Adolescent Patient

Engaging with and Assessing the Adolescent Patient

Key Points

• Adolescence is a transitional phase between childhood and adulthood, historically spanning ages 12-18 but now including young adulthood up to 25 years.
• Adolescents have the legal right to confidential health care.
• Adolescents less than 18 years old may be considered ‘mature minors’ and can give informed consent.
• The HEEADSSS interview is crucial for psychosocial screening in adolescent assessments.

Background

• What is Adolescence?
  • Traditionally, adolescence covers ages 12–18, from pubertal onset to legal independence.
  • Recently, it includes young adulthood up to 25 years.

Adolescent Health Care Considerations

• Increased risk-taking behaviors and psychosocial issues contribute to morbidity and mortality.
• Adolescents rarely access routine health care, making any contact an opportunity for preventative care.
• Some health services transition those aged >16 to adult services; transition planning should start before age 18.

Assessment

• Consultation Structure:
  • Include time with both the adolescent and guardian together, and time with the adolescent alone.
• Confidentiality and Consent:
  • Explicitly discuss confidentiality and obtain permission before contacting other professionals.
  • Adolescents can receive confidential health care unless they are not mature minors or there are significant risk concerns.
  • Mature minors can give informed consent based on their understanding and intelligence (Gillick competency).
  • Most 16-18-year-olds are presumed mature minors, but younger adolescents may also be considered based on the intervention’s nature.
  • Special considerations are needed for adolescents involved with child protection services.

Psychosocial Interview

• HEEADSSS Interview:
  • Home: Who they live with, relationships, stress, violence, smartphone/computer use.
  • Education & Employment: School attendance, performance, relationships, bullying, future plans, work.
  • Eating and Exercise: Weight, body shape, eating habits, dieting, exercise, menstrual history.
  • Activities: Extracurricular activities, screen time.
  • Drugs and Alcohol: Usage patterns of cigarettes, alcohol, and illicit drugs.
  • Sexuality and Gender: Gender identity, sexual experiences, contraception, STIs.
  • Suicide, Depression & Self-harm: Feelings of stress, sadness, self-harm thoughts, suicide risk.
  • Safety: Serious injuries, online safety, exposure to violence, criminal behaviors.
• Interview Tips:
  • Use open-ended, non-judgmental questions.
  • Preface with confidentiality and the purpose of personal questions.
  • Focus on the most relevant areas for the patient.
  • Conclude by asking the adolescent about their trusted confidants.

Examination

• General Considerations:
  • Use a chaperone.
  • Ensure privacy.
  • Consider self-assessment for pubertal staging (Tanner staging).

Management

• General Considerations:
  • Management depends on issues identified during the psychosocial interview.
  • Health concerns can be categorized as risk or protective factors.
  • Immediate management plans for significant health risks may include mental health assessments and possible admission.
  • Document the adolescent’s contact details for follow-up.
  • Consider opportunistic vaccination.
• Medicare Cards:
  • Encourage those over 15 years to obtain their own Medicare card.

Transition to Adult Services

• Transition planning should start in mid-adolescence with formal support and education.
• Aim to transition by 18 or after high school completion.
• Complex cases may need overlapping pediatric and adult services for safe transition.
• Consult local pediatric teams for adolescents at significant risk; mental health, adolescent medicine, or social work teams may be more appropriate based on the presentation.