CLIENT/CLINICIAN SCRIPT

Alisha: Positive Pregnancy Test, Options Counseling and Assessment for Possible Partner Retaliation
Clinician: Hi, Im Lisa your clinician. How are you doing today? Alisha: Im kind of nervousjust waiting on the test results. Clinician: Well, I ran the test. Can you tell me what youre hoping the results will be? Alisha: Well, Im still in college. What are the results? Clinician: Alisha, the pregnancy results are positive. Alisha: Oh, God. Clinician: I can see this isnt the result you wanted. Alisha: I actually took a test at home. I was hoping it was wrong. Clinician: Im sorry this wasnt the news that you wanted. Is there someone that you can talk about this with who is supportive? Alisha: Yeah, I guess. Clinician: Well, before I get into your options. Does the person who got you pregnant know that youre here today? Alisha: No. Clinician: Will you share the test results with him. Is he still in your life? Alisha: Hes my boyfriend. He actually thinks that I might be pregnant and actually hes really excited. Im not ready to be a mom. Clinician: That kind of disagreement can really make it difficult deciding what to do. Have you two be together long? Alisha: About a year. Clinician: Not being in the same place about a decision like this can be really stressful. Are you planning on telling him? Alisha: Yes.

Clinician: In terms of making a decision according to your last period youre still early in your pregnancy. So that gives you time to think about your options to make a decision. Whether to keep the pregnancy and be a mom go with adoption or have an abortion. Alisha: I really wish I didnt have to think about any of this. Clinician: Yeah I really understand. Are you afraid of what will happen when you tell him? Alisha: Well, I want to have an abortion but I think hell lose his mind if he finds out. I actually have been going back and forth on whether or not to tell him. Clinician: What does that look like going out of his mind? Alisha: He literally told me, if I find out that you killed my baby, Ill kill you. Clinician: Alisha, this is really scary. Has he ever hurt you physically in the past? Alisha: No, hes just crazy jealous. He really wants to have a baby with me. Clinician: Do you think he got you pregnant on purpose? Alisha: I dont know. I feel so stupid about all of this. He told me that if I got on birth control that would make me fat and that he just wanted to use condoms. I didnt want him to think that I was fat so I didnt get on birth control and then he pulled the condom off or it fell off and then whatever. Ive taken emergency contraception a few times but I guess that I missed a couple. Clinician: Im really sorry you have to go through all of this, Alisha. Is this something you can share with friends and family? Alisha: No, no. Im too embarrassed. I know better. I know that Im not supposed to be in this kind of relationship. Clinician: Alisha, all kinds of women at different points in their lives find themselves in this type of situation. Im not an expert in controlling and abusive relationships but I know someone who is. Would it be okay if I called my colleague, Debbie? She can help you develop a safety plan and think about your next steps. Shes helped a lot of women in your situation. She can come here to the clinic if thats what you want to do or you can even talk to her on the phone. Alisha: Yeah, Id like to talk to her. Clinician: Thank you for trusting me with your story. For now I want you to get support and be safe so that you can make the choice thats right for you, not out of fear of what your partner will do. Clinician: (calls Debby on the phone) Hi, Debby, its Lisa from the clinic and I have a client here, Alisha, who has some things shed like to go over with you.

Alisha: Hello, Debby?

