety going on; assure the parents about the confidential care you are able to offer. What does that mean?

Dr. Sadhir:  The confidential care basically means that the provider whether it’s a medical or a mental health provider, they take time to talk to the teenagers and they assure confidentiality. What confidentiality means that whatever conversation the teen is going to have with the provider, is going to stay with the provider. The provider is not going to share the information to the parents unless there are certain conditions. And those conditions are typically related to safety. One very important thing is that we as providers, we want to ensure that we take care of teen and ensure their safety. So, while most of the information stays confidential, that means we don’t share with the parents, but safety is most important and that’s where we would reassure parents that we will do everything to make sure that the child is safe.

So, some of the conditions that we often talk to families just in the beginning of the visit or for the initial visit is that for me, as a doctor, to share information with parents I have this discussion with the child and the parent in the room and say, I’m going to talk to your child and when your child’s health means that they are at risk for self-harm or they want to hurt themselves, they want to hurt others or they have been exposed to any kind of physical, sexual or emotional abuse; that’s where I am going to involve parents and or the legal guardians to make sure the child is safe. Obviously, before that, I always take permission from the teenager to make sure that they are okay with it. So, that is what typically means confidential care that there are certain things that I cannot disclose to parents. But obviously, we always talk about, it’s always good to have an open and honest communication between a parent and their child and we are there to help support teens and families and provide resources how that can happen.

Host:  It’s so important. And Dr. Briggs, I think this is just such an important question. During these times of social isolation, I’m sure there are a lot of teens who are struggling with not being able to see their friends and might be dealing with anxiety and depression. I have two teens. So, I know that they are absolutely dealing with this right now. It’s pervasive. What are some signs parents should look our for to determine if their child is going through something more than just normal teen issues. This is as I said in the intro, unprecedented. What should we be looking for with our teens right now you know to see and red flags to notice that something more is going on?

Alissa Briggs, PhD (Guest):  Right Melanie. I think that’s a very important question and a lot of times it can be difficult to determine whether this is typical behavior of a teen or something more. During regular times and during these times as well. I think a primary find during this time would be anger. Anger is common when somebody experiences trauma and I think it’s safe to say that what we’re going through now is traumatic. So, anger protects us from what we feel like is unfair or difficult emotions and when teens don’t know what to do with the frustration or the hurt or sadness, they feel from this situation it would make a lot of sense for them to feel angry. And sometimes they misdirect this at other people so you may experience teens kind of lashing out and talking back more, seeming to overreact more from time to time. And all of this happens on occasion with teens because they do feel emotions more intensely than really any other age group.

But what you would be looking for is really kind of maybe more frequent outbursts or expression of anger than maybe what you have seen before. So, I think that would be a really important sign that they are struggling. I think what is also true too for us is that a lot of us are struggling to maintain a regular schedule during this time. And teens sleep in but I think if they are spending more than twelve hours a day in bed or just having a really difficult time getting out of bed; that would be a sign of concern as well. I think also, a lot of us are probably eating – overeating maybe or eating more processed foods during this time and we feel stressed and we want comfort. But I think you would want to look for any dramatic change in appetite in either direction, right like so complete loss of appetite or binge eating would be a sign of concern as well.

You may also notice your teen if they feel anxious or depressed, they might just look more fidgety or more restless or seem more on edge. They may talk more fast or more slowly than normal. They may be crying a lot. Although as a parent, you may not necessarily see this because they are going to try and keep this private. Another thing, another job of adolescence is to separate from parents and connect more with peers. Just to a certain extent it’s pretty normal for teens to go hide out in their room. But if you notice kind of increased withdrawal or they are not texting or chatting with their friends as much, that would also be a sign that they may be going through something a little more and struggling with some anxiety and depression.

Host:  Wow, Dr. Briggs, you hit the nail on the head with every single one of those things about teens hiding in their room and I checked off a bunch of boxes for my teens. So, Dr. Sadhir, if parents like me are checking off those boxes, based on what Dr. Briggs said, what resources are you able to offer teens who are dealing with anxiety and depression, all of these things that she mentioned? Tell us a little bit about individual and group therapy available.

