Seattle Children’s Hospital will be included in the Premera Blue Cross health insurance networks through 2017 as a result of an agreement that ends a lengthy legal dispute.
Children and teens are more likely to wear life jackets when out on the water when adults onboard are wearing them as well — yet relatively few adult boaters in Washington state wear life jackets while boating, according to recently published studies by UW Medicine researchers at Seattle Children’s Hospital and Harborview’s Injury Prevention & Research Center.
The findings, the researchers write, underscore the important role adults can have in encouraging the young to wear life jackets when out on the water.
Wearing a life jacket has been shown to reduce a boaters risk of drowning by half. Nevertheless, nationwide only about 15% of boaters wear a life jacket or personal floatation device (PDF), and, as the new studies show, Washington state boaters do little better. Continue reading
By Carol Ostrom, Seattle Times
APR 23, 2014
Health insurers and hospitals, usually on opposite sides, lined up together Tuesday to give Insurance Commissioner Mike Kreidler an earful about his proposed new rule for insurance-provider networks.
Kreidler proposed the rule after complaints that consumers have been taken by surprise about narrower networks in insurance plans offered in the Affordable Care Act.
Those networks exclude some of the region’s prominent hospitals and medical centers, meaning some consumers don’t have access to providers they expected to use. Continue reading
From Seattle Children’s On the Pulse blog
On Dec. 14 of last year, 20 children and seven adults lost their lives in the senseless tragedy that took place at Sandy Hook Elementary School in Newtown, Conn.
As we approach the anniversary of this horrific event, we remember and mourn the victims and the families who have been affected by this tragedy.
No parent should ever have to suffer through the pain of losing a child to gun violence. And with guns in more than one third of all U.S. households, firearms present a real, everyday danger to children, especially when improper safety techniques are followed.
Frederick Rivara, MD, MPH, division chief of general pediatrics and vice chair of the Department of Pediatrics at Seattle Children’s Hospital, and Dimitri Christakis, MD, MPH, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, offer the following tips and advice for parents looking to keep kids safe from firearms, and to help reduce their exposure to gun violence in the media.
Gun safety in the home
Less than half of U.S. families with children and guns store their guns unloaded and locked away. Each year just in Washington state, about 25 children are hospitalized and four to five die due to unintentional gun injuries. Most of these shootings occur in or around the home.
The best way to protect children from firearms injury in the home is to remove the firearms entirely. However, if this is not an option, Rivara says there are a number of ways that you can minimize the risk:
Store your guns safely:
- All weapons should be stored in a securely locked case, well out of the reach of children, and make sure children do not have access to the key or combination.
- Stored firearms should be unloaded and in the uncocked position.
- Store ammunition separate from the weapon, also in a securely locked location out of the reach of children.
- Use trigger locks or chamber locks on weapons. Even a padlock can be used to prevent the cylinder of a weapon from locking into place.
- Remove guns from your home if a family member is depressed, suicidal or is abusing drugs or alcohol.
With the popularity of shooting video games and toy guns, the lines between these weapons and their very real consequences are often blurred. Parents should talk with their children and make them aware that weapons are not toys and that if they ever do come into contact with a weapon, they are not to touch it under any circumstances. The National Rifle Association (NRA) recommends teaching children four things about what to do when finding a gun: stop, don’t touch, leave the area and tell an adult.
Gun violence in the media
Whether or not you keep a weapon in your home, children will be exposed to gun violence in the media at some point, often very early in life. In fact, a recent study found that the rate of violence in movies is increasing, and that this violence is now more predominant in the PG-13 movies your teens are watching than in R-rated movies. And with the medical consensus being that exposure to violent media can increase aggression in children, and that children often imitate what they see on the screen, parents must be mindful of their children’s exposure to gun violence in the media.
While it’s challenging to prevent your child from encountering this violence, you can help to limit it while you talk to them about its real-world consequences. Here are a few tips to help:
Implement a media diet. Christakis recently conducted a study that found that children reproduce what they see on television or in the movies, both bad and good. He suggests staying aware of what your children are watching by keeping a media diary. He also advises to watch more TV and movies with your children so you’re always aware of the content they’re consuming and can discuss it with your kids.
Be available. When events like the Sandy Hook tragedy occur, these stories of violence are plastered all across the news. Each child responds to this in a different way. Many become fearful and have questions about these events. Some end up angry or grief-stricken, while others feel a sense of betrayal. Be sure to talk with your children about these events to reinforce that they are safe and to assuage their fears. Doing this will also show that you are available to talk with them about anything, no matter how difficult it may be.
Keep an eye out for red flags. Pretend gun play, violent video games and movies and other aggressive influences are a part of our lives, and finding the right balance between limiting children’s exposure to these stimuli and not keeping them entirely in the dark can be difficult. However, it can help to look out for potential red flags, such as a child “accidentally” hurting another, aggressive behavior, or a lack of empathy or remorse for their actions. Please discuss these concerns with your child’s doctor.
- Gun Safety
- Firearms facts
- For children’s behavior, TV content as important as quantity
- Navy Yard shooting, helping kids cope with violence in the news
- AAP policy statement on firearm-related injuries
From Seattle Children’s On the Pulse blog
Tis the season for mistletoe, gingerbread and carefully strung lights. It’s the most wonderful time of the year, but also a potentially dangerous one for children. And although festivities, candles and garland may make the holiday season more cheerful, with them come some serious safety concerns.
Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says the most important thing to remember this holiday season is supervision.
“The holidays are a fun and exciting time, but there are a few more things inserted into the environment, like holiday plants, electrical cables, new toys and festive beverages, which are potentially dangerous,” says Woodward.
Holiday safety tips
To keep kids out of the emergency room this year, Woodward recommends some basic safety tips to ensure an injury-free, but still festive holiday season.
Lights, trees and décor. Sparkly ornaments, shiny holiday decorations and small holiday figurines are potential choking hazards for small children. If an object can fit through a toilet paper tube, it can obstruct the airway of a small child and prevent breathing.
“Think like a child,” says Woodward. “Get down on your hands and knees and look around the house. If something looks shiny and enticing, a child may want to put it in their mouth. Keep decorations high and out of reach.”
Make sure trees and decorations are properly secured, either by a sturdy stand or to the wall. Also, talk to children about holiday decorations and explain that they are not toys. Set limits and supervise children.
Poisoning potential. Holiday plants like mistletoe, holly and poinsettias are commonly used as decorations, but they can be hazardous to children. These plants are considered potentially poisonous and should be kept away from children and out of reach. If a child ingests any part of these plants call a pediatrician or the Poison Help Line immediately at (800) 222-1222. Symptoms from poisoning may include vomiting, diarrhea, nausea or rash.
Medicines and vitamins can also be hazardous for children. Keep an eye out for medicine, vitamins and other personal products found in purses or suitcases that guests visiting for the holidays may bring into the home. Also, be aware when visiting other houses this holiday with your family, especially households without young children because the house may not be child proofed.
Be cautious of raw or undercooked foods during the holidays. Wash hands frequently when handling raw meat or eggs, and don’t leave foods out in reach of children.
Holiday parties. Hosting a holiday gathering this year? Plan for a party’s youngest guests first. Take small children into consideration when planning a party’s food and beverage menu, and before adorning the home with festive décor.
“Decorating the home with garland and strung beads may look great for the holidays, but children can mistake the brightly colored beads and floral arrangements for candy or food, which may cause choking or poisoning,” says Woodward.
Alcohol is another common risk for children around the holidays and during holiday gatherings.
“Kids see adults drinking alcohol and become curious. If glasses are left sitting out in reach of children they may ingest the alcohol, which even in small amounts can be dangerous to kids. Use common sense and always keep an eye on children,” says Dr. Woodward.
Also, stay home from parties or gatherings if children aren’t feeling well. Don’t risk spreading germs to others. Talk to children about proper hand washing and coughing techniques. Germs are easily spread, but these techniques can help prevent the transmission of germs from one person to another.
Fire safety. Keep decorations and trees away from heat sources within the home, which includes fireplaces, radiators, space heaters or electrical outlets. Also, avoid using candles if there are small children in the home.
When buying an artificial tree, make sure it is “fire retardant,” and also make sure a child’s sleepwear is labeled “fire retardant” as well. Be sure to also remove dry trees after the holiday season to reduce fire risk.
Use socket covers to baby-proof electrical outlets and make sure extension cords are well hidden and out of reach. Ensure cords are all the way in the outlets so kids don’t get shocked. Also, do not have water around outlets and wires.
Cooking is the leading cause of home fires in the U.S. Try to keep small children out of the kitchen while cooking or preparing food. Turn pot handles in so they can’t be accidently knocked over and stay in the kitchen while frying, grilling and broiling.
Toy safety. Many toys and holiday decorations require button batteries, which can pose fatal risks for young kids. Be sure batteries cannot be removed easily from toys and gadgets. If a battery is swallowed, it can cause life-threatening injuries. Also, avoid magnets. Toys that contain small magnets are especially dangerous for young kids. If swallowed, magnets can attract to one another in a child’s intestine and cause serious complications and even death.
“Make sure toys are appropriate for the age of a child, but also think about other children,” says Woodward. “Think about the worst case scenario. If a 1-year-old or 2-year-old will be in the home visiting for the holidays, ask if there are toys that could potentially be harmful to them.”
Just like checking a food’s ingredient list, parents should read toy and product labels. Avoid toys and products that contain PVC plastic, xylene, toluene or dibutyl phthalate.
Cold weather. With temperatures dropping, make sure children are properly dressed for the weather with hands, feet and heads covered. Dress children in layers and make sure they come in out of the cold periodically. The nose, ears, feet and hands are at the biggest risk of frostbite if temperatures are below freezing.
Supervise children while they play. Activities like sledding can be dangerous without proper supervision and safety gear. Also, be extremely cautious around water. Never allow children to walk across frozen lakes or ponds.
Lastly, wear sunscreen. It may be cold, but children are still at risk for sunburn.
The holidays are a time for celebration and fun. By following these simple safety tips, families can enjoy the holiday season without injury. Happy Holidays!
Photograph courtesy of Jay Simmons
By Jordan Rau
KHN Staff Writer
More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.
Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates.
Another 1,451 hospitals are being paid less for each Medicare patient they treat.
For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings.
Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.
The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.
“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.
Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms.
Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.
“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”
Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis.
Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.
How A Hospital Is Rated
Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers.
The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.
To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals.
A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement.
It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.
This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.
Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.
The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations.
Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.
Will Penalties Bring Change?
Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.
“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health. Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods.
“The fiscal penalties are nominal, frankly, in the scheme of things,” she said.
Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”
The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates.
“They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”
The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent. Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements.
The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.
The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.
“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”
Many Past Winners Continue To Get Bonuses
Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores.
Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.
A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.
This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money.
Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.
For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent.
As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country.
Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.
Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.
Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.
Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.
Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010.
For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.
The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.
Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.
In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.
Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.
“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”
- Data For Individual Hospitals (interactive chart)
- Downloadable CSV spreadsheet
- State Averages
This article was produced by Kaiser Health News with support from The SCAN Foundation.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Seattle Children’s Hospital filed suit Friday over the state Office of the Insurance Commissioner’s “failure to ensure adequate network coverage” in several of the health plans sold on the state’s new online insurance marketplace, called Washington Healthplanfinder.
Most health plans now being sold through the state’s new health-insurance exchange do not include Seattle Children’s as an in-network provider.
As a result, families that enroll in those plans could face significantly higher cost-sharing if they seek care at Children’s than if they seek care at the plans’ preferred providers.
The higher cost-sharing could seriously disrupt care for families currently receiving services at Children’s and could delay new patients from getting the specialized care they need, said Dr. Sandy Melzer, the hospital’s senior vice president and chief strategy officer.
Melzer said parents may be enrolling in health plans through the exchange without realizing that Children’s is not included in the plan’s network.
“The notion that a major insurance plan is going to exclude us from their network is truly precedent-setting and represents a new level of degradation in children’s access to care,” Melzer said.
Of the seven insurers offering plans in King County, only two – Group Health Cooperative and Community Health Plan of Washington – are offering plans through the exchange that include Seattle Children’s in their network.
The five in King County that do not include Children’s in their network are Premera Blue Cross, LifeWise Health Plan of Washington (a subsidiary of Premera), BridgeSpan (a subsidiary of Regence Blue Shield), Molina Healthcare and Coordinated Care.
Kaiser Foundation Health Plan of Washington, which is offering plans only in Clark and Cowlitz counties, also does not include Seattle Children’s in its network.
Children’s is asking that the OIC reverse its decision to allow Molina and Coordinated Care to sell plans on the exchange as long they do not include the hospital in their networks.
OIC spokeswoman Stephanie Marquis says the OIC takes concerns about access to care seriously. “We are reviewing Children’s petition to see what lies at the heart of their concerns and will see how it gets resolved through the legal process,” she said.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Seattle Children’s is filing suit to be included in more healthcare plans on Washington’s Health Benefit Exchange.
Here is their press release:
Today, Seattle Children’s Hospital filed suit citing the failure of Washington state’s Office of the Insurance Commissioner (OIC) to ensure adequate network coverage in several Washington’s Health Benefit Exchange (Exchange) plans.
We believe strongly that the OIC and the majority of plans on the Exchange have failed to meet their mandate, as they do not currently cover care provided at Children’s.
Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest.
Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation.
Without inclusion of Children’s, current and future patients and families who obtain insurance from several plans offered will not be able to access care at Children’s as an in-network provider.
This lack of suitable access to pediatric services means that families enrolled in these plans may not receive the most timely, appropriate care, and face larger out-of-pocket amounts.
“Every child should have access to essential healthcare and the intent of the new Exchange is to make it available to all families,” said Thomas Hansen, MD, CEO, Seattle Children’s. “However, we are very concerned about the limited networks being offered by some Exchange insurance plans. Omitting coverage for care at a facility like Children’s prevents families from accessing vital services they may desperately need.”
Children’s is committed to working with the OIC and Exchange insurers, and we hope a solution to this concerning situation can be found soon for Washington families.
By Sharyn Alden, HBNS Contributing Writer
Research Source: Journal of Adolescent Health
‘Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health.
Recommendations for routine vaccination of meningococcal (MCV), tetanus, diphtheria, and acellular pertussis (Tdap) and human papillomavirus (HPV) in adolescents are fairly new and many parents may be unaware of the need for adolescent vaccines.
“Our study found that when adolescents who are vaccine-eligible come to their health care provider for preventive visits, there are missed opportunities for vaccination. Adolescents who come in for non-preventive visits have even greater missed opportunities,” said lead author Rachel A. Katzenellenbogen, M.D., assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.
“Our data found that adolescents who have an appointment come into their health care provider’s office and leave without receiving all three recommended vaccines—Tdap, HPV and MCV,” Katzenellenbogen said.
Adolescents need fewer preventive care visits than infants and are a relatively new population to be targeted for vaccination when compared to infants and children, she explained.
Katzenellenbogen and her colleagues analyzed vaccination rates for 1,628 adolescents aged 11- 18 with 9,180 visits to health care providers between 2006 and 2011.
All of the teens in the study were seen at a pediatric clinic in Seattle. During that time frame, 82 percent missed being vaccinated against MCV, 85 percent missed Tdap and 82 percent missed the first dose of HPV1.
“If parents know to expect that their adolescent should receive three vaccines when they turn 11 or 12, they may be more likely to schedule a preventive visit or bring up vaccination with their child’s health care provider during any office visit,” commented Kristen A. Feemster, M.D., assistant professor in the division of infectious diseases at the University of Pennsylvania School of Medicine.
Feemster said she was not surprised that missed opportunities occur because there are many challenges to implanting adolescent vaccine recommendations. “It is more challenging, for example, to establish eligibility for adolescent vaccines—many registries do not yet reliably capture adolescent vaccination. Providers may have questions or concerns about the recommended schedule, plus adolescents may seek care in alternative locations where it is particularly difficult to establish eligibility.”
