Table 1.
Patient vignettes related to the way COVID-19 has impacted youth exposed to or experiencing violence with potential responses from AYA-serving health professionals
| Patient vignette | Potential response with resource provision |
|---|---|
| Gabbya is a 16-year-old girl with symptoms of discharge, abdominal pain, and spotting. She missed her last Depo-Provera injection at the school-based health center six weeks ago. The health center staff sent her several reminder messages; and then school closed abruptly, including the health center. The school-based health center was a safe space for her to receive contraception. Her partner, who goes to a different school, does not want her to use hormonal contraception. | Responding to a post on social media about AYA telemedicine services, Gabby calls to schedule an appointment. She is asked if she has a private place to have the visit through telehealth. During the visit, the clinician shares information with her about the national dating abuse helpline (loveisrespect.org), saying, “In case you or your friends could use this information, we make sure to share this with all our patients.” Arrangement is made for Gabby to be seen at the AYA medicine clinic closest to her home for a nurse visit to receive a pregnancy test, Depo-Provera, and antibiotics for presumed pelvic inflammatory disease. She receives daily check-in calls from the clinic to ensure her symptoms are resolving; during each call she also receives adolescent-relevant resources. |
| Aarava is a 17-year-old boy with a history of anxiety and ADHD. He was about to start therapy when the pandemic started and behavioral health visits were switched to telehealth. His primary care provider called and spoke with him about virtual visits. He said he does not feel safe doing visits in his home because his father is emotionally abusive to his mother and also to him if he tries to stop the abuse. He says the walls are thin and it would be impossible to start therapy now. | His pediatric clinician called and asked for a safe time to schedule a telehealth call. Aarav provided his and his sister's cellphone number, both which he felt safe using. They decided on a time when his father was out of the house. Aarav spoke with the clinician first and then asked his sister to join. They decided to start therapy, using behavioral health resources provided by the clinician, but would need to limit it to times when their father was not at home. The clinician also provided resources to a local victim services agency for youth exposed to parental IPV. |
| Daneesha,a a 9th grader, was an active participant in a support group on healthy relationships in an after-school program. In group, she had shared her fears about her stepfather's anger. One of the facilitators saw bruises on her wrist. With the support of the group facilitators, child protective services got involved. Several weeks later, she shared how grateful she was to have the support of the adult facilitators who cared about her safety as well as the counselor whom she sees in school. Owing to COVID-19, the schools and after-school programs closed. The facilitator has not been able to reach her by phone; no one from the school district has responded to messages from the facilitator. The facilitator wonders what more she can do. | The facilitator reached out to the clinician who was overseeing the group, who then reached out to the school principal. The principal was grateful to hear that community partners were also seeking to support students during this difficult time and connected the facilitator to the school social worker. The school social worker was able to reach the home to check in and speak with Daneesha, and to let her know the facilitator was worried about her and offered the facilitator's phone number so that Daneesha could call her. |
| Since school closed, Daniela (age 17) has had fights almost daily with his mother. A housekeeper in a large hotel downtown, his mother is now without work. He cut his electronic ankle monitor and left his house to go stay with his boyfriend. This boyfriend was working in construction; three weeks ago, he was laid off as all nonessential building has stopped. He threatens to call Daniel's probation officer if Daniel seems reluctant to do what his boyfriend wants to do sexually. | Daniel sees a post on social media about the drop-in clinic for youth run by a local community health agency. While the clinic is closed due to the pandemic, he receives a call from a youth coach who offers a phone or video visit with a clinician. The youth coach also offers information about confidential services provided by a local intimate partner violence agency. The clinician speaks with Daniel by phone and offers to help make a call to this victim service agency together. While Daniel declines, he also knows that he can reach out to the youth coach or clinician any time. |
| Natea (age 16 years) sustained a gunshot wound after a dispute in his neighborhood. Nate is admitted to the hospital trauma service for medical stabilization. His physical wounds begin to heal and he is discharged home to continue his recovery. Sitting in the passenger seat on his way home, his heart begins to race as his mother's car nears the block where the shooting took place. Nate is worried about his safety and the safety of his siblings amidst an escalating turf war. | Following consent from Nate's mother and a referral from a nurse, a violence intervention specialist reaches out to Nate after discharge to discuss safety planning. Nate is skeptical about speaking with the interventionist by phone. The interventionist offers to send take-out to Nate's home and they enjoy a virtual meal together to build their relationship. |
a
Patient names are pseudonyms.