Health Quarters welcomes Julie Johnston, M.D.

Health Quarters is proud to announce the addition of Julie Johnston, M.D. to help us address the demand for specialty reproductive and sexual health care in the North Shore and Merrimack Valley.  Dr. Johnston will replace Dr Lou Dilillo, HQ’s Medical Director for the past 16 years.

Dr. Johnston will act as the supervising physician for our Advanced Practice Nurse Practitioners and responsible for working with and assisting Health Quarters in the development and execution of strategies to position the agency as a thriving specialty practice—committed to access, communication and care coordination—in the new neighborhood of medical homes.

Dr. Johnston has been practicing as a Family Physician with the Greater Lawrence Family Health Center in Lawrence on a part-time basis since 2004. She coordinates the Center’s Gynecology and Women’s Health Rotation and runs the Reproductive Health Interest group for medical residents. Johnston is fluent in Spanish and a passionate advocate for women’s reproductive health and rights.

Birth Control Toolkit is Now Available!

There have been a lot of questions around women’s preventive health services – particularly contraception. We wanted to make sure everyone had this toolkit that the National Women’s Law Center has developed: Getting the Coverage You Deserve: What to Do If You Are Charged a Co-Pay or Deductible for a Preventive Service.

It’s a toolkit that provides information on the coverage of preventive services in the health care law, information on how to find out if a plan is currently covering these services, and detailed instructions on how to appeal to an insurance company if it is not, including draft letters to the insurance company.  The services addressed in the toolkit are:

• Preventive Services (all services)
• Birth Control (Including generics, ring, patch, and IUDs)
• Breast Pumps
• BRCA Testing
• Colonoscopy
• Well Woman Visit

What kind of questions or concerns are you or your staff receiving about the preventive services, particularly birth control? 

2013 Exceptional Advanced Practice Clinician & Mentor Award

Health Quarters is pleased to announce Judy Formanek, our Lawrence Health Center Nurse Practitioner, was awarded the 2013 Exceptional Advanced Practice Clinician and Mentor Award at the Massachusetts General Hospital Institute of Health Practitioners.  Judy has been worked at Health Quarters’ Lawrence Health Center since 2004.  Congratulations to Judy and thank you for applying your exceptional clinical skills to the care of our patients!

Judy Formanek, HQ’s Nurse Practitioner at our Lawrence Health Center

Revenue Cycle Management Workshop, January 15, 2013, Endicott College, Beverly, MA

Health Quarters’ hired Priority Management Group Inc. to train its clinicians and medical billing staff, along with their counterparts from Tapestry Health, Citizens for Citizens and Health Imperatives, on revenue cycle management—including coding, billing and reimbursement.  Increasing revenue from third-party payers will allow essential community health care providers, such as freestanding reproductive health care centers, to better deliver quality health care to the uninsured and underserved.  HQ is grateful to Endicott College for providing the venue.

New Technology – “Sexting”

By now, most of us have probably heard about the latest wrinkle in teen dating and adolescent sexuality – “sexting.”  Just this weekend, The Boston Globe reported that police are investigating possible child pornography charges after an occurrence of sexting at a local middle school.

The cleverly coined phrase is used to define a situation where a person takes a photo of him – or usually – herself or others nude and/or involved in some sort of sexual behavior.  A camera phone is often used, and the photo is then sent to another person or persons, sometimes even posted on Facebook.  A recent survey by the National Campaign to Prevent Teen and Unplanned Pregnancy found that one in five teens have electronically sent, or posted online, nude or semi-nude pictures or video of themselves. There have been a number of media stories lately about teens and sexting, including a push to prosecute teens as sex offenders, a course of action that Health Quarters does not endorse.

This issue is hard to understand and downright scary to many adults – especially parents – and trying to get a handle on it can seem daunting.