The researchers suggest that improved vaccine tracking and screening systems, such as provider prompts through electronic health records or manual flags by nurses or medical assistants, would enable providers to more easily identify those teenagers eligible for vaccines at all visit types.
The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.
By Kathryn Bluher
From Seattle Children’s On the Pulse blog
The long, sunny days of summer are the perfect time to get the bikes out of the garage, but parents should hit the brakes and talk to children about bike safety first.
Bike accidents are the second-leading cause of serious injury in school-age children.
According to the Centers for Disease Control, in 2010, 800 bicyclists were killed in the U.S. and an estimated 515,000 sustained bicycle-related injuries that required emergency department care.Roughly half of these cyclists were children and adolescents under the age of 20.
Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says most biking injuries occur because a child either isn’t wearing a helmet or is putting themself in a potentially dangerous situation. “Children may see themselves as invincible when they are on a bike, which is not the truth,” says Woodward.
Biking is a great summer time activity for children and families, incorporating both physical fitness and family time, but proper safety measures are important to keeping kids injury-free. Accidents can and will happen while biking, even on the quietest roads and safest sidewalks, but these tips can help reduce the risk of serious injuries.
Top tips for keeping kids safe while biking
Wear a helmet every time. Children should wear a helmet every time they ride a bike. “Most of the serious and life-threatening injuries we see are head injuries,” says Woodward, but that risk can be reduced by wearing a properly fitted helmet. By simply wearing a helmet that fits correctly, children can reduce their risk of serious injury up to 85 percent. It doesn’t matter if a child is biking across town or across the driveway, children should wear a helmet every time they ride their bike, says Woodward. “Children shouldn’t be allowed on their bike unless their helmet is on their head first.”
Make sure you have the right helmet and the right fit. Not all helmets are made for biking. For instance, football helmets or hard hats are not acceptable for biking. Bike helmets are made specifically for head-first falls and should be properly fitted on a child. Helmets should meet safety standards and should have a CPSC (U.S. Consumer Product Safety Commission) or Snell sticker inside. Proper fitting is also important. “Helmets only work if they are the right size,” says Woodward. If you can move the helmet from side to side, the helmet should be adjusted. Helmets should fit solidly on a child’s head and feel level. Due to the type of built-in protection, helmets are also only good for one crash. Remember, after a crash consider it trash!
Wear proper clothing. Kids should wear bright clothes while biking to be more visible to other bikers, pedestrians and cars. Reflectors or lights on the front and back of a bike and helmet are also a great way to increase visibility and ensure safety. Avoid wearing loose-fitting clothing that could catch in the bike’s chain and mechanics, and wear proper shoes. “Wearing closed toed shoes while biking can reduce the risk of losing a toe and long sleeves can help guard against road rash if a child falls off their bike,” says Woodward. Flip-flops or shoes with heels are also hazardous.
Ride a bike that is right for you. Bikes come in all shapes, colors and styles. Choose a bike that fits your child’s skill level and style, but most importantly, find a bike that is the right size. Don’t purchase a bike that a child will grow into. A properly sized bike is a safer bike. Your child should be able to sit on the seat with their feet flat on the ground and the handlebars should be no higher than their shoulders.
Perform a safety check before every ride. Before every ride check to make sure a bike’s seat, handlebars and wheels are all adjusted correctly and in good shape. Nothing should be loose or falling apart. Check the chain of the bike and the brakes, and make sure the tires have enough air.
Be aware of surroundings while biking. Set clear guidelines with your child about where it is safe to ride their bike – on the street or on the sidewalk – and how far is too far away from home. Woodward recommends kids younger than 10 not ride without an adult in the street. Bike paths are a great option for children, free from motor vehicles. However, bike paths are not free from potential hazards, like sticks, rocks, protruding objects and other potential obstacles such as dogs, people and faster bikers. Also, bike paths are meant to be shared. Teach children to be respectful of walkers and other bikers and to always pay attention to their surroundings.
Proper supervision is key. Supervision is key, but it isn’t just when kids are on their bike, says Woodward. Supervision starts by preparing kids for their bike, with proper equipment and modeled behavior.
Follow road rules. Most pediatricians recommend not allowing children under 10 to bike on the roads, but if a child is deemed old enough and mature enough to ride on roads, make sure they understand the rules of the road:
- Ride with traffic, never against traffic
- Always stop and check for traffic in both directions when exiting a driveway
- Stop at all stop signs and obey traffic lights
- When riding on the road, act as a car
- Use bike lanes and bike routes
- Avoid riding too close to parked cars to avoid car doors opening suddenly
- Use proper hand signals, when safe to do so
Accidents can happen anywhere – on the sidewalk, in the driveway, even on a quiet bike path – that’s why being prepared, supervised and aware of surroundings are so important. Biking is fun, but safety comes first!
- Seattle Mama Doc: Why You Should Make Sure The Helmet Fits
- Summer bike safety for kids
- Bike Helmet Safety
- Bicycle Safety: Myths and Facts
- Bicycling Basics
From Seattle Children’s On The Pulse blog
Not only do parents need to worry about firework safety, but families should also keep in mind alcohol and sun safety, too.
Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s, says that inadequate preparations for what might happen is the standard issue on Fourth of July.
