MODULE 4

Objectives

Overview

• Goals and Concerns
• Parent/Teen Interactions
• Developmental Surveillance
• Screening

Key Components

• Self Esteem
  • Confidence
• Moods
  • Depression
  • Suicide
• Body Image
• Sexual Development
• Sexuality
• Sexual Identity
• Independence
• Family Relationships
  • Resolving Conflicts
  • Rules & Responsibilities
• Friends
• Social Media
• School Functioning
• Future Plans
• Risk-Taking Behaviors
• Violence
• Substance Use and Abuse

Developmental Checklist

Office Practices

Community Practices

Sexual Identity

Sexual Orientation and Gender Identity

Sexual identity, which encompasses sexual orientation, gender identity, and gender roles, influences sexual behavior and is shaped by a variety of social and cultural factors. Sexual identity can be represented as a continuum and may vary over time and with changing circumstances. Many teens engage in sexual exploration with same-sex friends. Sexual behavior, especially during early or middle adolescence, does not necessarily reflect present or future sexual identity.

Providers may encounter teens who are gay, lesbian, bisexual, transgendered, unsure, or uncomfortable with their sexual orientation or gender identity. Many of these youth remain unidentified and secretive because they are not comfortable enough to identify themselves and their sexual concerns. They may fear rejection or stigmatization from disclosure of their sexual orientation or gender identity issues to health care providers. The goals for these youth are the same as for all teens—to promote healthy development, social and emotional well-being, and optimal physical health.

Questions to Ask

For the Teen

• Are you romantically involved with someone? Is that person a guy or a girl?
• Do you sometimes have sexual feelings for someone of your own sex?
• Are you sexually active now? How many partners have you had in the last year?
• Were your partners male or female? Have you had both male and female partners?

Provider Tips

• Avoid making assumptions about the teen’s sexual identity. Examine your interview style and how you word your intake forms. Use gender-neutral language in discussing sexuality—the word partner rather than boyfriend or girlfriend; protection rather than just birth control.
• Awareness of same-sex sexual orientation often occurs during adolescence. Formation of homosexual identity has generally been described in four stages—feeling different, confusion, assumption, and integration. More information

  Researchers feel that for many, the development of a homosexual identity goes through several stages, although different people get through the stages at different rates and many don’t complete the development until they are in their twenties or thirties.

  Stage 1: Feeling Different. Having social experiences in the middle teen years that made them feel different from other adolescents, such a boy’s sharing few interests with other boys or a girl’s feeling unfeminine.

  Stage 2: Identity Confusion. Reaching physical maturity and realizing that they are attracted to members of the same sex, causing emotional turmoil and questioning their heterosexuality.

  Stage 3: Identity Assumption. Moving from private acknowledgment of sexual preference to admitting it openly, if only to other homosexuals.

  Stage 4: Identity Integration. Adopting homosexuality as a way of life, both emotionally and sexually.

  Source: Your Adolescent. American Academy of Child and Adolescent Psychiatry. 1999. Pages 163-164.

• Help teens who identify themselves as gay or lesbian to recognize and handle the difficulties they may face, including responses of their family, heterosexual peers, and community.
• Teens who struggle with gender identity and the social stigma it may impose, especially males struggling with a gay or bisexual identity, are at greater risk for depression and suicidal ideation and behaviors than other teens. Ask the teen about these feelings.
• Providers who are uncomfortable or unable to discuss sexual identity issues with teens should refer teens for appropriate care elsewhere.
• Help raise awareness among school and community leaders of issues relevant to non-heterosexual youth. (See resource below for school personnel.)
• Using the guidance listed below, help the teen understand his sexual orientation and be safe.

Guidance for the Teen

For the Teen

• You may be confused or concerned about your sexual feelings for someone of the same sex. Take the time to think your feelings through carefully. Strong same-sex feelings and even sexual experiences sometimes occur at this age and do not define sexual orientation. Talk with your health care provider or another trusted adult about any questions you may have.
• You will come to know if you are a homosexual over time. Remember that homosexuality is not a disease, an illness, or a mental disorder. Your sexual orientation is a part of who you are. Sometimes it is helpful to get counseling to learn how to accept and express yourself and to deal with feelings of guilt or anxiety.
• Sexually transmitted infections (STIs) can be transmitted by oral and anal sex. If you become sexually active, protect yourself and your partner from STIs. Use condoms correctly and consistently and limit the number of partners you have.
• Abstaining from sexual intercourse is the safest way to prevent STIs, including HIV infection and AIDS.

Resources for Providers and Families
For Providers Sexual Orientation and Adolescents Factsheet: Bullying and Gay Youth For the Teen I think I might be gay. What should I do? For Families Gay, Lesbian and Bisexual Adolescents Gay and Lesbian Teens Parents, Families and Friends of Lesbians and Gays (PFLAG) For School Personnel Just the Facts about Sexual Orientation and Youth: A Primer for Principals, Educators, and School Personnel