Experts in adolescent psychological development would probably say that there is a generational gap between the way teens and their parents use technology, and possibly a greater gap between each population’s view of sexual behavior and relationships.   Although these gaps may seem wide, it’s imperative that parents try to connect with their children on this issue: Let them know your concerns, the potential consequences of sexting, and strategies to keep themselves safe.  The following tips, adapted from materials developed by the National Campaign to Prevent Teen and Unplanned Pregnancy, can help:

1. Talk to your kids about what they are doing in cyberspace.
Just as you need to talk openly and honestly with your kids about real life sex and relationships, you also want to discuss online and cell phone activity. Make sure your kids fully understand that messages or pictures they send over the Internet or their cell phone are not truly private or anonymous. Also remind them that others might forward their pictures or messages to people they do not know or who they don’t want to see them. Worse yet, school administrators and employers often look at online profiles to make judgments about potential students/employees. It’s essential that your kids grasp the potential short-term and long-term consequences of their actions.

2. Know who your kids are talking to.
Of course it’s a given that you want to know who your children are spending time with when they leave the house. Also do your best to learn who your kids are spending time with online and on the phone. Supervising and monitoring your kids’ whereabouts in real life and cyberspace doesn’t make you a nag; it’s just part of your job as a parent. Many young people consider someone a “friend” even if they’ve only met online. What about your kids?

3. Consider limiting electronic communication.
The days of having to talk on the phone in the kitchen in front of the whole family are long gone, but you can still limit the time your kids spend online and on the phone. Consider, for example, telling your teen to leave the phone on the kitchen counter when they’re at home and to take the laptop out of their bedroom before they go to bed, so they won’t be tempted to log on or talk to friends at 2 a.m.

4. Be aware of what your teens are posting publicly.
Check out your teen’s MySpace, Facebook and other public online profiles from time to time. This isn’t snooping – this is information your kids are making public. If everyone else can look at it, why can’t you? Talk with them specifically about their own notions of what is public and what is private. Your views may differ but you won’t know until you ask, listen, and discuss.

5. Set expectations.
Make sure you are clear with your teen about what you consider appropriate “electronic” behavior. Just as certain clothing is probably off-limits or certain language unacceptable in your house, make sure you let your kids know what is and is not allowed online either. And give reminders of those expectations from time to time. It doesn’t mean you don’t trust your kids, it just reinforces that you care about them enough to be paying attention.

A final thought: Much of what teens are dealing today regarding navigating relationships and sexual decision-making is pretty similar to issues their parents faced.  Whether or not they are participating in this new trend, teens still are concerned about, and need information on, body image, self esteem, gender stereotypes, healthy relationships, communication skills, sexual orientation, and pregnancy and STD prevention.  Keep this in mind when you sit down to talk with them about sexting – they need to hear parents’ values and wisdom about these more “traditional” topics, as well.

HQ Clients Exceed Standard for Completing Three-Shot HPV Vaccine Series

According to a recent study conducted by researchers at the University of Maryland of almost 10,000 teens and young women who were eligible for the human papillomavirus (HPV) vaccine at the school’s medical center, only 31% finished the three-shot series. In contrast, Health Quarters’ data on its Beverly health center population shows that 79% of its clients received all three shots.
The HPV vaccine was first approved for females in 2006 to prevent certain strains of the virus that can cause cervical cancer in women and genital warts in both sexes. Health Quarters started offering the vaccine to men shortly after its recent FDA approval for boys and men ages nine through 26 to prevent genital warts.
The vaccine presents a challenge with a three-shot series: The second shot should be administered one to two months after the first dose, with the third dose administered six months after the first.
“We’ve been successful in having clients follow through with all three shots because we’re so diligent in follow up,” says HQ Director of Health Care Quality Renee LaForce.  “Compliance is important, so we’ll mail reminders or call clients to make sure they come in at the right time. “
The University of Maryland findings are consistent with other studies, lead author Kathleen Tracy said. She said that the results suggest a need for better methods of ensuring patient compliance with the dosing schedule, adding, “Any time you require a patient to get more than one dose, especially when it requires a clinic visit, you’re setting up a barrier.” A pilot study is underway to assess compliance among women ages 18 through 26 who receive daily reminders via text message for seven days before their vaccine appointments.

