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Adolescent Consultation

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In order to do an effective consultation on an adolescent you have to do a few things well that may not be part of your usual Paediatric consultation.

Understanding Adolescent Health

1 Focus on the young person not the disease.
2 Most young people do well, in most areas, most of the time
3 Use the risk and resiliency model.
Most risks are historical and cannot be altered.  Risk behaviours often co-occur.
Most resiliencies are dynamic and can be nurtured.
4 Keys to resiliencies are:
Safety (personal, emotional, sexual)
Connectedness (family, friends, school institutions, religion)
Performance (particularly at school)
5 Typically, young people with chronic illness engage in the same risk behaviours as their peers without chronic illness (sex, drugs etc).
6 Being in school is a very significant resiliency and positive prognostic indicator. Do everything you can to maintain it.
7 Develop rapport: if you can't, someone else on your team probably can.

Consultation Process Issues

1 Confidentiality
Explain that what transpires will be confidential (i.e. private) with the exception of:
- Correspondence - whom you will write to and what you will include
- Safety - Harm to self, harm to others, self-harm (you will share that with the powers that be, but will tell the young person what you are doing).
2 Attitude
3 Be Inclusive
Involve young person and family in the planning process. You need to see both the young person and family together and separately.
4 Risk and Resiliency Model
Reduce risk (where possible) and build on resiliencies (protective factors, strengths, positive relationships). For example, you may be more likely to improve a young person with asthma's health status by encouraging them to get a job or build on a hobby than by educating them about asthma.
5 Interdisciplinary and Intersectional Approach
Involve other significant agencies and teams.
6 Thoroughness
Don't be superficial - this will take time.

HEADSSS Examination

This is a tool for assessing the issues that will be impacting on the health of the young person and that will point to ways for successfully intervening.  

HEADSS A Developmentally Appropriate Overview

In each area scan for safety, connectedness* and performance/actual behaviour.  Note: this is a brief summary, issues of concern should be followed up in more detail.

H     Home 

Where do you live and who lives with you?  Who do you get on well with at home?  Who makes the rules at your place? What happens when you break them?

E      Education/ Employment 

Are you at school / training or work?  What do you like about school?  How much are you going?  How are you doing in school? Has that changed from how you used to do?

A      Activities 

What do you do after school / work?  In the weekends? Do you go to parties?  How do you get around (transport)? Do you do any sport / exercise?   Have you tried to lose weight?

D      Drugs and Alcohol 

Many young people try cigarettes, alcohol and other drugs.  What  are young people you know using?  What have you tried?  What do you use?

S      Sexuality 

Some young people of your age are getting into relationships, is that something that's happened for your friends?  - for you?   Have you talked about safe sex at school / home? Have you had a sexual relationship with anyone?

S      Suicide risk 

Everybody has good days and bad days.  What is your mood like?  Do you ever have really good  / bad days?  Do you ever feel like you want to end it all? Have you tried/ do you have a plan to hurt/kill your self?

S      Safety

Are there issues in the environment or behaviour of the young person that are unsafe. If so, are the safety issues immediate (do something about them), possible (discuss strategies) or remote (keep them in mind).

*Positive, ongoing relationships are proven to be protective factors in most areas of young people's lives.

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Document Control

  • Date last published: 01 May 2007
  • Document type: Clinical Guideline
  • Services responsible: Youth Health
  • Author(s): Bridget Farrant, John Newman
  • Review frequency: 2 years

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