HEADSSS ASSEMENT FOR ADOLESCENT IN NEEDS

HEADS

1. Click to add textClick to add text
Communicating with Communicating with
AdolescentsAdolescents
Eric ChisupaEric Chisupa

2. OutlineOutline
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What’s an adolescent?What’s an adolescent?
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Communicating with AdolescentsCommunicating with Adolescents
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DVDDVD
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HEADSS Assessment ToolHEADSS Assessment Tool

3. DefinitionsDefinitions
Adolescent Adolescent 10 to 19 years10 to 19 years
Young person Young person 10 to 24 years 10 to 24 years
Youth Youth 15 to 24 years15 to 24 years
(WHO)(WHO)

4. Defining Adolescence
•Defining adolescence chronologically has
limitations
•Divided into stages: early (c10-13), mid (c14-
17) and late adolescence (c17-?)
•Developmental tasks associated with
adolescence
–Transition between childhood and adulthood
–Moving on a continuum towards independence

5. ‘‘a variable period between childhood and a variable period between childhood and
adulthood, largely bounded by 10 and 20 years adulthood, largely bounded by 10 and 20 years
of age, characterized by of age, characterized by rapid development in rapid development in
psychological, social and biological domainspsychological, social and biological domains’’
Bridging the Gaps, 2003Bridging the Gaps, 2003
Adolescence DefinedAdolescence Defined

6. Psychosocial developmentPsychosocial development
(D Christie & R Viner in ABC of Adolescence)(D Christie & R Viner in ABC of Adolescence)
Development of social Development of social
autonomy; intimate autonomy; intimate
relationships; relationships;
development of development of
vocational capability vocational capability
and financial and financial
independenceindependence
Complex abstract thinking; Complex abstract thinking;
identification of difference identification of difference
between law and morality; between law and morality;
increased impulse control; increased impulse control;
further development of further development of
personal identitypersonal identity
Boys: end of puberty; Boys: end of puberty;
continued increase in continued increase in
muscle bulk and body muscle bulk and body
hairhair
Late adolescenceLate adolescence
17 – ? years17 – ? years
““separation”separation”
Emotional separation Emotional separation
from parents; strong from parents; strong
peer identification; peer identification;
increased health risk increased health risk
(smoking); heterosexual (smoking); heterosexual
peer interest; early peer interest; early
vocational plansvocational plans
Abstract thinking, but self Abstract thinking, but self
still seen as “bullet proof”; still seen as “bullet proof”;
growing verbal abilities; growing verbal abilities;
identification of law with identification of law with
morality; start of fervent morality; start of fervent
ideology (religious, ideology (religious,
political)political)
Girls: mid-late puberty Girls: mid-late puberty
and end of growth spurt; and end of growth spurt;
menarche; development menarche; development
of female body shape of female body shape
with fat depositionwith fat deposition
Boys: mid-puberty; Boys: mid-puberty;
spermarche and spermarche and
nocturnal emissions; nocturnal emissions;
voice breaks; start of voice breaks; start of
growth spurtgrowth spurt
Mid- AdolescenceMid- Adolescence
14 to 17 years14 to 17 years
““peers”peers”
Emotional separation Emotional separation
from parents; start of from parents; start of
strong peer strong peer
identification, early identification, early
exploratory behaviours exploratory behaviours
(smoking, violence)(smoking, violence)
Concrete thinking but early Concrete thinking but early
moral concepts; moral concepts;
progression of sexual progression of sexual
identity development identity development
(orientation); possible (orientation); possible
homosexual peer interest; homosexual peer interest;
reassessment of body reassessment of body
imageimage
Early puberty (girls: Early puberty (girls:
breast bud, pubic hair, breast bud, pubic hair,
growth spurt; boys: growth spurt; boys:
testicular enlargement, testicular enlargement,
genital growth)genital growth)
Early AdolescenceEarly Adolescence
10 to 13 years10 to 13 years
““on stage”on stage”
SocialSocialPsychologicalPsychologicalBiologicalBiological

7. Why communicate differently with Why communicate differently with
adolescents?adolescents?
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Adolescents have evolving health needs – very rapid Adolescents have evolving health needs – very rapid
development- that are different to those of children development- that are different to those of children
and adultsand adults
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Continuum of developing independence: from Continuum of developing independence: from
dependence of family towards independence and dependence of family towards independence and
identification with peer groupidentification with peer group
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Developing different cognition skills: concrete to Developing different cognition skills: concrete to
abstractabstract
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Standard paediatric assessment / interview is Standard paediatric assessment / interview is
inappropriate for this group of patientsinappropriate for this group of patients
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Requires more time – take longer to digest informationRequires more time – take longer to digest information

8. Communicating with adolescents
•Be aware of body language (yours and theirs)
position is power. If parent there where have they
sat? (‘Gatekeeper’)
•What’s the dynamic / atmosphere with parents
like? Who have they argued with?
•Be yourself, friendly and approachable but
remember boundaries - don’t be too personal
•Take an interactive approach, no-one likes being
interrogated
•Be honest if you don’t understand dialogue clarity
is all important
•Be aware of how you phrase questions/statements

9. Communicating with adolescents
•Listen carefully and show interest in answers
•Take ‘third person’ approach
•How tired are they?
different body-clock, need more sleep
•Sometimes a good time for you isn’t a good time
for them
•Don’t make assumptions, be non-judgmental
•Preferably see without parents for some of
time (especially if you want honest answers!)

