Netflix’s Hit Show 13 Reasons Why – How Do I Respond?

Critical next steps for adolescent health professionals and parents of teens


If it seems like everyone is talking about the hit Netflix show, 13 Reasons Why, it’s because they are. The bestselling book turned Netflix series produced 3.5 million tweets—more than any other Netflix show. Its overnight buzz among teens and young adults is leaving parents and professionals feeling troubled and conflicted on how to respond.

From the beginning of the show, we know the fictional character, Hannah Baker, has already taken her own life—an unfortunately relevant issue in our society. Suicide is the second leading cause of death among teenagers in the U.S. While 13 Reasons Why brings to light the intensity and darkness of suicide, it is also a raw encounter of the hardships teens deal with—from bullying, peer pressure, betrayal, and sexual assault.

Hannah Baker wasn’t showing signs of depression that we often associate with suicide, but she was experiencing common hardships that can lead to unhealthy behaviors. To make matters worse, Hannah felt that no one listened to her cries for help.

How to identify at-risk teens

No teen is immune to risks—from the biggest troublemaker in school to the straight-A-student, all teens deal with pressures that they may not be equipped to handle on their own.

How can you ensure they will come to you if they’re struggling? The key is two-pronged:

1) Establish a strong relationship that sets the foundation for real talks.

Establishing that strong relationship—whether you’re a parent or an adolescent health professional—takes time, energy and practice—but it’s worth it. A recent study surveying more than 63,000 youth in the U.S. reveals that teens with a trusted adult to talk to are 2.2 times less likely to engage in risky behaviors, and 3.1 times less likely to report thoughts of self-harm or suicide, compared to teens who reported not having an adult to talk to.

2) Apply proven communication strategies that foster open, real conversations about issues that could affect a teen’s safety and health.

How to have real conversations

Understanding exactly what is happening (and why it is happening) during adolescence can help you support the teens in your life during this physically and emotionally challenging time. Talking to teens about common issues that may lead them to a state of helplessness is a critical next step.

There are evidence-based techniques and communication strategies that are proven to help break through a teen’s silence about the stressors in their life. Those strategies can be explored in Teen Speak, a how-to guide for real talks with teens. Teen Speak provides a detailed road map on how to get the conversation started, using real-world examples of teen-adult interactions and sample responses to common scenarios to support positive change and safer decision-making. In this book, you’ll gain practical strategies for connecting with teens to reduce their risks.


Learn communication strategies for real talks with teens at

Download resources to support parents in building strong relationships at

The impact of a positive adult influence on our youth

For teens, an adult influence is mission critical to their overall health and well-being. Whether it’s a teacher, parent, health care provider, coach, mentor or other family member, having a trusted adult to confide in when it comes to issues or problems is an extremely important determinant on a teen’s decision-making.

Looking at 2015-2016 RAAPS data, nearly 1 in 10 out of the more than 63,000 youth completing RAAPS, indicated that they did not have at least one trusted adult in their lives. Further investigation of the data shows that adolescents who do not have a trusted adult to talk to about problems or worries are 2.2 times more likely to engage in risky behaviors than adolescents who report having a trusted adult in their lives.

These results emphasize the crucial need for adults to build strong relationships with teens during adolescence, a time when they are starting to engage in risky behaviors, considering these behaviors are the primary cause of premature death and serious injuries. The infographic below shows the significant findings of this two-year study, including actions to help teens connect with a trusted adult.


The importance of engaging and coaching parents to reduce adolescent risk

It’s a statistic you’re probably familiar with: 3 out of 4 adolescent deaths in the US today are due to identifiable and preventable risk behaviors. Common risk behaviors that include suicide, substance use, unsafe sexual behaviors and unintentional injuries and violence.

When it comes to keeping our teens safe, the phrase “it takes two to tango” rings especially true. Adolescents need access to a trusted adult in a private setting where they can disclose information that may be detrimental to their health or well-being. That’s where professional risk screening and counseling comes in. If a health care professional is providing risk behavior counseling and a parent isn’t enforcing the same practices and principles at home, it can be a wasted and ineffective effort. Parent influence is so important. Family closeness and attachment have been shown to be one of the most important factors in leading to less drug use, delayed sexual experiences, and fewer suicide attempts in teens.