To keep your kids out of the emergency department this year, Woodward recommends some basic safety tips.
Photo: Courtesy of JohnNyberg
Stay safe around fireworks
First and foremost: The main event on July Fourth is fireworks. Even though they are fun and exciting, they can be dangerous ifprecautions aren’t taken around kids.
The best way to avoid injury is to leave the pyrotechnics to the professionals and attend public fireworks displays. But if you plan to use fireworks at home, Woodward has some suggestions to keep your kids safe.
Children should never be allowed to use fireworks, including the popular sparklers. Woodward says the majority of firework-related injuries to children under the age of 5 are caused by sparklers.
“We often see kids with preventable burns and injuries from sparklers,” he says. Sparklers burn at a very high temperature (up to 2,000 degrees Fahrenheit).
Another important tip is to only light fireworks on level ground. “At least 50 percent of kids that we see are not the people who are setting off the fireworks, but the bystanders,” Woodward says.
Anticipate the consequences and provide adequate supervision to minimize any chance of injury. Never re-light or touch a firework that has not exploded.
If a child is injured by fireworks, Woodward says, “Remove them from the area and stop the burning. If it is serious, you are unsure or it involves face, eyes or hands, the child should be seen by a medical professional.”
Avoid heat illness
Don’t forget that July can have particularly hot weather, says Woodward. During a long day in the sun, he recommends that parents be on the lookout for symptoms of heat cramps, heat exhaustion, and heat stroke. Kids can become very ill if proper safety measures are not taken.
Woodward recommends that parents make sure kids drink plenty of fluids and wear lightweight, loose clothing. Stay indoors during the hottest part of the day, usually the afternoon.
If your child is experiencing heat cramps, be aware that they can be painful, says Woodward. Stop activity, take a break, and encourage your child to drink small amounts of water. In serious cases, heat cramps can lead to heat exhaustion, with symptoms such as pale skin, headache, dizziness, exhaustion, and nausea.
The third and most dangerous stage of heat illness is heat stroke. Parents should be alert to symptoms such as vomiting, decreased alertness or loss of consciousness, extremely high body temperature, rapid or weak pulse, and shallow breathing. Heat stroke can be life threatening, so be prepared to call 9-1-1 if symptoms worsen.
Talk to your teen about drunk driving dangers
According to the National Highway Traffic Safety Administration, Fourth of July is the deadliest holiday of the year – even deadlier than New Year’s Day. Many teens find themselves in dangerous driving situations during July Fourth celebrations, especially when alcohol is involved.
Research has shown that nearly 80 percent of high school kids have tried alcohol. In a recent Teenology 101 blog post, Yolanda Evans, MD, MPH, with Seattle Children’s adolescent medicine division, offers tips for parents of teens to help keep them safe during summer celebrations.
Evans recommends parents keep an open line of communication with their teens, as well as the parents of their teens’ friends. She also encourages a “free phone call” policy, so teens know they can call any time of night if they need a ride home. Visit Teenology 101 for more tips on talking to teens about alcohol and drugs.
Photo: Courtesy of JohnNyberg
More safety tips from On the Pulse:
- Doctor offers 8 tips to keep kids safe while biking
- Water safety tips for kids
- Camping safety tips for families
- Doctor offers spring safety tips for parents and kids
By Kathleen O’Connor
Publisher of the O’Connor Report
This year was the first year that hospitals in Washington State were required to report their executives’ compensation. I did not conduct this research independently.
The figures below are what the hospitals themselves reported to the Department of Health. The complete list of executive pay in not-for-profit hospitals can be found on The Department of Health website here.
For profit hospitals were not required to report their executive compensation, presumably for proprietary reasons. Some hospitals and hospital systems apparently chose not to report. See the list of non-responders at the end of this article.
These salaries raise more questions than answers. The differences between hospitals are staggering and incomprehensible. I offer questions for Boards of Directors and consumers at the end of the article.
We have several millionaires. Some in places I would not have predicted. In order of magnitude:
- Gary Kaplan, MD, Virginia Mason Medical Center, Seattle $3,737,678
- John Evans, Jr., Central Washington Medical Center, Wenatchee $1,766,084
- Rich Roodman, Valley Medical Center, Renton $1,285,860
- Elaine Couture, Providence Sacred Heart, Spokane $1,034,994
- Medrice Caluccio, Providence St. Peter, Olympia $1,010,027
Top Seattle Hospitals
The following is the compensation details only for the top administrator at the four top Seattle hospitals. Swedish has several sites.
Details on other executives’ compensation are included in the compensation data on the DOH website referenced above.