Dr. Sadhir:  Absolutely. So, in our clinic, as I mentioned, we have a team of medical providers, mental health providers who are specializing in taking care of those concerns. So, parents can, if a parent is concerned about their teen, and they notice the symptoms that Dr. Briggs had mentioned, they can always call our clinic to schedule an appointment. Typically, when patients call, they are scheduled to see one of our medical providers who talks to the teen and the parent. They review their concerns, sort of go through their medical history. They do pretty extensive screening for mood concerns. They talk about some risk taking behaviors that the teen might be engaging in and after that, the medical appointment, the doctors meet with the teen and parents to sort of discuss some recommendations as to what are the next steps.

Now for the most part, when teens are struggling with anxiety and depression, counseling can be a great help. We do different types of individual, family or group counseling depending on what is going on with the teenager. And at the same time, if a child needs additional help through medications, that is also something that’s discussed. Now individual and group therapy, they play very important roles and they meet at various levels. Individual therapy is more focused on our counselors working with teenager on a more one on one basis and kind of addressing their concerns. And group therapy is more where you have a group of teenagers who work with our counselor to address different types of concerns.

And so, as I said, our approach is not to just do medication if a child is struggling. Our approach is a more holistic approach with doing combination of counseling and or medication as needed and as I said, counseling plays a really important role to help these kids dealing with their mood concerns and find ways to cope with that. And I think Dr. Briggs really specializes in individual and group therapy for our teenagers.

Host:  Well so Dr. Briggs, let’s talk about that a little bit. Tell us some of the benefits, but while you’re telling us that, right now, with this pandemic, Telemedicine and that’s what we’re talking about today. Tell us how that works. Tell us what you’re doing, how you are able to do these therapies via Telemedicine and group therapy as well. What can parents expect and how does that process work?

Dr. Briggs:  Right and so, we’re doing individual and group therapy through them. We have a secure account and actually we have somebody in our office who is kind of a technological wizard with it and he has set up an entire virtual clinic. So, when the teen comes in for a Telemedicine session, they are greeted by a registration person just like they would be in the clinic. That registration person gets them registered and either sends them into a virtual waiting room or sends them to me directly with a provider if they are ready. And then the session is conducted face to face through the screen through Zoom. And I think one of the benefits of being [00:13:02] during this time is that they’re generally pretty comfortable with Facetime and video chatting and I think a lot of them are really enjoying the opportunity to do Telemedicine and interact with their therapist in this way.

I’ve also found too that a lot of the adolescents are a lot more comfortable interacting with me through Zoom than even they are in the office. Because I think they feel a little more comfortable talking with their therapist from their own home than maybe they do when they come into an office. And when I’ve done group therapy sessions through Zoom, I found that the adolescents are actually more engaged than they are when they come into the clinic. I think the only concern would be there are some adolescents who struggle to access a good internet connection especially if they live in more rural areas or they struggle to access privacy depending upon their living situation and so, Telemedicine would not be ideal for them. But for a lot of the patients we serve, they’ve actually really enjoyed it, they enjoy connecting with an adult therapist that way.

Host:  What a great point. I mean the kids know about these things way more than the parents at this point. I mean we are all learning, right? This is all learning on the go as far as Telemedicine and Zoom and it’s happening across the medical spectrum. Dr. Briggs, aside from helping the teens get connected with their mental health issues and with professional; speak to parents for me. Tell them how they can help support their kids. I’m listening. Parents are listening. What do you want us to know about getting them out of their rooms or getting them out of bed or really making sure that we observe these red flags, we notice them and what can we do to help them?

Dr. Briggs:  Right. I have a close friend who is also a therapist and she said one thing her stepmom did when she was a teen that made a huge difference is, they had a routine where every Friday night she and her stepmom would sit down and play Rummikub. And she said that was just so important for her. Sometimes she didn’t talk with her stepmom at all, but it gave her the opportunity to share with your stepmom what was going on with her in kind of a nonthreatening, nonconfrontational way. So, I think engaging with teens in nonscreen activities like card and board games, having a family game night would be so important right now. And I think teens may find it easier to open up with their parents either while they are engaged in activity.

In addition, it helps build a relationship between the teen and the parents so they may feel more comfortable coming to them or coming to you at another time. I think what’s also important is to just role with resistance. So, allow teens to express why they don’t want to do X, Y, or Z, empathize with them, use validation, so acknowledge how they are feeling and why, like I hear you are feeling upset because your online courses are just so irritating. If they feel understood and heard, they may feel safe enough to open up more. They may also be kind of less defensive when it comes to the time that you need to engage in problem solving with them or negotiation or offer some suggestions.