What is your STD IQ? ANSWERS

1.    A person can have an STD without knowing it. TRUE
Many STDs have no symptoms.  The only sure way to know if you have an STD is to be
tested for it.
2.    It is normal for women to have some vaginal discharge that is not indicative of an STD.  TRUE
3.    Once you have had an STD and been treated for it, you can’t get it again.  FALSE
Bacterial STDs can be treated and cured, however if you have a partner with the infection again in the future, you could be re-infected.  
4.    HIV is present in semen, blood, vaginal secretions, and breast milk.  TRUE
5.    Chlamydia is the most common bacterial STD.  TRUE
6.    Most STDs eventually go away by themselves.  FALSE
The only way to treat or cure an STD is to be treated at a medical facility.  
7.    Untreated STDs can cause infertility.  TRUE
If left untreated, some STDs including chlamydia and gonorrhea, can develop into Pelvic Inflammatory Disease (PID), which can cause scar tissue in the fallopian tubes, leading to problems with fertility.  
8.    Birth control pills, patches, and rings offer excellent protection from STDs.  FALSE
9.    Condoms can help prevent the spread of STDs.  TRUE
Condoms, when use consistently and correctly, are very effective at preventing STDs that are spread through vaginal fluids,  semen, and blood.  Condoms offer less protection against STDs that are spread through skin to skin contact (herpes and HPV), however some studies indicate that condoms do reduce the likelihood of transmission.
10.    If you know your partner, you can’t get an STD.  FALSE
11.    What should you do if you think you have an STD?
Go to Health Quarters or your physician’s office to be tested.  Don’t wait!
12.    How can you avoid getting an STD?
Abstain from sexual activity
Use condoms and dental dams during sexual activity
Get tested regularly or with every new partner
Refuse to share needles
Get the Hepatitis A and B and HPV vaccines!  

Health Quarters provides rapid HIV testing and STD testing and treatment at its health centers in Beverly, Haverhill and Lawrence.  Call 800.892.0234 or visit healthq.org for info.

What is your STD IQ?

1.    A person can have an STD without knowing it.
2.    It is normal for women to have some vaginal discharge that is not indicative of an STD.
3.    Once you have had an STD and been treated for it, you can’t get it again.
4.    HIV is present in semen, blood, vaginal secretions, and breast milk.
5.    Chlamydia is the most common bacterial STD.
6.    Most STDs eventually go away by themselves.
7.    Untreated STDs can cause infertility.
8.    Birth control pills, patches, and rings offer excellent protection from STDs.
9.    Condoms can help prevent the spread of STDs.
10.    If you know your partner, you can’t get an STD.
11.    What should you do if you think you have an STD?
12.    How can you avoid getting an STD?

Health Quarters provides rapid HIV testing and STD testing and treatment at its health centers in Beverly, Haverhill and Lawrence.  Call 800.892.0234 or visit healthq.org for info.

Study of Teen Condom Use Encouraging

Findings from the largest nationally representative study of sexual and sexual-health behaviors ever fielded, conducted by Indiana University researchers, provides interesting data on intercourse and patterns of condom use by adolescents.

The National Survey of Sexual Health and Behavior (NSSHB), conducted by researchers from the Center for Sexual Health Promotion at Indiana University’s School of Health, Physical Education and Recreation, is one of the most comprehensive studies on these topics in almost two decades.  It includes the sexual experiences and condom-use behaviors of 5,865 adolescents and adults ages 14 to 94.

Asked how many of ten past vaginal intercourse acts included condom use, men reported 79% condom use and women reported 58% condom use in the age 14-17 group. Numbers drop among 18-24 year olds: men report 45% condom use and women report 38%.

