title: The "ins" and "outs" of provider-parent communication: perspectives from adolescent primary care providers on challenges to forging alliances to reduce adolescent risk.
abstract: OBJECTIVE
  For several decades, the goal to protect adolescents' confidentiality in addition to state and professional mandates to provide confidential health services have sometimes outweighed the interest of involving parents in risk reduction efforts. More recently, experts acknowledge that a balance must be found between maintaining adolescent confidentiality and involving parents in preventing poor adolescent outcomes resulting from risky behaviors. The purpose of this research was to elucidate the challenges in and identify solutions to realizing this newer vision in the primary care setting.
  
  
  METHODS
  We conducted a qualitative study featuring in-depth interviews with 37 primary care providers among whom a significant component of their practice involved adolescent patients. Purposeful sampling was aimed at a diversity of gender, practice specialty, practice venues, and geographic areas.
  
  
  RESULTS
  We identified individual and structural barriers and facilitators to involving parents in their adolescents' primary care. Barriers included parents' lack of knowledge and awareness of their children's risk behaviors; providers time constraints and competing clinical demands, concerns for confidentiality and developing a trusting relationship with the child; and legal and system requirements that limit engagement with parents. Facilitators included interest and for some, planned approaches by the provider to engage the parent; encouragement by the provider to the adolescent to communicate with a trusted adult about their risky behavior; and opportunities to educate the parent about risk reduction in general.
  
  
  CONCLUSIONS
  Opportunities for further research on strategies to improve communication and develop a partnership between providers and parents are described.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico 87131, USA. Helitzer@salud.unm.edu
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Helitzer
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Sussman
authors.forename: Brisa Urquieta
authors.initials: BU
authors.lastname: de Hernandez
authors.forename: Alberta S
authors.initials: AS
authors.lastname: Kong
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D003299:Cooperative Behavior; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009516:New Mexico; D011320:Primary Health Care; D011368:Professional-Family Relations; D040242:Risk Reduction Behavior