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Teaching SSHADESS v HEADSS to Medical Students:Association with Improved Communication and Increased Psychosocial Assessments

Coble, Chanelle; Srivastav, Shivani; Glick, Alexander; Bradshaw, Chanda; Osman, Cynthia
OBJECTIVE:The most recent Bright Futures edition describes both the HEADSS (Home, Education, Drugs, Sexuality, Safety) and the strength-based SSHADESS (Strengths, School, Home, Activities, Drugs, Emotions, Sexuality, Safety) frameworks for conducting an adolescent psychosocial history. We found limited research comparing the effectiveness of these two frameworks. Our study objective was to examine whether teaching medical students SSHADESS versus HEADSS is associated with increased communication skills and/or completion of the psychosocial assessment. METHODS:In this retrospective cohort study of pediatric clerkship students at NYU Grossman School of Medicine, we collected data from observer (faculty, fellow, and resident) and standardized patient (SP) assessments during Objective Structured Clinical Examinations. Primary outcomes were observer and SP-rated usage of communication skills. Secondary outcomes were observer-rated assessment of six psychosocial factors. Our predictor variable was whether students were taught HEADSS (11/2015-10/2016) or SSHADESS (11/2016-10/2017). We used Fisher's exact tests and then logistic regressions to adjust for pediatrics clerkship timing and baseline communication skills. RESULTS:200 students were assessed (n=97 HEADSS cohort, n=103 SSHADESS cohort). In adjusted analyses of observer scores, the SSHADESS cohort was more likely to use all communication skills (adjusted odds ratio [aOR] 3.2, 95% CI 1.7-6.3]) and assess all psychosocial factors (aOR 1.9, [95% CI 1.01-3.4]). There was no significant difference in SP communication scores. DISCUSSION/CONCLUSIONS:Teaching SSHADESS was associated with higher observer-rated communication skills scores and improved completeness in assessment of psychosocial factors. Future work should examine the efficacy of SSHADESS through workplace-based assessments and 360 degree assessments from adolescent patients.
PMID: 36130691
ISSN: 1876-2867
CID: 5328592

A Closer Look: Examination of Suicide Risk Screening Results and Outcomes for Minoritized Youth in Subspecialty Pediatrics

Lois, Becky H; Mournet, Annabelle M; Menz, Reagan; King, Mya; Malizia, Rebecca; Haines, Elizabeth; Coble-Sadaphal, Chanelle; Liaw, K Ron-Li
OBJECTIVE:To describe a sample of minoritized youth who screened positive for suicide risk within medical subspecialty pediatrics, compared to non-minoritized youth and describe the screening outcomes of these youth. METHODS:This retrospective chart review from October 2018 to April 2021 used electronic medical record data from an academic pediatric medical subspecialty clinic that screens universally for suicide risk for all patients ages 9 and up. Chart reviews were conducted for 237 minoritized youth (operationalized as identifying as non-White or Hispanic/Latinx, identifying as a gender minority, and having a preferred language other than English) who screened positive for suicide risk. Descriptive statistics include need for escalation to an emergency room, connection to mental health care, receival of a mental health referral, and attendance at follow-up visits. RESULTS:Minoritized youth were more likely to screen positive and report a history of suicide attempt when compared to non-minoritized peers. Youth identifying as gender expansive had significant elevation in suicide risk. The majority of youth in this sample were already connected to mental health care, with youth preferring a language other than English being the least likely to be connected. CONCLUSIONS:Findings indicate heightened suicide risk for minoritized youth, with gender expansive youth having particularly elevated suicide risk. A need to support youth with a preferred language other than English in getting connected to mental health care was also revealed.
PMID: 35597439
ISSN: 1876-2867
CID: 5247752

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 3.0

Gibson, Marie Eve S; Alaniz, Veronica I; Coble, Chanelle; Dumont, Tania; Howell, Jennifer O; Karjane, Nicole W; Lawson, Ashli A; Nur, Marcella; Parks, Melissa; Teelin, Karen L; Thieu, Hong-Thao; Romano, Mary
Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.
PMID: 33810968
ISSN: 1873-4332
CID: 4851222