Heather: Routine ScreeningPrenatal Health Obstetrics

Doctor: Hi Heather, hows it going? Heather: Hi, how are you? Doctor: Im good, thank you. Lets take a look. Youre twenty-two weeks along, you look great and your blood pressure is good. Just a follow-upany UTI symptoms, have you completed the medication? Heather: No. Doctor: Good. Morning sickness, are you keeping things down? Heather: That is all better. Doctor: Good. How are things between you and your husband? I know that baby number two came along a little earlier than planned. Heather: Where getting used to it. What can I say? Our friends sent us to a delicious dinner at a fancy hotel with a wine pairinghave you worked that in to your what not to do if you dont want to get pregnant spiel? Doctor: No, but I think that we will soon. But I really do want to know. In fact, Im giving out these cards to all of my patients. Heather: Cute baby. Why have you started giving these out? Doctor: I had a patient whom I really cared about and she lost her baby when her partner hit her in her abdomen. I didnt ask her about her relationship and didnt ask if she was ever afraid of him. I didnt even ask if she wanted to be pregnant. I found out later that she was afraid to use birth control because she thought hed hit her. She was going to leave him when he did hit her. Heather: Im so sorry, thats horrible. Doctor: Heather, it is and Im giving out these cards because things come up and relationships change and I want my patients to know that I am there for them. On the back of the card is the national hotline number for folks that will help you with a safety plan and just to talk things through if they come up. I guess what I asking from you is this happening in your relationship, are you ever afraid of him or has he ever harmed you in any way? Heather: Oh no, nothing like that. He is a total sweetheart, truly. But it did happen to his sister and it was really hard on her and her kids. So I do know that it happens.

Doctor: Im glad that youre okay. I think that you can share this information with your sisterin-law or another mommy. Theres some good information in there that can be helpful in a lot of ways. Heather: Thank you, I really appreciate that you took time and that you care. It matters.

Jocelyn: PID Follow Up Visit Due to Chlamydia Infection

Jocelyn: Im sorry if this is making you late. I can stay here by myself if that helps. Husband: You know that that cant work. Look, I need you to be at home when I call you from work or else I start to worry about where you are. Jocelyn: Of course. Husband: Besides, I want to know whats going on with you as much as you do. Jocelyn: Sure. Husband: Good. Now, Im glad youre thinking this through. Clinician: Hey, Jocelyn. Jocelyn: Yes. Clinician: Oh, good. And you are (looking at Jocelyns husband)? Husband: Im Jocelyns husband, Michael. Clinician: Im glad you came in we like to see supportive husbands. Now, Im going to take Jocelyn in the back and well come get you later on in the visit, okay. Husband: I figured since I am her husband Id be able to go back there as well especially since I came here with her today. Besides, Ive been worried about the symptoms shes been having. Jocelyn: He is. Clinician: Im sorry its just clinic policy. We always see the patients first by themselves then come back and get family and friends later. Husband: Okay, thats disappointing. Ill be here waiting for the call back. Clinician: There magazines in the cornerMens Health and People. Husband: Thats okay. Im fine. Clinician: Jocelyn, come on back.

Doctor: Hi, Jocelyn Jocelyn: Hi, Dr. Mitchell Doctor: You look better. Are you feeling better? Jocelyn: Im feeling better but I still have some pain. Doctor: Im sorry youre still having some pain. But you look better than you did two days ago and thats a really good sign youre improving. Are you taking your antibiotics? Jocelyn: Yes. Doctor: Good. Dont skip any. I see our office called you and confirmed that the infection was caused by Chlamydia. Jocelyn: Yes. They did call but I really dont understand. Ive been married two years. Doctor: Im really sorry. Its really possible the infection was symptomatic for a period of time. Thats the hard thing with STIs, pinpointing who, when, and how is really difficult when the most common symptom is no symptom at all. But I think it is also reasonable to consider if the infection came more recently. Jocelyn: My gosh. Doctor: Im really sorry this is happening. To get a sense of your sexual history so that you dont get this again, have you had other partners since youve been married? Jocelyn: No, of course not. Doctor: Okay, how about your husband? Is it possible he has other partners? Jocelyn: Its possible. Doctor: So, have you spoken with your husband about PID and Chlamydia? Jocelyn: No. I was just hoping that they screwed up the test results. That happens sometimes, right? Doctor: Thats not what happened this time and we did test you for gonorrhea and that was negative but we should also test you for syphilis and HIV today. Jocelyn: Youre kidding. Doctor: No, Im not. Anytime you have a sexually transmitted infection it puts you at greater risk for the others.

