Module 1 (b) Flashcards
Confidentiality
-Exploring Independence
- Explain at the 11 year WCV that beginning at the next visit, you will speak privately with the adolescent
- First discussion: Puberty, body image, exposure to violence, sex, drugs
- Subsequent discussions: Mental health, risky behaviors
Parent-Adolescent Collaborative
- Youth and parent dealt with jointly — Hx obtained from both & mgmt plan discussed with both
- Effective for younger teens or those w/ chronic illness
Patient Primary, Parent Secondary
- Provider interacts w/ adolescent primarily, yet communicates w/ parent on secondary level
- Start w/ both to determine purpose of visit
- Ask parent to step out of room
- Hx and PE w/ youth alone (Chaperone if appropriate)
Patient Alone, Parent Optional
- No direct communication between provider and parent
- Adolescent encouraged to discuss findings w/ parent
- Provider reserves the right to tell parents if youth may be seriously endangered
- Effective for older adolescents
Adolescent Interviewing
- Listen more, talk less
- Criticize the activity, not the adolescent
- Highlight the positive
4 .Avoid taking excessive notes - Eliminate interruptions
- Avoid yes/no questions
Under 18 needs?
- 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
Confidentiality
- Ensure the patient that the visit is confidential except in extreme circumstances
- Some exemptions include — Abuse, threats of harm to self or others - BEWARE of insurance bills that may send itemized items to parents insurance. Notify adolescent
Structure of Preventative Health Visit
- History — Includes recommended screening tools
- Exam
- Plan— includes recommended labs and immunizations
- Anticipatory guidance
Adolescents
-Psychosocial Hx (HEADSSS)
H — Home E — Education, eating, exercise A — Activities, associates D — Drugs (tobacco, alcohol S — Safety, suicide, sex
Screenings that WE MUST ask!
- HTN
- Obesity & Eating disorders
- Hyperlipidemia
- TB
- Problems at school
- Substance use/abuse
- Depression
- Sexual behaviors
- STIs
Adolescent Screening Recommendations
-HTN
- Screen annually
- USPFTF gives an “I” recommendation
- AMA GAPS and Bright futures both recommend
Adolescent Screening Recommendations
-Obesity and Eating Disorders
- Height, weight, BMI annually
- USPFTF - B recommendation for screening and offering referral
- 24 hr diet recall
- Advise on empty calories
- Increase fruits, veggies, and calcium
- Vitamin D: 400 IU daily
Adolescent Screening Recommendations
-Hyperlipidemia
- USPFTF “I” recommendation
2. AAP recommends fasting lipid profile at ages 10 and 20 yrs
Adolescent Screening Recommendations
-TB
- Testing is targeted to specific at risk groups
2. AAP and GAPS recommend — screen all patients to determine risk annually
Adolescent Screening Recommendations
-Problems at School/Learning Disorder
- Family hx of LD or parent concern
- Poverty and under stimulating environments
- Hx of prematurity or neurodevelopmental problems (ADHD, Autism)
- Neurologic conditions and chronic diseases
Adolescent Screening Recommendations
-Substance Use
- Universal Screening
- 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?
Adolescent Screening Recommendations
-Depressoin
- AAP recommends screening every year ages 11-21
- PHQ-2
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Adolescent Screening Recommendations
-Physical Exam
- VS, ht, Wt, BMI
- 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
Adolescent Screening Recommendations
-Anticipatory Guidance Priorities
- Physical and oral health
- Social and academic competence
- Emotional well-being
- Risk reduction
- Violence and injury prevention
Adolescent Psychosocial Development
-Misconceptions
- Transition is disruptive
- Disruptive family conflict is the norm
- Quality of thinking is flighty
Early Adolescence (10-13 yrs)
- Cognitive Development — Concrete thinking, egocentrism, impulsive behavior
- Independence — Beginning to shift from dependence on parents to independent behavior
- Body image — Rapid physical changes — preoccupation w/ body image and question of “Am I normal”
- Peer Group — Friendships replace parents as a source of comfort
- Identity — Self exploration, fantasy (Constantly on-stave vs alone and isolated)
Middle Adolescence (14-17 yrs)
- Cognitive Development — Develop efficiency w/ abstract, multidimensional, planned and hypothetical thinking
- Independence — Devote more time to peers
- Body image — Physical changes are typically complete, though a lot of time is focused on physical appearance to “fit in”
- Peer Group — Conformity w/ peer values, codes and dress in an attempt to further separate from family
- Identity — Feeling of immortality leading to risk taking behaviors
Late Adolescence (17-21 yrs)
- Cognitive Development — Ability to think abstractly and plan for future
- Independence — Stronger sense of personal identity, ability to delay gratifications, compromise
- Body image — body image issues may be significant based on peer group values and media
- Peer Group — Peer group values become less important. Relationships strengthen w/ one individual
- Identity —Sense of perspective, rational and realistic, refinement of moral, religious, and sexual values
Young Adulthood (18-25 yrs)
- Cognitive Development — Continued development of the frontal and parietal cortex
- Independence — Leaving the parents home
- Body image —Body image issues identified at earlier stages continue to be a risk, including anorexia, disordered eating and obesity
- Peer Group — Completing earlier tasks with peer groups and identity issues — Develop mature intimate relationships
- Identity — Experimenting w/ various life possibilities