Sounds complicated? It doesn’t have to be. Encouraging and supporting youth to make safe decisions is truly a partnership. It’s your role as a health professional to call the plays in “practice”, but it’s the role of the parent to coach and shape their children to perform well when it’s game time.

So, how do we most effectively work together?

First, understanding exactly what is happening (and why it is happening) during adolescence and utilizing effective communication strategies can help you support adolescents during this physically and emotionally challenging time.

Then, it’s up to you to equip parents with the understanding, tools and direction to guide their children to smart behaviors that keep them out of harm’s way.

If you need some support and resources for parent coaching, I encourage you to join me and other health care professionals from around the country as we come together to explore how to improve communication and engage parents to reduce adolescent risk.

Register today for the webinar on Thursday, December 8 at 3 p.m.:

Talking Sex with Teens: Community Health Centers ACT for Change

Today’s adolescents are engaging in risky sexual behaviors at earlier ages than ever before, resulting in nearly 250,000 teen births in 2014 and nearly 10 million new sexually transmitted infections annually. Sexually transmitted infections are a significant public health problem in the United States and of particular concern in the adolescent and young adult population. A big factor contributing to the spike is that often times, teens are reluctant to discuss their sexual health with their care team since information about sexual health related behaviors and risk factors has the potential to appear in care summaries, patient portals, insurance explanation of benefits and the like—all which adolescent and young adult patients worry can be viewed by parents and guardians. The lack of communication results in an increased risk for undiagnosed and untreated STIs, missed opportunities for behavioral health interventions, including guidance on managing risk and addressing social determinants of health, and increased disease burden in the community.

In order to improve sexual health screening and behavioral counseling in primary care, Possibilities for Change teamed up with the National Association of Community Health Centers (NACHC), the Health Center Network of New York (HCNNY), and four participating health centers across New Jersey and New York for a pilot project using the ACT Sexual Health System.

With today’s earlier onset of sexual activity comes an increased incidence of high-risk behaviors such as:

  • Early sexual intercourse (before the age of 13 years)
  • Multiple sexual partners (history of 4 or more lifetime partners)
  • Inconsistent condom and contraceptive use
  • Drug or alcohol use prior to sex

Research suggests that several key factors have a significant influence on sexual decision-making including: substance use prior to sex, depression and low self-esteem, homelessness, school failure, sexting, and history of abuse and dating violence. Our nation’s public health institutions have recognized the need to improve adolescent health care in the United States and are calling attention to this important issue. The Institute of Medicine (IOM), National Research Council, Pediatric Health 2011 Report concluded that “improving health outcomes for adolescents is essential to achieving a healthy future for the nation.”

In 2014, the Journal of the American Medical Association published a study that reported one-third of all adolescent health maintenance exams were completed without any discussion of sexual health. For those providers who did introduce the subject, an average of 36 seconds was spent discussing sexual health. It was concluded that strategies need to be utilized to engage adolescents in open discussions around sexuality, promoting healthy sexual development and decision-making:

  • Prioritize adolescent sexual health and ensure that all adolescents are screened and counseled on their risk behaviors using standardized, validated tools – according to nationally-recognized guidelines;
  • Become educated and aware of the inter-relationship between adolescent sexual health, high risk behaviors, and other population disparities;
  • Participate in continuing education on effective adolescent counseling strategies that will actively engage youth in the behavior change process (such as Motivational Interviewing);
  • Develop policies and processes to ensure adolescent engagement and comfort with disclosure of sexual feelings, behaviors and experiences; and
  • Address necessary workflow modifications to ensure risk screening and behavioral counseling is consistently incorporated.

To learn more about the disparities and behaviors that contribute most to sexual risk and how primary care practices and school-based health centers can meet the needs of adolescents to positively impact their sexual health, download and view the recorded webinar.

How do you talk to adolescents about safe sex decisions? Share your experiences in the comments below!

Having Real Talks with Teens: A Roadmap to Better Communication

This post originally appeared on ETR:

Whether you’re a parent or an individual who works with youth, you are placed in an influential role to help keep teens safe and healthy. But that’s no easy task! Risky behaviors account for the majority of teen injury and premature death. In the face of these challenges, educators, providers and parents need concrete strategies to support teens in smart decision making.