Harborview Medical Center:
Eileen Whalen, base salary $485,000, bonus incentive -0-, other $1,692, retirement/deferred compensation $61,550, non-taxable benefits, $19, 268 Total: $567,599
Swedish Medical Center: First Hill
Todd Strumwasser, base $435,848, bonus incentive $2500, other $71,000, retirement/deferred $76,928, nontaxable benefits $21,928 Total: $607,702
Swedish Medical Center: Cherry Hill
Rayburn Lewis, base $303,584, bonus incentive $24, other $51,875, retire/deferred $51,194, non taxable $17,713 Total: $424,390
Swedish Medical Center: Ballard
Jennifer Graves, base $241,620, other -0-, bonus incentive $37,500 retire/deferred $12,882, nontaxable $11,245 Total: $303,187
University of Washington Medical Center:
Stephen Zieniewicz, base $518,405, bonus -0-, other $1692, retire/deferred $61,793, non taxable $23,942, Total: $605,832
Virginia Mason Medical Center
Gary Kaplan, MD base $1,039,978, bonus incentive $449,871, other $17,788, retire/deferred $2,199,932, non-taxable $30,109 Total: $3,737,678
Other State Hospitals and Medical Centers
Valley Medical Center, Renton, Washington
Rich Roodman, base $706,575, bonus incentive $487,105, other $33,306, retire/deferred $32,201, nontaxable $26,471. Total: $1,285,860
Evergreen Medical Center, Bellevue
Robert Malte, base $592,423, bonus incentive -0-, other $51,581, retire/deferred $194,960, nontaxable $4,272, Total: $843,236
Providence Sacred Heart, Spokane
Elaine Couture, base $360,667, bonus incentive $592,708, other $17,901, retire/deferred $46,618, nontaxable $17,100 Total: $1,034,994
Providence St. Peter, Olympia
Medrice Caluccio base $417, bonus incentive $141,498, other $17,577, retire/deferred $419,464, non taxable $15,710 Total: $1,010,027
Central Washington Medical Center, Wenatchee
John Evans, Jr. base $141,598, bonus incentive -0-, other $1,491,778, retire/deferred $127,110 nontaxable $5,597 Total: $1,766,084
Smaller Hospitals: Top Administrators Total Salaries
Lake Chelan $177,242
Lourdes Medical Center, Pasco $823,668
Skagit County Hospital, Anacortes $378,386
Yakima Valley Memorial Hospital $565,441
Kittitas Valley Hospital, Ellensburg $277,674
Kadlac Medical Center, Richland $879,058
Walla Walla General Hospital $393,221
Shriners’ Hospital for Children $144,910 (Spokane)
Mid-Valley Hospital, Omak $159,972
Hospitals Not Reporting
For profit hospitals were not required to report, presumably for proprietary reasons. Other hospital and health systems apparently chose not to report. All these hospitals accept public money in the form of Medicaid and Medicare money.
There were some health systems that were not abundantly clear about who made what at which hospital, such as Multicare Health System out of Tacoma.
It was not clear what was Multicare, Mary Bridge Children’s Hospital and their other hospitals, so they were not included here. You can check them online at the DOH website.
Overlake Medical Center, Bellevue
Seattle Children’s Hospital
Seattle Cancer Care Alliance
Peace Health Hospitals
Franciscan Health System Hospitals
It’s Time for Accountability
Each of these organizations has a Board of Directors, Trustees or Commissioners. You can go to each hospital website. If you do not easily find the list of their Boards of Directors/Trustees/Commissioners, you can type in “Board of Directors” in the search function on their website and the information will come up.
For example, here is the list of the Board of Trustees for Virginia Mason.https://www.virginiamason.org/BoardMembers
University of Washington Medical Center: http://www.uwmedicine.org/Global/About/Pages/UWMedicineBoard.aspx
Central Washington Medical Center: http://www.cwhs.com/Content.aspx?id=71&terms=board%20of%20directors
Valley Medical Center: https://www.valleymed.org/About-Us/Meet-the-Board/
Providence Health System: This is more difficult since it is a health system, and there is a system board, as well as a local board, but here is Spokane:http://washington.providence.org/donate/providence-health-care-foundation-eastern-wa/board-of-directors/
Mid Valley Medical Center, Omak http://www.mvhealth.org/leadership
Forks Community Hospital, Forks, http://www.forkshospital.org/board-minutes
What We Need to Do
As members of Boards of Trustees, Commissioners, you need to ask the hard questions:
- What value and outcomes are you getting in your community for the salaries you are paying your executives?
- Are they improving patient care?
- What are patient outcomes?
- How many readmissions do you have that may have been avoided?
- How are you doing in managing hospital infections?
- How much uncompensated care does the hospital provide as compared to other hospitals in the community?
This last question, of course, would not apply to communities such as Omak or Forks where they are the only hospital.
Certainly the choices in Omak and Forks are different than the ones in Tacoma and Seattle, but the question is, how do we hold our health care institutions accountable?
I believe, but I do not know for certain, that many Boards of Trustees are paid to serve on these Boards. If you are paid to serve, who is going to ask the hard questions? Who is going to ask about outcomes, readmission rates, infection control, necessary or unnecessary surgeries?
Certainly the problems in Forks, Omak and other disproportionate share rural hospitals are different from an urban Swedish or Evergreen. But we all need to be smarter about health care.
I offer two sites in Washington State that are dealing with documented health care outcomes as determined voluntarily by community practicing doctors: http://www.qualityhealth.org and its respective programs and the Bree collaborative: http://www.hta.hca.wa.gov/bree.html
As patients and consumers, we need to hold the Boards of Directors/Trustees accountable. Your doctor determines where you go, because of admitting privileges and insurance contracts. Ask him or her why they chose to work with the hospital they use. Talk to the hospital board of director members. Look at the outcomes from facility to facility.
I don’t know how many states require hospitals to report their compensation. But it is time we had community conversations about what we expect from these institutions in return for our community investments.
I am not the only person looking into this.
Here is an article by Kaiser Health News: Hospitals reward CEOs for growth that increase costs.
Kathleen O’Connor, MA: O’Connor, publisher of the O’ConnorReport, has nearly 30 years experience in health care reform publishing and consulting, reform strategies, and consumer advocacy locally and nationally. She is a member of the Association of Health Care Journalists.
