Module 1 (b)

Question 1

Confidentiality

-Exploring Independence

Answer 1

1. Explain at the 11 year WCV that beginning at the next visit, you will speak privately with the adolescent
2. First discussion: Puberty, body image, exposure to violence, sex, drugs
3. Subsequent discussions: Mental health, risky behaviors

Question 2

Parent-Adolescent Collaborative

Answer 2

1. Youth and parent dealt with jointly — Hx obtained from both & mgmt plan discussed with both
2. Effective for younger teens or those w/ chronic illness

Question 3

Patient Primary, Parent Secondary

Answer 3

1. Provider interacts w/ adolescent primarily, yet communicates w/ parent on secondary level
2. Start w/ both to determine purpose of visit
3. Ask parent to step out of room
4. Hx and PE w/ youth alone (Chaperone if appropriate)

Question 4

Patient Alone, Parent Optional

Answer 4

1. No direct communication between provider and parent
2. Adolescent encouraged to discuss findings w/ parent
3. Provider reserves the right to tell parents if youth may be seriously endangered
4. Effective for older adolescents

Question 5

Adolescent Interviewing

Answer 5

1. Listen more, talk less
2. Criticize the activity, not the adolescent
3. Highlight the positive
   4 .Avoid taking excessive notes
4. Eliminate interruptions
5. Avoid yes/no questions

Question 6

Under 18 needs?

Answer 6

1. Parent consent IS NEEDED!!

Exceptions to needed consent

• Incase of emergency
• Adoptive/foster parents (Biologic parents do not need to consent)
• Emancipated minor
• Mature minor — living apart from parents, HS grad, pregnant, minor parents
• Abuse
• Threats of harm to self or others

Question 7

Confidentiality

Answer 7

1. Ensure the patient that the visit is confidential except in extreme circumstances
   - Some exemptions include — Abuse, threats of harm to self or others
2. BEWARE of insurance bills that may send itemized items to parents insurance. Notify adolescent

Question 8

Structure of Preventative Health Visit

Answer 8

1. History — Includes recommended screening tools
2. Exam
3. Plan— includes recommended labs and immunizations
4. Anticipatory guidance

Question 9

Adolescents

-Psychosocial Hx (HEADSSS)

Answer 9

H — Home
E — Education, eating, exercise 
A — Activities, associates 
D — Drugs (tobacco, alcohol 
S — Safety, suicide, sex

Question 10

Screenings that WE MUST ask!

Answer 10

1. HTN
2. Obesity & Eating disorders
3. Hyperlipidemia
4. TB
5. Problems at school
6. Substance use/abuse
7. Depression
8. Sexual behaviors
9. STIs

Question 11

Adolescent Screening Recommendations

-HTN

Answer 11

1. Screen annually
2. USPFTF gives an “I” recommendation
3. AMA GAPS and Bright futures both recommend

Question 12

Adolescent Screening Recommendations

-Obesity and Eating Disorders

Answer 12

1. Height, weight, BMI annually
2. USPFTF - B recommendation for screening and offering referral
3. 24 hr diet recall
4. Advise on empty calories
5. Increase fruits, veggies, and calcium
6. Vitamin D: 400 IU daily

Question 13

Adolescent Screening Recommendations

-Hyperlipidemia

Answer 13

1. USPFTF “I” recommendation

2. AAP recommends fasting lipid profile at ages 10 and 20 yrs

Question 14

Adolescent Screening Recommendations

-TB

Answer 14

1. Testing is targeted to specific at risk groups

2. AAP and GAPS recommend — screen all patients to determine risk annually

Question 15

Adolescent Screening Recommendations

-Problems at School/Learning Disorder

Answer 15

1. Family hx of LD or parent concern
2. Poverty and under stimulating environments
3. Hx of prematurity or neurodevelopmental problems (ADHD, Autism)
4. Neurologic conditions and chronic diseases

Question 16

Adolescent Screening Recommendations

-Substance Use

Answer 16

1. Universal Screening
2. Be non-judgmental

CRAFFT
C- Have you ever ridden in a car driven by someone or yourself who was high or using drugs or alcohol
R - Do you ever use alcohol or drugs to relax, feel better about yourself or fit in
A - Do you ever use alcohol or drugs while you are alone
F - Do you ever forget things you did while using drugs or alcohol
F - Do you family or friends ever tell you that you should cut down on your drinking or drug use?
T - Have you ever gotten into trouble while you were using alcohol or drugs?

Question 17

Adolescent Screening Recommendations

-Depressoin

Answer 17

1. AAP recommends screening every year ages 11-21
2. PHQ-2
   - Little interest or pleasure in doing things?
   - Feeling down, depressed, or hopeless?

Question 18

Adolescent Screening Recommendations

-Physical Exam

Answer 18

1. VS, ht, Wt, BMI
2. Sexual maturity rating — review tanner stages for boys and girls

Indications for a Pelvic Exam

• Sexually active or >20 yrs old
• If requested
• If there is pelvic pain, discharge or severe menstrual disorders

Question 19

Adolescent Screening Recommendations

-Anticipatory Guidance Priorities

Answer 19

1. Physical and oral health
2. Social and academic competence
3. Emotional well-being
4. Risk reduction
5. Violence and injury prevention

Question 20

Adolescent Psychosocial Development

-Misconceptions

Answer 20

1. Transition is disruptive
2. Disruptive family conflict is the norm
3. Quality of thinking is flighty

Question 21

Early Adolescence (10-13 yrs)

Answer 21

1. Cognitive Development — Concrete thinking, egocentrism, impulsive behavior
2. Independence — Beginning to shift from dependence on parents to independent behavior
3. Body image — Rapid physical changes — preoccupation w/ body image and question of “Am I normal”
4. Peer Group — Friendships replace parents as a source of comfort
5. Identity — Self exploration, fantasy (Constantly on-stave vs alone and isolated)

Question 22

Middle Adolescence (14-17 yrs)

Answer 22

1. Cognitive Development — Develop efficiency w/ abstract, multidimensional, planned and hypothetical thinking
2. Independence — Devote more time to peers
3. Body image — Physical changes are typically complete, though a lot of time is focused on physical appearance to “fit in”
4. Peer Group — Conformity w/ peer values, codes and dress in an attempt to further separate from family
5. Identity — Feeling of immortality leading to risk taking behaviors

Question 23

Late Adolescence (17-21 yrs)

Answer 23

1. Cognitive Development — Ability to think abstractly and plan for future
2. Independence — Stronger sense of personal identity, ability to delay gratifications, compromise
3. Body image — body image issues may be significant based on peer group values and media
4. Peer Group — Peer group values become less important. Relationships strengthen w/ one individual
5. Identity —Sense of perspective, rational and realistic, refinement of moral, religious, and sexual values

Question 24

Young Adulthood (18-25 yrs)

Answer 24

1. Cognitive Development — Continued development of the frontal and parietal cortex
2. Independence — Leaving the parents home
3. Body image —Body image issues identified at earlier stages continue to be a risk, including anorexia, disordered eating and obesity
4. Peer Group — Completing earlier tasks with peer groups and identity issues — Develop mature intimate relationships
5. Identity — Experimenting w/ various life possibilities