A Nurse Practitioner is interviewing a 14-year-old male living with his grandmother in public housing in a high-density complex. Finding the appropriate techniques to approach adolescents on their health is significant. This discussion will focus on communication techniques for building a health history, using risk assessment tools, and designing targeted questions.
The setting is essential; with adolescents, a lack of formality can be helpful. Coming from behind the desk sitting in a chair shows a vulnerability in the provider and hopefully garners one in the patient. It may also help to have a previsit screening to fill out a questionnaire about their concerns and reason for the visit (Ball et al., 2019). They start with addressing the patient and asking how they would like to be referred to, listening to pronoun choices, ethnicity, city, and charting them, so the patient is remembered (SULLIVAN, 2019). Adolescents often need confidentiality; it is essential to establish a safe place to share anything they want. However, let them know that if their or others’ safety is in danger, the confidentiality can be broken at the very start, so they know the limits. Start with open-ended questions, let the patient talk, and lead the conversation. Patients often talk about things to gauge their reaction before getting to their primary concern to establish trust. If the patient starts rambling instead of interjecting, ask questions like, “Oh, is that why you are here today?” Adolescent patients are more prone to engage in risky behaviors regarding sex, drugs and have concerns about future health issues, death, and career choices. These should all be addressed when interviewing the patient. Treat the patient like an adult capable of making their own decisions. Do not preach what they should do but explain different treatment options in your professional opinion and let them decide (Ball et al., 2019).
Risk Assessment Tools
Screening assessment tools are an effective way to address a large number of issues in a simple format. There are different screening tools for adolescents than adults that help focus on home life, school, peer pressure, and safety. Three prevalent screening tools are as follows HEEADSS stands for; Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide, Safety. Then there are PACES, Parents, Accidents/Alcohol, Cigarettes, Emotional issues, School/Sexuality. Lastly, CRAFFT is Car, Relax, Alone, Forget, Friends, Trouble. This acronym breaks down into have you ever driven high or been in a car driven by someone tall? Do you use substances to relax or fit in? Do you use your senses when you are alone? Do you forget things you have done while using? Have you ever been in trouble because of substance use? (Ball et al., 2019)
For this patient at 14 years old, the HEEADSSS risk assessment tool is most appropriate. The patient lives with his grandmother, and knowing more about the household dynamic will affect treatment options. Does he take care of her? Is the patient working? Etc. If the patient is around or admits to using alcohol or drugs, then use CRAFFT to understand the degree of the drug use. Using risk assessment tools provides a road map for the assessment. Still, they are not unchangeable; providers should tailor the evaluation to the patient’s needs. Listening to the patient is more important than filling out the risk assessment perfectly (Prinstein et al., 2020).
Designated Target Questions
Solely using the brief information given about the patient, here are seven target questions for the patient. “What is your home life like?” “Do you ever need to take care of your grandmother?” “Have you ever felt unsafe where you live? Do you feel safe at school?” “Tell me about the school, what interests you? What do you not like about school?” “Tell me about your friends? What do you all do for fun? How would your friends define you?” “Have you ever been around people using alcohol or drugs? Have you used drugs or alcohol yourself?” “Are you sexually active? If so, in what way?” “How would you describe yourself? Do you like yourself, or do you wish were someone else?”
Patients have the right to a timely, thorough and respectful assessment. Healthcare providers can use communication tools, risk assessment tools, and targeted questions to provide these necessary services. These tools can be adjusted to adolescents to be more appropriate for their situations. While the life the patient is living is full of challenges, the medical office can be one place that is safe to be heard and listened to. Medical professionals should be actively promoting the change from dependence to independence transition as healthy as possible.
Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination: An interprofessional approach. Elsevier.
SULLIVAN, D. E. D. E. B. R. A. D. (2019). Guide to clinical documentation. F A DAVIS.
Prinstein, M. J., Nesi, J., & Telzer, E. H. (2020). Commentary: An updated agenda for the study of Digital Media Use and Adolescent Development â€“ Future Directions following Odgers & Jensen (2020). Journal of Child Psychology and Psychiatry, 61(3), 349â€“352. https://doi.org/10.1111/jcpp.13219