The research of my team at Possibilities for Changealong with my work at the School Based Health Center Program and the Adolescent Health Initiative at the University of Michigan, have introduced evidence-based practices and principles that support better communication with teens. In our work, we leverage motivational interviewing techniques to encourage teens to think through their motivations, plan ahead for risky situations and feel empowered to make positive choices. Our ultimate goal is that they make safe and healthy decisions for themselves.

Tips for Talking

Here’s an approach we’ve used that will work for educators, youth service providers and parents. Professionals can teach these skills to parents. We suggest starting by using one of our tried-and-true techniques to shape behaviors—roleplays. Of course, outside of a classroom setting, it’s probably not going to work to ask teens to act out situations or read through a script. Not many would take that approach seriously. But you can bring up issues during opportune moments and talk through options and possibilities. This is a sort of “thinking” roleplay process, and it helps teens actively consider and practice decision making.

You can use current events or teachable moments as a starting point. For example, imagine you and a teen see a news story about a collision caused by texting and driving.

  • Make a comment. Avoid a directive warning such as, “See! Look what happens when you text and drive!” Instead, empathize with the situation. You might say, “It can be really hard not to look at a text and respond, even if you’re driving.”
  • Wait. A few seconds of silence is normal. Teens need time to process what’s been said. If you don’t have a response after 30 seconds or so, you might say, “What do you think?”
  • Listen to the response without judgment. A teen might say, “I can text fast. It doesn’t affect my driving.” Or maybe, “Yeah, when I get a text, it’s hard not to look.”
  • Follow up with your concern. You might say, “I worry about you when you’re driving. I don’t want anything to happen to you. No text is worth your life.” Once again, listen to the teen’s response without making judgments.
  • Ask questions to help the teen plan for future situations. For example, if the teen has acknowledged that texting and driving can be dangerous, you might say, “What are some things you could do to keep yourself from checking texts while you’re driving?”
  • Discuss solutions. Listen to the teen’s ideas. Offer some of your own. “Maybe you could put your phone in the glove box when you’re driving, or put it on ‘Do Not Disturb’ mode.”
  • Ask for a commitment. Invite the teen to make a commitment to a plan that will reduce the risks.
  • Follow up. Remind the teen of the plan the next time he or she is about to drive. “Remember when we talked about texting and driving?” Wait a moment and give the teen a chance to tell you the plan. If it’s not volunteered, offer a reminder: “You were going to keep your phone in the glove box whenever you’re driving.”

4 Tips That Build the Roadmap

The steps above can actually be distilled down to four broad tips. We use this structure in many of our discussion activities with teens.

  1. Ask permission. Teens are struggling for control in their lives. That’s developmentally normal. Offering an invitation to talk will be more effective than issuing a directive.

Example: “I’d like to talk with you about the situation that happened at school. When is a good time today?”

  1. Ask open-ended questions. Lecturing isn’t effective in keeping teens safe. Discussions can be. Ask questions that can’t be easily answered yes, no or with just a word or two.

Example: “Tell me about the party.”

  1. Find their motivations. Find ways for teens to tell you themselves why they need to change a risky behavior.

Example: “What is it about wearing a seatbelt that you don’t like? What are some reasons you should wear one?

  1. Use change talk. That means help teens think first about what they want to do (Desire), how they would do it (Ability), why they would do it (Reasons) and how important it is to them (Need).


  • “How do you feel about wearing a condom?” (Desire)
  • “How would you protect yourself from STIs if you needed to?” (Ability)
  • “What would be your biggest reason for waiting to have sex?” (Reasons)
  • “How important is it for you to wait to have sex until you’re older?” (Need)

More Guidance

My recently published book Teen Speak offers additional examples and further guidance for effective communication with teens. It explains what’s happening to adolescents from a developmental perspective as they are growing from children to teenagers. It reviews what risk behaviors are most common at each developmental stage as well as the strengths and challenges that influence teen behavior.

The book is geared towards parents, but the suggestions will work for any provider working with youth. It’s also helpful for providers working with parents of teens.

Jennifer Salerno, DNP, is the founder of Possibilities for Change, an organization that is transforming adolescent health through the development of state-of-the-art health care delivery systems designed to support the professional workforce and empower adolescents and their families. She can be reached at