Jocelyn: Of course. Doctor: What would happen if you told your husband about the infection? If it would help we could explain all about it here in the clinic. I understand he came in the clinic with you today. Would it help if I talked to him and explained? Jocelyn: No. I dont think so. I dont know. Doctor: Another idea is to have Health Department call him. They do this kind of thing all the time. They would call and tell him hes been exposed to Chlamydia but they cant tell him where they got the information from. Jocelyn: I dont think thats going to help. Doctor: Jocelyn, are you afraid when he finds out hes going to hurt you? Jocelyn: Hes going to be really, really mad. Hes not going to believe I didnt do something. Doctor: This seems really hard and I hear this from a lot of patients. Im not an expert in how to help in the situation with your husband but I know someone, a colleague, Jackie, she really understands and she can help you with a plan to be safer. Are you afraid to go out in the waiting room right now? Jocelyn: I just cant. I cant right now. It comes in waves with him. I cant right now. Hell blame me. Doctor: Do you think he can become violent with you or someone else in the clinic? Jocelyn: Hes not going to act up in public. Doctor: Okay. Because this is so common Im giving this to all of my patients. Its all about relationships and what women deserve in relationships. Being hurt and being afraid shouldnt have to be a part of that. There are hotline numbers on the back, I called them myself. Theyre really good and theyre there 24/7 just to listen or to help you with a safety plan. So, lets finish with your other tests and take care of the rest of the visit and then if you want you can borrow my phone or have me call the hotline or call Jackie. Jocelyn: Okay.

Marta: Oral Contraceptive Visit

Dr. Copland: Hello Marta, I Dr. Copland and Ill be taking care of you today. Marta: Hi.

Dr. Copland: It says here that youre coming today for a birth control method. Marta: Yes, I need birth control pills. Dr. Copland: Okay great, lets see here. It looks like everything here is in order. Your Pap is up to date and you just started your period yesterday. Any change in partner since your last visit? Marta: Well, we got married. Dr. Copland: Congratulations and does he know youre here today for birth control? Marta: No, I didnt tell him. Do I need to tell him to get the pills? Dr. Copland: No, no not at all. You dont need to get your husbands permission to get the pills. Marta: Okay. Dr. Copland: Is he supportive of you using birth control? Marta: It would be a time to have a baby right now. Dr. Copland: Is that he wants to have a baby right now even though you think it would not be a hard time? Marta: Its complicated. I want babies too just not right now. Dr. Copland: It sounds complicated. Marta, one of the things I talk about with all of the women who come to the clinic is that its your right to make decisions about sex and pregnancy. No husband or boyfriend has the right to force you to do something you dont to do. What would happen today if he found out you were here for birth control? Marta: He says the reason I want birth control is to sleep with other men, which is not true. Dr. Copland: And what would happen if he found the pills? Marta: I would tell him that theyre my sisters. Dr. Copland: Do you think he might hurt you if he found out that the pills were yours? Marta: I want to wait until we have our own place before we have a baby. It would less stress. Dr. Copland: Marta, this makes me worried for you and that maybe youre at risk of him hurting you. No matter what its not your fault even if he says it is. Marta, I think there are things I do to help right here today in the clinic so you dont have to be worried about pregnancy with everything else going on in your relationship. Would you like to hear my ideas on how to help? Marta: Yes.

Dr. Copland: Given what youve told me about him being mad if he found out about the pills there is another form of birth control that he wouldnt have to find out about so you would have to hide. Because we hear about this from so many women we made this card about safe and healthy relationships and what to do if hes trying to pressure you to get pregnant when you dont want to. Dr. Copland: Intrauterine Contraceptive. Its a mouth full. With the IUC youll still get your period the same time every month but with some women they experience more bleeding and cramps, although most women who use it really love it. Its a device that we insert in to the uterus and its good for twelve years. Although you can have it removed sooner if you would like to get pregnant. These strings we would cut them short and they curl up around the cervix. Although some women want them cut all together so their partner wont know about it. We can even insert this today if you like. Marta: Really, today? Dr. Copland: Is that something you would be interested in? Marta: Yes, I think this would be better for me than the pill. Dr. Copland: Okay, great. Ill go ahead and get the consent form ready for you to sign and well get the room ready for the insertion. Marta: Yes, good. Dr. Copland: While were waiting on this Marta Im wondering if you would like to take with someone about when youre having a hard time in your relationship. I have a really kind colleague, Nina who works for a local organization who helps women who are having trouble in their relationships. She works with a lot of women who come here to the clinic and she could even speak with you in Spanish if you like. She runs the weekly group for women who like to talk about their concerns in their relationships and she also has a safe shelter that you could go to if you ever had to leave your house in a hurry for safety. Would you like to talk to her? Marta: Just talk? Dr. Copland: Yes, and you can talk to her without giving your name if that would make you feel more comfortable. I can go ahead and make the call to get things started if you like. Marta: Maybeyes. Dr. Copland: Hello, Nina. Hi, its Dr. Copland. How are you? Im sitting here with a Spanish speaking client and she has some questions for you. Marta: Hello, yes. My name is Marta.

