Adolescent Interview

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Adolescent Interview

• William B. Shore, M.D.
• Professor of Family Community Medicine - UCSF
• AAFP
• November 20, 2004

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Adolescent Interview

• General Guidelines
• Adolescent friendly office or exam room
• Discuss approach to adolescent care with patient
  and family around onset of puberty

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Adolescent Interview

• As appropriate, include parent(s) in initial
  portion of interview
• Review Confidentialityimportant if also seeing
  parents in your practice
• Include parents in the conclusion, with
  adolescents consent

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Adolescent Interview

• Questions should be developmentally
  appropriateearly, middle, late adolescence
• Early Adolescence-more close-ended questions

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Adolescent Interview

• Generalize questions Many people your age have
  questions about.
• Introduce more sensitive questions with
• I ask all my patients these questions
• Some of these questions may make you
  uncomfortable

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Adolescent Interview

• Non-judgmental approach
• Dont be a parent
• Dont be a peer

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Adolescent Interview

• Avoid lecturing
• Dont trivialize patients concern

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Adolescent InterviewHEADSSS1

• H Home environment
• E Education and employment
• A Activities
• D Drugs/Diet
• S Sexual activity/sexuality
• S Suicide/depression
• S Safety

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HEADSSS

• Home
• Tell me a little about your home life. Who do you
  live with?
• How are things going at home? Are you home alone
  very often?
• Are there other adults who are important to you?

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HEADSSS

• Home
• Tell me about your relationship with your
  parent(s), brother(s)/sister(s), other family
  member(s).
• Do you feel safe in your home? In your community
  or neighborhood?

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HEADSSS

• Education and Employment
• Are you going to school? What grade? How do you
  feel about school?
• How are you doing in school? Grades/marks?
  Better, worse, or the same? Ever been expelled?

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HEADSSS

• Education/Employment
• What do you like the best? The least?
• Do you go to classes? How often do you cut?
• Do you work? How many hours?

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Problems with Schoolwork

• Youths who have problems with schoolwork are more
  likely than others to experience or be involved
  health risks.
• School failure is a public health problem.

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HEADSSS

• Activities
• How do you spend your spare time?
• What do you do for fun?
• Who do you hang out with? What do you do when
  you hang out?

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HEADSSS

• Activities
• Are you involved with any organized sports
  activities? Community center? Religious/church
  groups?

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The Influence of Friends

• Teens who spend a lot of time just hanging out
  with friends, especially friends involved with a
  specific risk behavior, are more likely to be
  involved themselves.
• There may also be health consequences to
  substantial amounts of unstructured leisure time.
• Ones choice of friends matters.

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HEADSSS

• Drugs/Diet
• Do you drink alcohol (beer, wine, coolers, hard
  liquor)? How much/how often? In what kinds of
  situations?
• Do you smoke tobacco or marijuana? Chew tobacco?
  How much /how often? In what kinds of
  situations?

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HEADSSS

• Drugs, Alcohol and Diet (cont.)
• Do the people you hang out with smoke, drink,
  smoke marijuana, use other drugs, sell drugs?
• Have you used steroids?
• Are you concerned about your weight?

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Drugs

• Ergogenic supplements - associated with high
  risk behaviors - alcohol (and heavy use), riding
  with someone who has been drinking, and history
  of physical fights.
• Supplements can be associated with high risk
  (fatal) outcomes. ASK ABOUT THEM!

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HEADSSS

• Sexuality
• Are you attracted to guys, girls or both?
• Has anyone ever touched you in a way that made
  you uncomfortable or forced you to have sex?
• How do you feel about your sexual life?

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HEADSSS

• Sexuality (cont.)
• Have you ever had sex? What do you mean by
  having sex? If yes
• How old were you the first time you had sex
  (intercourse or sexual relations) with a partner?
• How many people have you had sex with in the last
  3 months? In your life?

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HEADSSS

• Do you (or your partner) use anything to prevent
  getting pregnant or getting an STD? Ever had an
  STD?
• Have you had any pregnancies (or fathered
  pregnancy)?
• How old are your sexual partners?

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HEADSSS

• Suicide and Depression /Psychiatric
• How is life going in general?
• Do you ever feel very sad, tearful, bored,
  disconnected? Is there a family history of
  suicide (or B.A.D.)?

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HEADSSS

• Suicide
• Have you ever felt so sad that you feel life
  isnt worth living? Do you think about hurting
  or killing yourself? Have you ever tried to hurt
  or kill yourself?

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HEADSSS

• Safety
• When you drive or ride in a car, do you use a
  seat belt?
• What do you do if the person you are riding with
  is drunk or using drugs?
• When you bike, ride a motorcycle, skate board or
  roller skate, do you use a helmet?

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HEADSS

• Safety
• Do you ever carry a weapon to protect yourself?
• Is there a gun in your home?
• How is the gun stored?

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Percent of Teenage Males inWeapon-Related
Violence
7,018,700
1,237,600
1,568,600
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Percent of Teenage Females inWeapon-Related
Violence
7,036,100
1,252,500
1,640,200
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• When we nurture the capacity of parents and
  families to be involved in the lives of their
  teenage children, young people are the
  beneficiaries.

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Bibliography

• Reif, CJ, Elster, AB. Adolescent Preventive
  Services. Adolescent Medicine 1998 25 1-20
• Blum, RW et al. The Effects of Race/Ethnicity,
  Income, and Family Structure on Adolescent Risk
  Behaviors. American Journal of Public Health
  2000 90 1879-1884
• Jelalian, E et al. Adolescent Motor Vehicle
  Crashes The Relationship Between Behavioral
  Factors and Self-Reported Injury. Journal of
  Adolescent Health 2000 27 84-93

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Bibliography

• Video, Talking to Your Teen Ages 11-14. AMN
  2000 www.ama-assn.org/adolhlth/adolhlth.htm
• Woods, ER. Neinstein, LS. Office Visit, Interview
  Techniques, and Recommendations to Parents. In
  Adolescent Health Care, fourth ed. Neinstein,
  LS.,editor. Lippincott Williams Wilkins
  200259-78

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Bibliography

• 6. Shore WB. The Adolescent Patient in Ambulatory
  Medicine, third ed. Mengel MB, Schwiebert LP
  editors. McGraw-Hill. N.Y.2001715-725
• 7. Ahrendt, DM. Ergogenic Aids Counseling the
  Athlete. American Family Physician 2001 63
  913-922

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Bibliography

• 8. Unsafe Sexual Behavior and the
  Characteristics of Sexual Partners of HIV
  Infected and HIV Uninfected Adolescent Females.
  Journal of Adolescent Health 2001 29S 64-71
• 9. Greening, L, Stoppelbein, L. Young Drivers
  Health Attitudes and Intentions to Drink and
  Drive. Journal of Adolescent Health 2000 27
  94-101

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Bibliography

• 10. Belknap, N. Minding the Children in 1951
  Who is Minding Them in 2001? Reclaiming Children
  and Youth 2001 10 66-69
• 11. Valleroy LA, MacKellar DA, Karon J, et al.
  HIV Prevelance and Associated Risks in Young Men
  Who Have Sex with Men. JAMA 2000 284 198-204

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Bibliography

• 12. Adolescent Health Working Group
  www.AHWG.net