UW Medicine and PeaceHealth have agreed to create a “strategic affiliation,” with details to be spelled out by the end of September, Seattle Times health write Carol Ostrom reports.
PeaceHealth, a not-for-profit system based in Clark County and founded by the Sisters of St. Joseph of Peace, operates nine hospitals and physician groups in Alaska, Washington and Oregon, and a Medicaid health plan.
The two organizations said they will remain legally separate and independent, but critics of such affiliations noted that after Swedish Medical Center used such language in an affiliation with Providence Health & Services last year, it stopped doing elective abortions and closed its hospice service.
The U.S. Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services restrict such services as abortion, birth control, sterilization and patients’ rights regarding end-of-life treatment.
Seattle Times staff columnist Danny Westneat questions the growing role of the Catholic church in healthcare in Washington state.
By the end of this year, half of our state’s medical system will be Catholic-run, as measured by number of hospital beds. That’s the highest share in the nation, and rising fast — up from about 30 percent just last year. Somehow our godless state has become Ground Zero for faith-based medicine.
We’d never turn our education system over to one church to run. Why are we doing it with health care?
To learn more:
- Read Ostrom’s article: UW Medicine, Catholic health system to have ‘strategic affiliation’
- Read Westneat’s column: Is Catholic Church taking over health care in Washington?
Advice from Seattle Children’s On the Pulse blog
The days are getting longer, the weather is getting warmer and kids are spending more time outdoors. It is spring time – a season for hiking, grilling, gardening and outdoor fun. But with spring also comes the occasional bump, bruise, bite, rash and fall. How can parents help their kids avoid injury?
Tony Woodward, MD, MBA, medical director of the division of emergency medicine at Seattle Children’s Hospital, offers advice for keeping kids healthy and out of the emergency room.
The hazards that come with spring
Many common spring injuries can be prevented by taking just a few moments to focus on safety. Woodward reminds parents, “the first thing for everything is supervision.”
With warmer weather comes more open windows, and with more open windows comes more danger. According to Consumer Reports, each year more than 5,200 children fall from windows, and at least one in four is injured badly enough to be hospitalized. Young children four years old and younger are at a greater risk for window falls and are more likely to sustain serious injuries or die, according to the Journal of Pediatrics. To prevent window falls, move furniture away from windows, install window guards or stops and don’t rely on window screens. Keep in mind, Woodward says, kids can fall from windows open as little as five inches.
“Families look at screens as a barrier,” says Woodward, “but screens aren’t a barrier for kids. Many times, the screens are improperly installed or loose, causing children to fall through, sometimes causing serious injury.” Screens keep bugs out, but they don’t keep children in.
Keep a close eye on small children and keep windows latched. Learn more by watching this short video.
Spring cleaning and gardening
It’s time to dust off the cobwebs and get the yard in shape, but be cautious of hidden dangers in cleaning and gardening products.
“Poisoning is a concern throughout the year, but in spring we see products that were hidden away become more easily accessible to children,” Woodward says.” Fertilizers or poisons for outdoor use that were once stored deep in the garage or house come out in spring,” says Woodward.
According to the American Academy of Pediatrics (AAP), approximately 2.4 million people – more than half under age 6 – swallow or have contact with a poisonous substance each year.
“Children may think a poison is ingestible, especially if a parent has placed excess cleaner or poison in a bottle that resembles a drinking bottle,” says Woodward. Even a small amount of poison is enough to harm a child. “A swallow or two, the amount of a teaspoon, is enough to cause serious damage, “says Woodward.
His advice to parents is to store all cleaning and gardening products in their original containers, up and out of the reach of children. Trade in heavy-duty cleaning products for non-toxic cleaners, and make sure your child doesn’t get near the poisons you’re using while you’re in the middle of a project. Lastly, post the Poison Center phone number by each phone in your home, and program it into your cell phones: 1-800-222-1222.
Before lighting up the grill this spring, think safety first. “The best thing for a parent to do is get down on your hands and knees and access potential dangers,” Woodward recommends.” Put yourself in the position of a small child. If you see something that looks like it may be enticing around the grill or in the backyard ask yourself, could this be a danger to my child’s safety?“
Keep kids away from grills, and establish a safety zone, making sure the zone is at least 10 feet away from the grill. By taking this safety measure, parents can reduce the risk of a child touching the grill and severely burning themselves.
Always have kids wear shoes around the grill. The charcoal from a grill, which can be very hot, can come out the bottom, increasing the likelihood of a child getting burned. Also, sharp utensils used for grilling may fall on the ground. Wearing proper footwear can reduce the risk of puncture wounds.
Each year many children are severely injured by lawnmowers, according to the AAP. However, most of these injuries can be prevented. The AAP recommends not letting children under 12 use a walk-behind mower and not allowing children under 16 to use a riding lawnmower. Never let a child use a lawnmower without proper shoes – boots or closed-toe shoes. Safety goggles or glasses with side shields will keep their eyes protected. Also, make sure lawnmowers have an automatic shut-off mechanism.
Before mowing, pick up any items in the lawn that could be potential safety hazards. Woodward says rocks and nails hidden in the grass can become fast-moving projectiles that could harm a child.
Be aware of your surroundings while mowing. “You can’t see 360 degrees around you,” says Woodward. Make sure small children are indoors when operating a lawnmower to reduce the risk of injury.