Maya: Repeat Pap/Emergency Contraceptive Visit

Clinician: Hi Maya, how are you today? Maya: Fine, thanks. Clinician: Okay, can you tell me what you are here for today? My computer is being slow. Maya: For a repeat Pap and also I had a condom accident yesterday so, since Im here Clinician: So you need a repeat pap and emergency contraception Maya: Exactly. I know I can get it at the Pharmacy but its crazy expensive and its free here. Clinician: Same partner? Maya: Yeah. Clinician: It looks like weve given this to you several times in the past few months. Im sorry my computer being slow. Can you remind me of what methods you use again? Maya: Just condoms. Clinician: Okay. Would you be interested in using something else in addition to the condoms? Maya: No, the hormones make me crazy and I gain weight. I dont want to gain weight. Im just going to stick to condoms. Clinician: Okay. Well, ultimately it is your chose but there are some great effective methods with no hormones in them. Maya: I dont know. My boyfriend doesnt like anything that isnt natural. He thinks its unhealthy and could have side effects and those side effects can contribute to woman not being able to get pregnant when they get older. Clinician: We have a lot of data to shows that women have no problem getting pregnant when theyve used birth control. One of the things that worry me when I hear combinations of things like this the condoms breaking so much and youre boyfriend not being supportive of you using effective birth control method is that he may be trying to get you pregnant. Do you think he could be breaking the condoms? Maya: Well, he has been talking about wanting to have a baby with me but Ive been clear that I dont want to have one. Well, at least until I finish college and figure out my life career and stuff.

Clinician: Um. Well, this may or may not be the case for you but sometimes men will use pregnancy as a way to keep you in their life forever. Maya: Really? Clinician: It could really be a form of control. Hearing what youve told be me makes me wonder if there have been other situations where hes tried to be in control. Has he tried to hurt you in any way? Maya: No, no. Nothing like that, hes never hurt me. But hes definitely upset about whats in the card for me after graduation. Its weird. I never really thought about putting the pieces together before. Clinician: If you really want to avoid getting pregnant there are methods of birth control that are total safe and effective without hormone. This is the IUC, its inserted in to the uterus, it lasts up to twelve years and you could remove it anytime you want to plan a pregnancy. Maya: Do the strings stick out? Could hewould you feel it? Clinician: Potentially he could feel it but we would cut the strings short and they curl around the cervix but we usually leave a small bit of string so that you could feel that the device is still in place. We could cut the strings of completely because there are some women that dont necessarily want their partners to know about the device and wed have to use an ultra sound to remove it. Does the IUC sound like something that could work for you? Maya: It would definitely be a lot less stressful especially if the condom breaks again. Clinician: Great. In the meantime Im giving all my patients this card. Its about healthy relationships and inside there is a self quiz and stuff about partners using pregnancy as a means of control. On the back there are 24-hour national hotlines if you need help or you want talk to an expert or if you have any questions. Is there anything else I can help you with? Maya: No, nothing right now. Thank you. Clinician: Okay, so I going to step out and let you get undressed for the Pap test.

Olivia: Forced Sex Identified During Visit / Trauma Informed Mandatory Reporting Demonstrated.
Clinician: Hi Olivia, Im your clinician and Ill be taking care of you today. Olivia: Hi. Clinician: I see you wanted to be treated for STIs and get some emergency contraception is that right?

