The "ins" and "outs" of provider-parent communication: Perspectives from adolescent primary care providers on challenges to forging alliances to reduce adolescent risk

Purpose: 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. Conclusion: Opportunities for further research on strategies to improve communication and develop a partnership between providers and parents are described.