“Many surveys of adolescent sexual behavior create an impression that adolescents are becoming sexually active at younger ages, and that most teens are sexually active,” said Dennis Fortenberry, MD, MPH, Professor of Pediatrics in the Indiana University School of Medicine, leader of the adolescent aspects of the study.  “Our data show that partnered sexual behaviors are important but by no means pervasive aspects of adolescents’ lives. In fact, many contemporary adolescents are being responsible by abstaining or by using condoms when having sex.”

At any given point in time, most U.S. adolescents are not engaging in partnered sexual behavior. While 40% of 17 year-old males reported vaginal intercourse in the past year, only 27% reported the same in the past 90 days. Read more at http://www.nationalsexstudy.indiana.edu/

Health Quarters offers a large variety of free male and female condoms, including fruit-flavored, glow-in-the-dark, lubed and unlubed, and more to clients and local non-profits and business establishments.

Seize “Teachable Moments” When Talking to Teens about Sex

It’s Let’s Talk Month a.k.a. National Family Sexuality Education Month, when we’re glad for the chance to urge parents and other adults to talk to their children about puberty, relationships, sex, and love.  Have we got great tips for you!

Parents worry whether their sons and daughters are prepared to make smart choices regarding preventing pregnancy and the spread of sexually transmitted diseases. Parents are also concerned that their values and beliefs will get lost amid the sex-saturated media and its many mixed messages. We’ve found that the correct information paired with good communication is the foundation of solid adolescent decision-making.

The most important way for parents to make their voice heard is by taking a deep breath, and preparing themselves to talk about L-O-V-E and S-E-X.  Many are unsure about how to broach the subject of sexuality, because they are afraid they will do it incorrectly, or because they did not have a good experience with their own parents.  There is no perfect way to talk to kids about sex, but being alert to “teachable moments” is an easy way to get started.

A teachable moment is an unplanned event during the day that adults can seize on as a conversation starter.  They provide a meaningful context to introduce or expand on important information and messages from the parent. For example, my colleague was riding in the car with her 16 year old daughter when they passed an obviously young girl pushing a carriage. Mom commented on whether the girl was the babysitter or parent herself, prompting a remarkably open conversation, starting with her daughter’s stated intention not to become pregnant and the reasons why.

Or try watching a television show or movie together. Just because Gossip Girl depicts high school sex doesn’t mean you can use the characters’ situations as a jumping off point for a talk about choices your daughter or son might make. And with Glee, The Secret Life of the American Teenager, Teen Moms all over People magazine, and the resurgence of 90210 and Melrose Place, you’ve got a wealth of material to work with.

A few other tips:
•    You can use something that might happen in the life of your kids’ friends or with a student at school as a conversation starter.
•    At a time when your kids seem receptive to conversation, ask them if they have any questions about dating or sex. If you get the eye roll, just continue to quickly make your point.
•    An excellent time to bring up the subject of dating and expectations is immediately after the school has studied sex education in class.
•    Any time a sibling is having trouble on the dating scene, or parents are having difficulties with an older child on this subject, remember that the younger children are paying attention. Use these times to feed dating expectations to the younger siblings, but do so without trespassing on the older child’s privacy.
•    For some children, darkness seems to bring anonymity and loosens one’s tongue. At bedtime, take a moment for a “how was your day” talk. You’ll be surprised what subjects these conversations can bring about.
Of course, once you’re engaged in a teachable moment, how can you make the most of it?  You want to try to avoid jumping to conclusions or judgments because anything that sounds like a lecture can shut the door on the chat in a split second; asking casual questions can draw out a kid’s thoughts and let you know if he/she is on or off base. Rather than challenging a viewpoint, more slightly probing questions can be a subtle way of letting the young person see things differently on his/her own.  And remember, don’t give up.  If one talk doesn’t end terribly well, there will be other chances to make a connection, as long as you’re committed to finding agreeable ways to spend time together.
And, of course, there are a number of websites and books that provide adults with even more information to help them engage in discussions about sexuality with their teens.  Visit www.healthq.org/education-outreach/resources/#ParentChild to learn more.