Olivia: Yeah. Clinician: Lets see. No known drug allergies, correct? Olivia: Right. Clinician: So we can work this all out today, no problem. Olivia: Good. Clinician: I do want to remind you this conversation is private and confidential unless you tell that someone hurt or is hurting you or if you have thoughts of suicide. Those things I need to report, okay? Olivia: Okay. Clinician: So, why dont you tell me about wanting to be treated for STIs? Olivia: Im not sure if I have anything or not so I wanted to get checked. Clinician: Im really glad you came in. Normally we dont treat for STIs unless you have a positive test result or you partner has a positive test result. Olivia: Well, I dont know and I wont know so can you please just treat me? Clinician: Why dont you tell me more about why you wont know? Olivia: I was at a party a couple days ago and I dont know who he is. Clinician: Okay, well that happens. When I hear about parties and having sex with people you dont know I worry that maybe thats something that happened that you didnt want it to. Did you agree to have sex with him? Olivia: I was kind of wasted. Clinician: Okay, well were you passed out? Olivia: I dont know. I woke up with my clothes off. Clinician: Olivia Im so sorry that happened to you. Its never okay for someone to have sex with you without your consent even if youve been drinking. So, I can go ahead and give you the medicines for STIs in case youve been exposed and this is the emergency contraception to prevent pregnancy. Also, I want to come back in 3-months to test for HIV just to make sure, okay? Olivia: Thank you.

Clinician: Olivia, what happened to you at that party, someone having sex with you without your consent, its not your fault and its a crimes. Im not an expert on sexual assault but I work with these counselors at a local program especially this woman named Jessica. She gets it. She can go with you to the ER to get a specially trained nurse Olivia: No. I dont want anything like that. Im fifteen I was just stupid at a party and I dont want to talk about it. Clinician: Okay. Just so you know you can talk to Jessica whether you decide to have the exam or not. Also, this is the national hotline on the back of the card for RAINN and theyre open to talk to you 24/7 and its all confidential and theyre really supportive. Olivia: Thanks. Clinician: So Olivia, do you remember when we talked earlier and I said there were some things I would need to report? This is one of those things. Olivia: What? No. No. You cant. I mean, I wasnt even supposed to be at this party. My parents dont that I was at this party. My boyfriend doesnt know that I was at this party. You cant. Clinician: I know this isnt what you want and dont want to make this more stressful than what it is Olivia: Then dont. Clinician: Olivia, you do have some choices here. I have to make the report butwe can do it together. You can sit in when I call it in and I can put a report in the about what you want to have happen, the safest way for your parents to be told, that kind of thing. But I do need to make the report whether you want me to or not, even whether I want to or not. So, what do you say? Olivia: You have to? Clinician: Yeah, I do. Olivia: I guess I want to hear the call.

Olivia: Pregnancy Test and Anticipatory Guidance on Health Relationships (without Mandatory Reporting / with Mandatory Reporting)
Clinician: Hi, Im Lisa your clinician and Ill be taking care of you today. So I see youre here for a pregnancy test, you already left your urine sample? Olivia: Yes.

Clinician: Im really glad youre here and its really normal to feel nervous so as we go through these questions let if there is anything I can do to make you feel more comfortable. Olivia: Okay Clinician: And just to remind you about the consents you signed out front. We automatically test your urine for Chlamydia and Gonorrhea. Those results will be ready in 3 to 5 days and well only call you if the results are positive, so no news is good news. Your pregnancy results will be ready in a few minutes and go over those with you today. Olivia: Okay. Clinician: Before we go over the results I want you to know that our conversation is private and confidential unless I find out that someone is hurting you or you are feeling suicidal, that I would have to report. Okay? Olivia: Okay. Clinician: So, to start with can you tell me what you hope the pregnancy results will be? Olivia: Oh I hope negative. I really dont want to be pregnant. Clinician: The person you had sex with does he know that youre here for a pregnancy test today? Olivia: Yeah, he knows. Clinician: And is he hoping for the same results you are or is he hoping that youll be pregnant? Olivia: Oh, he hopes that it will be negative too. Clinician: Oh, okay. So if the results are negative we should think about ways to keep it that way. I see that youre using condoms as your birth control method and it also says from your paperwork that your last period was 3 weeks ago. Was that normal period for you? Olivia: Yeah. Clinician: It also says that we gave you emergency contraception the last time you were here and some to take home. Did you use that when you were having trouble with the condom? Olivia: I did but Im just worried. Clinician: Its always good to come in to find out for sure. Sometimes people dont use condoms because theyre in the heat of the moment or they break or theyre not having sex that often. Can you tell me if any of these things are happening with you? Olivia: Sometimes, my boyfriend forgets and we dont have sex that often.

