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Fundamentals of Adolescent Care and Cultural Competence

Introduction

Adolescence is a time of dramatic physical, emotional, cognitive, and social change. The transitions that occur during adolescence and young adulthood usher youth into the social and sexual world as independent beings. These changes provide opportunities for positive growth experiences but they also bring new vulnerabilities.

Unfortunately, young people in the United States and other parts of the world are particularly vulnerable to HIV infection. One of the developmental markers of adolescence is the formation of a sexual identity; another marker is the propensity for taking risks. When mixed, these characteristics can be dangerous. Proof of that is reflected in the fact that half of all new HIV infections each year are estimated to occur among youth aged 13 to 24.

HIV-infected youth deserve care that is not only clinically competent but also culturally competent. The goal of this educational series is to provide clinicians with the basic tools needed to deliver culturally competent HIV clinical care and support to adolescent and young adult patients.

The information in this introductory module provides an overview of the HIV epidemic among youth in this country. One of the most significant lessons is that minority youth are especially at risk of HIV infection. Additionally, many Blacks/African Americans, American Indians/Alaska Natives (AI/AN), Asian Americans/Pacific Islanders (AA/PI), and Latino youth often experience significant disparities in health care. One of the greatest disparities these youth face is a health care system that is not sufficiently prepared to address the many ways that medicine and culture interact. This module offers an introduction to cultural competence in the health care arena and offers strategies for providers who are interested in beginning and maintaining the ongoing process of cultural competence training.

Following this introductory module are 4 additional modules that explore key domains of adolescent HIV care:

In Psychosocial Issues, the authors review the known challenges that frequently confront perinatally and behaviorally acquired HIV-infected youth as they negotiate adolescent development. The module also provides training on how to perform a brief psychosocial assessment (the HEADSS interview) that is sensitive to cultural norms particular to racial and ethnic minorities and lesbian, gay, bisexual, and transgender (LGBT) youth, with the aim of improving capacity to identify comorbid conditions and create a more bias-free and supportive clinical environment.

Antiretroviral Therapy and Adherence addresses the challenges of initiating antiretroviral medications for adolescent patients and helps providers to select regimens that are compatible with patients' different lifestyles. The module begins with an overview of general clinical care considerations for treating HIV-infected youth, and highlights important concepts that can facilitate culturally competent care.

In Transitioning Care, the authors offer providers practical strategies for devising transition plans for youth of different ages and races/ethnicities. The module explores the key issues related to transitioning from pediatric to adolescent and adult care settings, and guides participants to begin thinking about how cultural beliefs on growing up and becoming independent can influence a family's process of allowing an adolescent to assume responsibility for his or her own health care.

Prevention with Positives provides guidance to providers on how to work with young racial/ethnic minority HIV-infected patients to reduce their risk behaviors, with a goal of improving their health and reducing the annual number of new infections. The module discusses customized risk-reduction counseling for clinical providers that is culturally and developmentally appropriate for youth, and provides guidance to participants on how to integrate culturally competent prevention counseling into their care for HIV-infected patients.

This is not a textbook approach to teaching, nor should these modules be considered a comprehensive review of all issues relevant to provision of culturally competent HIV clinical care. Instead, the modules in this series focus on presenting the essential elements of several topics of particular concern to clinical providers working with HIV-infected youth. Our hope is that the information presented in these modules and the resources provided for further learning improve the clinical care delivered to HIV-infected racial/ethnic minority youth.

Learning Objectives

Upon completion of this module, providers will be able to:

  1. Describe the epidemiology of HIV among youth in terms of race, gender, and mode of infection.
  2. Integrate at least 3 concrete strategies for achieving cultural competence in their clinical practices.
  3. Appreciate at least 3 factors that put adolescents at increased risk of HIV infection.
  4. Identify at least 3 issues affected by culture that often challenge the relationship between providers and young HIV-infected patients.

Instructions

  • The course may be navigated either by selecting the "Next Page" button at the bottom of each screen, or by using the course outline buttons in the left navigation column.

  • All users will be asked to complete a final evaluation to help the sponsors assess the value of the course.