Page 1048 - TNFlipTest

P14 Pediatrics
Adolescent Psychosocial Assessment
HEEADSSS
Home Education/Employment Eating
Activities
Drugs
Sexuality
Suicide and depression Safety/violence
Rates of drug use in high school students who have used in the past year: alcohol (58.2%), cannabis (25.6%), tobacco (11.7%)
Date rape comprises 80% of sexual assault in teenagers
Prevalence of depression: 1-2% in pre-pubertal children and 6-8% in adolescents
Adolescent Medicine Toronto Notes 2019 Adolescent Medicine
Adolescent History (HEEADSSS)
• tailoryourhistoryaccordingtotheclinicalcontext
Home: Who do you live with? What kind of place do you live in? Do you get along with your parents and/or siblings?
Education/Employment: What grade are you in? What are your favourite subjects? What was your average on your last report card (ask for changes)? How much school have you missed this past year? Do you work (if so, how much)? Do you get along with teachers/employers?
Eating: Tell me about your meals/snacks in a typical day. Have you ever gone on a diet? What are your favourite and least favourite foods? (see Psychiatry, Eating Disorders, PS31)
Activities: What do you do after school? On the weekends? How much time do you spend on the computer/watching TV every day? Do you use social media (i.e. Facebook, Twitter, Instagram, etc.)? What do you do with your friends outside of school?
Drugs: Which seems to be more popular at your school, alcohol or drugs? How often do you drink/ smoke marijuana/take other drugs? Do you smoke cigarettes? When you drink, do you usually get drunk? Have you ever passed out or not been able to remember what happened while you were drinking?
Has anything bad ever happened to you while you were drunk or stoned? (see Psychiatry, Substance Abuse, PS22)
Sexuality: Are you romantically interested in anyone? When you think about having sex with someone, do you think about females, males, or both? Have you ever had sex with anyone? Whether the answer is yes or no, the next question is: What activities would you include in the term ‘having sex’? What do you do to prevent getting a STI/getting pregnant/getting someone pregnant? Has anyone ever given you money, drugs, or other stuff in exchange for sex? (see Gynecology, Sexually Transmitted Infections, GY26)
Suicidality/Depression: On a scale of 1 to 10, where 1 is so sad that you might kill yourself and 10
is the happiest you could be, where are you most days? Have you lost interest in activities that you used to enjoy? Do you often have trouble sleeping (Is there a difference between school days and the weekend)? Have you ever thought seriously about suicide? Did you make a plan? (see Psychiatry, Depression/Suicide, PS10, PS4)
Safety/Violence: Do you ever get into a car with a driver who has been drinking? Do you always wear a seatbelt/bicycle helmet? Are you being bullied at school? Has anyone ever touched you in an unwanted way?
See Sexual Development, P29
Child Abuse and Neglect
Definition
• anactofcommission(physical,sexual,orpsychologicalabuse)oromission(neglect)byacaregiverthat harms a child
Legal Duty to Report
• uponreasonablegroundstosuspectabuseand/orneglect,physiciansarerequiredbylegislationto contact the CAS to personally disclose all information relevant to the child safety concern
• dutytoreportoverridespatientconfidentiality;physicianisprotectedagainstliability
Ongoing Duty to Report
• ifthereareadditionalreasonablegroundstosuspectabuseand/orneglect,afurtherreporttotheCAS must be made
Risk Factors
• environmentalfactors:socialisolation,poverty,domesticviolence
• caregiverfactors:personalhistoryofabuse,psychiatricillness,postpartumdepression,substanceabuse,
single parent family, poor social and vocational skills, below average intelligence
• childfactors:difficulttemperament,disability,specialneeds(e.g.developmentaldelay),premature
Management of Physical Abuse, Child Abuse, and Neglect
• reportallsuspicionstoCAS;requestemergencyvisitifimminentrisktochildoranysiblingsinthehome • acutemedicalcare:hospitalizeformedicalevaluationortreatmentofinjuriesifindicated
• arrangeconsultationtosocialworkandappropriatefollow-up