Clinician: And is he your only partner or are there others? Olivia: Oh, hes my only one. Clinician: And how long have you two been together? Olivia: About a year. Clinician: And when you started to have sex was it something that you both wanted or something that just he wanted? Olivia: Something that we both wanted. Clinician: Okay, good. And can you tell me something about whats happening with the condoms. I can imagine how stressful it must be to have to use them just some of the time. Does he ever get mad at you for asking him to use them? Olivia: He We dont talk about it. Clinician: Okay. One of the things that were doing with all of the girls that come in to the clinic is were talking to them about relationships. Im going over this card that talks about healthy and safe relationships. Its kind of like a quiz and it talks about situations where you might feel afraid of your partner or youre forced to have sex when you dont want to and we find that about half of the girls that come in to the clinic have had this happen to them at some time or other. Olivia: Really? It happens that often? Clinician: Im afraid it does. Olivia: What do you do if its happening to someone? Clinician: I listen. I try to get them a method of birth control that their partner is less able to mess with or control, if thats a problem. And if its something different like forced sex or violence something that I have to report then I get the patient to sit with me while I make the report and ask them questions to make them feel comfortable while the report is happening. I tell her that it isnt her fault and that doesnt deserve this and I give her this card with the hotlines on it so that she can get support and someone to talk to 24/7. Olivia: Wow. Clinician: So, Olivia is any of this happening with your boyfriend? Olivia: No, no, hes just having a hard time with the condoms. But I do have a friend. Maybe she can come and talk to you sometimes?

Clinician: Yes, Id be happy to talk with her and her some extra cards to share with your friends. Olivia: Thanks. Clinician: So when I get back we should talk about some methods of birth control that are more effective than condoms and less dependent on him since hes having trouble using them. Sound good?

Preparing Your PracticePrevalence of Violence among Staff

Clinician #1: Most of the providers will have completed the online training in the next month or so after that there is nothing to stop us from mandating the expanded clinical assessment to include routine assessment for physical and sexual partner violence and for reproductive coercion. Clinician #2: I think its great youre spearheading this effort with provider training and want to institutionalize these changes. But, I really think there are some things we really need to consider before mandating anything. Clinician #3: Yeah, youre talking about adding on a lot of work. We already got serious time pressures here. Clinician #1: Given what we know about the prevalence of this type of violence I think its unethical to wait on anything. Quite frankly I surprised youre both fighting on this. Clinician #2: I wasnt referring to time pressures. Im saying that we really need to consider the staff here. People went in to this field for a reason. Clinician #1: Were all healthcare providers. We agreed to do certain things to improve the lives of our patients. If I have cancer and Im an Oncologist should I not practice? Maybe its my cancer that makes me the best Oncologist. Dont assume strength doesnt grow out of pain. People do this work to give. Im not asking them to fix it just to bring it up. Give them information, provide support. We might be the only people to talk to a patient about this. Clinician #4: Im not sure were hearing Rebecca clearly. Clinician #2: I guess Ill just have to out myself here. I know that this is important. But honestly I cant bring it up to patients right now. It makes me feel like I cant breathe and then I get nauseas and then Im no good to them. Its too soon. Im sorry Im not in a different place but I not. Clinician #1: Im sorry. The reason Im chomping at the bit for this to happen is because of my mom. Shes gone now but I wish her life could have been different. I tried to take on my dad

once and he nearly knocked my thru a wall. Im really sorry Rebecca. Of all people I should have gotten your point sooner. Clinician #4: No what? This was important. I think we should institute a policy to talk to staff first, tell them about their employee assistance benefits so that they know what they have available including anti-stalking support. Clinician #3: And we should reread our policy about having a violence-free workplace. Clinician #2: Maybe we could pair staff that might not be ready to ask about partner violence and reproductive coercion with other who is. Clinician #1: I think those are great suggestions.