10. Communicating with adolescentsCommunicating with adolescents
My mum’s beside me…My mum’s beside me…
““Are you sexually active?” You’re just like: my mum! Are you sexually active?” You’re just like: my mum!
Me and my mum! I don’t wanna answer. It’s like: do Me and my mum! I don’t wanna answer. It’s like: do
you smoke, do you take drugs? Are you an alcoholic? you smoke, do you take drugs? Are you an alcoholic?
You don’t wanna answer to that in front of your mum!’You don’t wanna answer to that in front of your mum!’
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female, 14 years female, 14 years

11. Communicating with adolescents
•Treat as an individual
•Respect concerns and opinions
•Remember that it may take time for them to trust
/ like you enough to open up
•Be aware of history - they may not trust adults /
professionals. And you are going to stick a needle
in them.
•Think who else has asked these questions – it’s
boring repeating yourself
•Progress from neutral to more sensitive topics /
build a rapport (HEADSs)

12. HEADSSHEADSS
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H- H- hhomeome
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E – E – eeducation/ducation/eemployment (mployment (eeating and ating and
eexercise)xercise)
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A – A – aactivitiesctivities
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D - D - ddrugsrugs
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S - S - ssexex
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S – S – ssuicide and depression, uicide and depression, ssafety, afety, sspiritualitypirituality

Goldenring & Cohen 1998Goldenring & Cohen 1998

13. HEADSS provides :-HEADSS provides :-
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An opportunity to develop a relationship An opportunity to develop a relationship
and rapportand rapport
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A guide to future interventionsA guide to future interventions
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A method of risk assessmentA method of risk assessment

14. HEADSS HEADSS
Interview tipsInterview tips
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Interactive rather than interrogativeInteractive rather than interrogative
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Listen carefullyListen carefully
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Check languageCheck language
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Progress from neutral to more sensitive Progress from neutral to more sensitive
topicstopics
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Take ‘third person’ approachTake ‘third person’ approach
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Respect the young person’s concerns & Respect the young person’s concerns &
points of viewpoints of view

15. HEADSS HEADSS
Interview tipsInterview tips

best practice: using HEADSS when best practice: using HEADSS when
young person is wellyoung person is well
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‘ ‘other adults should not be present other adults should not be present
when HEADSS used’ unless….when HEADSS used’ unless….
setting the scene: confidentialitysetting the scene: confidentiality
young person central to interviewyoung person central to interview

16. HEADSS - HomeHEADSS - Home
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Who lives with YP ? Where?Who lives with YP ? Where?
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Own room or shared?Own room or shared?
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What are relationships like at home?What are relationships like at home?
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What do parents/carers do for living?What do parents/carers do for living?
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Any recent moves? Running away?Any recent moves? Running away?
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New people in home environment?New people in home environment?

17. HEADSS- Education & EmploymentHEADSS- Education & Employment
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Likes/dislikes school ? Performance?Likes/dislikes school ? Performance?
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Favourite subjects, worst subjects?Favourite subjects, worst subjects?
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Likes/doesn’t like teachers ?Likes/doesn’t like teachers ?
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Suspensions/dropping out of lessons?Suspensions/dropping out of lessons?
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Changes in school?Changes in school?
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Further education/career goals?Further education/career goals?

18. HEADSS- ActivitiesHEADSS- Activities
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Fun with peers? When/ where?Fun with peers? When/ where?
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Activities with clubs or family?Activities with clubs or family?
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Sports-regular exercise?Sports-regular exercise?
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Hobbies –other home activities?Hobbies –other home activities?
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Reading for fun/TV/Computer games?Reading for fun/TV/Computer games?

19. HEADSS- DrugsHEADSS- Drugs
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Use by peers?Use by peers?
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Use by young person (tobacco, alcohol)?Use by young person (tobacco, alcohol)?
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Amounts, frequency, patterns?Amounts, frequency, patterns?

20. HEADSS-SexualityHEADSS-Sexuality
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Degree and types of sexual experience?Degree and types of sexual experience?
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Orientation?Orientation?
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Number of partners?Number of partners?
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Contraception and knowledge of STD’sContraception and knowledge of STD’s
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Comfort with sexual activityComfort with sexual activity

21. HEADS-SuicideHEADS-Suicide
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Sleep disorders?Sleep disorders?
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Appetite/eating behavior changes?Appetite/eating behavior changes?
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Hopeless/helpless feelings?Hopeless/helpless feelings?
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Self harm/suicide attempts?Self harm/suicide attempts?
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Suicidal ideation?Suicidal ideation?
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Affect in interview?Affect in interview?

22. Help is out thereHelp is out there
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Hospital play staffHospital play staff
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NursesNurses
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Nurse specialistsNurse specialists
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Allied health professionalsAllied health professionals
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Student nursesStudent nurses
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ParentsParents

23. Help is out thereHelp is out there

GMC guidelines for 0 to 18 GMC guidelines for 0 to 18
year olds:year olds:
‘ ‘Effective communication Effective communication
between doctors and between doctors and
children and young people is children and young people is
essential to the provision of essential to the provision of
good care. You should find good care. You should find
out what children, young out what children, young
people and their parents people and their parents
want and need to know, what want and need to know, what
issues are important to issues are important to
them, and what opinions and them, and what opinions and
fears they have about their fears they have about their
health or treatment….’health or treatment….’