Case of a Girl with Vaginal Discharge Who Has Sex with Girls

Chapter by: Coble, Chanelle; Futterman, Donna
in: Adolescent gynecology : a clinical casebook by Talib, Hina J
[S.l.] : Springer International, 2018
pp. 127-136
ISBN: 9783319669779
CID: 2793662

Description of Sexual Orientation and Sexual Behaviors among High School Girls in New York City

Coble, Chanelle A; Silver, Ellen J; Chhabra, Rosy
STUDY OBJECTIVE: Examination of the association of sexual orientation to the sexual practices and health behaviors of high school girls in New York City (NYC). DESIGN, SETTING, AND PARTICIPANTS: Data were drawn from the 2013 Youth Risk Behavior Surveillance System survey of public high school students in grades 9-12 in NYC. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Independent variables included sexual orientation and gender of sexual partners. Dependent variables include sexual/health risk behaviors. We used t tests to compare mean ages and chi2 tests to compare distributions according to sexual orientation, gender of sexual partners, and differences in risk behaviors. RESULTS: The survey was completed by 4643 girls; mean age, 15.5 years; (1103 + 1842)/4254 (69%) black or Latina; 1101/4000 (27.5%) sexually active; 3574/4412 (81%) heterosexual; and (92 + 526)/4412 (14%) sexual minorities; 24.1% were heterosexual, 52.1% lesbian, and 49.4% were bisexual girls and were sexually active; 247 were classified as women who have sex with women (WSW) or WSW and men (WSWM). Of the sexually active girls, (65 + 182)/1081 (23%) were WSW/WSWM. The WSW/WSWM reported earlier sexual debut, more sexual partners, higher pregnancy rate, use of alcohol at last sex, history of intimate partner violence, and less likelihood of having an HIV test. CONCLUSION: Almost one in four of sexually active high school girls in NYC can be classified as WSW, who are vulnerable to increased sexual and health risk-taking behaviors leading to adverse health outcomes. The discordance between sexual behavior and sexual orientation emphasizes the importance of the provider sharing protective strategies in the sexual health counseling session for their patients who engage in sex with female partners regardless of sexual orientation.
PMID: 28279826
ISSN: 1873-4332
CID: 2613842

Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital

Maslyanskaya, Sofya; Talib, Hina J; Northridge, Jennifer L; Jacobs, Amanda M; Coble, Chanelle; Coupey, Susan M
STUDY OBJECTIVE: To evaluate whether ovulatory dysfunction due to polycystic ovary syndrome (PCOS) is a common underlying etiology of abnormal uterine bleeding (AUB) in adolescents who require hospitalization and to explore etiology, treatment, and complications of AUB with severe anemia in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We identified female patients aged 8-20 years admitted to a children's hospital for treatment of AUB from January 2000 to December 2014. Our hospital protocol advises hormonal testing for PCOS and other disorders before treatment for AUB. We reviewed medical records and recorded laboratory evaluations, treatments, and final underlying diagnoses as well as recurrences of AUB and readmissions in the subsequent year. RESULTS: Of the 125 subjects, the mean age was 16.5 +/- 2.9 years; mean hemoglobin level was 7.0 +/- 1.8 g/dL; 54% were overweight/obese; and 41% sexually active. PCOS accounted for 33% of admissions; hypothalamic pituitary ovarian axis immaturity 31%; endometritis 13%; bleeding disorders 10%. Girls with PCOS were more likely to be overweight/obese (74% vs 46%; P < .01) and girls with hypothalamic pituitary ovarian axis immaturity had lower hemoglobin levels (6.4 g/dL vs 7.4 g/dL; P < .05), than girls with all other etiologies of AUB. Treating physicians failed to diagnose endometritis as the etiology for AUB in 4 of 8 girls with positive tests for sexually transmitted infection and no other etiology. CONCLUSION: PCOS was the most common underlying etiology in adolescents hospitalized with AUB. Screening for hyperandrogenemia is important for early diagnosis of PCOS to allow ongoing management and prevention of comorbidities. Endometritis was frequently underestimated as an etiology for AUB.
PMID: 27903446
ISSN: 1873-4332
CID: 2524542