As fun as trampolines can be, they can also be extremely dangerous. Thousands of children are injured on trampolines each year. “Trampolines are more dangerous the more people there are on them,” says Woodward.
The AAP advises against trampolines for home use, but offers the following precautions if families do choose to have a home trampoline:
- Insist on adult supervision at all times
- Allow only one jumper on the trampoline at a time
- Do not allow flips or somersaults
- Check for adequate protective padding on the trampoline and make sure it is in good condition and appropriately placed
- Check all equipment often and repair or replace parts immediately when needed.
Beautiful landscapes, warm weather and sunnier days make hikes a popular spring time activity. But before hitting the trail, make sure your family is properly prepared. Remember to wear appropriate footwear and clothing, and pack extra water. Also, don’t forget sunscreen, insect repellant and a first aid kit. Plan ahead and keep in mind the dangers of the outdoors: bug bites and stings, plants that may cause rashes and allergic reactions and exposure to sun, heat, wind, water or cold.
Woodward says winter run-off and eroded rock are two of the major causes of hiking-related injuries and fatalities each spring. “A stream that you may have been able to walk across in August may be twice as deep in April, May or June,” says Woodward. “In spring, streams are higher, faster and colder. Keep children away from running water.”
“In a wet environment, boulders and rocks may become loose,” Woodward says. ”I’ve seen instances where kids were climbing on rocks and they’ve become dislodged and pinned a child, resulting in death. Things that were stable in the past can become unstable with water erosion.”
Urgent care or emergency department?
Unfortunately, accidents do happen, sometimes at inconvenient times when primary providers aren’t available. When your child or teen needs immediate medical care for serious injuries, parents have many options available for care.
If your child gets hurt or sick this spring, Woodward recommends that you assess the severity of the injury or illness to determine whether a trip to an urgent care clinic is more appropriate for your child. For a quick guide, refer to this helpful chart.
“In general, if you’re worried about altered mental status, disfigurement, large lacerations, concussions or loss of consciousness, a child should be taken to the ED,” says Woodward. If a child becomes injured, Woodward advises parents to take a deep breath, first and foremost. “We don’t want two patients instead of one,” says Woodward. Parents should calmly asses the situation and act in the best interest of their child.
Remember, if your child’s illness or injury is life threatening, call 911.
In 2012, the Emergency Medicine team at Seattle Children’s saw over 36,000 patients. Hopefully, your child never has to visit the Emergency Department, but just in case, Seattle Children’s new Emergency department, opening April 23, will be able to meet the needs of any child, no matter the injury.
When I was about 15, a friend was confiding in me about our friend Sasha’s* fight with her boyfriend James*. Sasha had been dating James for a while, and their relationship included sexual activity. She told me that Sasha had cheated on James, and he had found out and been furious.
“What did he do?” I asked.
“He was really mad. He yelled at her and threw things and made her have sex with him,” she said.
“Like, he made her have sex, when she was saying no?” I said, incredulous.
“Well… I don’t know. I don’t think so. He said she was crying but didn’t fight him or anything.”
Reading this as an adult makes me cringe. But as teens, we were a little confused as to whether James could really rape Sasha, given that they were going out and had had sex before.
When we saw Sasha next, she and James were together and they seemed happy. We concluded that she couldn’t have been sexually assaulted.
When we think of teens being sexually assaulted, we often think of stranger/ acquaintance rape, but teens can and are sexually assaulted by their romantic partners. This can occur even if they have consented to sex in the past, and might again in the future. Consenting to one episode of sexual contact does not mean that there is blanket consent for sexual consent at all times.
This seems like an easy concept for adults to understand, but it’s important to remember that the very idea of date and marital rape wasn’t really addressed by our society until the 1970s. One of my earliest memories of talk radio is listening to (and being confused by) a debate in the early 80s that boiled down to, “Is it really possible to rape your own wife?”
Teens- especially younger teens- can be confused by the concept of sexual assault within the confines of a romantic relationship that has already involved sexual contact. It’s important that teens realize that it’s wrong to make, or coerce, someone into having sex, even if they’ve consented to sex before.
It’s also important that teens know they can say no to someone- with every expectation of an immediate halt to sexual activity- even if they’ve said yes before, no matter what the circumstances. In Sasha’s case, I found out later she felt she’d “deserved it” for having sexual contact with someone else while dating James.
While it’s very important that your teen realize that it’s important to gain consent for sexual contact, they also need to know that consent is important for every sexual contact.
It doesn’t necessarily mean that a teen has to seriously sit down and formally ask for consent every time (although they can if they want to), but they do need to realize that consent is not a one-time process when one is dating someone, or has had sexual contact with them before.
This may not be one of those concepts where you can give a step-by-step guide on how to deal with it, but it’s still important that they’re aware the concept exists.
Once you’ve discussed how important this is with your teen, ask them how they’d go about making sure every sexual contact is consensual. There isn’t one correct answer. Discuss their ideas with them.
Depending on your teen, they may be so embarrassed at the idea of talking to you about this that they stop the conversation, which is fine. Once you’ve asked the question, you can leave their mind to fill in the blanks when it’s time… although bringing it up again when they’re in a romantic/ sexual relationship never hurts.
What conversations have you had with your teen about this? What was their reaction?
Top photo courtesy of Sanja Gienero
About Jen Brown, RN, BSN
Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.