Younger Adolescent Visit

YOUNGER ADOLESCENT VISIT Objectives Be able to assess adolescent patients’ peer relationships and health/risk behaviors. Be able to discuss healthy and unhealthy peer relationships with adolescents. Understand and be able to implement prevention and intervention strategies for teen dating violence.
Green Light Video See Vignette Script Full Vignette Available on CD	In adolescence, it becomes critical to take a complete psychosocial history because an adolescent’s behavior, family, peers, school, and community have a tremendous effect on his or her health. HEEADSSS is a useful mnemonic for such an assessment; it stands for Home Education and employment Eating Activities with peers Drugs Sexuality Suicide and depression Safety Note that while discussion of sexual violence may be mostly likely to occur while discussing sexuality or safety, the topic could arise during any part of the HEEADSSS assessment (eg, discussion of domestic violence in the home, discussion of eating eliciting concerns about body image, discussion of drugs leading to counseling on personal safety and rape prevention). It is important for the practice to provide a teen-friendly environment where teens know that they can talk about sexual violence or other problems. Tools Clinical HEADSS/HEEADSSS Quick reference guide Parent/Patient Expect Respect Talking With Your Teen About Sex English Spanish Teen Dating Violence Community Resources/Advocacy Choose Respect Practice Management Tips for Making Your Practice Teen Friendly
Yellow Light Video See Vignette Script Full Vignette Available on CD	Peer relationships are a key part of shaping adolescents’ sexual development, but teens also need trusted adults they can turn to for guidance. A more detailed violence-related history (using the FISTS [Fighting, Injuries, Sex, Threats, Self-defense] mnemonic) can help identify risk for involvement in violence and areas in which teens may benefit from having additional prevention strategies. Tools Clinical FISTS
Red Light Video See Vignette Script Full Vignette Available on CD	The relationships and conflict resolution styles teens see at home have a powerful influence on how teens approach dating and conflict in their own relationships. When potential problems with sexual violence are identified with teen patients, it is important to consider the context of the family environment, while navigating the complexities of ensuring the privacy and confidentiality of teens and their parents. Tools Community Resources/Advocacy The Pediatrician's Guide to Community Collaboration on Sexual Violence Prevention Practice Management Privacy and confidentiality tool
Quiz Case A 16-year-old girl is seen for a health maintenance visit and reluctantly tells you she is worried about a vaginal discharge she has noticed. You ask about sexual contact and she tells you she has had sexual contact with one boy, also 16, last month. In discussing the relationship, she mentions that she did not want to have sex, but did because he threatened to break up with her if she didn’t. 1. A good next question would be “Why did you give in to him?” “Has he threatened you in any other ways?” “What do you like about him?” “Does your mother know about this?” 2. She tells you he has slapped her a few times when he became jealous that she was talking with another boy. You tell her “If it left a mark when he hit you, you should leave him because it will only get worse.” “Have you asked him to get some counseling? If he cares for you he would do it.” “If he’s done this to other girls, he probably won’t stop. Talk to your friends about what he’s like.” “I am worried about the way he treats you, and from my experience in talking with other teens in similar situations, he is not likely to change.” Answers
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