Reviewing the Limits of Confidentiality: Pitfalls to Avoid (Part 1)

Sophie: Carla, please wait. Clara: Go to hell!!! Clinician #1: What was that? Sophie: I just totally screwed up. Clinician #1: What happened? Sophie: Im an idiot. Clinician #1: Why Sophie? What just happened? Sophie: Ive been running late all day. Its been one of those days. So anyway, I walk in to this room and the poor girl is sobbing. So I say you look like youre having a hard time, can you tell me about it? So she tells me about how shes in a fight with her boyfriend then the whole story comes out complete with forced sex, controlled behavior. He didnt even want her to come to clinic today. He was texting her the whole timehurry the heck up. Anyway, after I dry her tears and I tell her everything is going to be okay. Of I have to tell her that Im mandated to report the forced sex. She flipped out and said I thought this was confidential. My friend told me to come to you because youre so nice. Please, you cant do this. My mom is sick; my d ad is going to kill him like for real. I came here because thought you were going to help me, this is not helping me. Youre making things worse. Clinician #1: Oh, I am so sorry Sophie.

Reviewing the Limits of Confidentiality: Pitfalls to Avoid (Part 2)

Clinician: This is the medicine to prevent pregnancy and if you were exposed these are the medicines that will treat Chlamydia and Gonorrhea. You should come in for a HIV test in three months just to be sure. Violet: Thanks. Clinician: You know Violetdo you think someone might have slipped something into your drink? Violet: I dont think so. I got pretty sloshed playing those drinking games. Like I said, I pretty much remember the whole night even passing out in my friends bed. I honestly wouldnt have thought anything was wrong if Clinician: You hadnt woken up naked. Violet: Yes. Clinician: Are you sure I cant convince you to go to the hospital to a rape exam? With that tear I saw Violet: NO!!! I dont want to okay. Clinician: You dont have to do anything with the results if you dont want to and if you dont do it now you cant go back and do it later. Violet: Thats not it. Look, Im fifteen and I was drinking booze and I dont want anyone to find out okay. Youre not going to tell anyone are you?

SamSTI HIV Visit and Anticipatory Guidance on Healthy Relationships (Part 1)

Dr. King: Hi, Im Dr. King and Ill be taking care of you. So, I see youre interested in getting tested for sexually transmitted infections and HIV today? Sam: My girlfriend and I decided to get tested for STDs and HIV, so yeah thats why I here. Dr. King: Okay, great Im glad you came in. Before we get started on testing I want to talk to you about your relationship I want you to know that this conversation is private and confidential unless I find out that someone is hurting you or if you are feeling suicidal. Okay, those things I would need to report. Sam: Yeah. Dr. King: Okay, so back to testing. Did you already leave your urine sample? Sam: Yeah.

Dr. King: So you said you and your girlfriend both came in to get tested today which is great. Are either of you experiencing symptoms like discharge or burning during urination or anything like that? Sam: No Im not having symptoms it just a new relationship and I want to make sure were okay. Dr. King: Okay. I want to understand more about the people you have had sex with. Have you partners been men, women, or both? Sam: Seriously, girls and only girls. Dr. King: Okay and how many girls have you had sex with? Sam: A couple. Dr. King: And are seeing more than one person right now, having sex with more than one girl? Sam: No, no I just ended it with the other girl like 2 or 3 months ago and just started seeing Sophie. Dr. King: Okay, so tell me about Sophie. Hows that going? Sam: I dont know shes pretty coolsmart, pretty, nice. Dr. King: Have you and Sophie had sex yet or is testing something you wanted to do before you had sex? Sam: Just something we wanted to do before we had sex.