But I would say, also to just kind of be patient with this process. It takes time for teens to kind of air out their thoughts and feelings and for them to feel heard. I know as parents; you really want to have your teens talk with you about what’s going on, but I think it’s really important not to push or demand that they talk with you. This will just kind of build resistance and build that wall between you and your teen. So, I think instead, just remind them that you are there for them and you are ready to support them if they need you.

A question I really like to ask of your kids is what do you need from me right now. How can I support you? I think that comes off very different than tell me what’s going on with you. When you ask your teen how they are doing, or how they are feeling; I think it’s really important to be in a situation or setting where you have the time and capacity to sit down and truly listen to them. I think they can tell the difference between a general how are you doing today and really tell me how you are feeling. I’m here to listen to you.

And I also think as parents, it’s okay for you to say things like this is hard. I’m so frustrated with this whole cold social isolation thing. I think modeling being honest about your feelings is really helpful for our teens to hear. And they may relate with you and then you may open a door for them expressing their own thoughts and worries. And I think the other thing is teens of course miss their friends. There are some creative ways that they have found to connect with their friends that parents could be supportive of that are safe whether it be one teen sits on a front porch and the other sits in the front yard and they get to have lunch together that way. Or you can brainstorm with them ways that they can connect with their friends.

Host:  What great advice. Absolutely spot on. So, Dr. Sadhir, as we wrap up and I’d like to give you each a chance to sort of wrap up and let the UK Healthcare community know what you would like them to know about Adolescent Telemedicine and what our teens are going through at this time. So, Dr. Sadhir, give us your best advice and what you’d like them to know as an Adolescent Medicine Specialist about the difficulties at this time.

Dr. Sadhir:  Yeah, definitely. We’ve seen these are some challenging times and something that as a whole, we all are experiencing something new experience altogether for teenagers especially and for adults that means changing their daily routine and staying at home, not being able to interact with anybody. The whole social isolation and obviously the anxiety that the whole pandemic brings and the challenges that it’s bringing. Obviously, this pandemic has affected many families and so, what I just wanted to kind of mention that through Telemedicine, it has really given us the opportunity to reach out to families and teenagers. Previously the in-person visits of how we did things, but with Telemedicine we can reach out to all the teens and families who want to be connected. I just want to mention that we are here for them and we are here for teenagers. They can just call and get an appointment scheduled with us and we will be able to connect them to Telemedicine. Telemedicine, we have really been more comfortable with doing it through Facetime or face to face through the Zoom link. I’ve had parents who feel like it’s such a great opportunity that they are able to connect with us even though they are not able to come to the clinic but we are still able to provide the services they need and be able to do counseling for these patients who are in need for additional support and resources. With Telecare, we are here, and we would love to be able to be a resource for our teenagers as well as parents.

Host:  And Dr. Briggs, last word to you. What would you like parents of teens to know at this time about reaching out when they feel that their teens need a little extra help and the Adolescent Medicine Telemedicine program at UK Health?

Dr. Briggs:  I would like them to know that there is absolutely nothing wrong with reaching out for help. All of us are struggling during this time. Like I said, this is traumatic and it’s something that we’ve never had to navigate before. So, there’s definitely no shame in reaching out and I think no matter what’s going on and of course I say this with the bias of a therapist, but I believe a little bit of therapy is good for everybody. It’s helpful to have a neutral party to just sound off your thoughts and your feelings with and empathize with you and help you work through what to do next. And I think teens really appreciate having a neutral adult help them through this.

And they are really comfortable with the Telemedicine services we offer. Like I said, they are used to connecting with others through Facetime and through technology. And so I think of every age group our adolescents are really kind of most equipped to engage with our Telemedicine services.

Host:  Thank you both so much. What an excellent, informative segment. Thank you so much for joining us and sharing your incredible expertise for parents at this time. To learn how UK Healthcare is dealing with COVID-19, and for information including symptoms and prevention advice, please visit our website at www.ukhealthcare.uky.edu/covid19 and to learn more about Adolescent Medicine at UK Health please visit www.ukhealthcare.uky.edu. That concludes another episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all the other University of Kentucky Healthcare podcasts. I’m Melanie Cole.